HHS Plans to Encourage National EMR System

CAP’s SNOMED licensed to supplement IOM’s effort to standardize patient record

CEO SUMMARY: Last week, the U.S. Department of Health & Human Services (HHS) announced two major steps toward the universal electronic health record. One project involves the licensing of CAP’s SNOMED CT system to make it available to all healthcare providers in the United States. The second project is a commission to the Institute of Medicine (IOM) to design a standardized model of an electronic health record.

BASED ON THE ANNOUNCEMENT of two new initiatives last week, it appears the federal government will drive the effort to create the universal electronic health record.

On July 1, the U.S. Department of Health & Human Services (HHS) held a press conference to announce the details of these two initiatives. The goal is to build “a national electronic healthcare system that will allow patients and their doctors to access their complete medical records anytime and anywhere they are needed, leading to reduced medical errors, improved patient care, and reduced healthcare costs.”

Laboratories Must Respond

These two new initiatives will inevitably engage the nation’s laboratories, since laboratory data is a key part of every patient’s medical record. For this reason, lab directors and pathologists should closely follow the progress of these two initiatives. There is clear intent by HHS to drive implementation of an electronic health system that allows all types of providers to easily exchange healthcare data.

The first project announced by HHS is a major coup for the College of American Pathology (CAP). In a five-year contract worth $32.4 million, HHS has permanently licensed CAP’s SNOMED® CT system. SNOMED CT is a standardized medical vocabulary containing precise terms for 340,000 medical concepts. HHS will make SNOMED CT available, at no cost, to virtually all of the nation’s healthcare providers.

At the same time, HHS announced the second project. It has commissioned the Institute of Medicine (IOM) to design a standardized model for the electronic health record. The model will be built upon HL7 and will be reviewed by Health Level Seven, Inc., the standards body based in Ann Arbor, Michigan which administers HL7 and its development.

The IOM is expected to deliver this standardized electronic health record model by the end of next year. HHS will share this model and all its components, at no cost, with the U.S. healthcare system.

Together, these two initiatives are expected to provide the foundation for a uniform methodology for collecting healthcare data, storing it, and transmitting it between providers and payers. Because the nation’s largest providers and IT vendors have not been able to collaborate and agree on a set of common standards, the federal government has stepped in to take that role.

Action Steps For Labs

These newly-announced HHS initiatives will probably cause some laboratories to defer the purchase and implementation of new LIS systems. They will prefer to wait until the IOM’s standardized medical records format is released next year.

It would also be reasonable to expect that LIS vendors will immediately begin the process of making their LIS products fully compatible with SNOMED CT. They will also prepare to integrate the as-yet undeveloped HL7-based standardized medical record with their various healthcare software products.

In the short term, laboratories will want to study SNOMED CT to understand what it is and how it should be integrated into their existing clinical repositories and systems for ordering and reporting. Because SNOMED CT was designed by individuals who understand laboratory medicine, that should not be a daunting task.

THE DARK REPORT believes the July 1 announcement by HHS was timed to coincide with publication of the RAND Health study. Just five days earlier, on June 26, the New England Journal of Medicine published the findings of researchers, who determined that only 55% of the time do patients get a diagnosis and care which is in keeping with the recommended clinical course of action. (See this related article.)

This will have a profound impact on laboratories, because the primary product of a lab is information
—laboratory test data.

In that study, researchers observed that the failure of providers to deliver recommended care almost half the time can be attributed, in part, to the inability to access complete and up-to- date medical records of individual patients. To rectify the current morass of paper files, researchers recommended the development of a standardized electronic system of clinical data capture, storage, and transmission.

Two-Pronged Initiative

This is precisely the goal of the two-pronged HHS initiative. HHS is putting money on the table to develop a standardized electronic system of healthcare informatics. It appears the health systems of the U.S. Military and the Veterans Administration will be early-adopters and demonstrate the capabilities of this system as it is developed. Both of these systems provide healthcare to millions of individuals, so they can demonstrate the viability of such an electronic system on a large scale.

Clients and long-time readers of THE DARK REPORT will recognize that these recent events are in keeping with the public campaigns to improve patient safety and reduce medical errors. (See TDR, January 28, 2002.) The Leapfrog Group, the Midwest Employers’ Group on Health, and similar organizations represent employers taking active steps to change the American healthcare system.

Employers are actively challenging hospitals and large clinics to accurately measure outcomes. They want providers to implement and use quality management methods to revamp work processes as a way to eliminate medical errors, improve outcomes, and reduce the cost of care.

Standardized IT Needed

A standardized network that permits seamless electronic data collection, storage, and transmission between hospitals, physicians, payers, and patients is a necessary component of the drive to improve patient safety. It appears that the federal government is willing to fund important projects to make that a reality.

This will have a profound impact on laboratories, because the primary product of a lab is information—laboratory test data. Anything that revolutionizes the way providers and payers use and share information will require a comparable revolution in how laboratories create, manage, store, and transmit laboratory test data.

The IOM’s model for an electronic patient medical record should be ready by next year, which accelerates the development and implementation curve for a standardized, national system of individual electronic medical records (EMR). An early version of a standardized EMR format may happen swiftly, even within 30 months.

Choice of SNOMED By Federal Government Is Strong Endorsement of CAP’s Hard Work

ONGOING EFFORTS over the past four decades to develop SNOMED® appear to be paying off for the College of American Pathology (CAP).

The agreement with the U.S. Department of Health and Human Services (HHS) to use SNOMED CT for medical terminology validates the foresight and hard work of CAP and the individuals who championed the development of SNOMED. It will play a primary role within the clinical terminology database that payers and providers within the United States will use to capture, store, and exchange clinical data.

The one-time payment specified in the contract will be shared by the Department of Veterans Affairs, the Department of Defense, and several agencies within HHS. This is also significant, because the U.S. Armed Forces and the Veterans Administration (VA) are actively working to create a universal electronic medical record for active duty personnel, dependents, and veterans.

Within the international network of military laboratories, use of LOINC to standardize lab test data has been under way for several years. (See TDR, June 24, 2002.) Because such work puts military labs and the VA ahead of most large health systems, this current endorsement of SNOMED CT is a powerful vote of confidence.

HHS has licensed the English and Spanish language versions of SNOMED CT, which stands for Systematized Nomenclature of Medicine Clinical Terms. SNOMED was developed in collaboration with the United Kingdom’s National Health Service.

In the United States, SNOMED CT will be administered by the National Library of Medicine (NLM), starting in January 2004. It will be accessed through the NLM’s Unified Medical Language System®, also called Metathesaurus®. This is a compendium of “biomedical concepts and terms from many controlled sources.”

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