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HIT for LTC 101

A story of growth…

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Tuesday October 9, 2007Session T-2

Presented by:Eileen Doll and Nathan Lake

HIT for LTC 101

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Introduction Experiences

Needs

Ever growing

To goals…

Seeds of need

Roots

Trunk-IT components

and knowledge

EHR AND INFORMATION

EXCHANGE

Growth and expansion…and seeds

IT tree HIT tree

HIT trunk

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Seeds of need National Presidential Healthcare IT

Goal “Within ten years, every American must have a personal

electronic medical record”George W. Bush, “President Unveils Tech Initiatives for

Energy, Health Care, Internet”, Minneapolis, MN, April 26, 2004

“Executive Order 13335: Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator” (a) The National Coordinator shall, to the extent permitted by law, develop, maintain, and direct the implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors that will reduce medical errors, improve quality, and produce greater value for health care expenditures. Executive Order, George W. Bush, April 27, 2004

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Seeds of need National Presidential Healthcare IT

Goal Executive Order 13410--Promoting Quality

and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs “…in order to promote federally led efforts to implement more transparent and high-quality health care, it is hereby ordered as follows: …Purpose:…to ensure that health care programs administered or sponsored by the Federal Government promote quality and efficient delivery of health care through the use of health information technology, transparency regarding health care quality and price, and better incentives for program beneficiaries, enrollees, and providers. …to make relevant information available to these beneficiaries, enrollees, and providers in a readily useable manner and in collaboration with similar initiatives in the private sector and non-Federal public sector. Consistent with the purpose of improving the quality and efficiency of health care, the actions and steps taken by Federal Government agencies should not incur additional costs for the Federal Government.

George W. Bush August 22, 2006

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Needs… Timetables/plans for other national goals

2003—HIPAA 2006 and 2007—CCHIT certification for ambulatory EHR March 2008—CDC convene experts to discuss availability of

local/regional cancer, immunization, trauma or other public health data base (registry) information

June 2008– CDC facilitate development of national administrative or legal approaches to allow the routine and emergency inter-state data exchange of countermeasure and immunization information .

October 2008—CDC to communicate the availability of these “registries” to assist local/regional public health agencies in emergency efforts

December 2008—laboratories must be able to receive and route (exchange) all lab results

March 2009—CDC to provide free software to local/regional public health agencies to manage “outbreaks”

2010—Institute of Medicine--E-prescribing implementation deadline

2014—”EHR for all” implementation

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Needs…THE GOAL—1 Presidential efforts, beginning in 2004, and Congressional efforts, and Consumer efforts, and Healthcare Professional efforts, and Governmental public health and

emergency management efforts, and Private, insurance, and governmental

payer efforts toElectronically

Produce, store and

Confidentially exchange healthcare information

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Needs…THE GOAL—2 To provide “better” care—to more people,

who will live longer, and who will require and REQUEST increasingly more complicated care in multiple and varied care settings.

“Better” care includes a reduction of redundancies, errors, and improper billing—benefits to the patient, provider and payer.

These efficiencies yield financial benefits for all=“better value”

Financial benefits will allow us to CONTINUE to provide “better care”

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In the next 2 hours we will discuss…

IT—(Information Technology)Beginning seeds of need—how we got

started…Development and growth of roots into

the “trunk” or body of IT—a review and definition of technology components—hardware, software, and STANDARDS–necessary to make a computer or system do its intended job.

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AND… Health Information Technology—a new tree

develops…with many external forces Shoots and branches—Terminology, acronyms,

“buzz words”

Roots develop Trunk—HIT STANDARDS—types, purpose, development, approval, certification

Branching into—network information exchange—RHINNHIN

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AND…

HOW—to be effectively involved in your facility or on other levels

HOW—to decide what HIT solution is best for YOU

When you come to the fork When you come to the fork in the road…take it…in the road…take it…

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And Be SMART©…TO SUCCEED, the fork must lead to…

STANDARDS based programs (software), and

MULTIPLE ways (hardware) to enter information and to connect;

ACCEPTANCE by users;

RELIABLILITY, with

TECHNOLOGY updates or support when needed

SMART © EDHC INC

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Tree—IT

“Information technology (IT), as defined by the Information Technology Association of America (ITAA) is: "the study, design, development, implementation, support or management of computer-based information systems, particularly software applications and computer hardware." In short, IT deals with the use of electronic computers and computer software to convert, store, protect, process, transmit and retrieve information.”

Trunk-a body of IT knowledg

e

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Seeds…

Seeds or weeds??

