Medical Device Daily

The Healthcare Information and Management Systems Society (HIMSS; Chicago) is taking still another shot on goal, the goal in this particular case being the development of an electronic health record (EHR, often also referred to as EMR, for electronic medical record) that is interoperable – or, in everyday language, portable.

In its newest effort to push for achieving this often-talked-about but not-yet-accomplished technology goal, HIMSS last week reported the results of a meeting it held April 21 and 22 in Chicago with a group of government and industry policymakers, health information technology (HIT) vendors and leading HIT users.

Perhaps the most important of these results: “a plan of attack for interoperability” of EHRs, according to Joyce Sensmeier, RN, director of informatics for HIMSS, to be demonstrated early next year. This plan of attack, which she also termed “a road map,” will come in two stages, she told Medical Device Daily.

HIMSS first will hold a “testing event” during the second week of January, in Oak Brook, Illinois, she said. This testing event will include the participation of several HIT vendors, large and small, using an agreed-upon set of standards. Based on this event, HIMSS then will provide a “demonstration event” at its annual meeting, Feb. 12-16, in San Diego, Sensmeier said.

The critical factors in this effort are also twofold, she noted.

The first is the agreement on the necessary “templates” – or more broadly, the electronic standards and medical language coding – that will be used in this system. Hand-in-hand with agreement on standards is the active participation of vendors supplying EMR products, with several of them attending the meeting in Chicago last month, she said.

Vendor buy-in, ultimately, may be the critical driver.

This market is highly fragmented, featuring perhaps as many as 800 firms supplying electronic records systems, but not yet having standards for developing an EHR that a patient in the U.S. can carry from one doctor – or one healthcare system – to another.

About 25 of the major vendors were represented at the April meeting, Sensmeier reported, and she said that more than 50 EHR vendors are working with HIMSS in the new effort to establish interoperability.

Failure to buy in to the effort has its obvious repercussions, she said, but noting that “not a one” of the vendors working with HIMSS wants to be left behind.

Another important factor is vendor/product certification by the Certification Commission for Healthcare Information Technology (CCHIT), a group launched by President George Bush with an executive order almost exactly a year ago.

Potential certification by that group looks to be an essential element for vendor participation in the new interoperability project.

While the CCHIT has been challenged in some quarters as overly “vendor-centric,” Mark Leavitt, MD, PhD, commission chair and medical director of HIMSS – has emphasized that the group’s financial support has come mainly not from vendors, but from three professional groups representing a broad range of HIT interests: HIMSS, the American Health Information Management Association (Chicago) and the National Alliance for Health Information Technology (Washington).

CCHIT’s essential clout could be validated by a proposed piece of federal legislation that would make it the exclusive certification authority for HIT products and, more critically, mandate that federal purchasing dollars would be spent only on those HER products that are certified.

The bill, however, specifies no funding for CCHIT – estimated at up to $1 million annually – a problem plaguing all EHR efforts, but especially those at the federal level.

While CCHIT has reported “discussions” for its financing with David Brailer, the government’s HIT/EHR czar, Brailer’s office also has had trouble nailing down funding in the federal budget to validate its existence, either short- or long-term.

CCHIT held its first meeting last September (Medical Device Daily, Sept. 20, 2004), and in early April it issued a draft report setting proposed requirements for certifying EHR products for the ambulatory care setting, an important step toward establishing a certification program targeted for roll-out this summer.

That report is currently available for public comment – – and the organization said it will set a second public comment period later this year, along with a series of conference calls.

The pilot certification report was developed by four work groups of the CCHIT, those groups made up of 40 people representing a range of interests, from physicians to health insurers.

HIMSS’ participation in the early-2006 demonstration project was given the thumbs-up officially at the organization’s April 8 board meeting in Washington.

“The industry can only achieve its goal of interoperable [EHRs] by developing cohesive and collective initiatives such as this,” said Pamela Wirth, vice president and chief information officer for the Susquehanna Healthcare System (Williamsport, Pennsylvania). “The HIMSS board recognized the value and need for the EHR Interoperability Collaboration Process and looks forward to the development of interoperable standard clinical templates that will result from this effort.”

Others joining the collaborative effort include Health Level Seven (HL7; Ann Arbor, Michigan), Integrating the Healthcare Enterprise (IHE) and the HIMSS EHR Vendors Association (EHRVA), via coordination of various activities that would provide an HL7 implementation guide and launch a new patient care coordinated IHE domain.

Health Level Seven, founded in 1987, is a not-for-profit, ANSI-accredited standards developing organization attempting to develop a framework as the foundation for an interoperable EHR. HL7’s 2,200 members represent about 500 corporate members, and says these members represent 90% of the largest information systems vendors in healthcare

IHE is attempting to bring together HIT stakeholders in the HER effort.

The EHRVA is a trade association of EHR vendors promoting EHR adoption in hospitals and ambulatory care settings.