HHS lays out a plan to have e-health records on the table by next June

'[I]f the American public doesn't see it, feel it, touch it and taste it, it simply is never going to get to where it needs to be.'

'HHS' David Brailer

Rick Steele

Health and Human Services secretary Mike Leavitt and national health IT coordinator David Brailer have spent a lot of time talking about what health IT systems could do for medicine. Recently, they got a glimpse of what it can look like.

Leavitt and Brailer observed a District of Columbia physician conduct a heart patient's checkup using an electronic health record and a laptop. (Yes, they obtained permission from the patient to see personal health information, in accordance with Health Insurance Portability and Accountability Act rules.)

From a list of patients he was to see that day, Dr. Ryan Bosch clicked on the patient's name, opening a screen with a variety of categories.

An assistant took the patient's blood pressure, which was automatically entered in the health record. The software put the data in the correct field so Bosch could access it to perform trending analysis.

Bosch next clicked on a panel to view the patient's history of cholesterol measures and a list of medications, in order to discuss a revision in dosages. Bosch typed his treatment orders and patient comments into the record as they were talking.

'It's had a profound effect on quality,' said Bosch, who conducted the checkup at George Washington University Medical Faculty Associates in Washington.

By next June, electronic health record systems will be available that are certified as capable of exchanging data with other providers when standards are decided. They will also meet criteria for basic clinical doctors' offices functions, said Mark Leavitt, director of the Certification Commission for Health Information Technology of Chicago, the nonprofit organization in charge of establishing the certification process.

The first set of interoperability standards also will be ready next summer.

HHS is focused on 'low-hanging fruit' to move the health IT agenda forward, while laying a foundation for the long-term infrastructure, Brailer said during a recent telebriefing.

'[I]f the American public doesn't see it, feel it, touch it and taste it, it simply is never going to get to where it needs to be,' he said.

HHS last month awarded $17.3 million in contracts to harmonize standards, create a process for health IT product certification and assess the variations in state privacy laws.

Under the standardization contract, the American National Standards Institute of New York will bring together other standards development organizations to form the Health Information Technology Standards Panel. The group will evaluate and reconcile existing standards that enable interoperability among applications, starting with the use cases that the public-private American Health Information Community recommended.

The initial cases for health IT applications are for chronic care management, disease or bioterror surveillance and a personal health record, said John Halamka, chairman of the Health IT Standards Panel and Harvard Medical School CIO. His panel also will review the standards that contractors propose for national health IT network prototypes.

'By [next] summer, we'll have the implementation guide on the three use cases and recommend standards for the NHIN,' he said.

Standards development organizations already have done a lot of work in the breakthrough cases. The Health IT Standards Panel is creating an inventory of inventories of all their work to create a master standards inventory. The panel hopes it will make evident the standards on which the groups could agree.

'Some use cases may offer low-hanging fruit, in that they'll find different standards development organizations use the same or duplicative standards,' Halamka said.

Later this month, the panel will assess the inventory for standard matches for one of the health IT use cases.

The panel will work on the other uses with competing standards over the next six months, he said.

At the same time, the certification commission will develop criteria and evaluation processes to ensure that electronic health record systems are able to share data.

The certification group will launch a pilot for ambulatory electronic health record certification criteria in December and start production of certification in March, Leavitt said.

He anticipates that testing should take from 60 to 90 days, and the first announcement of certified products should be in June.

CCHIT will test for functionality, standards and security. For example, an electronic health records system should be able to alert the physician that a new medication for a patient has a negative interaction with other drugs prescribed for the patient.

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