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Roots… Punch technology—

used since the 1800’s

Binary—1 0

Each punch

represented DATA, a term first used in 1946

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Roots …

IBM card—pink=1st card of a set

IBM—normal card

8 bits = 1 byte

One of the first IT

“STANDARD” s

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Roots…

IBM 7030 “Stretch” computer

Fastest computing 1961 to 1964

Photo used for educational purposes from IBM photo archives

Informationpunchesread

data

sortanalyze (computations)

information

Scanned from the Annuals of the History of Computing, Vol. 3 #4 October 1981

UNIVAC--UNIVersal

Automatic

Computer

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Roots and growth……

Personal…

Space

Convenience

Life is complicated…

Can’t quite stretch for a “Stretch”…

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Roots trunk

SO…Personal Computing was born…

From pchistory.org

MITS Altair 8080—the first PC—Personal Computer

From www.old-computers.org

The Victor 9000 PC

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Trunk… A PC, or any computer, is HARDWARE

Something we can see, feel…or pound on if necessary…

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Trunk…

What HARDWARE makes a MODERN PC?

A “tower” which encases standardized key components and attaches to other components.

A “hard drive”—which stores data and software

In fashionable

grey or black

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Trunk…ALL STANDARDIZED

http://creativecommons.org/licenses/by-sa/2.5/

The MOTHERBOARD—this runs the show; all connections are routed in/onto/out via “slots” or “ports” to integrate and operate smoothly

Photo Courtesy of Creative commons

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Trunk …standardizedA peripheral is a device such as: A monitor (to display information),

a Keyboard (or many other types of

device such as an ATM with touch screen) to enter or input information;

A modem (to transmit and receive external information either over phone line, DSL line, cable or satellite line),

An accessory drive, either for CD, DVD, or “floppy”;

A “mouse” or other device to make screen selections;

A printer or other “output” device, such as speakers…

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Trunk…all standardized… HARDWARE— Items such as a Blackberry or other Personal

Digital Assistant; or the DSL, T1, phone line, or fiberoptic wire to

PHYSICALLY “connect” a computer to other computers or to the internet;

A transmitter for “wireless” radio communication; Any/all of the PHYSICAL interconnections and

devices. Each piece can ONLY DO TASKS FOR WHICH THEY

WERE MECHANICALLY DESIGNED IN A STANDARD WAY

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Trunk…NETWORK Small network—for a

small business or small facility—

“Thin client” terminal or PC workstations connect via wire or “wirelessly” to

Central or “main” computer—stores all information and acts as the “server”

Peripherals are shared Number of users

limited by number of terminals

From expertsolutionsinc.com

MDS Business office

Activities

Admin

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Trunk…NETWORK

Large multi-purpose networks…

From expertsolutionsinc.com

“Communicate”

Bi-directional data exchange

In a standard way

Centralized data storage

Data in multiple areas, can be shared—example of RHIO structure

Data in ALL areas—can be connected to through a combination of routings—examples are internet, NHIN

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Trunk…Disc Operating System One disc told the system what to do (SOFTWARE)

One disc stored what was done

8 inch=10KB, 100,000 characters—about the size of a 38 page text document

5 ¼ inch—100KB to 1.2 MB

3 ½--1.4 MB

EvolutiongrowthSMALLER=MORE STORAGE

“Floppy” disc

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Trunk Uppercase AND

lower case letters!! Software supplied on

disk, cassette and cartridge!

Memory—25KB, 20 KB ROM, 5 KB RAM

Video

Interface

Chip

Color

1980—cost=$300

=2007 ~ $900

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Trunk…MEMORY ROM=READ ONLY MEMORY

Used to store data which is infrequently changed, like how the system should “boot up” or start—this data REMAINS on the computer hard drive

RAM= RANDOM ACCESS MEMORY Used to find, use, and store many pieces of data

as a software program “works” or processes data—the data is not saved when the computer is turned off

VIRTUAL MEMORY—if memory needs exceed RAM capabilities, the actual computer hard drive is used for random data storage

RAM—more RAM=faster processing within the limits of the central processing unit—or “chip”

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Trunk--SOFTWARE SOFTWARE—a “language” which tells

the hardware HOW TO RUN, WHAT TO DO WITH data and HOW TO STORE data “System” software—the Operating System

(OS)—MS DOS, Windows 98, Windows Vista, Mac OS, LINUX, UNIX. The OS also contains software programs or “drivers” which tell peripherals how to do their tasks…telling a printer how to actually print.

“Programming” software—gives the programmer tools to write our

“Application” software—which turns keyboard strokes or items touched on a screen or the button on a TV remote control into formatted bits/bytes of data. The data is stored in a specific way so that INFORMATION can be retrieved or specific actions taken.

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Trunk

Software allows us to make a spreadsheet, connect to the internet, write and save a letter, or play Sims® 2 (or 25…).

