You Get What You Ask For - A Guide to Developing Good Requirements for Your EHR Project

By Kaye Eisele

 

Congress has recently passed requirements for electronic health records (EHRs) into legislation, and it is important to know what these are when developing an EHR project. Whether your clinic, private practice, hospital, and/or state agency is expanding on current EHR implementation, or whether you are initiating first-time EHR usage, a little bit of guidance goes a long way. 

 

By now, you are most likely familiar with President Obama's federal stimulus package and what this is going to mean to the livelihood of your practice or agency as you jump into the ever-changing electronic healthcare records arena. In case you are not aware, here are a few key points:

 

·         The government is offering financial incentives and grants for providers for EHR implementation

·         Stiff penalties may be incurred for non-adherence to the new laws

·         The Health Information Technology for Economic and Clinical Health (HITECH) Act requires all healthcare providers to be utilizing EHRs by the year 2011. 

 

These make it necessary for providers not only to familiarize themselves with EHR usage, but to gain certification provided by the Department of Health and Human Services (DHHS). Many providers such as yourself will have to strive to uphold the new requirements of the HITECH Act when implementing EHR projects.

 

Project Management, Consultations, Staff Involvement and EHRs

 

To receive financial incentives for medical record compliance, all healthcare agencies must employ proper EHR usage. So, while choosing the correct vendor and implementing EHR standards, it may be useful to follow the guidelines outlined here. It is crucial to understand the HITECH Act requirements and to know what to ask for when choosing a vendor. This can be accomplished when you know exactly what it is you want EHR records to do for you. 

 

EHRs are effective tools in providing care and gathering medical information, and also aid in streamlining the billing process. Patients' needs are an integral part of successful EHR project implementation. Patients must be able to view their EHRs when requested, so efficient and user-friendly data collection platforms within EHR system applications are must-haves.

 

But just how should you go about ensuring an EHR system works for you, your patients, and also meet federal guidelines?

 

Project Management

 

Pilot projects across the country are being implemented to discover what methods of project management are largely successful. For this reason, your agency may want to contact various EHR pilot projects to gain useful EHR project information. Choosing the right project manager within your organization, or hiring one from outside the organization is highly suggested. You should also define key decision makers, including board members if helpful. These individuals will identify the goals and needs of your organization related to your EHR project.

 

For specialty clinics, this task may be somewhat easy. Remember, there is no need to reinvent the wheel. Similar-sized practices and similar types of practices can lend useful knowledge or make recommendations, for which the project manager should be encouraged to explore. 

 

Depending on the size and service variables, the project manager and EHR team should be pared down or sized up accordingly. Information technology personnel should be put into place or designated as such within the organization.

 

While EHR implementation involves time and money, it can be done with greater ease if ample attention is given in the planning process. The project plan is the central tool in managing project activities and communicating progress on the project. Budget management can also be assigned to the project manager, as well as task assignments, the sequence of the project, and project timelines as well as requests for additional resources.

 

Consultations

 

Many vendors can guide you along the process based on your data needs, but there is no need to go overboard or to spend unnecessarily if your projects will involve a relatively small database.

 

However, for clinics that provide a broader range of medical services, EHR implementation may become more complex. If large amounts of data need to be captured while adhering to EHR requirements, it may be useful to invest in a consultant. Sometimes vendors provide implementation consultants, but it may be a good idea to hire someone from a private firm.

 

Staff Involvement

 

As with any process of change in the workplace, it can prove beneficial to garner comments and suggestions from all staff so that the EHR implementation is as successful as possible. Essential to this is proper education including staff certification preparedness and EHR status reports provided to all staff. 

 

Providers and IT personnel can help identify which medical information should be included in EHRs more effectively if they are kept abreast of the progress of EHR development and revision. They will undertake a level of ownership in the process of change in the workplace.

 

With the team's efforts in open communication, staff may be invited to attend meetings enabling them to offer possible solutions and troubleshooting ideas. These requests may require additional resources, time and cost; therefore, the process should be managed clearly and consistently through a designated method of tracking, reviewing and reporting.

 

 

"Meaningful Use" Guidelines

 

New EHR-related laws dictate certain standards so that providers use their new EHR systems in a “meaningful” way and can then receive financial incentives. Providers must maintain detailed patient medical history, including past and present medical problems or diagnoses, and a demonstrated ability of their health records systems to successfully render electronic medical prescriptions. 

 

Another meaningful use requirement is the ability for EHRs to combine pertinent medical information from outside sources into current electronic records. Providers must also demonstrate that their system has the ability to exchange pertinent medical information in a confidential manner, known as Health Information Exchange (HIE). Additionally, medical personnel must maintain a high level of records quality.

 

Demonstration of sufficient certifiable staff and software for EHR implementation is another "meaningful use" requirement. Standards of EHR medical data will likely evolve before 2011, and the designated project manager should stay abreast of changes and additions to current EHR requirements and "meaningful use" guidelines.

