Emergencies First

June 24, 2011
HL7, a healthcare IT standards development organization based in Ann Arbor, Mich., has created the first registered clinical profile for electronic

HL7, a healthcare IT standards development organization based in Ann Arbor, Mich., has created the first registered clinical profile for electronic health record (EHR) systems used in the emergency department (ED). The new Emergency Care Functional Profile (EC FM) is based on HL7's EHR System Functional Model (EHR-S-FM).

The EHR System Functional Model was launched in February of this year, and serves as "the granddaddy of functionality for all EHR systems," explains Donald Mon, president, American Health Information Management Association (AHIMA), and HL7 EHR Technical Committee Co-Chair. The functional model is an umbrella standard that provides a foundation upon which to create unique profiles, he says. In this case, it provided the basis for the emergency department profile. "The idea is to have the more specific purposes of each profile derive their functionality against the larger umbrella," Mon says.

Many of the features outlined in the umbrella standard have also been implemented in the ED EMR profile. However, the emergency department operates differently than other areas of the hospital, and its EHR system must reflect these unique needs, explains Todd Rothenhaus, chief medical information officer, Caritas Christi Health Care System, and HL7 Emergency Care Special Interest Group Co-Chair.

"In the ED, we don't always document our encounters in a straight-forward fashion. In some instances, you might start work on a patient before they even arrive. So it is important that the profile address the fact that documentation might not be captured in a linear fashion, yet it still needs to be reconstructed in a traditional sequence," he says.

Rothenhaus contends there are three main functions essential to any ED EHR. The first is a tracking system that records both the physical location of the patient and where they are in the care system. The second is the ability to chart documentation, which is often carried out by multiple providers. Finally, the system should be able to perform quality assessments in order to evaluate the ED's performance.

Other functions that are not seen in all EHRs, but that Rothenhaus feels are equally important, include e-prescribing tools and clinical decision support. "I feel like we really need to move in the direction of pushing clinical decision support, and thus the functional profile really stresses this," he says.

According to Rothenhaus, benefits of the profile are incurred by both vendor and provider. "The profile gives specific guidance to vendors on what elements need to be included in their system. Because the functional requirements are outlined pretty clearly, they get to compete on features, which frees them up to be innovative," he says.

In most hospitals, the task of acquiring an EHR system usually falls on the IT department, explains Rothenhaus, yet IT staff often don't know very much about the ED. If procurement ends up being the responsibility of ED staff, IT requirements are often neglected. "The profile is an off-the-shelf product that providers can use to see whether an EHR product meets all the necessary functional requirements for the ED. It provides them with a checklist of functionalities that they can match up against any potential EHR system," says Rothenhaus.

CCHIT certification

Now that HL7 has completed the emergency care profile and it has been approved by the American National Standards Institute (ANSI), the next objective is to have the Chicago-based Certification Commission for Health Information Technology (CCHIT) develop a certification package to test ED EMR products.

"There is definitely a difference between the functional profile that HL7 creates and the certification criteria that the CCHIT develops. The profile is essentially a list of all the things that an ED EHR should do—all its essential functionalities. Whereas the certification criteria are a practical application of the profile—it identifies how to test each of the functionalities," explains Mark Leavitt, chairman of CCHIT. The CCHIT inspection process not only tests functionality of a software product but also its interoperability, security, and reliability, he says. "These features aren't necessarily addressed in HL7's profile."

Earlier this year, the CCHIT accepted applications from a variety of stakeholder groups in order to determine which specific care setting would be the first to have its EHR certified. The American College of Emergency Physicians spearheaded the effort to have the ED EHR be the first system to gain certification. "People in the industry decided that emergency care was on the map for a couple of different reasons, so it made sense for CCHIT to chose it for certification at this time," says Mon.

In order to develop the criteria for certification, the CCHIT employs a volunteer work group consisting of physicians and various providers, HIT vendors, payers, and government agency representatives, says Leavitt. "HL7's profile has served as a good foundation for CCHIT to work off, it's definitely been very helpful in identifying the key elements of an ED's EHR. As CCHIT's work group begins to publish its proposed criteria, the group will look to their community to provide public comment on their findings."

Leavitt cites financial savings as a major benefit of CCHIT certification. "It costs a lot of money for hospitals to put various systems through a rigorous testing process each time they want to test an EHR system, but with CCHIT certification, there's no need, it's already been done for them," says Leavitt. "With CCHIT certification, providers can narrow down their selection process just by looking for our stamp of approval."

However, getting the industry to embrace CCHIT's stamp is not guaranteed. And certification isn't free—the first year inspection and maintenance fee is $28,000, and the annual maintenance fee is $4,800. "Hopefully the industry will see that we've been through a rigorous and in-depth process to create our certification criteria, and they will be confident in our result," says Leavitt.

CCHIT is slated to release its certification criteria for ED EHRs in July of next year. Long term care is the next EHR subset selected for CCHIT certification, and development is expected to be launched in 2008. CCHIT is expected to open its application process again in 2008 to determine the next round of specific care setting EHRs for certification.