Software can be “proprietary”, “open source”, or mixed…

Software operates using RAM!!! More complicated software=More

instructions, more system work and more SPACE to work in…

Exce

l ®AOL ®

Lotu

s note

s

®

Microsoft Word ®

Openoffice.org, UNIX, Firefox

Windows Vista®

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Trunk—needs growing room! 1 bit=1 binary decision 1 or 0—yes or no

8 bits=1 byte10 bytes=one word

1 stored characterfun

1024 bytes=1 KiloByte ~ The alphabet, plain text, 35 times

1024 KB=1 MegaByte ~2 minute mp3 music file (like from I-tunes ®); a small novel

1024 MG=1 GigaByte mp3 music~18 hrs, 1000 novels, a regular length movie

at TV quality

1024 GB=1 TeraByte

4 TB70 TB

50,000 trees paper, and printed; est. amount of EHR

data produced by a 250 bed NF in 9 months;

Size of largest PC hard driveLibrary of Congress data

content as of 5/2007—”high risk” digital material

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Trunk—grow faster…NO MORE HOT and BULKY

MULTIPLE LARGE TRANSISTORS!!

Central processing unit--CPU

One unit—or “chip” which contained multiple small transistors

1971—Intel—first PC “chip”—it could only add and subtract, at 4 bits at a time—but ALL ON ONE CHIP!!!

The “microprocessor” erupted—silicon fed the “tree”

ADD SPEED

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Trunk…rapid speedy growth 1965, clarified in 1975—Moore’s law—

the rate of the ability to add transistors to chips doubles approx. every 2 years—a prediction

1989—80486—1,200,000 transistors

2004—Pentium 4—125,000,000 transistors

This growth continues…and bits handled in larger numbers—from 4 bits, to 8 bits, to 32 bits and now 64 bits.

Executing one billion instructions per second…

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Branches…need more

So…in response…

Congressman Al Gore

invented the internet…

Academia, business, and all people wanted to connect with each other and share their information…

“…a series of tubes.” (Senator Ted Stevens)

NOT!!

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Trunk

Over telephone and later other “lines”…

One large network—with many small networks and individuals—communicating via data exchange…

MAGIC???

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Trunk— exchange data

TCP/IP—the first, most important data exchange standard

Transmission Control Protocol and Internet Protocol…

Developed and tested from 1973 Adopted by military in 1982 Adopted in January 1, 1983 as the standard for the internet Commercial use began in 1985 (Compuserve, later AOL in

1991)

Without this standard, we would not be here…

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Trunk—network and internet communication standard—TCP/IP Connect—via some type of device—modem (telephone) or

ethernet (cable, DSL)—each connection location has an Internet Protocol address—in a standardized format and standardized “language” based on type of connection

Connection is routed to another IP address—standardized format

A data request from one IP address to another is transmitted via a transmission control protocol (type of data guides which protocol)—each protocol has standard function and process

The process or application puts data into standardized “packets” based on the type of data to be transported

This standard will be changing!!!More users=more addresses

needed

Different devices

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TRUNK—Standards In the US—standards are developed by

organizations in a field, trade, or industry—a part of our democratic history

Each organization is comprised of individuals (“experts in the field”) who know what SHOULD BE (“best practice” for safety or efficiency) and the WORST of what actually is.

Standard—represents the expected physical characteristic or performance—and can change

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Trunk—standards

Standards CHANGE

By “vintage” standards, Marilyn Monroe wore a size 12 dress---

In “modern” standards, she would wear a size 6 or 8…

WHY??

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Trunk—Standards an agreed upon “norm”— “…an approved model…a rule or

principle that is used as a basis for judgment…weight, measure, value, or comparison…authorized or approved…” (from Dictionary.com Unabridged (v 1.1). Random House, Inc.)

STANDARDS for functional or operational parameters exist for just about everythingA STANDARD IS TESTED and CERTIFIED

by other organizations/agencies

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Trunk…Standards…USA

NIST—“promote U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life.”

From—www.nist.gov

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Trunk…Standards…USA

ANSI—American National Standards Institute promotes and facilitates voluntary consensus

standards and ensures their integrity. provides all interested U.S. parties with a

neutral venue to come together and work towards common agreements

Standards approved by other organizations may be submitted to ANSI for “final” approval and acceptance From—www.ansi.org

ANSI cooperates internationally

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Trunk—Standards…international

ISO—International Organization for Standardization “…world's largest developer and publisher of International

Standards. …a network of the national standards institutes of 155

countries, one member per country, with a Central Secretariat in Geneva, Switzerland, that coordinates the system.

…a non-governmental organization that forms a bridge between the public and private sectors. On the one hand, many of its member institutes are part of the governmental structure of their countries, or are mandated by their government. On the other hand, other members have their roots uniquely in the private sector, having been set up by national partnerships of industry associations.

…enables a consensus to be reached on solutions that meet both the requirements of business and the broader needs of society.

ISO forms a bridge between the public and private sectors.”

