Marshfield scores with homegrown EHR

By: Melanie Evans / HITS staff writer

Story posted: February 7, 2007 – 6:00 am EDT

The Marshfield (Wis.) Clinic scored the first certification for an ambulatory electronic health record not created by a commercial vendor, and officials say it won’t be long before they put it on the market.

The multispecialty physician group said Jan. 29 that its homegrown digital record cleared the final hurdle—a test of operations before three anonymous judges—to win endorsement from the Certification Commission for Healthcare Information Technology, a private Chicago-based organization with a federal contract to evaluate and approve the quality, privacy and interoperability of EHRs.

The Marshfield clinic’s EHR, named CattailsMD for the reedy marsh plant in the clinic’s logo, was one of 18 products to recently win approval. In all, 55 ambulatory EHRs have won certification; only Marshfield’s was developed by a provider for internal, not commercial, use.

Until November, clinics, health systems or other nonvendors could not seek certification for digital records of their own creation. The original intent of certification was to encourage clinics and doctors to invest in EHRs by guaranteeing certain operating standards among vendors, such as interoperability, said Mark Leavitt, an internal medicine physician on leave as chief medical officer of the Healthcare Information Management Systems Society to act as CCHIT’s chairman. The commission expanded its certification to nonvendors after insurers began considering the endorsement as criteria for performance initiatives, Leavitt said.

The Marshfield Clinic, which operates 41 Wisconsin clinics and surgery centers, went after certification so that it could attract customers, said Tom Berg, Marshfield Clinic’s information technology strategic relations general manager. The clinic’s ambulatory EHR—which began with the 1985 conversion to electronic laboratory records—is already in use in 200 locations, including Wisconsin schools, state health department clinics and some independent practices, he said.

In 1995, the Marshfield Clinic required doctors to use electronic records, but they have been honing and expanding it since then, Berg said. Prescriptions went paperless in mid-2005 and roughly 60% of Marshfield Clinic’s paper charts have been converted to electronic files, he said. “We are shutting off the lights in the old paper chart rooms,” he said. Berg credits the record’s development to Marshfield Clinic’s ongoing investment in technology, which he said totals 3.5% to 4% of its operating expenses annually.

Marshfield Clinic officials felt certification would boost future sales, he said. The certification is like a Good Housekeeping Seal of Approval, he said.

Winning certification wasn’t easy, despite CCHIT’s “open book” approach to testing, he said. CCHIT reviewed documentation for 35 policies and procedures, such as how to conduct audit trails and password enforcement, said Tina Ellis-Coyle, Marshfield Clinic’s information technology strategic relations project manager. There’s another 143 functional criteria, which must be demonstrated in less than eight hours before three remote judges, who monitor performance and ask questions via the Internet, she said. “It’s pretty strenuous,” she said, noting that labor expenses added an undetermined amount to the overall cost of certification, which includes a $28,000 fee.

Leavitt said commercial vendors and nonvendors face similar certification tests. However, EHRs developed in-house for providers face a few different criteria. For example, CCHIT requires commercial vendors to demonstrate a disaster scenario by shutting down and restarting the record systems. For EHRs developed and used by providers—which are typically in use—certification judges require proof that such a test has been performed to guarantee data security and backup, he said.

In preparation for certification, Marshfield Clinic technology staff abandoned their first mock test of the 143 functional criteria. “We quit,” Berg said. “We had to go back and practice, practice, practice.” In the final weeks, crews ran two mock functional tests daily, he said. “We were working 16 hours a day those days,” he said. For the actual test, Marshfield Clinic’s team finished the demonstration in just four hours. “It really paid off,” he said.

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