1. EHR–System Developing a Functional Model and Standard
HIMSS Audio Conferences
August 7 and 14, 2003

2. Outline History Charter HL7 and IOM Roles and Deliverables
HL7 EHR-S Model and Standard
IOM EHR-S “Key Capabilities” Report
HL7 Balloting Process
HIMSS Role and Member Call to Action

3. History
Health and Human Services (HHS) and CMS want to pilot “pay for performance”
Provide financial incentives for better quality care.
How to measure quality?
Focused on use of EHR System to
Accelerate rate of adoption of clinical systems to achieve better quality at lower cost.
Support adoption of message and content standards for secure and private transmission of medical information.
Provide for consumer use of interconnected health systems.

4. Charter
Call to Action: HHS Secretary Tommy Thompson Announcement NHII on 7/1/03
HHS has licensed SNOMED medical vocabulary and made available for free to providers.
Enlisted Institute of Medicine and HL7 to develop a functional model for a standardized electronic health record.

5. HL7 and IOM Roles and Deliverables
CMS and Veterans Health Administration approached HL7 and its EHR Special Interest Group (SIG) at spring HL7 meeting.
Asked them to meet challenging goal of an ANSI balloted EHR System (EHR-S) Functional Model and Standard by January 2004.
HL7 EHR SIG directed to create EHR-S Functional Model and Standard.
IOM directed to provide EHR-S Functional Needs and Priority by Care Settings.

6. HL7 EHR System Functional Model and Standard
Scope and Definition
Framework
Content
Functional triplets
Care Setting Profiles
User Profiles
Tools
Hierarchy
Submittal Forms

7. HL7 EHR-S Scope and Definition
Discovery uncovered definitions of EHR and EHR-S from many standards groups including IOM, ISO, ASTM and HIMSS.
Did not define the EHR but accepted the concept of the EHR-S as a set of functions for primary and secondary users.
Note that it is a “System” not just an EHR.
CMS wants advanced functions such as CPOE with decision support not just access to a record in electronic form.

8. HL7 EHR-S Framework

9. HL7 EHR-S Framework

10. HL7 EHR Functional Triplets
Example drug-to-drug checking
Rationale for Use
Prevent adverse drug event through interaction.
Conformance Criteria
If a drug is ordered that interacts with currently prescribed drug, system notifies user.

11. The HL7 EHR-S Functional Groupings
Direct Care Health Information
Work Flow and Operations Management
Communications
Records, Documents and Views
Clinical Support
Measurement, Analysis, Research and Reports
Administrative, Finance

12. IOM Letter Report
“Key Capabilities of an Electronic Health Record System” – July 31, 2003 at
Prepared by the Committee on Data Standards for Patient Safety
Defines core functionality of EHR-S in four care settings
Hospital, ambulatory, nursing home, and care in the community (personal health)
Sets time frame (2004-5, and )

13. The IOM’s Definition of an EHR-S
Includes:
longitudinal collection electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual
immediate electronic access to person- and population-level information by authorized, and only authorized, users;
provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care;
support of efficient processes for health care delivery.

14. Primary and Secondary Uses of an Electronic Health Record System Adapted from Institute of Medicine (1997)
Primary Uses
Patient Care Delivery
Patient Care Management
Patient Care Support Processes
Financial and Other Administrative Processes
Patient Self-Management
Secondary Uses
Education
Regulation
Research
Public Health and Homeland Security
Policy Support

15. IOM’s Core Functionalities for an Electronic Health Record System
Health information and data
Results management
Order entry / management
Decision support
Electronic communication and connectivity
Patient support
Administrative processes
Reporting & population health management

16. High Level Abstraction
IOM EHR Capabilities
High Level Abstraction

17. The HL7 Ballot Process
ANSI accredited Standards Developer Organization
Participation in balloting by any interested party
Does require a $100 administrative fee if not a HL7 member
Open meetings to develop consensus and reconcile negatives
Also requires meeting registration fee
Draft Standard for Trial Use
Requires 2/3 affirmative vote to pass

18. Status of the Draft Ballot
Ballot available August 7th
Ballot closes on September 6th
Available on HL7 web site
Ballot reconciliation at HL7 Plenary and Working Group Meetings In Memphis
Full meetings September 7 – 12
EHR SIG September 9 – 11
Must register at

19. HIMSS Role
HIMSS has strongly supported a universal EHR and applauds this effort
Submitted its Definitional Model – June 2003
Funded HL7 EHR Standard effort (subject matter experts)
Member of EHR Collaborative to promote industry participation in EHR-S standardization process
Will draft a response to the Ballot by August 15 for comment by members

20. HIMSS Call to Action Standards development is an inclusive process.
Standards rarely pass on first ballots, but
This is a major opportunity for the healthcare and the HCIT industry.
We want to be part of the ongoing dialogue and solution.
We also want to insure that whatever standard CMS adopts has gone through a open consensus process.
Use HIMSS resources and participate!

21. Contacts Charlene Underwood Pat Wise Ed Larsen Joyce Sensmeier
Siemens/
Pat Wise
HIMSS/
Ed Larsen
E. R. Larsen, Inc./
Joyce Sensmeier
HIMSS/