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Office of the National Coordinator for Health Information Technology


Development of Health Information Exchange organizations. Privacy and Security: ... Health Information Portability and Accountability Act. Medico-Legal Concerns ... – PowerPoint PPT presentation

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Title: Office of the National Coordinator for Health Information Technology

  • Office of the National Coordinator for Health
    Information Technology

Medical Professional Liability and Electronic
Health Records
Karen M. Bell MD MMS Director, Office of HIT
Adoption Department of Health and Human
Services March 14, 2008
U.S. Department of Health and Human
Services Office of the National Coordinator for
Health Information Technology
HIT Key Components
  • EHRs providers create, import, store, and use
    clinical information for patient care
  • PHRs individuals create, import, store, and use
    clinical information to support their own health
  • Health Information Exchange the electronic
    movement of health-related data and information
    among providers, patients, and other entities
    according to agreed upon protocols

Current State EHR Adoption US Physicians, 2007
  • Range up to 28 using some functions
  • 14 with electronic note keeping, lab and med
    orders, and ability to obtain lab results
  • 7 of solo physicians
  • 28, 11 or more physicians in practice
  • 3X more prevalent in metropolitan areas

Current State EHR Adoption Hospitals 2007
  • 68 with full or partial adoption
  • 11 with fully implemented EHRs
  • Size matters 3(lt50 beds) to 23 (gt500 beds)
  • Full implementation does not represent physician
    use (fourth of implemented hospitals report 50
    MD use.)

Workgoup Broad Charges
  • EHR Workgroup Make recommendations to the
    Community on ways to achieve widespread adoption
    of certified EHRs, minimizing gaps in adoption
    among providers.
  • Consumer Empowerment Make recommendations to
    the Community to gain wide spread adoption of a
    personal health record that is easy-to-use,
    portable, longitudinal, affordable, and

Areas of Focus
  • Business Case
  • Technical Considerations
  • Privacy and Security Concerns
  • Medical Legal Issues
  • Organizational/Cultural Issues (Workflow,
    Workforce, Public expectations, etc.)

Business Case Barriers
  • Physician office average cost 20,000/user of
    software, installation, loss of productivity
    hardware additional
  • Recent findings suggest no financial ROI to
    physician providers in todays environment
  • ROI accrues to payers of health care

Business Case Enablers
  • Certification of products, decreased risk of
    failed investment
  • Stark amendment and anti-kickback relief allowing
    hospital donations to physicians
  • HRSA grants to rural and community based
    federally qualified health centers
  • Malpractice fee credits
  • Selected private and public (CMS demonstration
    project) insurer incentives based on adoption and
    effective use of EHR functions, leading to
    improved performance on specified metrics

  • Founded in 2005
  • Multi-stakeholder public/private partnership with
    a public process
  • Criteria for functionality, security, and
    interoperability (accepted by Secretary, DHHS)
  • First ambulatory EHR products certified 2006
  • Currently covers 75 to 80 of installed market
  • Over 25 of ambulatory EHRs now in use have been
  • Ongoing process new functionalities, new
    interoperability standards, specialty EHRs, new
    settings, PHRs, interoperable networks

CCHIT Ambulatory Roadmap
and/orSpecializedCase Scenario
FutureSpecialty Additions
Child Health Criteria
ED EHRCriteria
InpatientEHR Criteria
AmbulatoryEHR Criteria
Technical considerations Barriers
  • No killer apps (usability an issue)
  • CCHIT criteria for some key functionalities still
    in development (registry functions,
    administrative processes, etc.)
  • Cost of interfaces with multiple other providers
    (labs, hospitals, radiology centers, etc.)

Technical Considerations Enablers
  • Harmonized interoperability standards prioritized
    for key clinical data
  • Certification guarantees state of the art
    security criteria
  • CCHIT criteria roadmap
  • Development of Health Information Exchange

Privacy and Security Concerns
  • Control of information and flow
  • Breaches of security
  • Consequences (loss of insurance, work, or other
    forms of discrimination)
  • Secondary Uses of Data
  • Genomic and Family History affect family members

Privacy and Security Policy Development in
  • Authentication
  • Authorization
  • Patient Identify Proofing and Linkage
  • Principles and Policies for Secondary Uses of
  • Protection from discrimination based on Genetic
    Information (GINA)
  • Health Information Portability and Accountability

Medico-Legal Concerns
  • Erroneous or incomplete information
  • Responsibility for information not requested
  • Management of large amounts of data
  • Responsible for breaches of confidentiality
  • Disabling of intrusive decision support modules

Medico-Legal Risk Mitigation
  • Most concerns also exist in paper world
  • Physicians using comprehensive EHRS in large
    Integrated Delivery Systems not overwhelmed by
  • Almost all physicians use the functionalities
    available to them
  • CCHIT certified functionalities

Prevention of Liability CCHIT
  • Improved aggregation, analysis and communication
    of patient level information for patient care
  • Diagnostic and therapeutic decision support
  • Prevention of adverse events
  • Documentation of informed consent
  • Demonstrated adherence to evidence based best
  • Audit trails re who makes what entry when

Organizational Concerns
  • Lack of vision within office or organization
  • Workflow redesign cumbersome
  • Inadequately trained workforce
  • Patient/Consumer wariness

Organizational Enablers
  • Highest level of Federal Gov is engaged and
    focused on HIT, and actively engaging major
    employers, insurers, and providers
  • DOQ-U available on line to all clinicians
    interested in adoption and needing consultative
    support for the process and accompanying workflow
  • Implementing AHIC recommendations to better
    support workforce development
  • Widespread marketing to general population

Summary Federal Support for widespread adoption
of Certified EHRs
  • Business case CMS EHR demo HRSA grants
    Stark relaxation and Anti Kickback relief
    Certification process to decrease risk of failed
    investment and medical liability ROI analyses
  • Technical Use cases and interoperability
    standards to support patient care and health
    information exchange
  • Privacy and Security clarification of HIPAA
    with minimal variance in interpretation across
    states, Privacy and Security Principles, CCHIT
    criteria for security
  • Workflow/workforce DOQ-IT and DOQ-U
    workforce recommendations re DOL and DOE
  • Medical legal CCHIT functions to decrease risk
    of MPL. Engagement of malpractice insurers

Thank You!