The HIE Blog

Happy New Year! I hope everyone has recovered from those late night “meaningful use” parties.

Continuing the discussion around client-cloud computing, I thought it would be interesting to map how a client-cloud computing system would leverage EHR modules to meet the meaningful use criteria for a certified EHR.

First, the “Top 25” list of functions that an EHR system must perform to be certified:

1. Perform drug-drug, drug-allergy, drug-formulary checks
2. Maintain up-to-date problem list
3. Maintain active medication list
4. Maintain active medication allergy list
5. Record and chart vital signs
6. Track smoking status
7. Incorporate laboratory test results
8. Generate patient lists
9. Report quality measures
10. Check insurance eligibility
11. Submit claims
12. Enable medication reconciliation (compare and merge)
13. Submit data to immunization registries
14. Public health surveillance
15. Security (access control, emergency access, automatic log-off, audit log, integrity controls, authentication, encryption)
16. Account for disclosures
17. Computerized provider order entry
18. Electronically exchange prescription information
19. Record demographics
20. Generate patient reminder list
21. Clinical decision support (rules, alerts, statistics)
22. Create an electronic copy of patient’s health record (results, problems, medications, allergies, immunizations, and procedures)
23. Provide patients timely access to clinical information
24. Provide clinical summaries for each office visit (results, problems, medications, allergies, immunizations, and procedures)
25. Exchange clinical information and patient summary record

In the world of client-cloud computing, the client platform provides the security (15), accounting for disclosures (16), and information exchange (25) functions (using a REST-based architecture). As discussed in my last post, the distributed patient object – patient data organized by the client into a structured object that can then be exchanged with other clients – would be the mechanism to store patient data including problem list (2), medication list (3), medication allergy list (4), laboratory test results (7), and other required data elements.

EHR modules would perform the remainder of the functions for a Certified EHR:

• A Data Entry Module (essentially a web form) would enable users to enter data directly into the patient object, such as vital signs (5), smoking status (6), and recording demographics (19).
• Data Rendering Modules would leverage the patient objects to chart, graph, and create standards-based summaries of patient data (22 & 24), and generate filtered lists of patients (8).
• e-Prescribing Modules would address prescribing (18), drug/allergy/formulary checks (1), update the medication list (3), and perform medication reconciliation (12).
• Payer Modules would provide eligibility checks (10) and claim submission (11).
• Analytics Modules would be able to look across all of the patient objects to report quality measures (9) and generate patient reminder lists (20). This module could also leverage cloud services to report public health surveillance (14) and to submit data to immunization registries (13).
• Order Modules would be provided by local hospitals, national labs and others either running on the platform or accessible as services through the cloud (17).
• Cloud services that update PHRs provide patients access to timely information (23). Another approach may be to let patients use a client-cloud platform to directly interact with the care team.

Because the patient objects can be built from the data already captured in local Practice Management Systems and the core workflow of the practice does not have to change to suit the platform, the implementation of a client-cloud platform may be far less disruptive than implementing a complete EHR.

So, it’s clear that a theoretical EHR built on a client-cloud computing platform could be used to achieve meaningful use. The underlying platform with its concept of distributed patient objects makes it quite different from the complete EHR in terms of cost and effort, which may make it quite suitable for the smaller practice setting.

We’re also sure to see a surge in EHR modules as vendors focus their expertise to capture these new emerging markets, making the scenario I’ve described even more attainable. Of course, we’ll have to again hurry up and wait to see what the certification is all about.