Archive for the ‘Electronic Health Records’ Category
The Office of the National Coordinator for Health Information Technology (ONC) has released the Safety Assurance Factors for EHR Resilience (SAFER) Guides. These guides are a suite of tools that include checklists and recommended practices designed to help health care providers and the organizations that support them assess and optimize the safety and safe use of EHRs. Each SAFER Guide has extensive references and is available as a downloadable PDF and as an interactive web-based tool.
The release of the SAFER Guides marks an important milestone in the implementation of the HHS Health IT Patient Safety Action and Surveillance Plan, which was issued in July 2013. The SAFER Guides complement existing health IT safety tools and research developed by the Agency for Healthcare Research and Quality (AHRQ) and ONC. AHRQ’s Patient Safety Organizations (PSO) have explicitly identified health IT as a high priority area because of the enormous impact EHRs are having on patient safety right now. PSOs are charged to help their members improve patient safety, and the SAFER Guides give them an evidence-based tool to do so.
Rigorously developed by leading health IT safety and informatics researchers and based on the latest available evidence, expert opinion, stakeholder engagement, and field work, each SAFER Guide addresses a critical area associated with the safe use of EHRs through a series of self-assessment checklists, practice worksheets, and recommended practices. Areas addressed include:
- High Priority Practices
- Organizational Responsibilities
- Patient Identification
- Computerized Physician Order Entry (CPOE) with Decision Support
- Test Results Review and Follow-up
- Clinician Communication
- Contingency Planning
- System Interfaces
- System Configuration
The National Library of Medicine has released an enhancement to MedlinePlus Connect, NLM’s service for patient portals and electronic health record (EHR) systems. MedlinePlus Connect makes it easy for EHRs to link to targeted information for patients from MedlinePlus, using their existing coding for diagnoses (problem codes), medications, and laboratory test results.
The latest enhancement provides responses to one code system for problems, SNOMED CT, to information from NLM’s Genetics Home Reference (GHR) web site. GHR is the NLM’s web site for consumer information about genetic conditions and the genes or chromosomes related to those conditions.
With this new enhancement, MedlinePlus Connect can respond to requests for information related to SNOMED CT codes with information from MedlinePlus and from GHR. Currently this feature is available only for English SNOMED CT requests.
The Office of the National Coordinator for Health Information Technology’s (ONC) Office of the Chief Privacy Officer (OCPO) has released its second web-based security training module, CyberSecure: Your Medical Practice. This latest game focuses on disaster planning, data backup and recovery, and other elements of contingency planning. Contingency planning helps providers and staff prepare for power outages, floods, fires, or weather related events such as hurricanes or tornadoes. These events can damage patient health information or make it unavailable. Planning for these events can help ensure that patient health information is protected and that patient information can be accessed when the disaster is over. This training module uses a game format that requires users to respond to privacy and security challenges often faced in a typical small medical practice. Users choosing the right response earn points and see their virtual medical practices flourish. But users making the wrong security decisions can hurt their virtual practices.
October is National Cyber Security Awareness Month, and is an opportunity for ONC to remind providers about the need to create contingency plans to assure a safe and secure cyber environment. Contingency Planning is also required by the HIPAA Security Rule.
The National Library of Medicine (NLM) will join with other health data leaders and innovators for the fourth annual Health Datapalooza. The unique event will be held June 3-4, 2013, at the Omni Shoreham Hotel in Washington, DC. Health Datapalooza IV highlights new, innovative, and effective ways health data is being used by companies, startups, academics, government agencies, and individuals. More than 1,500 people are expected to attend. The event is organized by a consortium of private sector, non-profit and government agencies, including the Department of Health and Human Services (HHS). NLM has participated in the event every year.
As the world’s largest medical library, NLM has made its electronic data freely available for decades, so that others can use it to develop new products and services. Additionally, NLM provides application programming interfaces (APIs) so that external products and services, such as electronic health records, can easily access its data. NLM experts will be in the Health Datapalooza exhibit hall (Booth 12), to explain how developers can utilize the variety of available NLM data, including medical literature; consumer health information; clinical trials; medical terminology; and drugs. NLM will also participate in the “Datalab” breakout session, featuring federal government data experts.
The NLM exhibit booth at the 2013 Annual Meeting of the Medical Library Association in Boston featured theater presentations to bring users up-to-date on several NLM products and services. The presentation recordings are captioned and accessible from the NLM Distance Education Program Resources page. The presentations include:
Note: To listen to the voice recordings and view the captions you may need the latest version of Flash® Player (download for free from the Adobe Web site). To zoom in to detailed screens, use the scroll button. For more information, go to the NLM Technical Bulletin page.
Research funded by the National Library of Medicine provides new insight into why patients stop taking drugs that lower their cholesterol, and what happens when patients try those drugs, known as statins, a second time. Researchers found that more than 90% of patients who stopped taking statins because of an adverse reaction could tolerate the medication when tried again. The study is published in the April 2, 2013, issue of the Annals of Internal Medicine.
NLM grantee Alexander Turchin MD, MS, of Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, notes that statins are commonly stopped even though their benefits are well documented. He and colleagues wanted to better understand why statins are discontinued and whether adverse reactions play a role. They conducted a retrospective study, analyzing clinical data in an electronic medical record (EMR) system. Researchers examined structured data as well as the narrative electronic notes of health providers. Those notes frequently are the only place in an EMR where adverse reactions to medications are documented. Using the NLM grant, researchers developed natural language processing software and scoured more than 5 million notes, on more than 107,000 patients, recorded over nearly a decade. The software generated data on a scale that could not have been done manually. Researchers say the next step would be to conduct a clinical trial to determine if outcomes are improved when statins are tried again, after an adverse event.
