How many times have you been frustrated by the fact that your new vendor cannot interface with your current EMR? HIM professionals know that this unfortunate scenario occurs all too often, sometimes costing organizations upwards of $30,000 for the development of a single interface.
Health Level 7 International (HL7) is a 2,300 plus member non-profit standards-making body accredited by the American National Standards Institute. HL7 standards developed by consensus-based guidelines were released into the field to advance interoperability; however, over time, vendors customized interfaces to their own unique products, leaving the industry with essentially no common language or model on which systems could rely. This was certainly not the intent of the HL7 organization.
HL7’s mission is to provide “standards for interoperability that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, fellow SDOs and patients.” HL7 Version 2 is the most widely used healthcare exchange standard in the world.
The good news is that HL7 standards are evolving to meet the original intent of their creators – that is, to drive the interoperable exchange of electronic health information. Clinical Document Architecture (CDA), an HL7 Version 3 based standard, is leading the way.
What Exactly is CDA?
CDA is essentially a document markup standard that specifies the structure and semantics of clinical documents for the purpose of exchanging those documents between providers and patients. According to the HL7 Web site, CDA has the following six characteristics:
• Persistence
• Stewardship
• Potential for authentication
• Context
• Wholeness
• Human readability
The CDA can include a discharge summary, imaging report, history and physical, pathology report, or any other type of clinical content. Any computer with a basic browser (e.g., Internet Explorer or Firefox) can display a CDA as a basic style sheet. A system designed to process CDA can display the human-readable text and automatically process the coded data.
What Are Some of the Benefits of CDA?
First, it supports the exchange of clinical documents. Second, it allows organizations to re-use clinical data for public health reporting, quality monitoring, patient safety, and clinical trials. Third, it can be reused in multiple applications.
Unlike previous versions of HL7, CDA limits customization by vendors. In addition, Meaningful Use, Stage 2 requires providers to be able to receive and send CDA documents. CDA is required for transitions of care and providing a clinical summary to patients. Stage 2 certified vendors will be able to receive a document adhering to CDA standards, open and process it, and populate that information into the EMR as though the physician had entered it him or herself.
Why Is This Advantageous for Health Information Purposes?
Today an HL7 document is sent from one provider to another through a dedicated interface as a free text, PDF or TIF; and uploaded into the EMR as a standalone document-a document containing no structure at all. Imagine the efficiency and accuracy with which clinical care could be provided if information flowed seamlessly between applications and systems. HIM departments could share documents across sites and reconcile that information before a patient’s clinical visit.
Healthcare providers in the United States have been slow to adopt HL7 Version 3. However, this will soon begin to change as Meaningful Use moves full speed ahead. Despite the lag in general adoption, CDA is used in some HIEs as well as larger providers. Columbia-Presbyterian in New York initiated a project on CDA note generation with knowledge management and controlled vocabulary. The Mayo Clinic is also making advancements, producing thousands of CDAs every week with the anticipation of reaching 50,000 notes per week.
CDA is important because it will help the industry capitalize on the power of health information and big data. HIM professionals are at the center of this revolution because they understand the implications of a truly interoperable document and the positive effects it can have on the efficiency of healthcare. The more informed HIM professionals are about HL7 and CDA, the more equipped they will be to have meaningful conversations with IT, leadership, physician advisors, CMIOs, and others.
Important HL7 Conversations for HIM
HIM professionals must be prepared for a shift in how information is transferred between institutions. They must also be ready to develop new organizational policies and procedures. In particular, payers will be interested in electronic submissions using HL7 CDA, and HIM must be ready to enable those transactions.
There are various ways in which HIM professionals should be involved in conversations about HL7. Consider the following benefits of CDA for which HIM professionals can advocate:
• Coordinated clinical care. CDA can enable the exchange of information with skilled nursing facilities, inpatient rehabilitation facilities, and many other providers. This can promote higher quality of care and potentially reduce readmissions. CDA also enables interoperable care between the Veterans Affairs, Department of Defense, and private sector, improving the quality of care for veterans.
• Robust research. CDA provides researchers with more detailed clinical information that improve the accuracy and usefulness of clinical trials and studies.
• Lower costs for release of information (ROI). As CDA enables more sophisticated exchange of information, ROI costs may decrease over time. HIM professionals must continue to oversee the private and secure exchange of that information.
• Faster Medicaid coverage determinations. As CDA enables a more efficient exchange of information with the Social Security Administration, the number of uninsured individuals waiting for a disability determination to receive Medicaid coverage will likely decrease. HIM professionals are well-equipped to explain the positive ramifications that this can have on billing and managing denials.
• Increased physician adoption of EMRs. Rather than forcing physicians to adopt EMR technology, the technology must adapt to accommodate the physicians. If organizations can use Natural Language Processing to normalize transcribed documents and then import those documents as structured data into the EMR using CDA, physicians would simply be able to dictate rather than enter data directly into the system. This is a win-win scenario for everyone. HIM professionals can advocate for proper auditing of this information as it flows into the EMR.
Other Ways to Get Involved
HIM professionals should also consider the following ways to get involved with HL7 initiatives:
• Join and participate in any local HL7 work groups to increase your knowledge of the standards and their potential impact.
• Discuss interfacing strategies with your vendors. Does your vendor plan to add CDA? If so, when? If not, how might this affect your organization’s ability to meet Meaningful Use?
• Start conversations at your organization about the value of CDA in your environment. How might CDA solve business and other problems? How will it affect the success of Accountable Care Organizations?
• Combat patient identity management problems. A clear strategy for managing the enterprise master patient index is crucial as information exchange grows.
Steve Bonney is executive vice president of business development at Records One, and Brett Marquard is principal at River Rock Associates.
