Branching Out

Vol. 17 •Issue 17 • Page 12
Branching Out

Who’s Who in the World of EHR Development

“There are rich counsels in the trees.”
–Herbert P. Horne, British poet, 1864-1916

The seeds for the idea of EHRs across the nation were planted well before President George W. Bush declared his goal of having EHRs in place for most Americans by 2014. But it wasn’t until this announcement that the EHR initiative really began to sprout, helped in part by the executive order to establish the Office of the National Coordinator of Health Information Technology (ONCHIT).

Clamoring to put all the pieces in place to make the goal a reality, however, has led to a tangled web of acronyms. In fact, the HIT (there we go again) section of the Department of Health and Human Services (HHS–see?) Web site lists no less than 72 acronyms, ranging from the short and sweet (IT equals information technology) to ONCHIT itself, which has its own abbreviated acronym, also listed, ONC. Some roll off the tongue (hello, HIPAA), while others listed must be said letter by letter (for example, NIH, the National Institutes of Health, if pronounced as a word, would surely conjure thoughts of Monty Python and the Holy Grail).

Undoubtedly, the health care industry loves its acronyms. In the wide world of EHR development, it’s easy to get confused by the oodles of acronyms floating around. What do the groups do who are working toward making EHRs a reality across the nation? Who exactly lurks behind the letters? Here’s a basic guide to those working toward EHR implementation nationwide, as well as trying to form a national health information network (NHIN) linking the medical data of Americans and helping to, in the words of our president, “avoid dangerous medical mistakes, reduce costs and improve care.”

HIT in the Spotlight

In an effort to achieve a nationwide interoperable HIT infrastructure, the president established the position of the national coordinator of HIT. The ONC keeps HHS abreast of goings-on in the world of HIT and coordinates with HHS to plan interoperable HIT strategies. Robert M. Kolodner, MD, currently serves as the national coordinator.

On the HIM front, the American Health Information Management Association (AHIMA) hopes to see the ONC made a permanent fixture of the federal government, according to Dan Rode, AHIMA vice president of policy and government relations. Rode expressed his satisfaction with the work done by ONC so far, and noted how tough the job is of attempting to meet the president’s goal. “The work that ONC has done is made difficult because the office is only in existence through presidential order, which means staff members are under pressure to achieve objectives in a very short time, and through the efforts of a voluntary and collaborative work force. The work of ONC has highlighted the need for coordination of federal and private initiatives because standards alone do not achieve the necessary interoperability of systems and data.”

Welcome to the Community

Besides serving as a liaison between HHS and the world of HIT, the ONC also funds and staffs the American Health Information Community (AHIC). Shortened to the friendlier “The Community” by those in the know, AHIC also reports to HHS. The Community has seven established work groups, each dealing with a different issue, running the gamut from population health (formerly biosurveillance) to personalized medicine. The work groups, consisting of more than 120 experts and stakeholders, met 50 times last year, and this year approved and presented its first set of recommendations to HHS.

The Community is currently in the process of devising a transition plan, as it moves from the public to the private sector. For more on this transition, see the accompanying sidebar.

The Common Goal

Ah, the task force, the work group, the committee. They serve as a staple in the modern day working world. Founded on the principles of two (or more) heads are better than one, good old nose to the grindstone hard work and a common goal (in this case an interoperable EHR,), the world of EHR development abounds with task forces, work groups and committees.

According to the American Medical Association (AMA) Web site, the ONC presented numerous federal contracts to private-sector organizations. These groups work toward the EHR by focusing on specific areas, and they report findings back to AHIC.

The Health Information Technology Standards Panel (HITSP) hones in on issues dealing with EHR functionality, interoperability and privacy. According to its Web site, the panel works as a liaison between the public and private sectors and specifically helps with the development of the NHIN. The panel examines the exchange of patient data and the standards and interoperability associated with it. HITSP is sponsored by the American National Standards Institute (ANSI) in cooperation with strategic partners such as the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton, a consulting firm.

Theresa Wisdom, RHIA, MBA, manager, standards harmonization, HIMSS, and HITSP work group member, got involved with HITSP in 2006 when she completed the implementation of an EHR for a Chicago health care center. “I began to research everything I could find on the EHR and work group activities,” Wisdon explained. She found an article about HIMSS and its role as one of the partners with a government-contracted organization and scooped up an open position. She currently serves as HIMSS facilitator for HITSP.

The Certification Commission for Health Information Technology (CCHIT) also works with HHS and has garnered recognition for its work certifying technologies. Certification of products will help to accelerate adoption of HIT, and according to Sarah Corley, MD, FACP, chief medical officer for NextGen Healthcare Information Systems and CCHIT committee member, that’s exactly what’s happening.