From—www.iso.org

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Trunk—IT standards

Mother and babies.jpg—info

Info in

STANDARD DATA SYMBOL

STANDARD DATA ORDER

Info out

‹#÷äQE1…Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@Q@R1À4?›Ç¡¦ù˃֩ê:¤]Œ×W2Ç1©%åp‹ŸLšùïÆ¿´>¨yö:5¤v’ckÍâVqþÏ2’‰QŒ¤{OŒ¾$h>´/¨^§œ~å¬8’i \×¾gñßÄÿ?ˆ7#í±�[$¹0x$ŽM§³æWR݃�¢h³ø‡X1@²K<Ì<Éãˆ6Iî@¾ðÀí3I�+{{,·wG‘¹J*ý?5“–¥I$yƒþk/¸F“[Xdn—ǶQ¹ÿ?��€â½º„PŦÙØ}®ûÊÖG�6"à©È÷?�Ä~"½ÞÔ[ÆŠ¤£�$’JS=þµ©˜Ø"1Fƒ$àÏÒ¸ŸŒvO{à½E#Ÿ!Æç}½«º?�

DATA

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Trunk—IT Standards…

STANDARDS tell a software program how to convert entered informationdataPRODUCESTORE/“SAVE” A FILE ON THE DISK

The STANDARD file “type” is indicated at the end of the file—the file EXTENSION

STANDARDS tell a software program how to “open” a data fileconvertdisplay information SAME AS original, based on the file type

Data in a file with the “.jpeg” or “.jpg” extension (a STANDARD developed by the 'Joint Photographic Experts Group’ a member of ISO) IS ALWAYS STORED USING THE SAME STANDARD SYMBOL/S AND ALWAYS IN THE SAME STANDARD ORDER

INTEROPERABILITY

INTEGRATED

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Trunk—IT Interoperability INTEROPERABLE programs or systems

“talk” to each other—they “communicate” following exact STANDARDS

Information IN, Information OUT INTEROPERABLE = COMPATIBLE INTEGRATED = Built in—act as one SOFTWARE—“bells and whistles”, “look”,

“feel”=“USER FRIENDLY”

If a SOFTWARE program doesn’t produce the expected STANDARD result, no matter how

“user-friendly”, it cannot be used!!???????????????????????????????????????????????????????????

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Trunk…HIT H ealth I nformation T echnology “The application of information processing

involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.” (D. Brailer, ONCHIT, HHS, 2004)

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One goal…

From--http://www.flickr.com/photos/juhansonin/393271975/in/set-72057594067707294—a public file

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Trunk…EHR An EHR … (1) longitudinal collection of Electronic Health

information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual; …

And…(4) support of efficient processes for health care delivery. Critical building blocks of an EHR system are the electronic health Records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings) and by individuals (also called personal health records).” PHR

IOM report to Agency for Healthcare Research and Quality (AHRQ), July, 2003

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Trunk…EHR

“…a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.”

Healthcare Information and Management Systems Society

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Broken branch??…

EMR=Electronic medical record—refers to an institution’s or provider’s own record of medical care for a patient

May or may NOT meet the standards for EHR…

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Trunk…Standards for WHAT??? Content—What information should be

included, eg., lab results, x-ray results, narrative notes, history, physical findings, care plan interventions, diagnosis, eye color, name and nickname, Braden scale?, what pain scale, dog’s name??

Storage—How the content will be stored as DATA—nomenclature, ICD9 code, ICD10 code, standard name, alpha or numeric, mm-dd-yyyy versus dd-mm-yyyy

Functions—What the system can do—how it will work—how information can be entered, stored as data and for how long, retrieved and presented as information, and communicated securely when needed

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Trunk—FUNCTIONALITY Standards

IOM report to Agency for Healthcare Research and Quality (AHRQ), July, 2003What an EHR should DO--FUNCTIONALITY

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Trunk—developing HIT standards Standard:  ”Documented agreements containing

technical specifications or other precise criteria to be used consistently as rules, guidelines, or definitions of characteristics to ensure that materials, products, processes, and services are fit for their purpose.  A standard specifies a well defined approach that supports a business process and:

Has been agreed upon by a group of experts Has been publicly vetted Provides rules, guidelines, or characteristics Helps to ensure that materials, products, processes and

services are fit for their intended purpose Available in an accessible format Subject to ongoing review and revision process”

(from ehealth initiative at http://toolkit.ehealthinitiative.org/glossary)

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Standards—the “Bottom line”…We need standards to allow Information exchange

at 3 “interoperability” levels (From Clinical Loinc tutorial, pg 9, 050321)

Basic—allows messages to be exchanged between computer systems—word processing, spreadsheets, etc.

