EHR and "Meaningful Use" HIMSS 2010 By Herman Oosterwijk


{xtypo_dropcap}T{/xtypo_dropcap}he HIMSS meeting this year was all about EHRs and "Meaningful Use". First, lets talk about the “Meaningful Use” term:  I doubt whether a lot of people have tried to de-cipher the 700 pages document from the US dept of Health and Services (HHS) specifying the healthcare IT requirements, however many vendors claim to have done so and that they are more than able to meet these requirements.  I like the slogan of one of the whitepapers I picked up stating “Meaningful Use, not Meaningful Waste”.  In any case, this term was probably misused and misinterpreted by most product implementations I have seen at the floor. The bottom line is that one only should be able to claim compliance if their product was properly certified.

Certification is a major issue and challenge. The only organization which is certifying EHR's so far is CCHIT. There is a request for proposal for additional certification agencies so that there will be more testing bandwidth for those companies looking for certification and also to provide some competition. The major issue I have with the certification is that in my opinion the certification is geared too much towards whether a system has certain functionality, rather than focusing on interoperability. I believe a strong interface and interoperability certification is more important than functionality as the market will, to a certain degree, determine what is needed. However, the market will not typically determine the level of “openness” and potential for exchanging all of the information freely among multiple EMR’s, EHR’s and PHR’s. Another major need is for simulators, test tools etc. These are being generated at full speed by organizations such as NIST, but in my opinion the progress is not yet fast, sophisticated and easy to use.

Talking about PHR’s, there are quite a few coming out, Microsoft, Google and Dossia probably on the forefront. There is actually a good resource, called which has quite a list of PHR providers. The number one problem is that many people are still concerned about patient privacy and security. Just as an example, we still get regular calls in our office from people who want to order a  book about DICOM or PACS and do not feel comfortable buying on-line using credit card, therefore sharing medical information might even be more scary for such persons.

About EHR’s, I have to be honest, after seeing about five of them, I did not remember the first one and they all seem to kind of blur. Reason being that their functionality is basically all the same, except for some bells, whistles, and/or different colors for the tabs on the screen. I did find a major difference though in the level of decision support and automation.  I also learned, speaking with several vendors, that the main challenge prior to installing an EHR is to get consensus among physicians about care plans, standard order sets, etc. I have that experienced myself just dealing with lab results. Certain boundary values for cholesterol might be acceptable by one physician, and not by the other, and then conflict with a recent publication from the American Heart Association. Another thing what several vendors confirmed is that when implementing an EHR, you should go for the “big bang”, i.e. switch over all departments at the same time. If not, there is still a lot of documents being shuffled and unnecessarily printed.

The most impressive section at HIMSS was in my opinion the IHE interoperability show case. I have watched these vendors during the recent connectathon in Chicago communicating with ach other, but seeing it in a nice booth using real-life patient scenarios was very impressive. It seems very simple, i.e. vitals from an ER patient being automatically added to a data repository, EHR, using a universal patient identifier and the data also being added to his/her PHR. The amount of integration and various corresponding transactions that are needed to make this happen was impressive, and to see it all work was great. My compliments to HIMSS to allow for such a large booth (larger than any other commercial booth) and to the participants of this excellent presentation. This type of work will really make the healthcare evolution into a revolution and hopefully lead to a “Meaningful Use”.

{xtypo_quote_right}EHR and "Meaningful Use" HIMSS 2010 By Herman Oosterwijk{/xtypo_quote_right}