The National Library of Medicine, part of the National Institutes of Health, conducts and funds research in biomedical informatics, which involves applying computers and communications technology to the field of health. This research was supported by NLM’s Division of Extramural Programs grant RC1-LM010460. This was an NIH Challenge Grant, supported by NLM with funds from the American Recovery and Reinvestment Act. For additional information, visit the Brigham and Women’s Hospital News Release.
The National Library of Medicine (NLM) Value Set Authority Center (VSAC), in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), has published the annual update for the 2014 Eligible Hospital Clinical Quality Measure (CQM) Value Sets. The update includes revised value sets to address deleted and remapped codes in the latest terminology versions, as well as new codes for addressing CQM logic corrections and clarifications. The NLM update of the VSAC coincides with the CMS posting of the official updated 2014 Eligible Hospital CQMs.
The value sets provide lists of the numerical values and individual names from standard vocabularies used to define the clinical concepts (e.g. diabetes, clinical visit) used in the CQMs. The content of the VSAC will gradually expand to incorporate value sets for other use cases, as well as for new measures and updates to existing measures. The VSAC offers a Downloadable Resource Table (DRT), accessible from the “Download” tab on the VSAC Web page, that provides prepackaged downloads for the most recently updated and released 2014 CQM Value Sets, as well as to previously released versions. Access to the Value Set Authority Center requires a free Unified Medical Language System® Metathesaurus License. NLM also provides the Data Element Catalog that identifies data element names (value set names) required for capture in Electronic Health Record (EHR) technology, certified under the 2014 Edition of the ONC Standards and Certification Criteria.
The following resources are available to help health care providers and vendors navigate the 2014 CQMs:
A new database developed by the Agency for Healthcare Research and Quality (AHRQ), with support from the Centers for Medicare and Medicaid Services (CMS), can help software developers create better Electronic Health Records (EHRs) for the care of children. The children’s EHR format establishes a blueprint for EHRs to better meet the needs of health care providers and pediatric patients by combining best practices in clinical care, information technology, and insights from experts in children’s health. Since few EHRs have been created with children’s needs in mind, gaps in functionality, data elements, and other areas tend to occur. The format guides EHR developers in understanding the requirements for functionality, data standards, usability and interoperability of an EHR system to more optimally support the provision of health care to children, especially those enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The format is readily accessible and adoptable by EHR developers for use during product development or enhancement.
The children’s EHR format was authorized by the 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA). The format includes a minimum set of data elements and applicable data standards that can be used as a blueprint for EHR developers seeking to create a product that can capture the types of health care components most relevant for children. Child-specific data elements and functionality recommendations are sorted into topic areas that include prenatal and newborn screening tests, immunizations, growth data, information for children with special health care needs and child abuse reporting. The EHR format provides guidance on structures that permit interoperable exchange of data, including data collected in school-based, primary, and inpatient care settings. The format is compatible with other EHR standards and facilitates quality measurement and improvement through the collection of clinical quality data.
In addition to providing guidance to developers, the format can provide guidance for EHR system purchasers and policy makers. For example, policy makers and purchasers can use the requirements when assessing functionality of EHRs. More information about the children’s EHR format is available on the AHRQ website.
The Agency for Healthcare Research and Quality (AHRQ) and the Electronic Data Methods (EDM) Forum have announced the official launch of eGEMs (Generating Evidence and Methods to improve patient outcomes). eGEMs is a new peer-reviewed, open access journal designed to curate a knowledge base of emerging lessons learned, focusing on using electronic clinical data to advance research and quality improvement, with the overall goal of improving patient and community outcomes. Authors are welcome to submit papers, images, or other media focused on the four themes of data methods, informatics, governance, and the learning health system. Submissions are published upon acceptance.
Under a recent agreement with the American Medical Association (AMA), the National Library of Medicine (NLM) will be including the AMA’s Current Procedural Terminology (CPT) codes for molecular pathology tests in the National Institutes of Health’s Genetic Testing Registry (GTR). GTR is operated by NLM’s National Center for Biotechnology Information (NCBI), and provides a resource for comprehensive information about genetic tests. The database provides a central location for voluntary submission of test information by providers. Content includes the test’s purpose, methodology, validity, evidence of the test’s usefulness, and laboratory contacts and credentials.
Under the new agreement, AMA’s CPT codes for molecular pathology tests will be integrated into GTR. The AMA-created codes describe the latest advances in genetic testing and molecular diagnostic services for reporting and tracking purposes. AMA’s new, more detailed CPT codes for molecular pathology became effective in 2012. Inclusion of the CPT codes in GTR further enhances the database’s interoperability with electronic medical records and laboratory information management systems. GTR also incorporates SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms), an extensive clinical terminology produced by the International Health Terminology Standards Development Organisation (IHTSDO), and LOINC (Logical Observation Identifiers Names and Codes), produced by the Regenstrief Institute, which provides standardized terms and codes for identifying laboratory and clinical observations. NLM is the US Member of the IHTSDO and provides support for the development and free US-wide use of both SNOMED CT and LOINC. CPT, SNOMED CT, and LOINC are required standards in the certification criteria for electronic health record products issued by the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services.