ACC Electronic Health Record (EHR) Optimal
Functional Requirements for Cardiologists
Introduction
This document provides the optimal functional criteria recommended
by the ACC Health IT (Informatics) Committee for ACC members interested
in obtaining an HER and is a brief checklist not meant to be an exhaustive
review. The field of Health Information Technology (HIT) is rapidly evolving
and it is expected that this selection tool will need future revision.
Some of the functionality in this list is not yet established and will
not be available from EHR vendors until 2010. It is suggested that you
get from your EHR vendor both a timetable and contractual commitment in
your EHR purchase contract to incorporate the missing functionality once
it’s established. Additionally, usability (also called the user
interface) is a major selection factor that can only be determined by
experience from others and a “hands-on” trial of the EHR.
The ACC cannot endorse specific HIT products and the selection process
for an individual practice is highly dependent on an in depth needs assessment.
For more EHR information, please see the ACC
EHR Toolkit or read a recent
Cardiology article on tips for selecting an EHR.
Optimal Criteria
- CCHIT Certification
EHRs should have received Ambulatory EHR Certification
per the requirements of the Certification Commission for Health Information
Technology (CCHIT®, www.cchit.org). In addition, CCHIT’s Cardiovascular
Medicine certification for Ambulatory EHRs is highly desirable.
The CCHIT Ambulatory certification process focuses on both required
and desired functionality for the office setting. The objective testing
conducted by CCHIT requires 100% compliance spanning the areas of functionality,
interoperability, and security and privacy (note that there is no usability
testing per se – that is up to you to assess but CCHIT plans this
addition soon). Certification should be for the most recent criteria
released as prior year criteria may be less stringent (note, the term
of certification is currently two years). The benefit of a CCHIT Certified®
EHR is that you know the application will meet minimum standards. It
is anticipated that CCHIT certification will be required for ARRA payments.
Also, insist that your vendor commits to maintaining CCHIT certification.
- Use an Application Service Provider (ASP) solution
Unless you have very specific needs, select a vendor that provides the
EHR via an application service provider (ASP) model. An ASP vendor hosts
the servers, maintains the software, and takes care of all the IT issues
related to the operation of the application. For example, Web-based
email solutions provided by Yahoo, Gmail, and Hotmail follow the ASP
model – all you need is a Web-browser and a connection to the
Internet. With an ASP solution, there is typically only a nominal start-up
charge, and monthly maintenance fees are determined by usage. The alternative,
the traditional “client-server” solution, should be considered
only if you are in a large practice (>12-15 cardiologists). The client-server
approach requires substantial capital outlay as you will be hosting
your own hardware, purchasing the software, and will need IT staff to
maintain, service, update and troubleshoot the system.
- Integrated e-Prescribing
e-Prescribing is a foundational component of any EHR solution. Functionality
of the e-Prescribing module is assured if the EHR has received CCHIT
certification. This will include bidirectional electronic transmission
of prescription data (via SureScripts/RxHub) and compliance with the
Medicare Modernization Act of 2003 Part D prescription drug program.
Note: the separate e-Prescribing incentives will terminate in 2009.
- Compliance with IHE Profiles specific to your practice
Vendors who actively participate in the Integrating the Healthcare Enterprise
(IHE) survey and certification process have a proven commitment to interoperability.
IHE is a non-profit organization that works with HIT vendors to define
and demonstrate data transfer and information exchange between devices
and HIT systems as well as the modeling of system to system interfaces.
There are a number of profiles applicable to typically cardiology workflows
(see www.ihe.net). The importance of data interchange and interoperability
among systems cannot be overstated.
- Compliance with HIPAA
HIPAA is central to US legal requirements regarding patient privacy,
system security, and transaction processing.
- Eligibility for ARRA Stimulus funds
Meaningful use of the EHR solution should allow the practice to be eligible
for ARRA (American Recovery and Reinvestment Act) funds for EHR adoption.
Requirements of “qualified” EHR solutions per the ARRA legislation
include the following:
• Certified as meeting standards pursuant to ARRA
• Manages patient demographic & clinical health information,
including medications and the problem list
• Has the capacity to:
– Provide clinical decision support
– Support order entry
– Capture, query, and report on health care quality
– Participate in e-Exchange / integration of health information
from other sources
- Minimum installed base of 100 active practices.
The EHR should be established in the marketplace and there should be
a minimum installed base of 100 active physician office environments
currently using the product. This helps ensure that the vendor has demonstrated
viability in the marketplace and is large enough to provide customer
support and business continuity at a level adequate for ACC members.
Also, ask about the characteristics of the physician practices cited.
Are they large groups, small groups, exclusively cardiology or mixed
specialty groups?
- EHR can be integrated with your practice management system
(PMS).
The ability to exchange data with your office PM system is essential
for a successful EHR implementation. The simplest approach is to use
a single vendor for both PMS and EHR solutions; the alternative is to
have separately vended solutions that share the requisite data seamlessly.
- The practice should “own” the EHR data.
The practice must be the sole legal entity with ownership control over
the data. This includes the export of data from the EHR solution into
any other EHR in the event that you decide to change vendors. The export
format should be in a generalized format such as CDA (clinical data
architecture) that can be imported into another vendor’s product.
The EHR must also be able to export a report of an individual patient’s
data in both paper and electronic formats upon patient request or in
the event that the patient leaves the practice.
- Ancillary system connectivity
Ask the vendor for a list of all ancillary systems such as laboratory
vendors (e.g., LabCorp, Quest) ECG systems, PACs systems, and office
practice management systems from which information can be automatically
imported. Make sure the ancillary systems with which your practice wants
to connect are supported and included in the software contract.
- EHR upgrades
Does the vendor provide free upgrades required as a result of changes
in government-mandated programs and registries, or will the client have
to purchase such required upgrades?
- Support
Make sure the EHR vendor support hours match your practices hours of
operation.
Additional EHR features and functionality to consider depending
on your specific practice needs:
- The ability to interface with dictation vendors and/or speech recognition
software.
- The ability to create ad hoc reports at both the physician and practice
levels for practice management, quality improvement, and compliance.
- The ability to allow for remote secure access 24/hour day.
- Cardiology specific templates for physical examination, data review
and consultations, including fields for discrete data elements.
- The ability to generate high quality professional consultation letters
from within the EHR.
- Ability to scan documents and reports.
- Capacity for the autofaxing of documents.
Additional questions to ask EHR vendor:
- Does (or will) your EHR support “automatic” PQRI reporting
without requiring specific intervention by the provider? (Of note, PQRI
reporting is anticipated to be emphasized even more strongly in 2009
and beyond.)
- Does your EHR have interoperability plug-ins available? (labs, clinical
messaging, etc)
- As of January 2009, protected health information is no longer protected
by HIPAA exemptions for Treatment, Payment or Operations. Can an audit
trail be created of all PHI use?
- When accessing the EHR from a remote site or public computer, how
does vendor ensure security?
- If you have a local Regional Health Information Organization (RHIO)
or Health Information Exchange (HIE) with which you want to share patient
information, is the EHR interoperable with the RHIO or HIE?
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