KHAN NAPHSIS NCHS Annual Meeting Presentation 2010 03 by z5mc9N


									NAPHSIS/NCHS Annual Meeting                             Hetty Khan
June 7, 2010                                   Michelle Williamson
                                      Health Informatics Specialists
                              National Center for Health Statistics
                         Centers for Disease Control and Prevention
• Overview of Electronic Health Records -EHRs

• eVital Records Standards Activities
U.S. Plans for Health Information Technology

  “By computerizing health records, we can
  avoid dangerous medical mistakes, reduce
  costs, and improve care.”
    ~~ Former President G.W.Bush in State of the Union Address,
       January 20, 2004

  Established goal for most Americans to have
  access to an interoperable EHR by 2014.
U.S. Plans for Health Information Technology
                     “To lower healthcare cost, cut
                     medical errors, and improve care,
                     we’ll computerize the nation’s
                     health record in five years, saving
                     billions of dollars in health care
                     costs and countless lives.”

                     ~~ President Barack Obama
                        First Weekly Address
                          January 24, 2009

                     Consistent with Bush’s 2014 goal
                     for electronic health records
U.S. Plans for Health Information Technology (HIT)

    American Recovery & Reinvestment Act (ARRA)
            is stimulating adoption of HIT

       Feb. 17, 2009: President Obama signed ARRA

       December 30, 2009:
         Office of the National Coordinator (ONC) issued an Interim
          Final Rule (IFR) on an initial set of HIT standards,
          implementation specifications, and certification criteria to
          promote adoption and “meaningful use” o f electronic health
          records criteria

         Centers for Medicare and Medicaid Services (CMS)
          announced a notice of proposed rulemaking (NPRM) to
          implement provisions of the Recovery Act that provide
          incentive payments for the meaningful use of certified EHR
  U.S. Plans for Health Information Technology
Towards a Definition of Meaningful Use:

    Health IT Policy Council Recommendations to National
     Coordinator on Meaningful Use Objectives and Measures

    HIT Standards Committee Meaningful Use Measures Data
     Elements Grid

 CMS criteria for demonstrating meaningful use:
    Stage 1: Data capturing
    Stage 2: Reporting health information and tracking key
               clinical conditions
    Stage 3: Improving performance and health outcomes
               What is an EHR?

Source: Healthcare Information and Management Systems Society (HIMSS)
                 What is an EHR?
 Benefits of EHRs
     Increase Accessibility
     Improve Quality
     Reduce Medical Errors
     Reduce Cost
     Reduce Duplicate Tests and Procedures
     Increase Sharing of Health Information in Emergency Situations
     Improve Continuity of Care

 Barriers to EHRs
     Adoption
     Cost
     Certification
     Security and Privacy
     Interoperability
 Lay the foundation for standardizing the
 transmission of birth and death events as efforts
 towards developing and implementing EHRs

   Health Level Seven International (HL7) Vital
    Records Domain Analysis Model
   HL7 EHR-S Vital Records Functional Profile


                                        Birth Registration System (EBRS)

                 Birth Information                      (Select items)
                                                                           Birth Certificate      State
                                                                                               Department of

Birth Event

                                                Electronic Health

         Nurse               Obstetrician
• Identify the birth and death registration activities
 (Activities Model) and data items (Core Data Model)
 utilizing an HL7 recognized format

• Sponsored by the HL7 Public Health and Emergency
 Response WG

• Guide future design and implementation efforts for
 standardizing the electronic data exchanges between
 EHR and VR systems, NCHS and other public and
 private information systems
• Balloted and Approved as an HL7 Informative Standard, May

• Engaged in ballot reconciliation activities to finalize the VR
  DAM – estimated completion July 2010

• Plan to utilize the VR DAM to identify the initial scope for
  developing HL7 standards to support eVitals data exchange

• HL7 International representatives expressed interests in
  participating in the VR DAM activities to include models that
  represent the data items captured by their countries
 Sponsored by the HL7 Electronic Health Records Work
 Group - (PHER WG is a Co-Sponsor)

 Specify the functional requirements needed for vital
 records data exchange among providers, states, Federal
 agencies and other stakeholders

 Limit the scope to a subset of the vital records data items
 for the first iteration of the VRFP (including primarily
 data provided by the facility)
•The EHR-S FM presents a superset of
 functions for an EHR system from which
 a user/setting specific subset can be

•It lists all of the functions that an EHR-S
SHALL, SHOULD or MAY perform

•Creates a common platform for
 providers, vendors, payers and
 others to describe needed EHR
                                   HL7 EHR-S Functional Model
   Direct Care Supportive

                            DC.1          Care Management

                            DC.2          Clinical Decision Support

                            DC.3          Operations Management and Communication

                            S.1           Clinical Support

                            S.2           Measurement, Analysis, Research and Reports

                            S.3           Administrative and Financial

                            IN.1          Security

                            IN.2          Health Record Information and Management

                            IN.3          Registry and Directory Services

                            IN.4          Standard Terminologies & Terminology Services

                            IN.5          Standards-based Interoperability

                            IN.6          Business Rules Management

                            IN.7          Workflow Management

                                   Source: HL7 EHR-S FM Overview Chapter                  17
ID         Type    Name               Statement                  Description