Functional—describes the standard syntax (format) of the message—document templates, forms, data structures, message standards

Semantic—requires use of standard vocabularies within a message

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Trunk—HIT exchange standards-1 We must be able to exchange different types

of data at different times and in different ways…

1. Clinical messaging--delivers electronic clinical results (such as laboratory, test results, radiology reports, or transcribed reports) from the source system (lab, radiology center, etc.) to the intended recipients (ordering physician, primary care physician, hospital, SNF, etc.)

2. Sharing of clinical data at point of care—gathers and provides electronic clinical information (history, diagnoses, etc.)

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Trunk—HIT exchange standards-2 3. Medication history—electronically shares

medication history obtained from multiple sources (pharmacy, hospital, SNF, MD office) with the clinician or facility currently treating the patient

4. E-prescribing and/or CPOE (computerized physician order entry)—automates the process for clinicians to prescribe medications for patients. “Ideal” systems would automatically check for drug/drug interaction, prescription drug plan status, dosage (and other factors) and provide feedback to clinician

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Trunk—HIT exchange standards-3 4. Quality metrics—shares healthcare information

among multiple data sources for the purpose of quality measurement that can support provider quality initiatives and also serve as the basis for determining incentives (such as P4P.)

“Metrics”—parameters you or others use to measure or track periodic assessments of performance AND the methods to carry out and interpret the information. A “benchmark” or “best practice” metric may be company, industry, or patient specific.Return hospitalizations, fall rate, medication errors, persons over 60 who received influenza shot, in-house DU formation, etc. are all possible “metrics”.

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Trunk—HIT exchange standards-4 5. Administrative data sharing—

for emergency and community/public health purposes—transfer/discharge from one health setting to another

CCD HL7 approved standard--Continuity of Care

Document —standardized content, layout, terminology

Begin testing 2008

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Trunk—setting standards Who sets HIT standards, and who makes sure that the

standards produce interoperable data exchange?

SDO—Standards Setting Organization/s and the individuals in these organizations…

Within an interwoven structure… With oversight to be sure standards and products

“harmonize”… (are interoperable—work together)

And “certification” (tested and meeting or exceeding applicable standards)

for products which do…

With efforts/plan which are “transparent” (visible and open to discussion and review) to any/all interested parties.

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Trunk…The plan for growth…

ONCHIT—(AKA ONC)—Office of the National Coordinator for Health Information Technology —Robert M. Kolodner, MD—tasks— 1. consult with HHS Secretary Michael Leavitt–

to implement interoperable EHR by 2014 and

2. provides management and support for the…

AHIC—American Health Information Community

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A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability—4 contracts given to carry out specific functions

Healthcare Information Technology

Standards Panel (HITSP)

Nationwide Health

Information Network

Architecture Projects (NHIN)

The Health Information Security and

Privacy Collaboration

(HISPC)

The Certification Commission for

Healthcare Information Technology

(CCHIT)American

Health Information Community The Community is a federally-

chartered commission and will provide input and recommendations

to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a

smooth, market-led way.

The Community is a federally-chartered commission and will

provide input and recommendations to HHS on how to make health

records digital and interoperable, and assure that the privacy and security of those records are protected, in a

smooth, market-led way.

HITSP includes 348 different member organizations and is

administered by a Board of Directors

24 SDOs (7%) 247 Non-SDOs (71%) 30 Govt. bodies (9%)

12 Consumer groups (3%)36 Project Team and Undeclared (10%)

HITSP includes 348 different member organizations and is

administered by a Board of Directors

24 SDOs (7%) 247 Non-SDOs (71%) 30 Govt. bodies (9%)

12 Consumer groups (3%)36 Project Team and Undeclared (10%)

Evaluation of Standards Harmonization Process for HIT

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Trunk branches and grows…HHS will spend $13M to create AHIC

2.0

WASHINGTON …Office of the National Coordinator (ONC) for Health IT recently discussed details of its $13 million, 2-year contract proposal to design a successor for the federal healthcare IT advisory panel. Robert Kolodner, MD, the National Coordinator for Health Information Technology …transitioned to a private-sector successor by spring of next year. …part of HHS’s suggested model is for AHIC to derive some of its own revenue source through charging for access to the Nationwide Health Information Network.

NHIN…the standards process currently underway will not be jeopardized, as the Health Information Technology Standards Panel (HITSP) and the Certification Commission for Healthcare Information Technology (CCHIT) will become part of the planning process, Kolodner said.

Reported in Healthcare IT News By  Diana Manos, Senior Editor on 09/05/07

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Trunk—SDO

HITSP Dr. John Halamka,

Chair Member populated

Technical Committees

“Health Information Technology Standards Panel”

The HITSP team–“…a cooperative partnership between the public and private sectors…Comprised of a wide range of stakeholders… sponsored by the American National Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton…”—is charged with completing eleven different tasks, with current efforts focused on the harmonization process.

