Has your organization been confused, frustrated, and generally unable to decide what long-term care computer support system will meet your organization's needs, now and in the future? You are not alone. We all know that electronic health records (EHRs) will make administration more efficient, improve provider communication and, hopefully, upgrade care. The problem has been a nearly total lack of standards, except for those of the federally mandated Minimum Data Set (MDS). Selecting a system has meant countless hours of determining your facility's requirements, listening to sales pitches, contacting references, and seeing systems in operation—a time-consuming process, at best.
That may be about to change.
Physician offices and ambulatory practices can now ask to see the Certification Commission for Healthcare Information Technology (CCHIT) certificate for information systems they are considering for purchase. The certificate means that the system meets the minimum standards set through an extensive standards development process and hands-on testing. Systems will still need to be evaluated by purchasers themselves for ease of use and organizational fit, but purchasers can rely on the system's basic functionality and be confident in meeting current EHR requirements.
Soon, nursing homes will be able to do the same thing!
CCHIT and the Long-Term Care Functional Profile
CCHIT is a nonprofit organization that develops standards by consensus among a variety of stakeholders. All major health information associations and many vendors, nursing home operators, academics, and government officials are participating in the current effort to develop the LTC-Nursing Home Electronic Health Record System (LTC-NH EHR-S) Functional Profile. This profile builds on the Health Level Seven (HL7) EHR Functional Model and Profile, which provide a basic set of functions that are designed to facilitate interoperability of electronic records from various vendors in various settings. The American Health Information Management Association (AHIMA) is providing a resource page for documents relating to the profile development for long-term care (www.ahima.org/infocenter/whitepapers/ltc.asp).
According to the AHIMA LTC Health IT Summit home page, “CCHIT will use the LTC-NH Functional Profile as a reference while [it] develops the functionality, interoperability, and security requirements that certified nursing home EHR systems must have to be certified.” The standards developed will be the basic requirements that systems must meet to be considered an EHR. These basic requirements cover what must be provided, not how. Individual vendors will be able to develop various approaches and enhancements as long as their products meet the current requirements.
Significantly, the entire process is being done “in the sunshine,” that is, with an open membership available in the workgroup and a later balloting on the standard developed.
The current phase of developing the LTC-NH EHR-S Functional Profile is expected to conclude in the third quarter of this year. This phase evaluates each of the HL7 Functional Model requirements; determines if the function is “Essential Now,” “Essential Future” (i.e., for functions deemed essential but beyond the capability of any current system), or “Optional”; reviews the wording of each requirement statement; and revises statements as necessary for long-term care. The next phase will be registering the profile with HL7 and providing the registered profile to CCHIT.
Then, in first quarter 2008, the profile will be balloted through HL7 and the balloted profile will be provided to CCHIT. (“Balloting” is the method standards organizations use to track stakeholders' votes on each requirement.) CCHIT will then develop test scenarios and requirements to test systems against the requirements and to begin testing and certifying systems.
Actions to Take Now
If your organization is looking to replace your current computer system, it would be wise to review the current status of the LTC EHR standard and include this in discussions with candidate vendors. You should consider getting a commitment from prospective (and current!) vendors about their intention to commit to CCHIT testing. Without that certification, your organization's use of EHR functions may be limited in the future.
Transitions are always difficult, and this will be no different. The standards will require vendors to attend to infrastructure details and functional requirements that few current systems can support. Meeting these requirements is necessary, however, to comply with HIPAA privacy, security, and coding requirements, and to allow communication with other providers, payers, and quality monitoring agencies.
We can expect systems that meet the CCHIT standards to be more expensive than many current systems because of the increased functionality necessary to support an EHR. However, savings on administration, as well as better organization and communication of resident information, will help to offset those costs.
Organizations should start planning and budgeting now for the hardware, software, and support that the EHR will require once the standard is set. We can expect many long-term benefits from the EHR, but we will have to plan, acquire, and integrate the necessary systems into our operations to make it so. How to do this is the topic for a future article.