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Paving the Road to Use EHRs for Vital Records

Paving the Road to Use EHRs for Vital Records. NAPHSIS/NCHS Annual Meeting Hetty Khan June 7, 2010 Michelle Williamson Health Informatics Specialists

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Paving the Road to Use EHRs for Vital Records

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  1. Paving the Road to Use EHRsfor Vital Records NAPHSIS/NCHS Annual Meeting Hetty Khan June 7, 2010 Michelle Williamson Health Informatics Specialists National Center for Health Statistics Centers for Disease Control and Prevention

  2. Topics Overview of Electronic Health Records -EHRs eVital Records Standards Activities

  3. U.S. Plans for Health Information Technology “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” ~~ Former President G.W.Bush in State of the Union Address, January 20, 2004 Established goal for most Americans to have access to an interoperable EHR by 2014.

  4. U.S. Plans for Health Information Technology “To lower healthcare cost, cut medical errors, and improve care, we’ll computerize the nation’s health record in five years, saving billions of dollars in health care costs and countless lives.” ~~ President Barack Obama First Weekly Address January 24, 2009 Consistent with Bush’s 2014 goal for electronic health records

  5. U.S. Plans for Health Information Technology (HIT) American Recovery & Reinvestment Act (ARRA)is stimulating adoption of HIT • Feb. 17, 2009: President Obama signed ARRA • December 30, 2009: • Office of the National Coordinator (ONC) issued an Interim Final Rule (IFR) on an initial set of HIT standards, implementation specifications, and certification criteria to promote adoption and “meaningful use” o f electronic health records criteria • Centers for Medicare and Medicaid Services (CMS) announced a notice of proposed rulemaking (NPRM) to implement provisions of the Recovery Act that provide incentive payments for the meaningful use of certified EHR technology 

  6. U.S. Plans for Health Information Technology Towards a Definition of Meaningful Use: • http://healthit.hhs.gov/ • Health IT Policy Council Recommendations to National Coordinator on Meaningful Use Objectives and Measures • HIT Standards Committee Meaningful Use Measures Data Elements Grid • CMS criteria for demonstrating meaningful use: • Stage 1: Data capturing • Stage 2: Reporting health information and tracking key clinical conditions • Stage 3: Improving performance and health outcomes • http://www.cms.gov/Recovery/11_HealthIT.asp

  7. What is an EHR? Source: Healthcare Information and Management Systems Society (HIMSS) http://www.himss.org/ASP/topics_ehr.asp

  8. What is an EHR? • Benefits of EHRs • Increase Accessibility • Improve Quality • Reduce Medical Errors • Reduce Cost • Reduce Duplicate Tests and Procedures • Increase Sharing of Health Information in Emergency Situations • Improve Continuity of Care • Barriers to EHRs • Adoption • Cost • Certification • Security and Privacy • Interoperability

  9. CDC/NCHS eVitalsStandards Activities • Lay the foundation for standardizing the transmission of birth and death events as efforts towards developing and implementing EHRs continues • Health Level Seven International (HL7) Vital Records Domain Analysis Model • HL7 EHR-S Vital Records Functional Profile

  10. Standards to Support Capturing U.S. Vital Records Data at the Point of Care or Contact Mother's Worksheet Registrar Mother Birth Registration System (EBRS) Birth Information Specialist (Select items) Birth Certificate State Department of Health Birth Event Electronic Health Record CDC/NCHS Nurse Obstetrician

  11. U.S. Vital Records Domain Analysis Model • Identify the birth and death registration activities (Activities Model) and data items (Core Data Model) utilizing an HL7 recognized format • Sponsored by the HL7 Public Health and Emergency Response WG • Guide future design and implementation efforts for standardizing the electronic data exchanges between EHR and VR systems, NCHS and other public and private information systems

  12. Birth Registration Activities Model

  13. Birth Core Data Model

  14. U.S. Vital Records Domain Analysis Model • Balloted and Approved as an HL7 Informative Standard, May 2010 • Engaged in ballot reconciliation activities to finalize the VR DAM – estimated completion July 2010 • Plan to utilize the VR DAM to identify the initial scope for developing HL7 standards to support eVitals data exchange • HL7 International representatives expressed interests in participating in the VR DAM activities to include models that represent the data items captured by their countries 