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Trunk—SDO

The CommunityHHS Secretary

Mike Leavitt, Chair

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J Corley, ATI

Project Manager, Julie Pooley, BoozAllen

Project Management TeamExecutive in Charge, F. Schrotter, ANSI

Program Manager, L. Jones GSIDeputy PM, J Corley, ATI

Project Manager, Julie Pooley, BoozAllen

Harmonization Process Delivery

Technical ManagerJoyce Sensmeier,

HIMSS

Harmonization Process Delivery

Technical ManagerJoyce Sensmeier,

HIMSS

Harmonization Process Definition Technical Manager

Michelle Deane, ANSI

Harmonization Process Definition Technical Manager

Michelle Deane, ANSI

HHS ONCHIT1 PO, Dr. John Loonsk

HHS ONCHIT1 PO, Dr. John Loonsk

HITSPDr. John Halamka,

ChairMember populated

Technical Committees

Eleven Tasks are included in this contract:

1. Comprehensive Work Plan

2. Conduct a Project Start Up Meeting

3. Deliver Recommended Use-Cases

4. Participate in related meetings and activities, including the AHIC Meetings

5. Develop a Gap Analysis

6. Standards Selection, Evaluations and Testing

7. Define a Harmonization Approach

8. Develop Interoperability Specifications

9. Develop and Evaluate a Business Plan for the self-sustaining processes

10. Submit Monthly Reports – ongoing efforts

11. Assist with communications – ongoing efforts

Evaluation of Standards Harmonization Process for HIT

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“…engages multiple stakeholders to ensure an objective, open, and consensus-driven process and credible result. Stakeholders will include:

Clinicians and provider organizations who purchase health IT products; Safety net providers who purchase or receive health IT products; Vendors who develop, market, install and support health IT products; Payers or purchasers who are prepared to offer incentives for health IT

adoption; Health care consumers; Quality organizations; Public health agencies; Clinical and health-services researchers; Standards development organizations; Federal agencies and coordinating bodies representing various Federal

agencies as identified by the National Coordinator.”

From—www.cchit.org

Trunk—product certificationCertification Commission for Healthcare Information TechnologyWill assure that EHR products ARE COMPLIANT with standards asdeveloped…it…

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Standards—CCHIT & MITRE “Software to Evaluate Compatibility of Systems Will Be Free and

Publically (SIC) Available September 10, 2007…Certification Commission for Healthcare Information

Technology (CCHITSM) and the MITRE Corporation…collaborative relationship… to…evaluate compliance of electronic health records (EHR) and networks with certification criteria for interoperability... testing software will be developed under an open source license so that it is free and publically (SIC) available, and the Certification Commission will use the software running on a secure platform during its inspection of a product's compliance…Mark Leavitt, M.D., Ph.D., Commission chair. "It will be a big job, so we hope many others will collaborate: health IT companies, government entities and others -- that's why CCHIT and MITRE chose the open source project model. It's in sync with the Commission's transparent, volunteer-based processes as well.“ The first focus …tool to verify standards compliance of a Continuity of Care Document (CCD) sent or received by EHRs. … project schedule that will have the CCD verification tool ready in time for CCHIT's 2008 pilot testing and certification launch.”

From—www.cchit.org

NO MORE SILOS!!

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WHAT?? SILO? TRANSPARENT?? If each organization maintains its data

in a non-standard way, it is in a “silo”—

What is a silo?? a Central Park penguin? a storage facility for grain?

No—”Silo”ed means that a system “stands alone” and is incapable of reciprocal operation with other related management systems…

Data exchange requires interoperable systems…

And how we accomplish this must be transparent—open to, visible to, and understandable by all stakeholders

Silo—the NY Central Park penguin who raised a chick with another male penguin.

With transparency, all becomes clear

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Hold on…2008??? I like my silo!!Paper keeps me warm!!Where’s my SPACE!!! I need TIME!!!This is CRAZY!!!

WHHOOAAAAA!!

Prep, plan, change…

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Trunk—SDO—HIPAA

Health Insurance Portability

and Accountability Act

Personal Health Information

• Privacy

• Security of Electronic Records

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Trunk—SDO

•NIST—special division to test conformance to IT standards

•Gathers and displays current HIT standards at

http://hcsl.sdct.nist.gov:8080/hcsl/index.html

•May become a bigger “player” in HIT standards development…

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Trunk—SDO—CHI

•Under FHA (Federal Health Architecture) Program under ONC (Office of the National Coordinator)

•“CHI is a collaborative effort to adopt health information interoperability standards, particularly health vocabulary and messaging standards, for implementation in federal government systems. About 20 department/agencies including the Department of Health and Human Services, the Department of Defense and the Department of Veteran's Affairs are active in the CHI governance process.”

•Established 27 health domains

•Now working on•“Implementation of adopted standards, •Maintenance of adopted standards, and •Identification and adoption of new standards.”

