Incorporating HCT Tools/Functions into Electronic Health Record Systems Stuart T. Weinberg, MD, FAAP Assistant Professor Departments of Biomedical Informatics and Pediatrics Vanderbilt University School of Medicine Vice Chair, AAP Council on Clinical Information Technology Webmaster, AAP Electronic Medical Record Review Site October 21, 2011

Information Technology and Informatics Information technology centers on the technical tools – hardware and software Informatics centers on the *science* - “ The scientific field that deals with biomedical information, data, and knowledge — their storage, retrieval and optimal use for problem-solving and decision making. ” (Shortliffe). Clinical informatics highlights people, process, technology. There are several peer-reviewed journals AND on Sep 22 nd Clinical Informatics became a Board-Certified Medical Subspecialty.

Resolution #36SB Immunization Registry The Number 1 resolution at the 2010 AAP Annual Leadership Forum. RESOLVED, that the Academy work to create a mechanism that allows pediatricians ready access to existing vaccine registries in all states; and be it further RESOLVED, that the Academy support the establishment of, and consider the feasibility of sponsorship of, a national vaccine registry/clearinghouse with common electronic gateways to state registries, allowing ready access to vaccine histories of patients.

Involve Your Local Informatician! Clinical informaticians will have valuable insights not only into the medical workflow but also to the informatics literature which may have already studied ‘best practices’ approaches Clinical informaticians should be involved *early* in the process of designing tools and rethinking workflows – not at the end to just implement a solution that has already been developed Another example: the recent Centers for Medicare and Medicaid Services (CMS) initiative to have hospitals offer influenza vaccine to all inpatients

EHR Functionalities to Facilitate Transition Planning: Documentation – capturing all of the information that is ‘necessary’ to facilitate transition planning Process Management – using the stored information (or lack of it) to prompt for certain tasks to be performed or additional info to be entered at appropriate times in the workflow of the clinic/practice Interoperability – sharing data by being capable of both importing and exporting data to/from other systems (including EHRs, registries, and HIEs) using national standards/formats Consumer Access – supporting the ability for patient’s to access, review, and potentially update their own data in the medical record

Documentation: What specific data is necessary to facilitate transition planning? Where is this data normally captured in the course of the workflow of a patient’s visit? It should *not* be necessary to document the same information in more than one place. This would lead to more than one ‘source of truth’ which is an error-prone approach.. It *would* be appropriate to have an electronic form that collects transition information which is not entered anywhere else. The overall view of transition information would therefore be a compilation of the necessary elements coming from the appropriate portions of a patient’s record.

Process Management: In the workflow of a patient’s visit, how can we make sure that the right thing is being done at the right time? Business rules need to be developed, based on the published algorithm. Electronic outpatient whiteboards (next slide) and individual patient alerts can be developed to remind providers what needs to be done. Be careful about ‘alert fatigue’. Ideally the alert should allow the user to proceed directly to the task that needs to be accomplished; i.e., displaying the form where a required piece of data needs to be entered.

Interoperability: There may be sources of information where data can be *imported* to make sure your patient’s record is complete: - Immunization Registries - Health Information Exchanges (HIEs) - Continuity of Care Documents (CCDs) ARRA-HITECH Act: The demonstration of the Meaningful Use of a Certified EHR includes interoperability functionalities: - the capability to submit an immunization record to an immunization registry using national HL-7 standards - the capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care

Consumer Access: Several EHRs support patient portals. ARRA-HITECH Act: Some of the specific Meaningful Use Stage 1 objectives and measures include - patients having timely access to their health information (within 4 business days) - patients receiving an electronic copy of their health information upon request - patients receiving a clinical summary for each office visit

How Are Vendors Persuaded to Develop Functionalities? Understand that vendor resources are currently overwhelmed by Meaningful Use activities and requirements. Look for existing functionalities in your EHR that are similar and could be potentially tweaked to accomplish your requests. Priorities for feature development tend to focus on the ‘biggest bang for the buck’ – a feature that can benefit a broad range of customers, rather than a small subgroup. Think about how your request could be generalized to serve a similar function for a large group of users. American Academy of Pediatrics has several efforts underway to support pediatric functionalities in EHRs – CHIC, Vendors Consortium, COCIT

Held on June 6 th, 2011, a one-day Vendors Consortium provided an opportunity for vendors to: Learn more about the pediatric community and their needs relative to EHR system usage Learn more about AAP content and explore market opportunities for the distribution of this content Provide feedback and preferences for the dissemination of pediatric content through EHR systems Provide feedback on how the AAP can best serve the EHR vendor community and their pediatrician clients Define ways of potential collaboration between vendors and the AAP with the goal of disseminating pediatric content

Vendor’s Consortium: 18 People From 11 Vendors: Allscripts (2) Athenahealth (2) Cerner Corporation (1) – 1 MD e-MDs (2) – 1 MD Epic Systems Corporation (1) – 1 MD GE Healthcare (1) McKesson (1) – 1 MD NextGen (2) OptumInsight (3) – 1 MD Physician’s Computer Company (2) Sage Software (1)

Thanks! Questions? Contact Information: Stuart T. Weinberg, MD FAAP