As hospitals and physician practices progress with electronic health record (EHR) adoption, keeping up with emerging
standards, regulations and incentive markers can seem daunting. Tom Moore, technical director at NYCLIX, a regional health information organization (RHIO), has a few pointers for health care providers trying to wrap their heads around the decision-making processes surrounding EHR adoption, as well as marching toward meaningful use and earning federal incentive payments.
The New York Clinical Information Exchange (NYCLIX), formed in 2004, enables hospitals, ambulatory physician practices and home health care agencies to exchange information for the patients flowing among them. When a hospital first joins NYCLIX, the New York-based RHIO focuses on getting the emergency room up and running with information exchange -- because, Moore said, that’s where sharing of health records is critical. Getting an ER patient’s recent primary-care physician records and labs -- and not having to duplicate recent tests -- can speed diagnosis and treatment decisions in a time-critical environment, save money by preventing duplicate tests, potentially cut recovery time and, in some cases, save lives.
For individual physician practices, the first decision to make when evaluating EHR adoption has nothing to do with technology. Instead, it involves workflow and can be summed up in one question: Are you going to adapt an electronic health record system to your workflow, or are you going to change your workflow to adapt to a particular electronic health records system? There is no wrong -- or easy -- answer.
“Both [ways] are really challenging, but neither [is] very technical,” Moore said. Then comes the purchase of new hardware and software, and the change management involved in rolling out an EHR system. “These are not small investments for small practices.”
He encouraged providers to push their EHR systems toward the Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 standard, Moore said. That is hardwired into the Office of the National Coordinator (ONC) for Health Information Technology’s interim final rule for EHR technology, and he said he feels adopting that standard will get a facility closer to the eventual final certification standards the federal government will mandate for providers who want to keep their full Medicare reimbursements, come 2015.
Related to the HL7 record-exchange standard is the C 32 standard. This was devised by the Healthcare Information Technology Standards Panel, which is administered by the American National Standards Institute. NYCLIX requires the C 32 standard for record exchange, as it’s a key part of interoperability.
[EHR systems] are not small investments for small practices.
Tom Moore, technical director, NYCLIX
“That’s the one we are focusing on for our exchange with business practices,” Moore said. “I think it will cover [meaningful use] requirements.”
Moore said the next step is to pay attention to how the ONC addresses electronic health records vocabulary standards. Currently, for example, staffers at a physician’s office and a lab might use several different words -- all of them unreadable to computers -- to describe the same results of the same test.
“The devil’s in the details, so just exchanging a C 32 document is not going to be adequate in the long run for Medicare/Medicaid,” Moore concluded. “The first thing is to exchange the data object such as a lab result … but the next thing is to do that with common terminology. It’s one thing to package up a lab result and get it sent; it’s another thing to translate every possible lab result and lab order.”
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