During a workshop yesterday at the annual meeting of the Healthcare Information Management Systems Society (HIMSS) titled “Planning, Designing and Implementing a Technical Architecture for Your EHR,” Marty Zola, vice president and chief technology officer of Quality IT Partners, and Joe Miller, IS manager for Christiana Care Health System in Wilmington, Del., outlined processes and strategies for a successful implementation.
The workshop covered several definitions of the electronic health record (HER), beginning with the standard established by the 2003 Institute of Medicine report: a longitudinal collection of electronic health information that provides immediate electronic access by authorized users and knowledge and decision support to enhance the quality, safety and efficiency of patient care. The EHR also supports efficient processes for health care delivery.
Another in-progress definition, the HL7 functional model, is a developing standard that outlines key components and will serve as a basis for vendor certification. The HL7 model breaks the EHR into three categories: direct care, supportive and infrastructure -- and lists critical functional statements related to each category.
Another way of viewing, planning and implementing the EHR is via the clinical transformation staging model, a seven-stage developmental process.
- Stage 1 covers the installation of major clinical systems.
- Stage 2 feeds clinical data into a clinical data repository.
- Stage 3 involves documentation, charting and PACS.
- Stage 4 integrates CPOE (computerized physician order entry) and documentation.
- Stage 5 adds closed loop administration.
- Stage 6 brings full physician documentation and charting.
- Stage 7 includes electronic exchange of patient information.
According to HIMSS Analytics, nearly half of U.S. healthcare providers are in stage 2, with most others in earlier stages and just a handful of sites tackling clinical documentation and CPOE.
Zola espoused a layered architecture approach to the EHR implementation. This type of approach organizes information into smaller chunks including the functional layer, presentation layer, data layer, internal communications, external communications, security and continuity.
Presenters also provided a methodology for transitioning into the EHR. Key steps are identifying the functional baseline and components to be implemented, assessing the current infrastructure and architecture changes and determining an implementation sequence.