We built our HIE incrementally by adopting national models and harmonized standards, such as HITSP specifications. KeyHIE will expand later this year to include five additional hospitals in early 2009.
Chicago (Vocus) January 26, 2009
With the economic stimulus package under consideration, healthcare IT was one of five domestic priorities identified in Tuesday's inaugural address, with President Obama noting that he is ready to "wield technology's wonders to raise health care's quality and lower its cost."
HITSP Interoperability Specifications offer a proven tool to achieve the President's lofty goal - healthcare delivery has already been impacted by facilitating the exchange of patient health information across health settings and throughout a geographic region. A basic platform designed to make electronic sharing of health information real today, these specifications enable, and expand, the use of the electronic medical records (EMRs) in HIEs where hospitals, clinics and other community partners come together to provide efficient and quality patient care. As announced in the Federal Register on Jan. 21, the Secretary of Health and Human Services recognized the 2008 HITSP Interoperability Specifications and the standards they contain as "Interoperability Standards" for healthcare IT.
How does HITSP work in healthcare settings using these specifications? The Healthcare Information and Management Systems Society (HIMSS) talked with several HIE representatives about the benefits of HITSP for their communities.
Beth Israel Deaconess Medical Center
A teaching hospital of Harvard Medical School, Beth Israel Deaconess Medical hosts nearly three quarters of a million patient visits annually in and around Boston. John Halamka, MD, is the Chair of HITSP and the CIO of Beth Israel Deaconess.
"The HITSP C32 (Continuity of Care Document) has revolutionized our data exchanges at Beth Israel Deaconess Medical Center. We use CCD to summarize patient history as we discharge patients to ensure continuity with the next provider of care. We use CCD to send medical records to the Social Security Administration to rapidly and efficiently adjudicate disability claims. As a state, Massachusetts has embraced CCD for our statewide summary exchange. 2009 is the perfect storm with technology, standards, certification criteria and incentives aligning for use of CCD."
HITSP Interoperability Specifications play an integral part in healthcare settings around the country. Examples follow here from Connecticut, Pennsylvania, Massachusetts and Vermont.
Incorporated in January 2006, eHealth Connecticut (eHC) represents a collaborative approach to meeting the challenges of healthcare information technology adoption and interoperability for the entire state. The HIE is still in the planning process with implementation scheduled for this year.
eHC has been building relationships for shared, trusted services that everyone can use within Greater Bridgeport with the eHC pilot hoping to connect with the Department of Social Services to become a trusted statewide, sustainable health information resource. EHR interoperability policies will be collaboratively agreed upon as a community in the spirit of public and private safety.
"We are going to pilot healthcare environments that ideally are competitive," said Scott Cleary, program director, eHealth Connecticut. "We will have a Center of Shared Services that will use HITSP TP13 Manage Sharing of Documents. HITSP's federally recognized standards and IHE profiles are the tools to make it work. HITSP pulls all of this together for nationwide use."
Cleary explained that healthcare IT platforms used in eHealth Connecticut will have to meet specific requirements, including a CCHIT-certified electronic health record that is HIPAA-compliant and embraces HITSP standards. "We, as a state, will certify participants and monitor activity through periodic check-ups."
Keystone Health Information Exchange
Servicing 31 counties in northeast Pennsylvania, Keystone Health Information Exchange™ used HITSP specifications to connect three hospitals - Bloomsburg Hospital, Geisinger Medical Center and Shamokin Area Community Hospital. Over 250,000 patients have registered for the exchange using an authorization form from their healthcare provider. The organization was formed to provide healthcare professionals with the timely information they need to provide the best care possible for their patients and connect to more than 50 hospitals and other facilities in the region.
"Our initial HIE project focused on the needs of emergency department physicians and point-of-care access with external organizations," said Jim Younkin, IT program director, Geisinger Health System, and project director of the Keystone Health Information Exchange. The HIE avoided high costs by leveraging systems and data sources in place. "We built our HIE incrementally by adopting national models and harmonized standards, such as HITSP specifications. KeyHIE will expand later this year to include five additional hospitals in early 2009."
