08- Installation and Maintenance of Health IT Systems- Unit 2- System Selection- Software and...

8/12/2019 08- Installation and Maintenance of Health IT Systems- Unit 2- System Selection- Software and Certification

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This material Comp8_Unit2 was developed by Duke University, funded by the Department of Health and Human Services,

Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

Installation and Maintenance of

Health IT Systems

System Selection

Software and Certification


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System Selection Software and Certification

Learning Objectives

2Health IT Workforce CurriculumVersion 3.0/Spring 2012

Installation and Maintenance of Health IT SystemsSystem SelectionSoftware and Certification

1. Compare and contrast COTS(Commercial Off-The-Shelf) and In-House

/homegrown systems and describe theirrelative advantages and disadvantages

2. Verify system compliance with ONC-

ATCB certification3. Identify purpose and categories of ARRA

Meaningful Use criteria


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Off-the-Shelf Software

Commercial Off-the-Shelf (COTS)

Modifiable Off-the-Shelf (MOTS)

200+ companies claim to make an EHR(Electronic Health Record)

May include freeware with commercial

support



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Advantages of COTS

Lower development costs

Wider test market to find bugs and

limitations

Vendor training and product support, bugfixes

Easier learning curve Eliminate development time



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Disadvantages of COTS

Unalterable source code

Compatibility issues

Uncertain upgrade schedules Business practices may have to be

modified, and workflow often has to be

adapted to the particular product design.(Rice, 2009)


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In-House / Homegrown

Locally-installed and managed EHRimplementation

Only available to institutions with existingIT infrastructure and investment

Developed by

extending existing In-House systems, or

adapting open-source or other publicallyavailable software for institution needs



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Advantages of In-House

Developed wholly by the operatinginstitution

Design is specifically tailored to meetinstitutional objectives

Can mesh comfortably with existing

workflow processes


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Disadvantages of In-House

Higher development costs, initial andthroughout product lifecycle

Dependent on expertise of in-housedevelopment staff

Lack of vendor supportbug fixes,upgrades

Training must be developed in-house.

Longer development time


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EHR Certification

Office of the National Coordinator for Health Information Technology (ONC)provides for a certification program for EHR Technology Temporary Certification Program in effect June 2010 Permanent Certification Program in January 2011, replacing temporary program in

2012

American National Standards Institute (ANSI) is the ONC-ApprovedAccreditor (AA) for the Permanent Certification ProgramANSI will certifythe ATCBs Only 6 ATCBs as of Dec. 2011 (http://healthIT.hhs.gov/ATCBs)

ATCBs are the Authorized Testing and Certification Bodies that grantcertification to the products and vendors of Complete EHRs and EHRModules. Current list is available at http://onc-chpl.force.com/ehrcert

Certification is a prerequisite for participation in the Medicare and Medicaidincentive programs, which provide payment to doctors, clinics, and hospitalsthat demonstrate meaningful use of certified EHR technology

(ONC, 2011; CMS 2011)
http://healthit.hhs.gov/ATCBshttp://onc-chpl.force.com/ehrcerthttp://onc-chpl.force.com/ehrcerthttp://onc-chpl.force.com/ehrcerthttp://onc-chpl.force.com/ehrcerthttp://healthit.hhs.gov/ATCBs


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Why Certification?

Reduce risks to physicians in EHRinvestment

Facilitate interoperability of EHR systems

Enhance availability of EHR adoptionthrough stimulus incentives

Ensure that EHR systems and networks

are secure and protect privacy

(Pizzi, 2007)



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Why Certification? (contd)

Allow evaluation time to be used moreefficiently

Narrow the initial field of vendors

Assure basic functionality andinteroperability, allowing you tofocus evaluation more on special orunusual needs of your institution



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What are ARRA andMeaningful Use?

ARRA (American Recovery and Reinvestment Act,a.k.a. stimulus bill)

Passed by Congress February 2009

Over $22 billion allocated to modernize health ITsystem. HITECH (Health Information Technology for

Economic and Clinical Health) Act: initially rewardsinstitutions for meaningful use of EHRs, thenin

2015 imposes penalties.