In the early days of CCHIT, the budget was tight and everyone was a volunteer, and now, well, most are still volunteers, but there’s a bigger budget, an expanded support staff and more recognition as more products meet certification standards. But even back then, CCHIT recognized the need to keep lines of communication open. “It’s very important that all of these organizations maintain close contact with each other to not duplicate efforts but to also make sure that we don’t come up with conflicting things,” Dr. Corley advised.

A Network in Progress

A federal contract was awarded in 2005 to further NHIN development, according to the AMA Web site, and that contract went to four companies, Accenture, Computer Science Corporation (CSC), International Business Machines (IBM) and Northrop Grumman. The NHIN will allow for data exchange through an interoperable infrastructure, and will consist of a “system of systems,” in the words of the National Committee for Vital and Health Statistics (NCVHS), which serves as a public advisory board to HHS Secretary Michael O. Leavitt. In January, the four prototypes for the NHIN were handed over to HHS. According to the HHS HIT Web site, “Their delivery marks the beginning of the next phase of NHIN work–to connect the prototypes and state and regional health information exchange efforts in ‘trial implementations’ that will make up the ‘networks of networks’ of the NHIN.”

When working with a mammoth task like putting together a nationwide network of EHRs, privacy and security must not be forgotten. The ONC charged the Health Information Security and Privacy Collaboration (HISPC) with the task of examining differences in state laws and ensuring harmonization of privacy and security in data exchange between the states, according to the AMA Web site.

Past, Present, Future

The accomplishments of the ONC and the myriad groups working toward the goal of the NHIN are too numerous to mention. But will the goal be achieved by 2014?

Rode is doubtful. One issue is that the effort is composed almost entirely of volunteers, he noted. Volunteers make up HITSP, HISPC, CCHIT and AHIC, Rode pointed out. Also, there is a long road ahead until EHRs will be embraced and interoperable nationwide. “We have not developed all of the standards needed, nor even essentially addressed standards for data and information,” Rode commented. “All of this is necessary for interoperability and the building takes time, effort and money. We need to address the costs, the need for education in the industry and in the community. We need to gain an understanding of what an interoperable health network and EHR are, as well as the technology, cultural, legal, political and other barriers and changes that have to be addressed.”

Rode also pointed out that with each group working separately, things are getting done, but the process is a lengthy one. “We’ve got various groups, each trying to achieve consensus within that group, and then the groups coming together and trying to achieve consensus among each other, so we’re certainly moving in the right direction, but I don’t think we’re working as well as we might, and I wish I had the magic answer as to how we might,” Rode explained.

Dr. Corley agreed that the goal probably won’t be met, at least not 100 percent. She noted an increase in the pace of adoption of HIT, and added that with Medicare’s pay-for-performance plan that just began, she believes there will be more incentives for physicians to invest in HIT. “I think you’re certainly going to see over the next 5 years a quickening in the rate of adoption.,” Dr. Corley said.

Wisdom took an optimistic approach–she thinks that the president’s goal will be achieved. “I believe this work is going to explode. I’d like to be positive and say yes,” Wisdom said. “I think it’s going to happen–and it’s going to be through a lot of hard work.”


AMA Key Players and Initiatives. Accessed July 11, 2007.

The Department of Health and Human Services, Health Information Technology. Accessed July 11, 2007.

Lynn Jusinski is an assistant editor with ADVANCE.

A Private Community

The American Health Information Community (AHIC) recently announced that it will be moving to the private sector. The U.S. Department of Health and Human Services (HHS) painted a picture of AHIC’s future on its Web site at

Proposals for the future of the Community will be released after the July 31 AHIC meeting and will cover governance and a business model for the successor, according to the Web site. Work on a transition plan will continue this summer, and the AHIC successor group is expected to be up and running in 2009. The move to the private sector has drawn some heat from critics, in particular California Rep. Pete Stark. In a press release Stark called the Community a “toothless tiger” and chastised HHS Secretary Michael Leavitt. “If the private sector was interested in developing or able to promote interoperable standards for HIT, it would have done so years ago—and private companies wouldn’t be asking the government to pay for it. Self-interested private firms have and will continue to fight among themselves over specifics, further delaying the adoption of money saving and lifesaving technologies. It is well past time for federal leadership to fix this market failure,” Stark stated in the press release.

Leavitt praised the transition in a press release in early June. “Over the past 20 months, AHIC has proven its ability to effectively and efficiently address the breadth of complex issues surrounding the advancement of better health care through health information exchange,” he said. “Now we must preserve in the private sector the significant momentum AHIC has created to engage key stakeholders across the health care spectrum to ensure long-term sustainability as a guiding force for HIT development.”

Dan Rode, vice president of policy and government relations for the American Health Information Management Association, said that not many consumers or health care practitioners are aware of the changes going on in AHIC. He noted that it’s too early to predict what the Community successor will look like. “From the initial discussion, it is clear that there will be a healthy debate and that most see a significant need for government involvement,” Rode added.

Lynn Jusinski