HL7 and HIT Standards

Transcription

1 HL7 and HIT Standards Navigating the Strange, the Magical, and the Bizarre Reed D. Gelzer, MD, MPH September 25, :30PM Smart Data Solutions 2014 Symposium

2 Outline: I. Understanding the environmental factors driving Standards II. Standards III. Achieving peace of mind Bias: The best and proper objectives of the healthcare enterprise are patient and community health benefits

3 Healthcare: Largest U.S. Sector Underperforms

4 In For An Ounce HIT aspects of ARRA/HITECH and ACA as Dreyfus Affair Promises made ($30B ++++ spent) Problematic legacies CMS infrastructure US Healthcare infrastructure Successful magic = diversion (remember Too Err is Human?)

5 Failure As Success: HIT Policy as Magic Show Healthcare.gov ONC Standards and Interoperability Initiatives Congress as a collaborative herding of sacred cows

6 Backstory: Political Factors, Unintended Consequences Policy Determinants: What problems are policymakers aware of EHR vendors HIT advocates Where are the public benefit advocates? (Report vs. Accurate Report) Honesty is never the best policy but

7 Medical-Legal Sharknado : Unreliable Records ABA National Institute on ediscovery and Information Governance, 2013 and Summer 2014 George L. Paul, "Systems of Evidence in the Age of Complexity" Steven W. Teppler, "Testable Reliability: A Modernized Approach to ESI Admissibility" Drury, Gelzer, Trites, "Electronic Health Records Systems: Testing the Limits of Digital Records' Reliability and Trust" Risks apply to all downstream users of invalid records of patient care services

8 The Race Is On: Optimists, Pessimists, and Realists CBS/AP September 14, 2013, 8:54 AM The SCOOTER Store shutting down after federal scrutiny, CBS probe From , government auditors found The SCOOTER Store overbilled Medicare by as much as 108 million dollars. the company also ranked doctors based on whether they'd prescribe chairs, and that it had a program specifically to get chairs for people that physicians had already deemed ineligible. Allegations of Medicare fraud within the industry go back nearly a decade.

9 Optimists, Pessimists, and Realists Who s Who CMS and Program Integrity OIG and Enforcement FBI and HCFAC No worries unless you are VERY big and VERY bad Watch OIG reports, CMS Guidances on HIT, EHRs The mysteries of Standards and private payers

10 The Theater That Is Our Nation s Capital Film Noir: The Office of the National Coordinator for HIT (aka ONC) Political pragmatism The double entrendre of meaningful Delightfully cynical production: ONC s Standards and Interoperability (S&I) Initiatives Cast changes

11 We are all patients The principle challenge of the healthcare enterprise today is balance: Doing what s necessary (no matter how illogical, wasteful, silly) -Versus- Doing what is best for the intended beneficiary, the patient

12 Budgeting IT Every year the IT division has an unlimited budget, and every year they exceed it

13 HL7 and Standards What happens when $30+ Billion in incentives appear, along with a few sanctions threats, into a consumer-insensitive industry? The wreckage known as Meaningful Use Automotive metaphors, the Yugo, the 10+ airbag car, and the folks who destroyed Detroit (thank you)

14 HL7 Domains Messaging V2 and V3 Attachments Clinical Document Architecture (CDA) QRDA HQMF C-CDA Structured Documents Complete Documentation Template EHR Security EHR Functional Model Release 2 and derived profiles Fast Healthcare Interoperability Resources (FHIR) Question: Who makes certain any of it works?

15 HL7 Domains Messaging V2 and V3 Attachments Clinical Document Architecture (CDA) QRDA HQMF C-CDA Structured Documents Complete Documentation Template

16 HL7 Domains EHR Security EHR Functional Model Release 2 and derived profiles Fast Healthcare Interoperability Resources (FHIR)

17 EHR Functional Model Release 2

18 EHR Functional Model Release 2

19 CDA Provenance Resources Presume EHR System Sources

20 HL7 Domains Question: Who makes certain any of it works?

21 HL7 Domains Question: Who has an obligation to make sure it works? CMS, gaming, and its dusty statutory obligations

22 Peace of Mind Rule 1: Feds Solve Feds Problems Prior Authorizations will grow PMD initiative Prosthetic devices Home O2 Prescreening growth Data transmission Transactions exchange and validation esmd and the digital certificate signature EHRs

23 Peace of Mind Rule 2: Solve Your Own Problems OESS does not have a fleet of Suburbans Prior Authorizations will grow PMD initiative Prosthetic devices Home O2 Prescreening growth Data transmission Transactions exchange and validation esmd and the digital certificate signature EHRs

24 Peace of Mind: Watch This Space Electronic Submission of Medical Documents (esmd) and CMS Implementation Guides for Structured Documentation Templates The true digital certificate signature Provenance in EHR-sourced Records (DPROV in S&I)

25 Peace of Mind: Game Change Indicators EHR Compliance (may we all live so long ) The $64B Opportunity: ediscovery and Sharknado Prevention

26 HIT As Hockey Skate to where the puck is going Support the rough and tumble that forces the puck to move

27 SDS: Team HIT SDS is the team on the ice, paid to take the bruises Customers get to stay in Management

28 SDS: Keeping Moving Dots Connected

29 Example: Emergency Department record falsifying physical examination

30 30

31 31

32

33

34 Discussion

35 Reed D. Gelzer, MD, MPH Co-Chair, HL7 EHR Standards Workgroup Co-Facilitator, HL7 EHR Records Management and Evidentiary Support Trustworthy EHR, LLC (Provider Resources, Inc.) Newbury, NH Philadelphia, PA