By M.L. Baker 2/21/2007 10:18:00 AM

A health IT standards group released a new, more-comprehensive standard for electronic health records on Feb. 21. The standard, released by Health Level Seven, is the first that specifies functional requirements for electronic health-records systems to win approval from the American National Standards Institute, a key standard-setting body. Electronic health records are advocated by the federal government and many health advocacy groups as a way to make sure that doctors have more complete information when caring for patients. Besides cost, one large barrier to EHR use is that different EHR systems cannot work together to exchange information, a problem that could be greatly alleviated by industry-wide standards. But health IT is plagued by competing standards, often developed by different sets of experts for different purposes. The problem is widely recognized. Earlier this month, HL7 and ASTM International, another standards organization, announced a merged standard for describing patients’ medical histories and demographics when discharged from a health institution. The move was heralded as an important advance in creating a nationwide health-information network.

The HL7 standard released Feb. 21 describes 1,000 conformance criteria across 130 functions, including medication history, problem lists, orders, clinical decision support, plus supports for privacy and security. “This new standard is a ’superset’ of functions that enables a standardized description and common understanding of functions, which is necessary when you’re working across care settings,” said Linda Fischetti, EHR Technical Committee co-chair.

A federally supported industry collaborative that certifies electronic health-records systems praised HL7, saying the two organizations provided a good example of collaboration in the health IT field. “The HL7 standard for EHR systems has been extremely valuable to us, providing the starting framework for CCHIT’s development of certification criteria,” said Mark Leavitt, head of CCHIT (Certification Commission for Health Information Technology). The standard should also serve as the basis for additional functions of electronic health-records systems, such as the ability to serve as a legal record for business purposes. The standard is also designed to accommodate EHR systems aimed for special purposes, such as disaster preparedness, long-term care, behavioral health, children and clinical research.

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By: Joseph Conn / HITS staff writer
Story posted: February 13, 2007 – 10:56 am EDT

The compromise reached between two sometimes rival standards development organizations could have far-reaching implications for the development of a national healthcare information network, experts close to the effort say.

The collaboration, called the Continuity of Care Document, or CCD, is the handiwork of Health Level 7, Ann Arbor, Mich., and ASTM International, Conshohocken, Pa., which jointly announced its release Monday after required formal balloting was completed. Initial development efforts by both organizations was aimed at developing patient care summaries but has since broadened in scope.

The CCD is a melding of HL7’s broader Clinical Document Architecture, or CDA, and the Continuity of Care Record, or CCR, developed by ASTM in collaboration with the Massachusetts Medical Society. Balloting on the much-anticipated CCD began on Dec. 6, 2006, and concluded Jan. 7. It took two ballots to pass muster among HL7 members and other interested parties who reviewed the development, according to Robert Dolin, an Orange County, Calif.-based physician lead for national terminology services for the Kaiser Permanente Medical Group, a member of the HL7 board of directors and the editor-in-chief of CCD for the standards development organization.

Richard Peters, also a physician, is chairman of the ASTM International Committee on Healthcare Informatics and serves as ASTM’s lead in the collaboration on the CCD.

Peters could not be reached for comment by deadline.

“I am the primary editor, and I voted no on it on the first ballot,” Dolin said. “We had enough time so we tightened up all the constraints and the language to use to express the constraints that were a little ambiguous. We went through each section of the CCR and went through it line by line,” he said, making sure it dovetailed with the CCD.

In October 2006, the federally funded Healthcare Information Technology Standards Panel recommended to HHS Secretary Mike Leavitt its first batch of “harmonized” IT standards aimed at facilitating specific healthcare data transmission tasks chosen by HHS. Among those was a recommendation by HITSP that the then-unfinished CCD be adopted for the exchange of certain clinical information, including patient demographics, medications and allergies.

HITSP Chairman John Halamka, the physician chief information officer of Harvard Medical School, in an e-mail called the successful CCD ballot “a very significant development for healthcare IT” and “a milestone in the standards world.”

“HL7 and ASTM worked together seamlessly to incorporate the best of their standards into a work product that will now form the basis of many HITSP Interoperability Specifications,” Halamka said. “CCD was included in the HITSP interoperability specifications submitted to Secretary Leavitt last October. We’ll ensure any updates to CCD are included in our next release of interoperability specifications which will be voted on in May.

Work by ASTM on the electronic CCR flowed out of an initial effort by physicians in Massachusetts to develop a standard, paper-based discharge summary for patients leaving the hospital bound for nursing homes.

Dolin said a similar interest by HL7 members to develop a standard for patient summaries led HL7 to come up with on its own Care Record Summary, or CRS. But the parallel development work of ASTM on the CCR and HL7 on its CRS led to strained relations between adherents of the two standards—what Dolin diplomatically described as “all this politics going on between HL7 and ASTM.” Cooler heads apparently have prevailed and with the collaboration leading to the successful balloting, “CRS is now sunseted by CCD,” Dolin said.

A major event at the IT trade show, Toward the Electronic Patient Record, last May in Dallas, was a demonstration of the CCR by more than a dozen vendors of electronic medical-records systems. At the time, most of the participating vendors could export documents in the CCR format and at least one vendor could import a CCR document and seamlessly place discrete data elements from the record in the fields of the receiving vendor’s EMR.

The demonstration showed the potential of peer-to-peer communication between physicians with different EMR systems.

Peter Waegemann, chief executive officer of the Medical Records Institute, sponsor of the show, said development of the compromise CCD “is really a win-win situation.”

Vendors and users of large IT “legacy” systems that are backers of HL7’s Clinical Document Architecture will gain the most benefit from the CCD because they will be able to use the CCR format in their systems, Waegemann said. But the collaboration with HL7 on the CCD further establishes the CCR, he said.

“Both have a community and both are good for the doctors and everyone else,” Waegemann said.

The American Academy of Family Physician’s Center for Health Information Technology operates an online list of EMR and personal health record system vendors that have committed to using ASTM’s CCR. The list, currently with 31 vendors, also includes the status of their CCR incorporation efforts.