  15. HL7 VR Functional Profile • Sponsored by the HL7 Electronic Health Records Work Group - (PHER WG is a Co-Sponsor) • Specify the functional requirements needed for vital records data exchange among providers, states, Federal agencies and other stakeholders • Limit the scope to a subset of the vital records data items for the first iteration of the VRFP (including primarily data provided by the facility)

  16. EHR-S Functional Model Standard The EHR-S FM presents a superset of functions for an EHR system from which a user/setting specific subset can be generated It lists all of the functions that an EHR-S SHALL, SHOULD or MAY perform Creates a common platform for providers, vendors, payers and others to describe needed EHR functionality

  17. HL7 EHR-S Functional Model 17 Source: HL7 EHR-S FM Overview Chapter

  18. Overview of the EHR-S FM Standard Source: HL7 EHR-S FM Direct Care Chapter

  19. New VRFP Function

  20. Current Status of VRFP • WG is completing walkthrough of the EHR-S FM to identify functions and criteria needed to support VR • Plans to Ballot as an HL7 Informative Standard – September 2010 or January 2011 • Explore the process for developing certification criteria for EHR-S VR products based on the VRFP • Implement pilot projects utilizing the initial set of functional requirements in the VRFP, with the goal of monitoring and assessing the quality of the data that will be exchanged between EHRs and vital records systems

  21. International VRFP International VRFP

  22. Other eVitals Standards Activities EHR Cause of Death Work Group HITSP Maternal and Child Health Use Case IHE Maternal Child Health Profile

  23. EHR Cause of Death Work Group • NCHS formed an EHR COD Work Group to address the follow questions: • What information from an EHR would be most helpful for clinicians to view to facilitate determining and documenting a patient's cause of death for the U.S. Standard Death Certificate? • Are the requirements different for different use cases (for example: ED, nursing home, fetal death, pediatrics, etc.)?

  24. EHR Cause of Death Work Group • EHR COD WG identified 20+ functions/criteria to add/or modify to support documenting cause of death information for the VRFP • Functions/criteria presented to the VRFP Work Group for consideration and added to the VRFP • Example of New Function created: • DC.1.1.3.4 Capture Data and Documentation from External Sources for Vital Records • The system SHOULD provide a link to relevant resources for completing the cause of death section of the U.S. Standard Certificate of Death as provided on the CDC/NCHS/DVS website (for example using HL7 compliant infobutton technology) • IF a state has educational resources available to guide documenting cause of death information, THEN the system MAY provide State specific links to tutorials and other ancillary materials

  25. Healthcare Information Technology Standards Panel (HITSP) eVitals Related Activities ONC provided contractual support to HITSP to identify industry standards that would meet the needs of implementing specific use cases Maternal and Child Health Use Case Addresses the ability to exchange obstetric and pediatric patient information between EHRs, etc…….. Includes information exchanges for: Determination of pregnancy The birth event and incorporation of antepartum information Referrals and information flows to Vital Records NCHS provided input into the technical specifications developed by HITSP to assure consistency with the NCHS Edit Specifications for birth, death and fetal death RDSS 155 – Maternal and Child Health C170 – Vital Records Pre-Populate Component document http://www.hitsp.org/

  26. Integrating the Healthcare Enterprise (IHE) eVitals Standards Activities IHE is an initiative by healthcare professionals and industry to promote the coordinated use of established standards to address specific clinical needs IHE Quality, Research, and Public Health Technical Committee developed a Mother and Child Health (MCH) profile which describes the data contents to be used in the automatic submission of the child and maternal health information to public health agencies Developed through input from France Modeled using the 2003 U.S. Standard Birth Certificate May 2010 – NCHS provided input on the MCH profile for consistency with the 2003 U.S. Birth Standard Specification

  27. Contact Information Michelle Williamson, RN, MSIS Senior Health Informatics Specialist CDC/National Center for Health Statistics Ph: 301-458-4618 Em: mwilliamson@cdc.gov Hetty Khan, RN, M.Sc Health Informatics Specialist CDC/National Center for Health Statistics Ph: 301-458-4311 Em: hdk1@cdc.gov

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