DC.1.5     F       Manage             Create and maintain        A problem list may include, but is not
                   problem list       patient-specific problem   limited to: Chronic conditions,
                                      list                       diagnoses, or symptoms, functional
                                                                 limitations, visit or stay-specific
                                                                 conditions, diagnoses, or symptoms.
                                                                 Problem lists are managed over time,
                                                                 whether over the course of a visit or
See Also       Conformance Criteria

IN.2.5.1       1. The system SHALL display all active problems associated with a patient.
IN.2.5.2       2. The system SHALL create a history of all problems associated with a patient.
               3. The system SHALL retrieve a history of all problems associated with a patient.
               4. The system SHALL provide a user interface to deactivate a problem.
               5. The system MAY provide the ability to re-activate a previously deactivated problem.
               6. …

                  Source: HL7 EHR-S FM Direct Care Chapter
ID         Type     Name              Statement                  Description

DC.1.10    F        Manage            Capture and maintain       It is important to capture and store the
                    Admissions,       admission, discharge       name and National Provider Identifier
                    Discharges,       and transfer information   (NPI) of the facility to or from which a
                    Transfers for     for vital records          mother/patient or infant was
                    Vital Records.                               transferred.

See Also       Conformance Criteria
IN.2.5.1       1.   IF the mother is transferred from one facility to another for maternal medical or
IN.2.5.2            fetal indications for delivery, THEN the system SHALL provide the ability to set an
                    indicator accordingly, as specified in the NCHS/NAPHSIS ES. Transfers include, but
                    are not limited to, hospital to hospital, and birthing facility to hospital.

               2.   IF the mother was transferred to the facility for maternal medical or fetal indications
                    for delivery, THEN the system SHALL provide the ability to capture the name of the
                    facility from which the mother was transferred.
• WG is completing walkthrough of the EHR-S FM to identify
  functions and criteria needed to support VR

• Plans to Ballot as an HL7 Informative Standard –
  September 2010 or January 2011

• Explore the process for developing certification criteria for
  EHR-S VR products based on the VRFP

• Implement pilot projects utilizing the initial set of functional
  requirements in the VRFP, with the goal of monitoring and
  assessing the quality of the data that will be exchanged
  between EHRs and vital records systems
International VRFP

• EHR Cause of Death Work Group

• HITSP Maternal and Child Health Use Case

• IHE Maternal Child Health Profile
• NCHS formed an EHR COD Work Group to address the
  follow questions:

   • What information from an EHR would be most
     helpful for clinicians to view to facilitate determining
     and documenting a patient's cause of death for the
     U.S. Standard Death Certificate?

   • Are the requirements different for different use cases
     (for example: ED, nursing home, fetal death,
     pediatrics, etc.)?
• EHR COD WG identified 20+ functions/criteria to add/or modify to
  support documenting cause of death information for the VRFP

• Functions/criteria presented to the VRFP Work Group for
  consideration and added to the VRFP

• Example of New Function created:
    DC. Capture Data and Documentation from External
    Sources for Vital Records

        • The system SHOULD provide a link to relevant resources for completing
        the cause of death section of the U.S. Standard Certificate of Death as
        provided on the CDC/NCHS/DVS website (for example using HL7 compliant
        infobutton technology)

        • IF a state has educational resources available to guide documenting
        cause of death information, THEN the system MAY provide State specific
        links to tutorials and other ancillary materials
o ONC provided contractual support to HITSP to identify industry
  standards that would meet the needs of implementing specific use
o Maternal and Child Health Use Case
    o Addresses the ability to exchange obstetric and pediatric patient
      information between EHRs, etc……..
    o Includes information exchanges for:
        o   Determination of pregnancy
        o   The birth event and incorporation of antepartum information
        o   Referrals and information flows to Vital Records

    o NCHS provided input into the technical specifications developed by
      HITSP to assure consistency with the NCHS Edit Specifications for birth,
      death and fetal death
    o RDSS 155 – Maternal and Child Health
    o C170 – Vital Records Pre-Populate Component document
o IHE is an initiative by healthcare professionals and industry to promote
  the coordinated use of established standards to address specific clinical

o IHE Quality, Research, and Public Health Technical Committee
  developed a Mother and Child Health (MCH) profile which describes
  the data contents to be used in the automatic submission of the child
  and maternal health information to public health agencies

    o Developed through input from France
    o Modeled using the 2003 U.S. Standard Birth Certificate

o May 2010 – NCHS provided input on the MCH profile for
  consistency with the 2003 U.S. Birth Standard Specification
Michelle Williamson, RN, MSIS
Senior Health Informatics Specialist
CDC/National Center for Health Statistics
Ph: 301-458-4618

Hetty Khan, RN, M.Sc
Health Informatics Specialist
CDC/National Center for Health Statistics
Ph: 301-458-4311

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