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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