(Hitechanswers)


(Recovery.org, 2009)

(cms.gov, 2011)


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Meaningful Use Criteria:Stage 1

According to Centers for Medicare & MedicaidServices (CMS), the priorities for hospitals &providers are to:1. Improve quality, safety, and efficiency, and reduce

health disparities2. Engage patients and families in their health care3. Improve care coordination4. Improve population and public health5. Ensure adequate privacy and security protections

for personal health information

(CMS, 2011)



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Meaningful Use Criteria:Stage 1 (contd)

1. Improve quality, safety, and efficiency, and reducehealth disparities Computerized Provider Order Entry (CPOE, directly

entered by authorizing provider) for 10+% of all

orders Drug-drug, drug-allergy, drug-formulary checks Up-to-date problem list of current and active

diagnoses, based on ICD-9 or SNOMEDvocabularies

Active medication listActive medication allergy list

(CMS, 2011)



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1. Improve quality, safety, and efficiency, and

reduce health disparities (cont'd)

Demographics

Preferred language, insurance type, gender, race,ethnicity, date of birth, date and cause of death

Vital signs Changes in height, weight, blood pressure; calculate

and display Body Mass Index (BMI); plot and display

growth charts, including BMI, for children 2-20 years

(CMS, 2011)



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2. Engage patients and families in theirhealth care

Provide patients with electronic copy of health

information upon request Diagnostic test results, problem list, medication lists,

allergies, discharge summary, procedures

Discharge instructions at the time of discharge

(CMS, 2011)



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3. Improve care coordination

Electronically exchange key clinicalinformation

Medication reconciliation at relevantencounters and each transition of care

Summary of care record for each transition of

care and referral

(CMS, 2011)



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4. Improve population and public health Capability to:

Submit data to immunization registries

Submit data on reportable lab results (as requiredby state or local law) to public health agencies

Provide electronic syndromic surveillance data topublic health agencies

Actual data submissions under certaincircumstances

(CMS, 2011)


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5. Ensure adequate privacy and securityprotections for personal health information

Protect electronic health information created

or maintained by the certified EHR technologythrough the implementation of appropriatetechnical capabilities.

(CMS, 2011)



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Meaningful Use Criteria:Next Stages

Projected timeline of implementation Stage 2: 2013

Stage 3: 2015

Requirements Not yet officially defined

Expected to require taking stage 1 functions

even further; e.g., increasing e-prescribingfrom 40% to 50% (stage 2) and then to 80%(stage 3)

(Federal Register, 2011)



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Typical EHR Costs to Consider

Start up costs

Initial hardware and network upgrades

Initial software and licensing Initial interfaces

Maintenance costs

Annual software licensing, upgrades, supportAnnual interface upgrades and support



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S t S l ti


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Summary COTS advantages and disadvantages

weighed against in-house advantages and

disadvantages Costs involved in startup and maintenance of

the system should be addressed

Certified systems and modules are preferred Meaningful use priorities should be

addressed



l f


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System Selection Softwareand Certification

ReferencesReferences About ARRA. Retrieved from HITECH Answers website: http://www.hitechanswers.net/about/about-arra/

ARRA Meaningful Use Snapshot. (n.d.). Retrieved from Medical Information Technology, Inc. website:http://www.meditech.com/interoperability/pages/ARRA_snapshot_final_0311.pdf

Certified Health IT Product List. Retrieved from Office of the National Coordinator for Health InformationTechnology, US Department of Health & Human Services website: http://onc-chpl.force.com/ehrcert

Electronic Medical Record [cited 2010 June 20]. Retrieved from:http://en.wikipedia.org/wiki/Meaningful_Use#Meaningful_Use

EHR Incentive Programs Overview. (n.d.). Retrieved from Centers for Medicare & Medicaid Services website:https://www.cms.gov/EHRIncentivePrograms/

Medicare and Medicaid Programs; Electronic Health Record Incentive Program (2010, July). Federal Register.[Internet]. Retrieved from http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-program.

