Healthcare stakeholders of all stripes let their concerns be heard Monday in the first two of 11 planned public meetings on a national standard for electronic medical records, an ambitious public-private effort that hopes to reach consensus in less than a month.
More than 200 people attended one of two sessions in Chicago Monday to comment on an industrywide proposal first made public less that two weeks ago by standards-setting body Health Level Seven and the EHR Collaborative, representing the AMA, the American Nurses Association and six healthcare information technology and informatics groups.
The EHR Collaborative will hold meetings in Seattle tomorrow, Friday in Los Angeles and next week in Boston, Atlanta and Dallas. All but Los Angeles will have separate morning and afternoon sessions due to high demand for spaces, organizers say.
The Centers for Disease Control and Prevention will make a formal presentation at the Atlanta meetings.
"The beauty of this is all the input from users, says Janet Marchibroda, CEO of the eHealth Initiative, Washington, D.C., a not-for-profit healthcare information technology advocacy group
On July 1, HHS Secretary Tommy Thompson asked Ann Arbor, Mich.-based HL7 and the Institute of Medicine to develop a voluntary standard for electronic health records and report back by Sept. 1. EHR Collaborative officials say they will post a report based on the 11 public meetings on its Web site by Aug. 25.
HL7 is soliciting votes on the proposal until Sept. 5. HL7 members will review the final voting at a Sept. 7-12 meeting in Memphis, Tenn. If the standards pass, they will go into effect for a four-month provisional period, after which HL7 members will take a final vote.
David Stumpf, M.D., a pediatric neurologist at Children's Memorial Hospital in Chicago and a member of the patient safety workgroup of the American Academy of Neurology worries about where the standard is coming from. He would prefer a physician-led HHS agency like the Centers for Disease Control and Prevention or the Agency for Healthcare Research and Quality to the "heavy hand" of CMS.
"Nobody wants a mandate," Marchbroda says. She notes that this push for voluntary standards instead of a HIPAA-style mandate is more feasible because there is far less adoption of EMRs than electronic billing systems.
The current proposal is largely based on plans written by the Healthcare Information and Management Systems Society, Chicago, and the eHealth Initiative. The eHealth Initiative is a project of Connecting for Health, a collaboration of more than 100 healthcare provider, payer, vendor, pharmaceutical and governmental healthcare interests that is promoting electronic connectivity in healthcare.
In general, the proposal states that an EMR should be more than a digitized representation of a paper chart, but rather a real-time information resource for physicians and other practitioners at the point of care. The standard also calls for integration of clinical records with billing, quality management, outcomes reporting and public health surveillance systems.
According to the HIMSS version, an EMR "automates and streamlines the clinician's workflow, ensuring all clinical information is communicated and ameliorates delays in response that result in delays or gaps in care."
At the Monday afternoon meeting in Chicago, participants noted that physicians will not stand for any system that makes them look in more than one place for various segments of a patient's record.
Other concerns and questions posed Monday include:
- Growing patient demand to see test results;
- Whether the standards should include goals for clinical outcomes
- Why some parts of order entry are called "essential" and others are not. The proposal also makes no distinction between who enters electronic orders
- An apparent lack of distinction between inpatient computerized physician order entry of medications and ambulatory prescription writing
- Whether the record should include connectivity to external knowledge bases. External partners identified in the draft include outside pharmacies, insurers, laboratories and radiology departments but not knowledge bases
- Whether connectivity with radiology partners includes digital imaging or only reports
- The special needs of pediatric records, such as growth charts
Some of the debate centered on why some elements are deemed essential while others are not. The draft says that real-time surveillance of adverse events and near misses for public health purposes is not essential; the same is true for customized patient educational information.
Nothing under work flow and operations management is classified as essential or even desirable in the original proposal. There was some criticism of the classification of chronic disease management as essential only for hospital care even though a great deal of chronic care and disease management takes place in ambulatory environments and nursing homes.
Some elements are classified as "passive" because the information is available for viewing but is not fully integrated into the workflow process. Examples include guidelines for care planning and clinical decision support, clinical pathways, regulatory and statutory protocols, accreditation standards and local or regional conventions.