Seeking to better align health IT standards with health information management practices, three industry groups joined forces for a new report aimed at speeding standards-based interoperability.

call Health IT Standards for Health Information Management Practices, a “first-of-its-kind” report that’s meant to be a guide for those HIM and health IT professionals working to develop interoperability standards.

It aims to enlighten standards developers about information management practices and show how to better align them with health information technology. It will also serve as a roadmap of sorts for the development of standards to support information governance, including efforts in the U.S. and abroad to ensure semantic, technical and functional interoperability among information systems.

“To achieve interoperability, HIM and HIT professionals must each share their perspectives and determine how to bring the pieces together into a cohesive program that allows information to be used effectively throughout its lifecycle,” said AHIMA CEO Lynne Thomas Gordon, in a statement. “This inaugural collaboration with IHE has produced a great resource for our industry, and we’re excited to continue our work together.”

AHIMA, HIMSS and IHE International developed the white paper as part of AHIMA’s information governance initiative. In a unique collaboration, vendors and HIM professionals worked together on the report to help ensure interoperability is approached with the HIM perspective in mind and to promote standards-based “rules of the road” for electronic health records and other health IT.

The white paper offers an overview of HIM practices related to information governance; detailed analysis of HIM business requirements and best practices; five use cases derived from these business requirements and best practices for the information availability; a glossary of key terms; an initial gap analysis of existing HIT standards to support HIM business requirements under three governance principles (information availability, integrity and protection) and recommendations for HIM community and standards development organizations for further standardization of both HIM practices as well as capabilities of HIT products.

The collaborative “allowed us to share valuable knowledge on standards development and health information exchange as we developed this white paper,” said Mari Greenberger, director, informatics at HIMSS, in a statement. “Building on our current efforts in defining and developing use cases for secure exchange of health data, HIMSS recognizes the importance of and need for this ongoing alignment to provide information that is useful and drive meaningful outcomes to the healthcare community.”

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Should VA opt for a commercial EHR?

On October 28th, 2015, posted in: Industry News by

While the Veteran Affairs Departments homegrown electronic health record system is entrenched at VA outlets around the country, the once cutting-edge EHR appears to be under fire this week.

MITRE Corp. said that the EHR, called the Veterans Health Information Systems and Technology Architecture (VistA), is “in danger of becoming obsolete,” within a 4,000-page report it issued late last month.

The report suggested that the Veterans Health Administration CIO, in partnership with the VA CIO, should oversee a comprehensive cost-versus-benefit analysis among commercial off-the-shelf (COTS) EHRs, open source options, and continued in-house custom development of the VistA iteration currently in use.

“The analysis should take into account all the complexities of the VistA architecture and infrastructure and known issues with performance, scalability, extensibility, interoperability, and security,” the report said. “It should also address full life-cycle costs, including development time (based on recent delivery trends), availability of development resources, maintenance and licensing costs, and infrastructure costs.”

What’s more, VA officials are expected to testify this week in front of a congressional committee, defend the system, and oppose suggestions to scrap it in favor of commercial solutions much like what the Defense Department did when it awarded Cerner, Leidos and Accenture the massive contract this summer, Politico reported.

“VistA is a great big Buick with whitewall tires and tail fins that gets about 8 miles to the gallon,” said Rep. Phil Roe (R-Tenn.), a physician and member of the veterans committee, who noted that the VA is spending 80 percent of its IT budget on maintenance, according to Politico. “It gets you from A to B, but will it last 20 years?”

Another question likely to arise is whether or not VistA will ever be truly interoperable with the commercial EHR DoD announced it would implement this summer.

MITRE’s report said that VistA’s problems “stymie interoperability between Veterans Health Administration facilities as well as with DoD and non-VA providers.”

The DoD in late July awarded a $4.3 billion contract to the team of Cerner, Leidos and Accenture, which edged out two other teams, one being Epic and IBM, the other consisting of Allscripts, Computer Sciences Corp. and Hewlett-Packard.

Prior to that DoD and VA were working on a joint electronic health record system, dubbed iEHR, that fizzled out in early 2013.


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Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren’t used at all by the very people who may need them most.

The report, Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics, was published this month in the Clinical Journal of the American Society of Nephrology.

“Electronic health record patient portals allow individuals to access their medical information with the intent of patient empowerment,” researchers write. “However, little is known about portal use in nephrology patients.”

The study tracked patients seen between Jan. 1, 2010, and Dec. 31, 2012, at four university-affiliated nephrology offices; each of the patients had at least one additional follow-up visit before June 30, 2013. Researchers abstracted sociodemographic characteristics, comorbidities, clinical measurements and office visits from the EHR and also tracked median household income for patients’ neighborhoods for added context.

Of 2,803 patients, 1,098 (39 percent) accessed the portal. Of those, more than 87 percent of users reviewed their laboratory results, 85 percent reviewed their medical information, 85 percent reviewed or altered appointments, 77 percent reviewed medications, 65 percent requested medication refills and 31 percent requested medical advice from their renal provider, according to the CJASN study.

But in adjusted models, characteristics such as being older, being African-American, being insured by Medicaid or living in a neighborhood with lower median household income “were associated with not accessing the portal,” according to researchers, who pointed to factors such as data security concerns or lack of confidence or skills in accessing health information online as potential barriers.

“While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it,” the report concludes. “Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them and their potential to improve outcomes.”

“Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable,” Khaled Abdel-Kader, the study’s lead author, told NPR. “As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on.”

Access the study here.

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Arlington, VA (October 27, 2015) – HIMSS applauds the Senate for passing S. 754, The Cybersecurity Information Sharing Act (CISA) of 2015. CISA marks an important step forward in creating an infrastructure to promote greater sharing of cyber threat information between government and the private sector.

In particular, HIMSS strongly supports provisions in the bill aimed at addressing the cybersecurity needs of the healthcare sector. This includes the creation of an industry task force charged with, among other critical tasks, developing a plan to ensure healthcare leaders have access to actionable cyber threat information, through a single source, at no cost.

The healthcare community will further benefit from the establishment of a common set of security and risk management best practices that can be implemented consistently across the sector and mapped to a single, voluntary, national health-specific cybersecurity framework.

As CISA moves forward to a Conference Committee, HIMSS strongly urges the House and Senate to retain these essential provisions so critical to supporting healthcare organizations in more effectively protecting patients and their health information from growing cyber threats.

About HIMSS North America
HIMSS North America, a business unit within HIMSS, positively transforms health and healthcare through the best use of information technology in the United States and Canada. As a cause-based non-profit, HIMSS North America provides thought leadership, community building, professional development, public policy, and events. HIMSS North America represents 61,000 individual members, 640 corporate members, and over 450 non-profit organizations. Thousands of volunteers work with HIMSS to improve the quality, cost-effectiveness, access, and value of healthcare through IT. Major initiatives within HIMSS North America include the HIMSS Annual Conference Exhibition, National Health IT Week, HIMSS Innovation Center, HIMSS Interoperability Showcases™, HIMSS Health IT Value Suite, and ConCert by HIMSS™.

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The Departments of Defense and Veterans Affairs were both admonished on Tuesday for their inability to work together to create a fully interoperable electronic health record system.

The DoD and VA have been attempting to work together for more than two decades to create an interoperable system, and at a Congressional hearing on Tuesday, the House Information Technology Sub-Committee chided technology leaders from each.

“I don’t mean to understate the enormity of the challenge of integrating the two largest federal bureaucracies,” said Rep. William Hurd, R-Texas, chairman of the House Subcommittee on Information Technology during opening statements, “but it’s clear to me that the inability to integrate these two systems is a problem of leadership, rather than technical feasibility.

“We have sent men to the moon and robots to Mars,” he added. “I feel like we should be able to move one electronic file, no matter how big, no matter how old, from one computer system to another.”

The VA cited “persistent internal challenges” and “external pressures” as compelling reasons for change within the department. It also stated its intent to roll out another program to combat interoperability roadblocks.

“This transformation will be different,” said LaVerne Council, assistant secretary for information technology and chief information officer for the VA,” in prepared remarks. “We will measure success, ensure accountability, invest in the capabilities of OIT employees and collaborate across the VA to build trust.”

The VA also noted that it is working closely with the DoD/VA Interagency Program Office and the Office of the National Coordinator for Health Information Technology to ensure coding and data accuracy. However, these facts were not seen by the Congressional Subcommittee on Information Technology.

“The members of our armed forces are still coming home to find that two decades was not long enough for these two departments to get together and develop a workable and fully interoperable EHR,” said Hurd.

“At its core, this is not a problem of technology,” he added. “This is an issue of management.”

The DoD had an equal amount of reasons for a failed interoperable EHR system. Listing the amount of active armed servicemen, civilians and National Guard and Reserve members, David DeVries, Principal Deputy Chief Information Officer for the US DoD, pointed out the enormity of their network and “the $5 billion invested in cybersecurity” as reasons for integration complications, in a prepared statement.

But all of these reasons can’t explain how over $564 million dollars was spent on the failed iEHR attempt between the DoD and VA between October 2011 and June 2013. After which, the branches went their separate ways in terms of EHR development.

The DoD was awarded $4.3 billion to upgrade their Armed Forces Health Longitudinal Technology Application, while the VA is still struggling to modernize their own platform, VistA.

“Missed deadlines, cost overruns and failures to deliver on expectations, leave me with serious doubts about these two departments ability to work towards this common goal,” said Hurd.

The DoD and VA predict a 2022 completion date for their interoperable EHR, long after the 2017 timeframe given while the two organizations were still working together.

While the U.S. Government Accountability Office has noted some small improvements in inter-department connectivity, there is still a long way to go.

Both missed a critical Oct 1, 2014 deadline established in the National Defense Authorization Act for Fiscal Year 2014 that called for compliance with national standards, certify that all health care data in their systems complied with national data standards and were computable in real time, GAO chided.

Moreover, it noted, “the departments do not plan to complete the modernization of their electronic health record systems until well after the December 2016 statutory deadline by which they are to deploy modernized electronic health record software while ensuring full interoperability. Specifically, VA plans to modernize its existing system, while DOD plans to acquire a new system; but their plans indicate that deployment of the new systems with interoperable capabilities will not be complete until after 2018.”

The government’s Interagency Program Office took steps to begin developing metrics to monitor progress related to the standardization of the departments’ data and their exchange of health information, GAO wrote in its report.

For example, it called for the development of tracking metrics to gauge the percentage of data domains within the departments’ current systems that have been mapped to national standards. However, the office had not defined outcome-oriented metrics and related goals to measure the effectiveness of interoperability efforts in terms of improving healthcare services for patients served by both departments.

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