From: www.hhs.gov/healthit/chi.html

Consolidated Health Informatics (initiative)

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Trunk—SDO—function

HL7—Health Language 7—An ANSI approved American National Standard for electronic data exchange in health care. It enables disparate computer applications to exchange key sets of clinical and administrative information. (from ehealth initiative)

EHR-S (System) Functional Model—the EHR-S Functional model standardizes what functions our LTC EHR must possess—in areas of Direct Care, Information Infrastructure, and Supportive Services

The standard indicates the functions which may, should, or SHALL be included, structured, or “work” in an EHR system

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Trunk—SDO—function

In February 2007, at this year’s LTC HIT summit, the Chicago attendees received, and responded to, a challenge—Develop the HL7 LTC EHR-S profile—

participate and reach consensus with your expert colleagues

4 PERSONS LED AND STILL LEAD THE CHALLENGE…

136 LTC colleagues “answered” the challenge… care providers, vendors, IT specialists, pharmacy consultants, nurses, government liaisons, and many others…

But not all “met” the challenge”—for 1 ½, 3, or 5 or more hours each week—thinking and communicating, to develop and approve each profile section…

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Trunk—SDO—function

adediger@medicalodges.com; aprybyl@momentumhealthware.com; allan.neoh@achievehealthcare.com; akillian@phoebe.org; annessa@nasl.org; bmanard@aahsa.org; beth.delahunt@achievehealthcare.com; bpilous@ohqio.sdps.org; bill.russell@erickson.com; brenda_k_parks@keane.com; brian.young@accu-med.com; bryceb6@sunshineterrace.com; cmcspadden@ascp.com; cthomas@accu-med.com; christa.hojlo@va.gov; cbaker@accu-med.com; dan.cobb@healthmedx.com; daniel.stein@dbmi.columbia.edu; daniel.wilt@erickson.com; darin@american-data.com; daveo17@bellsouth.net; dave@ianet.org; debra_sperry@hotmail.com; denise.trcka@achievehealthcare.com; doc@mditech.com; dbrickey@healthtech.net; dgutkind@lintechsoftware.com; edoll@hfam.org, frank.leonard@AFRH.gov; frank.mckinney@achievehealthca re.com; geoffb@vigilan.com; gillian.gray@fundltc.com; gsloan@accu-med.com; gbean@txqio.sdps.org; hboddy@goldcrest.net; hk489@nyu.edu; irenewright@ahconline.com; jalbert@masonicare.org; jke6@pitt.edu; jhusher@good-sam.com; janet.barber2@va.gov; Jeanette.Kranacs@cms.hhs.gov; jwoodside@consulatehc.com; jennie.harvell@hhs.gov; jesse.wrenn@dbmi.columbia.edu; jdalton@parkriverestates.com; jim_hancock@qs1.com; joann.ross@genesishcc.com; john@mail.american-data.com; jobrooks@hcr-manorcare.com; joy.thompson@cms.hhs.gov; jdpurcell@savasc.com; jennik02@odjfs.state.oh.us; julie.thompson@beaconpartners.com; kingra@citizensmemorial.com; kdownie@aahsa.org; karthik.natarajan@dbmi.columbia.edu; kmhurst@savasc.com; kspeights@healthtech.net; kbrouse@chs-ga.org; keith.weaver@odh.ohio.gov; kevin_a_mccormack@keane.com; kevin@lakepointnc.com; kwarren@txqio.sdps.org; kcerchiara@hipconsulting.net; lhillock@chs-ga.org; lkunz@dartchart.com; llucas@fulhealth.org; llucas@bright.net; lorraine.toderash@momentumhealthware.com; lhyman@ehealthsolutions.com; derosiam@ahconline.com; mjwhite@columbus.rr.com; marellano@aanac.org; mmoen@healthware-consulting.com; martin.rice@cms.hhs.gov; mary.guthrie2@va.gov; mary.pratt@cms.hhs.gov; matthew.mullins@momentumhealth ware.com; melanie.brodnik@osumc.edu; carterm@ahconline.com; michelle.dougherty@ahima.org; mike.crowder@goldenven.com; measley@hqmmail.com; mmercier@hcr-manorcare.com; nrobinson@amda.com; nate@american-data.com; nlake@healthtech.net; nmadison@healthtech.net; ppadula@mslc.com; kress@actslife.org; rhonda@ahis.net; rhonda_g_hamilton@wellpoint.com; richard.giddings@achievehealthcare.com; rsutton@accu-med.com; rabrams@myziva.com; rsmith@co.strafford.nh.us; roiqualls@ehealthdatasolutions.com; rchambers@elizabryant.org; rdepriest@hcr-manorcare.com; septembers@nehca.org; sheila.lambowitz@cms.hhs.gov; shellyspiro@yahoo.com; steven.handler@verizon.net; suelewis@accu-med.com; sue.mitchell@omnicare.com; serucinski@savasc.com; spweaver@co.bucks.pa.us; tomwelsh@esgi.com; tim.smith@goldenven.com; tsmith@ahca.org; tydette.tisdell@va.gov; yael.harris@hhs.gov; zbolton@gmail.com;

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Trunk—SDO—functionLTC EHR-S Profile

Information Infrastructure section—almost completed…14 persons regularly attended—all participated in re-writing and voting on assuring that the profile reflects our industry needs

Direct Care section—moving slowly…16 to 20 persons regularly attend and vote—additional time will be spent by workgroup members to carefully review and finish—MEET the challenge!