Fornes, D. (2008, February 6). Should CCHIT Influence Your EHR Selection? [Web log post]. Retrieved fromSoftware Advice - The Medical Blog: http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection

Gates, M. (2009, Winter). All Systems Go? How to Select an EHR That Meets Your Needs. Correct Care,Retrieved from http://www.ncchc.org/pubs/CC/selecting_ehr.html


http://www.hitechanswers.net/about/about-arra/http://www.meditech.com/interoperability/pages/ARRA_snapshot_final_0311.pdfhttp://onc-chpl.force.com/ehrcerthttp://en.wikipedia.org/wiki/Meaningful_Usehttps://www.cms.gov/EHRIncentivePrograms/http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://www.ncchc.org/pubs/CC/selecting_ehr.htmlhttp://www.ncchc.org/pubs/CC/selecting_ehr.htmlhttp://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://blog.softwareadvice.com/articles/medical/should-cchit-influence-your-ehr-selection/http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttp://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid-programs-electronic-health-record-incentive-programhttps://www.cms.gov/EHRIncentivePrograms/http://en.wikipedia.org/wiki/Meaningful_Usehttp://onc-chpl.force.com/ehrcerthttp://onc-chpl.force.com/ehrcerthttp://onc-chpl.force.com/ehrcerthttp://www.meditech.com/interoperability/pages/ARRA_snapshot_final_0311.pdfhttp://www.hitechanswers.net/about/about-arra/http://www.hitechanswers.net/about/about-arra/http://www.hitechanswers.net/about/about-arra/


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References


References

Goals for EHR System. Retrieved June 20, 2010, from Health Technology Review website:http://www.healthtechnologyreview.com/viewarticle.php?aid=113

HITECH Act Enforcement Interim Final Rule. (n.d.). Retrieved from U.S. Department of Health & Human Serviceswebsite: http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

McKinney, D. (2001, August). Impact of Commercial Off-The-Shelf (COTS) Software and Technology on SystemsEngineering. Retrieved from Presentation to INCOSE Chapters website:http://www.incose.org/northstar/2001Slides/McKinney%20Charts.pdf

Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule, 75 Fed. Reg. 44314(2010) 42 CFR Parts 412, 413, 422, and 495 http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf

ONC-Authorized Testing and Certification Bodies. Retrieved from Office of the National Coordinator for HealthInformation Technology, US Department of Health & Human Services website: http://healthIT.hhs.gov/ATCBs

Pizzi, R. (2007, October 30). EHR adoption an "ugly process," but CCHIT can improve appeal. Retrieved fromHealthcare IT News website: : http://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appeal

Rice, R. (2009). Testing COTS-Based Applications . Retrieved June 21, 2010, fromhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htm
http://www.healthtechnologyreview.com/viewarticle.php?aid=113http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.htmlhttp://www.incose.org/northstar/2001Slides/McKinney%20Charts.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://healthit.hhs.gov/ATCBshttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.riceconsulting.com/articles/testing-COTS-based-applications.htmhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://www.healthcareitnews.com/news/ehr-adoption-ugly-process-cchit-can-improve-appealhttp://healthit.hhs.gov/ATCBshttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://edocket.access.gpo.gov/2010/pdf/2010-17207.pdfhttp://www.incose.org/northstar/2001Slides/McKinney%20Charts.pdfhttp://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.htmlhttp://www.healthtechnologyreview.com/viewarticle.php?aid=113


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28Health IT Workforce CurriculumVersion 3 0/Spring 2012


References

Installation and Maintenance of Health IT SystemsSystem Selection Software and Certification

References

Standards & Certification.Retrieved from Office of the National Coordinator for Health Information Technology, USDepartment of Health & Human Services website:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153Standards & Certification Criteria Final Rule. Retrieved from Office of the National Coordinator for Health Information

Technology, US Department of Health & Human Services website:

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_ifr/1195

Images

Slide 13: ARRA recovery.gov logo http://www.recovery.gov/News/mediakit/Picture%20Library/circle_recovery_logo.jpg

Slide 13: Center for Medicare and Medicaid Services EHR Incentive Programs logohttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentiveLogoweb.JPG
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_ifr/1195http://www.recovery.gov/News/mediakit/Picture%20Library/circle_recovery_logo.jpghttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentiveLogoweb.JPGhttp://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentiveLogoweb.JPGhttp://www.recovery.gov/News/mediakit/Picture%20Library/circle_recovery_logo.jpghttp://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_ifr/1195http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153

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