 

Resist Reinventing the Wheel during EHR Project Planning and Implementation

 

Identifying partner clinics or partner healthcare organizations early on is another requirement to developing a good EHR project. It is a good idea to communicate with "medical information partners" to establish cooperation between entities in the project development process. 

 

When exploring different software and vendors, it would be wise to consult with similar-sized or even larger agencies to see which features of an EHR system they need or have employed. Arranging occasional meetings with outside healthcare providers for whom you have identified as those you will likely share EHR information is also something to consider.

 

In addition, there is a plethora of information available about EHR implementation in medical journals and on the internet. (Please refer to additional articles by this author and other contributors listed in the EHR Institute's website.)

 

Patient Confidentiality is Imperative

Patient confidentiality is another important guideline when developing your EHR project. The following are ideas to keep in mind to ensure that patients’ records remain secure:

·         Utilize EHR services recommended by the Certification Commission for Healthcare Information Technology (CCHIT). 

·         Make sure you choose a vendor that complies with the government’s “meaningful use” standards. This way, you will find you are in compliance with evolving confidentiality issues.

·         Confidentiality implementation is slated for full adherence by the year 2011. 

·         Health Insurance Portability and Accountability Act (HIPAA) laws are continuously being reviewed by think tanks and federal medical records agencies and private medical records companies. Stay abreast of changes.  

Awareness, research and communication within and among agencies and EHR project managers and teams should be given high priority during each stage of EHR project implementation. The behavioral healthcare segment may need to pay special attention to unique and developing federal adherence guidelines when it comes to HIPAA and EHR project implementation. 

 

Standard Documentation Guidelines

 

Standard documentation guidelines are being defined by the HL7 Clinical Document Architecture (CDA), which was designed to represent medicolegal health care encounter documents in a standardized format. This was approved in June 2005. 

 

According to the Center for Healthcare Information Technology (CHIT), the ASTM Continuity of Care Record (CCR) was "designed and implemented as a standard for a comprehensive data summary that aggregates data from multiple sources, health care records, medical legal documents, and health care encounters to form a comprehensive overall clinical picture of a patient’s current and relevant historical health care status." 

 

The HL7 CDA and the ASTM CCR are working together to capture all relevant patient data in EHRs. CHIT further defines the intended use for the CDA/CCR as “provider-to-provider or institution-to/from-provider,” and is outlined as follows:

 

·         As a detailed health care summary that a provider can generate and give to the patient at the end of a healthcare encounter (inpatient, outpatient, or ambulatory care). This can be either in paper or electronic form.

·         As a data extract from an EHR, HIS (Hospital Information System), ePrescribing system, data registry, so that a patient health care summary can be transferred to another system, such as an EHR, HIS, or PHR.

·         To break down barriers to EHR adoption through facilitating the ability of an EHR purchaser to change to another EHR vendor, if desired, by exporting the critical medical information so that all future encounters on the system will have required summary information. The CCR is intended to increase adoption of EHRs by reducing the risk of choosing the “wrong” EHR and reducing the cost of sales and number of providers who are unable to make decisions by reducing concern over the financial health and future of an EHR company. The CCR can also facilitate incremental pathways to an EHR by allowing a practice or provider to begin with an electronic prescribing system or immunization tracking system and then export the data from those systems when a full EHR is implemented.

·         As a model for EHR data and data objects.

·         As a complete patient health care summary to accompany medical legal and administrative documents for patient admission, discharge, or transfer to/from a health care facility.

·         As a detailed patient health care summary generated by a patient’s providers that a pharmacist can use to review allergies, adverse reactions, test results, problems/diagnoses, and a complete medication list to optimize drug therapy and assure patient safety.

·         As a comprehensive data aggregation vehicle for submitting data to repositories, reporting, and regulatory purposes to support quality measures, public health, and health care research.

·         As a core production architecture for EHRs, PHRs, ePrescribing systems, registries, and health care data repositories.

Ask For What You Want, but Know What You Want

 

The project manager and work group of EHR implementation should be well versed in the wants and needs of your organization. These should be specific to the type and range of healthcare services you provide to your patients.

 

Remember these important guidelines, which will be instrumental in your EHR project success:

·         Know the rules on EHR confidentiality

·         Learn more about the legal aspects of EHRs

·         Identify which types of services your organization needs in its software

·         Communicate with other hospitals, agencies, and practices with whom you will be sharing information

·         Study pilot projects that can reveal successful EHR processes and system platforms already in use by other agencies

·         Consider using or hiring consultants to help with implementation

 

Both federal requirements and agency- or practice-specific guidelines can prove fruitful when you know what to ask for in your EHR project development. Knowing what you want and need, and taking the time to plan EHR implementation will always serve you best.