With the new age of informatics upon us, a whole subset of acronyms are now becoming part of our vocabulary.

While everyone is familiar with MI (myocardial infarct), CHF(congestive heart failure) and COPD(congestive pulmonary disease), the following list has sprung up over the last 3 years with more appearing every day.

So that we are all on the same page, the following is a small list of "meaningful letters" that you will come to intimately know.

AHIMA- American Health Information Management Association
AMIA-American Medical Informatics Association
JAMIA- the Journal of the AMIA
CCHIT-Certification Commission for Health Information Technology
CCR-Continuity of care record
CCD-Continuity of Care Document
CDO-care delivery organization
CPOE-computerized practitioner/physician Order Entry
EHR.-electronic health record
EMR- electronic medical record
HIMSS-Healthcare Information and Management Systems Society
NHIN-National Health Information Network
PHR- personal health record
PQRI-Physician Quality Reporting Initiative
QIO- quality improvement organizations
TRHCA- Tax Relief and Health Care Act

While some of these are more familiar to you than others, each will impact your medical care as we move forward in the health reformation.

Although many journalists or people in the medical community may mistakenly swap the terms EMR and EHR, they are actually two distinct entities.

EMR or electronic medical record is a legal recording of patient-healthcare provider encounters. It includes not only patient physical findings, and laboratory data but also clinical decisions including future tests, prescriptions and treatments. Covering both the ambulatory, inpatient and outpatient milieu, it is the basis by which health care of the individual can be managed and monitored by the CDO (care delivery organization.)

The record is owned by the CDO and is not interactive with the patient. It is also limited to the encounters of a particular CDO.

EHR or electronic health record is actually a summary or compilation of the patient's care -CCR (continuity of care record) or CCD (continuity of care document).

The patient owns this. As such, the individual may not only access the record, but also insert his/her own input.

The EHR contains data from several providers or facilities, which can be, located anywhere.

Another way to look at this is that the EMR is the patient's chart from a particular physician/healthcare provider. The EHR is the stack of all the charts from everywhere the patient has been- packaged neatly in one electronic program.

This system will certainly make for a more efficient arrangement once it is established.

Currently, the only recognized body for certification of electronic health records is the CCHIT (Certification Commission for Healthcare Information Technology).

The CCHIT is a private, nonprofit organization with a mission "to accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process".

The challenges faced by CCHIT and indeed, all of us, is to ensure that vendors are taking the appropriate measures to ensure that systems sold are fulfilling "Meaningful Use Objectives, Measures, Standards, implementation specifications and certification criteria" according to ARRA 2011-2012. (American Recovery and Reinvestment Act)

An additional challenge is that the current program addresses only product features, not usability, training, execution or how well it has been used out in the "field".

In the future certification fees might be a possible barrier for nonprofit electronic health record developers serving vulnerable populations.
And the current policies are not sufficiently compatible with open source licensing models.

A Town Hall meeting took place on June 16 and 17, 2009 to discuss the new paths to certification.

There are three forms that were discussed: EHR (comprehensive)-C, EHR (Module)-M and EHR-S (certified site)
Let's take a look at each one.

EHR-C:
Certification of a system that exceeds minimum Federal standards.
This is for those healthcare providers wanting maximum compliance and functionality.
The physician office or medical facility uses only one vendor and the usage complies with all Federal standards, meets all meaningful use objectives and all requirements dictated by CCHIT's process.
Success at utilizing "meaningful use" must be proven.

Inspection is by technical interoperability testing, usability evaluation,live site use verification and demonstration.

The cost ranges between $30,000 and $50,000

EHRM:
This module is for healthcare providers that integrate systems from more than one source or vendor

Inspection is by demonstration, documentation inspection and technical interoperability testing.

The cost range is $5000 to $35,000. Nonprofit suppliers may apply for grants or scholarships.>br>
EHRS:
This certification is for providers that have developed or assembled their own system from noncertified sources.

The inspection here is done with virtual site visit technology and offline inspector review.
The cost is $150 to $300 per licensed provider.

In each of these modules, the healthcare provider will obtain a certification code that is issued by CCHIT that can be submitted for ARRA Incentive Payments.
*taken from CCHIT slides 9-11

There are currently around 60 electronic health record products that are certified. But changes have been proposed and adopted this year by CCHIT over and above what was considered criteria in 2008:

· A patient's diagnosis must now be managed with the code,onset date, status, history or comment and the date that the problem was resolved.
· Prior allergy lists must now include the date the list was last discussed with the patient
· The Body Mass Index (BMI) is now part of the clinical data along with height and weight
· Scanned documents must be indexed by date and type.

While the above seems like common sense, the following is actually extremely helpful in terms of the "clinical decision support".

Test results which in the past were highlighted when abnormal, now will generate an alert.

Ordered medications will now alert the prescriber if the patient is allergic to it, if there is an equivalent generic form and if side effects are enhanced according to the patient's diagnosis.

· Recommended or overdue care will generate reminder letters automatically.
· Explanations will be generated to educate the patient on procedures and tests to be done.
· Codes will automatically appear for prescriptions as they are written. As the medications are ordered, a warning will be issued if the dose is contraindicated due to the patient's age or weight, pregnancy or interactions with other medications.
· Patient summaries will be generated as Continuity of Care Document.

In terms of generating reports, records can now be searched based on specific diagnosis or medications. This will be very helpful not only to the healthcare provider or facility but also for epidemiology studies in the region.

For additional changes, you can view the CCHIT site for exact listings available. While the task of converting to electronic records is daunting, the above standards are all extremely helpful as we analyze them and will aid us in improved patient care as we move forward.

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