Proposed standards aim to add legal clout to EHRs

ANN ARBOR, MI – Healthcare IT standards organization HL7 has released a functional profile for the Legal Electronic Health Record System.

A 30-day public comment period runs from June 18 - July 18.  Balloting will occur later this year at a date to be announced.

The profile represents a significant boost for the adoption of electronic records, says Don Mon, vice president of practice leadership with the American Health Information Association and co-chair of HL7’s EHR Technical Committee.

“It goes back to the whole issue of having a legal record,” Mon said. When organizations switch to an EHR, they have to define it as a legal record for business purposes,” he said. “The benefit of this profile is that it points out within the EHR what the functionalities should be.”

The legal profile is based on HL7’s EHR System Functional Model standard adopted in February.

“An EHR system must be able to create, maintain, and manage records within a framework of ever-changing jurisdictional rules, regulations, and laws that are intended to assure electronic records are valid, accurate, and trustworthy,” HL7 officials said in a news release. “Because legal validity is at stake for all uses of electronic records as admissible business records, including admissibility as medical records, the Legal EHR is of primary importance to healthcare operations and to interoperability.”

“The Legal EHR System Functional Profile strengthens the EHR System Functional Model standard,” said Michelle Dougherty, director of practice leadership at AHIMA, and co-facilitator in the development of the legal profile. “It identifies the functionality within an EHR System that helps organizations maintain a legally sound health record.”

Mon said the legal profile will benefit both providers and vendors and will help them talk to one another about functionality.

The profile will also help healthcare organizations reduce costs associated with inefficiencies caused by redundant paper and electronic health records, he said. Without a legal definition for electronic records, organizations would be apt to rely on paper records as the legal record – prompting dual record keeping in many cases.

“The financial benefit is to the organization to the extent it will help reduce their paper,” Mon said.

Article:  http://www.healthcareitnews.com/story.cms?id=7308

Survey: E-health records don’t have to jeopardize privacy

Harris Poll also finds most adults comfortable with existing state and federal health privacy laws

Heather Havenstein March 26, 2007 (ComputerWorld) — Electronic health records can be recorded and shared without jeopardizing privacy, according to a Harris Interactive Inc. survey of 2,337 adults that was released today.

In the survey, 63% of respondents said that a move to electronic health records could be done without endangering their privacy, while 25% disagreed. In addition, 60% of those surveyed said that existing state and federal health privacy laws provide a “reasonable level” of privacy.

The survey, which was done in January, was designed with Alan Westin, a professor of public law and government at Columbia University who studies electronic health records.

The survey showed “about a two-thirds majority are ready to accept the potential benefits of electronic health records systems if solid privacy and security rules are applied,” Westin said. “However, about one quarter of the public remains skeptical and worried about such systemic computerization, and it will take highly robust and transparent new privacy and security programs to overcome these fears.”

The survey also found that seven in 10 U.S. adults are generally satisfied with the way doctors and hospitals handle and protect personal health information. However, 50% noted that they believe patients have lost control over how organizations like insurance companies, employers and government health agencies use their personal health data.

The survey comes at a time when privacy concerns are at the forefront of federal government and health care providers’ efforts to help spur the adoption of electronic medical records and the creation of nationwide networks to share them.

Last month, the U.S. Government Accountability Office released a report  that said the federal government has not yet come up with a way to tie together the various ongoing initiatives it has to tackle privacy concerns associated with electronic medical records.

In addition, one of the country’s oldest regional health information organizations was shuttered  late last year, citing privacy as one of the challenges to continuing its operations.

Find article here:  www.computerworld.com

ANSI-Approved Health IT Standard Announced

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.

Find article here: www.channelinsider.com

Standards rivals’ collaboration could have major impact

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.