Boston Medical Center Ambulatory EMR
HITSP Interoperability Specifications play an integral part in healthcare settings around the country. Boston Medical Center is a not-for-profit, 626-licensed bed and 50-clinic Ambulatory Care Center and is the largest safety net hospital in New England. The hospital is the primary teaching affiliate for Boston University School of Medicine, which emphasizes community-based care.
"Boston Medical Center and its Community Health Center partners use a vendor ambulatory EMR with a vision to achieve interoperability among the EMRs from these partnering sites," said Joel L. Vengco, director, ambulatory practice systems, Boston Medical Center. Vengco explained that the Safety Network has four different types of EMRs with BMC and the 12 community healthcare centers positioning themselves to electronically exchanging health information for patients they share. "HITSP has been the foundation for the interoperability architecture of our health information exchange initiative. Our HIE work will be the cornerstone for at least the next two to three years of our EMR roadmap."
Vengco noted that the multi-vendor EMR environment has created silos, preventing an interoperable state. Now, with an HIE founded on HITSP Interoperability Specifications, BMC and its partners are implementing the exchange of fairly comprehensive medical summaries that include problems, medications and lab results. "The use of HITSP assures the creation of interoperability by serving as a blue print that addresses the 'container-content' problem by providing the guidelines for the message standard and the terminology standard."
Vermont Information Technology Leaders Inc. (VITL)
Vermont Information Technology Leaders Inc. (VITL) is supporting, with the use of HITSP standards, the Vermont Department of Health's Blueprint for Health chronic care management initiative. From several communities, providers send data, which is exported in the Continuity of Care document, or HITSP C 32, format, from their EHR systems to the health information exchange. The HIE then sends the data to a registry supplied by the Vermont Department of Health, where clinicians can use the registry application to track age and gender-appropriate health maintenance and chronic disease care; analyze care provided; and develop more effective interventions.
"VITL has provided grants to independent primary care practices that agree to implement one of six EHR products on VITL's pre-screened EHR product list," said Noam Arzt, PhD, interim vice president of HIE services, who also noted that all of these products are CCHIT-certified. "Because VITL is encouraging providers to use EHRs that are CCHIT-certified and have passed IHE Connectathon testing, the implementation of health information exchange will be accelerated and done at the lowest possible cost."
HITSP was established in 2005 as a cooperative partnership between the public and private sectors with direction from the U.S. Office of the National Coordinator for Health Information Technology to the American National Standards Institute (ANSI), in cooperation with strategic partners HIMSS, Booz Allen Hamilton and Advanced Technology Institute. Utilizing the nearly century-old open, inclusive, collaborative volunteer-driven approach developed and tested by ANSI, HITSP's harmonization work incorporates the views of 565 organizational members, of which 22 are consumer organizations, to address such areas as EHRs, biosurveillance, consumer empowerment, medication management, quality, and population health.
In Enabling Healthcare Reform Using Information Technology , a detailed report that includes HIMSS' recommendations for healthcare IT in healthcare for the Obama Administration and the 111th Congress, HIMSS recommended the use of HITSP interoperability specifications and CCHIT-certified products in all federally funded healthcare programs and for the codification of HITSP as the national standards harmonization body. More information on these recommendations can be found on the HIMSS Advocacy and Public Policy Center of the HIMSS Web site.
The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. Founded in 1961 with offices in Chicago, Washington D.C., Brussels, Singapore, and other locations across the United States and the globe, HIMSS represents more than 20,000 individual members and over 350 corporate members that collectively represent organizations employing millions of people. HIMSS frames and leads healthcare public policy and industry practices through its advocacy, educational and professional development initiatives designed to promote information and management systems' contributions to ensuring quality patient care.
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