Does the Vision of Your EHR Steering Committee Square with the IOM’s?

Vol. 13 •Issue 19 • Page 8
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Does the Vision of Your EHR Steering Committee Square with the IOM’s?

Leslie: For the past two months we have been discussing the importance of health care organizations having a unified vision of electronic health records (EHRs). This topic is so compelling for us at this time because the accumulation of national initiatives culminated this past May in the request to the Institute of Medicine (IOM) by the department of Health and Human Services (DHHS) to provide guidance on EHR standards. In essence, DHHS wants a clear definition to assess when a health care provider organization actually has an EHR.

Patty: This isn’t the first time the IOM has been asked to shed light on this issue. In 1991, the IOM published its report The Computer-based Patient Record: An Essential Technology for Health Care, which led to a flurry of activity by the health care community to address the needs for definitions, models of functionality, data standards, security and other important issues surrounding the implementation of electronic records in health care. The report called for the elimination of paper-based patient records within 10 years.

Leslie: Well it looks like we missed the deadline by a mile or two!

Patty: Let’s be fair, the EHR—as the computer-based patient record concept is now called—is unlike other IT projects because its potential impact is so far reaching and the technological, financial, organizational and cultural challenges are so daunting.

Leslie: Of course, it is very challenging. The new IOM report acknowledges that noteworthy examples of health care settings in both the private and public sectors have met some of the goals set back in 1991. However, they also point out that overall progress has been slow. But let’s come back to the concept of vision. How will the new IOM report help organizations create a viable vision and accelerate the migration to EHR?

Patty: The new IOM report recognizes that the EHR has many stakeholders, both internal and external. Unlike other IT projects, the EHR touches everyone in health care. All caregivers contribute to the creation of the record and use it to provide care. However, all clinical and administrative departments also use information extracted from patient records to conduct the business of health care. Outside of provider organizations, third-party payers, regulators, researchers, educators, public health and policy officials depend on information gleaned from patient records to fulfill their responsibilities in the health care community.

Leslie: Even the office of Homeland Security needs to be able to trend information from health records to assure the safety of our citizens in the event of bio terrorism or to quickly identify and curtail serious epidemics such as SARS.

Patty: Peter Waegmann, CEO of the Medical Records Institute, notes, “The view that EHRs are at the center of all health information technology (IT) activities is now widely accepted not only in the United States but also in many parts of the world.” Thus the vision of the EHR needs to encompass global needs all the way down to the needs of individual consumers who want to manage their own health information.

Leslie: Now that last thought is a new concept for many people in the health care industry. Patients and their families, accessing their health information online, adding to or amending their information, and controlling access to their records borders on revolutionary in scope.

Patty: Patients and their families accessing their records is the vision of Personal Health Records (PHR) that came out of the Personal Health Record Work Group of the Markle Foundation’s Connecting for Health project. It is a look into the future of how EHRs will change people’s lives. We are talking about much more than a paperless medical record. In many ways, the widespread implementation and use of EHRs will be a major paradigm shift for the health care community. It will transform how the industry accomplishes its work and how it interacts with the public.

Leslie: Although EHRs are being developed and implemented incrementally, having the bigger picture has never been more important. Grasping the value of EHRs as a prerequisite to the PHR suggests the definition of EHRs must include such concepts as interoperability across settings, including the community as a setting. Every health care provider organization needs to envision an EHR that fits into its strategic plan.

Patty: Let’s be careful not to let the bigger vision overwhelm us. In the IOM report, it clearly states that “EHR systems will be built incrementally utilizing clinical information systems and decision support tools as building blocks of the EHR, and the IOM Committee has strived to identify reasonable steps that can be taken by health care providers over the next seven years to advance the accomplishment of the overall goal.” I added the emphasis on reasonable.

Leslie: Health care providers will shoulder the lion’s share of the work toward implementing EHRs, but the extensive collaboration of public and private organizations that has spurred momentum toward EHRs this summer is also helping to remove some of the obstacles such as a lack of data standards, privacy and security concerns, and even financial barriers.

Patty: Yes, there is even a growing awareness that to achieve widespread implementation, some of the outside stakeholders will need to help address funding issues by offering help such as financial incentives, grants, low interest loans, guarantees, etc. As stakeholders and beneficiaries of the benefits of EHRs, it is both fair and necessary that everyone that can should help.

Leslie: Health care providers will feel the urgency to implement EHRs as more and more recognize their inevitability. Significant long-term economic benefits accrue to health care organizations that have successfully implemented some components of an EHR.

Patty: So where do you think health information management (HIM) professionals fit into the visioning process?

Leslie: I think that most health care organizations have begun, or will soon begin, to see the urgency of moving forward with the implementation of the EHR. A health care system’s Board of Directors will likely incorporate the development and implementation of the EHR into a corporate strategic plan and appoint an EHR Steering Committee to develop a unified vision and execute a tactical plan. Those steering committees should reflect the same collaborative nature that we have seen in other industry initiatives related to EHR. Just as the American Health Information Management Association (AHIMA) has been an active member of national collaboration groups such as the EHR Collaborative, the eHealth Initiative (eHI), and the Markle Foundation’s Connecting For Health Steering Committee, so should HIM professionals bring the HIM body of knowledge to their own organizations’ EHR Steering Committees.

Patty: It is really critical that HIM professionals make sure they are continuously building their personal body of EHR knowledge. We are fortunate that a great many readily accessible resources are available to keep current. For example, everyone should read the IOM’s report of July 31st. A copy can be found in the AHIMA HL7 EHR Functional Model Community of Practice. And, a more complete report will be issued within the next few months. We need to monitor the outcome of the work of HL7, which is developing consensus on the data standards. And of course, we should be keeping a close eye on Congress to see what legislation passes.

Leslie: Yes, keeping current with the rapidly breaking news about developments in EHRs is important, but HIM professionals may also want to take stock of their leadership skills and their expertise in change management. Contributing to a key strategic initiative, working through design and implementation issues with a multidisciplinary team of hospital leaders, and leading their staff through the transformation of HIM functions will require confidence, focus, awareness of relationships, clear thinking, decisiveness and highly developed communication skills.

Patty: I think that the summer of 2003 may very well be a turning point in the migration from paper-based medical records to EHRs. The exciting part is just beginning for a profession that has long dreamed of advancing the patient medical record to an EHR system.


1. Institute of Medicine, Key Capabilities of an Electronic Health Record System: Letter Report, July 31, 2003.

2. C. Peter Waegemann, Overview of International EHR Implementations: Who Is More Advanced? 2002,

Leslie Ann Fox is president and chief executive officer and Patty Thierry is vice president of operations and chief information officer, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to [email protected] or [email protected].