3.2 Electronic Health Records (EHR) Workgroup

Broad Charge

To make recommendations to the Community on ways to achieve widespread adoption of certified EHRs, minimizing gaps in adoption among providers.

Specific Charge

Make recommendations to the Community so that within one year, standardized, widely available and secure solutions for accessing current and historical laboratory results and interpretations is deployed for clinical care by authorized parties.

Key Accomplishments

As of April 2008, the EHR Workgroup has held 22 Workgroup meetings and has formally presented 32 recommendations to the AHIC. The recommendations cover a range of topics, and several areas are highlighted below:

Incentives for the Adoption of Electronic Health Records

• The EHR Workgroup recommended that HHS evaluate Pay-for-Use programs that rewarded improved structures, processes, and outcomes of health care using validated measures. Subsequently, CMS launched the EHR demonstration project which will provide bonuses for reporting on the use of specific functions of CCHIT-certified EHRs, reporting on various process and outcome measures, and ultimately for improved outcomes.

• ONC has been collaborating with the malpractice insurance industry to encourage premium reductions for those physicians who adopt CCHIT-certified EHRs as a result of another recommendation made by this workgroup.

Federal Procurement

• The Workgroup formally recommended that HHS should evaluate and recognize, as appropriate, HITSP-approved standards and include the use of federally recognized HITSP-approved standards in their contracting vehicles where applicable and appropriate. Further, HHS should encourage other Federal Agencies and Departments to follow the same measures. As a result, the President issued Executive Order 13410 and OMB is currently engaged in the process, effective for the 2008 contracts. ONC is working with all agencies that contract for health care services on behalf of the federal government to assure consistent language in health plan contracts.

Support for Laboratory Interoperability

• It was recommended that ONC should work with other components of the Department and other Federal Agencies to review the possible models for the exchange of both current and historical lab information and to determine whether and which would require CLIA/HIPAA guidance, regulatory change, and/or statutory change. As a result, ONC has worked with Centers for Medicare and Medicaid Services (CMS) to identify the possible models for current and historical lab results exchange.

• The workgroup recommended that HITSP identify and endorse vocabulary, messaging, and implementation standards for reporting the most commonly used laboratory test results to be included in the CCHIT interoperability criteria for March 2007 certification. The HITSP EHR-Laboratory Results Reporting Interoperability Specification (version 1.2) was accepted officially by the Secretary in December 2006. In January 2008, these achieved full HHS recognition status as version 2.1, which incorporated minor and technical updates. Also, CCHIT and HITSP have formed a joint workgroup to plan for the incorporation of HITSP Interoperability Specifications in CCHIT interoperability certification criteria.

Emergency Response

• The Workgroup recommended that an emergency responder use case should be developed and prioritized for the attention of HITSP and the other ONC lead initiatives. The use case described the role that an emergency responder electronic health record provides, comprising, at a minimum, demographic, medication, allergy and problem list information that is used to support emergency and routine health care activities. The use case was developed and finalized in December 2006. The HITSP ER-EHR Interoperability Specification was accepted by the AHIC in December 2007. In January 2008, it was officially accepted by the Secretary as an Interoperability Standard, with the intent to recognize it in January 2009.

e-Prescribing

• At the request of the AHIC parent committee, the EHR Workgroup developed recommendations that would give the HHS Secretary the authority to mandate use of certified e-prescribing technologies when caring for Medicare beneficiaries.

Health IT Workforce Needs

To gain a better understanding of health IT workforce needs, the EHR Workgroup gained insight on the human resource gaps that exist between the current health IT workforce and what is needed to widely implement EHR systems. Recommendations were subsequently presented to the AHIC regarding:

• Key health IT competencies and educational/training opportunities.

• The need to study, monitor, and grow the health IT workforce.

Future Activities and Transition Issues

In the upcoming months, the EHR Workgroup will begin the process of transiting its activities to the AHIC 2.0 Successor organization. For example, AHIC 2.0 might have an opportunity to build off what has been accomplished, and take a closer look at EHR adoption in additional settings, such as long-term care and home health.

By October 2008, the EHR Workgroup will have exhausted presenting recommendations to the AHIC. The last set of recommendations was presented in January 2008. The remaining work will consist of analyzing past testimony and performing gap analysis; summarizing workgroup activities, recommendations, and achievements; and describing opportunities for ongoing/future work.

Current Members

Co-Chairs

Lillee Smith Gelinas VHA, Inc.

Jonathan Perlin HCA, Inc.

ONC Director

Karen Bell HHS/Office of the National Coordinator for Health Information Technology

Members

Bonnie Anton University of Pittsburgh

Carolyn Clancy HHS/Agency for Healthcare Research and Quality

Laura Cranston Pharmacy Quality Alliance

Nhan Do Department of Defense

Peter Elkin Mayo Clinic

Linda Fischetti Veterans Health Administration

Richard Hays American College of Cardiology

Robert Juhasz American Osteopathic Association

Charles Kahn Federation of American Hospitals

Mark Lewis EMC Corporation

George Lynn American Hospital Association

Blackford Middleton Partners Healthcare System

Jack Price HIMSS Analytics

Pam Pure McKesson

Robert Smith Veterans Health Administration

Barry Straube HHS/Centers for Medicare & Medicaid Services

Robert Wears University of Florida Health Center