COCIT - Council on
Clinical Information Technology

e-Health Initiative Liaiason Report
last updated on March 16, 2005

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First placed on the World Wide
Web (WWW): March 28, 1995

E-Health Initiative: Working Group for Small and Medium Practices:
Drs. Kibbe and Basch, co-chairs
Summary Report to SCOCIT

This group was to address two specific issues:

  1. Supporting the acceleration of connectivity and mobilization of standardized data between EHRs and laboratories; and
  2. Simplifying and standardizing the contracting process and business practices to support migration to EHRs

1. Lab Connectivity subgroup

Dr. Alan Zukerman is the chair. The discussion has been around the means to connect reference labs EMR’s. It was proposed that the RHIO connectivit model is expensive and slow to develop, and that a “clearinghouse” model might have some advantages. Surescripts is an example of a clearinghouse model for e-prescribing. The company certifies pharmacies which comply with certain guidelines, such as no advertising at the point of care. Pharmacies pay Surescripts per transaction, and the service is free to the clinics and providers. Similarly, a lab connectivity clearinghouse could certify labs that comply with standards, and labs would pay for the transactions.

Lab representatives said they have an obligation to display reports to the provider in a certain way, and that the EMR vendors should not be free to represent the report any way they want to, in case the communication becomes less effective. There were discussions about issues with putting, for example, fasting blood glucose under a chem-7 label on the chart, and having a difficult to find lab result which could impact patient care.

Other issues that were discussed, but not resolved:

  • The need to close the loop of report, review, notification of patient, and appropriate action. It was noted that competition between EMR’s could be on the elegance of these steps.
  • The need for “non-repudiation”, a digital signature to show that the chart copy is the same as the copy that was sent
  • The need to have real-time, instead of batch data
  • Issues about partial and preliminary results reporting
  • ASPs and how the vendor should relay labs to them as the proxy
  • even using LOINC, tests end up in different places in the HER and may be difficult to find or missed

There was discussion from a reference lab representative that there were similar efforts going on in other groups, and that it was very frustrating.

It was noted that the PHIN and the CDC are already messaging between LabCorps and the Department of Health, and that hospitals in some states are doing this. It was suggested that some of the tools they have developed to do this could be shared.

The California Clinical Data Project, part of the California HC Foundation, and an NLM/AIMIA orders component project were also mentioned.

There is one more scheduled conference call on 3/16.

2. Business Practices Subgroup

Slides from the “kick-off” meeting in November were shared by the subgroup chair Dr. Heyman. The goal was to develop a tool for primary care docs to use when negotiating for an EMR, and help them cut through the sales hype. The draft form of this quote, written by Mike Uretz, has been offered to the subgroup to comment on. It will itemize things to specify in the contract, and also red flags for the vendor and/or software. Emphasis was made on the lack of inter-operability of systems, and the lack of interface to pharmacies, etc. Additional suggestions were to provide references and a user group for each EMR, an agreement as to how long the quote is good for, the type of specialty it is designed for, whether there are disease management capabilities, etc. The next conference call is 3/23.

-Kris Benson, SCOCIT rep to E-Health Initiative Working Group on Small and Medium Practices