This past Tuesday, I attended the NEHMISS Monthly Event and Social hosted at the Papa Razzi in Wellesley, MA with one of my colleagues, Patrick Zummo. It provided an invaluable opportunity to network with other healthcare IT professionals as the event had one of its best turnouts in the past two and a half years that we have attended (I would estimate about 65 attendees!) It was great catching up with folks and seeing new faces. The networking opportunity can’t be underscored enough!
The event featured a presentation on “An Approach to Meaningful Use” by Laura Leinin, Sr. Project Specialist, Clinical Information Systems at Partners Healthcare, and Jennings Aske, J.D., CISSP, CIPP, Chief Information Security Office at Partners Healthcare.
Laura started things off with an overview of the MU legislation to date:
- Original goal of MU legislation was to target full EHR adoption by 2014
- The three phase of EHR: Adoption – MU – Outcomes
- Compuer Sciences Corporation (CSC) estimated that for a hospital with 276 beds, the potential MU payout would be $4.2 million
- The major certifying entities for EHR software is Certified Commmunication for Health Information Technology (CCHIT) and the Drummond Group. The model utilized is a conformance tool where submission of data is required.
- Attestation if currently a manual process – submission of the numerator and denominator.
Jennings followed by addressing security compliance & MU:
- The main components of security compliance include access control, emergency access (“break-glass” capability), auto log-off, and audit log.
- Jennings noted that with the audit report, requirements included capture of userid, patientid, user activity and the ability to sort by time.
- An example of compliance presented was since Partners had a home-grown EHR system (longitudinal medical record – LMR), in order to comply with CCHIT & Drummond certification, the system needed to possess the capability to handle encrypted file import.
- Jennings expressed that Partners needed to exhibit compliance as described above, but in some scenarios (like the encrypted file import described above) they don’t actually intend on using the functionality. This led me to wonder what the percentage of cases were where the EHR needed to comply with security standards, but would never actually use or implement the feature in operational practice.
For the remainder of the presentation, Laura offered some statistics and updates with regard to Partners MU initiative:
- As of Thursday, September 30th, 114,644 EPs & EHs have registered for attestation.
- As previously noted, attestation for stage 1 is currently a manual process and Laura warned of the high chance that organizations are likely to be audited post-attestation and as such they should have the records and data to back it up.
- She noted that Academic Medical Centers (AMCs) need to be self-certified in that they often have home-grown systems in the inpatient setting and noted that community hospitals often have commercial off the shelf (COTS) systems provided by the leading EMR vendors.
- She provides a project status dashboard each month to stakeholders and executives with more than 125 data points to track each month!
- Laura also mentioned the challenges of qualifying for MU in the presence of the healthcare information system mosaic at Partners that we’ve previously touched on in our blog in that of the different organizations that are affiliated with Partners (Brigham and Women’s Hospital, Massachusetts General Hospital), there are different vendor systems for ED (Electronic Discharge) systems, PM (Practice Management) systems, etc.
- In some cases, to qualify for meaningful use, workflows had to be adapted. One example was the handout of clinical summaries to patients.
Several great questions were posed by the audience including the following
- Q: Is standardization of vocabularies at Partners being handled by IT or the clinical staff? A: IT staff
- Q: What’s the headcount needed at Partners for the MU initiative? A: About 50 people across hospitals and LMR teams
- Q: How is Partners handling the case where smoking status is not captured discretely, but rather exists in a note? A: The homegrown LMR at Partners currently captures smoking status discretely. However, there are NLP (Natural Language Processing) solutions (Autonomy, Nuance come to mind) to post-process the non-discrete data for those applications which do not store it discretely. We have touched on data-mining non-discrete data in a previous blog post.
- Q: What happens if an organization decides to switch an EHR going forward? How is certification and MU qualification handled? A: No presenter or audience member had experience in switching organizations, but as we’ve witnessed with EHR vendor consolidation and an explosion of acquisitions requiring data conversions, this is likely to be a hot topic going forward.