Supportive Services section—review and vote will begin shortly—MEET the challenge!!

14-20 persons directing EHR software functionality for 17,000 SNF’s???

STATUS AS OF 10-7-07

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Trunk—SDO—

pharmaceutical “Mission Statement:

NCPDP creates and promotes standards for the transfer of data to and from the pharmacy services sector of the healthcare industry. The organization provides a forum and support wherein our diverse membership can efficiently and effectively develop and maintain these standards through a consensus building process.

…a not-for-profit ANSI-accredited Standards Development Organization.”

From–www.ncpdp.org

Standards for prescription entry, transmission, reconciliation, and fulfillment—an integral part on an EHR.

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Trunk—SDO—terminology “Systemized Nomenclature of Medicine--

SNOMED

…a dynamic, scientifically validated clinical health care terminology and infrastructure that makes health care knowledge more usable and accessible.

SNOMED CT— SNOMED Clinical Terms– provides a common language that enables a consistent way of capturing, sharing and aggregating health data across specialties and sites of care.” –concepts, descriptions, relationships…(from www.snomed.org)

Example: For the concept Pneumonia (disorder), the ConceptID is 233604007

IHTSDO®

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Trunk—SDO—format/terminology• Logical Observation Identifier Names and Codes—LOINC

• “LOINC is a voluntary effort housed in the Regenstrief Institute, an internationally respected non-profit medical research organization associated with Indiana University. LOINC system was initiated in 1994 by the Regenstrief Institute and developed by Regenstrief and the LOINC committee as a response to the demand for electronic movement of clinical data from laboratories that produce the data to hospitals, physician's offices, and payers who use the data for clinical care and management purposes.”

(from www.regenstrief.org/loinc)

•LOINC has expanded beyond laboratory; for clinical symptoms and results

•MDS 2.0 has been LOINC’d or LOINCified…

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Trunk—EHR hardware…

The Motion C5 device helps hospital personnel monitor patient information, allowing them to document vital signs, medications, plan of care and test results. (Baltimore Sun photo by Chiaki Kawajiri / August 8, 2007) Photo for For non-commercial use only

A tablet device—usually wireless. Very portable, but has limited screen size.

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TRUNK—EHR HARDWARE

Stationary devices, such as KIOSKS—can be wall mounted or mounted on rolling table stands.

Staff enters information near OR IN patient care =timely and more accurate documentation.

Other hardware, wireless/wired—multiple configurations

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Branches and growth…

RHIO—Regional Health Information Organization or

RHIN—Regional Health Information Network, and finally a…

NHIN—National Health Information Network—CMS has selected vendors which will be allowed to compete for this “prize”—Enterprise System Developlent, 10 years, $4 billion

HIE—Health Information Exchangevia

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As the tree grows, where will you be??

Or gathering up the leaves and paper—hoping for a fire???…

In a “connected” home environment … with plans for continuing modernization??

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WE NEED YOU TO ADVANCE HIT!! Visit the “virtual

nursing home” and technology Halls. Talk with these vendors and other experts—be sure you have knowledgeable contacts who will REMAIN up to date!

SHARE and continuously expand YOUR KNOWLEDGE

Start your plan NOW!!

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WE NEED YOU TO ADVANCE HIT!! And when you get

back home…

GET YOUR staff and FACILITY READY—cultural change may prove to be more costly than actual system change if not tackled first

Don’t do it alone…

PARTICIPATE AT THE LOCAL LEVEL

PARTICIPATE AT THE NATIONAL LEVEL

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Thank you for your participation!!Grateful thanks are given to:

•Health Facilities Association of Maryland and Members of its HIT committee, and,

•AHCA’s HIT Committee,

•And others…

Who willingly offered their time and expertise to provide ruthless criticism and constructive suggestions…that’s what friends are for…

This presentation (containing links to organizations and other resources) will be available on the AHCA Members website shortly after the convention.

Eileen Doll, RN, BS, NHAHealthcare ConsultantEDHC INC

EDHCINC@gmail.com

Nathan Lake, RN, BSN, MSHADirector, Clinical DesignAmerican HEALTHTECH

nlake@healthtech.net

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