CCHIT Organizational Teleconference 3

Teleconference #3.

11AM 08-24-2009.

Here's the notes from last friday's meeting.

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OpenEMR Meeting 8/14/09 11:00am

Members announcing their presence at the beginning of the call:

Sam Bowen, MD
Dr. Michael Brody
Selvie Palanasamy
Karthik
Sena Palanasami
Tony McCormick
Yijin Woo
Chris Lucena
John Williams
Jason Morrill

Sam Bowen: Dr. Brody would you review the Meaningful Use criteria and would you give us comments on which should be the highest priority for our project to fix.

Dr. Brody: There are no new updates on the CCHIT Certification at this time.

The 2011 Meaningful Use Measures include capturing discreet data on

1) A1c (lab or manual entry)
Systolic blood pressure
Diastolic blood pressure
Total Cholesterol
LDL Cholesterol
Smoking status yes or no
If yes: Smoking cessation offered yes or no.

2) CPOE: Computerized Physcian order entry. Test ordered, details of test, date of test, status of test.
A Daashboard of pending orders.

3) Beers' criteria - It is fuzzy or unclear which of the Beer's medications / criteria will be implemented. Is there a standard beers criteria that should be used? There should a capture of medication names, compare to the Berr's list, report on Beer's criteria. The problem is that these criteria are terribly stabdardized. My recomendation is to hold off on implementation for now due to technical issues that have yet to be resolved.

4) Dr, Brody: Colorectal cancer screening: It is unclear which method of colorectal screening should be tracked:
Age over 50: yes or no
Was colorectal screening performed yes or no?
What type was it? Hemoccult, rectal exam, flexible sigmidoscopy, colonoscopy.

5) Females over 50 – mammogram

6) High risk of cardiac event:
On aspirin yes or no
Is their a contra indication to aspirin yes or no
From EMR, How do you determine if the patient is at risk of cardiac event?

Sam Bowen, MD:
If there are 2 or more risk factors, they're high risk.
Capture data and calculate a Framingham risk score if > 10% then they are high risk.

Mike Brody: That's the problem. It has not been decided yet how to determine who is at high risk for a cardiovascular event.

7) Received flu vaccine yes or no

8) Report percentage of Lab reports in EMR format
Here again the criteria are fuzzy. Some of the data is translucent such as entered by hand,
Some is structured – it comes in from the lab into database
Some is opaque – such as scanned lab documents

There will be neede some type of report builder to report by gender and race. My recommendation is to examine a report builder tool (3rd party tools available) for users to create their own report.

9) Percentage of generic medicaitons being prescribed. Easiest if combined with e-prescribing..

10) Percentage of high cost imaging studies.

Sam Bowen: It seems that plain x-rays are “low cost”, the ones that don't need appointments.
If it requires a scheduled appointment it will be high cost>

Mike Brody: Again there are a lot of opinions on what a “high cost imaging study is. Imaging tests need to be categorized which will allow reporting. The CPOE module will need a check box that the test is “High cost”

11) Percentage of claims submitted by EDI. I don't see how this is part of the EHR because it is outside of the EHR.

12) Percentage of claims where eligibilty is confirmed.
Sam Bowen: But what if they don't have insurance?
Mike Brody: This is one of the problems. It will be necessary to report on Medicare and Provate insurance.

Tony McCormick: How can this be is the EDI interface is outside of the EMR?

Mike Brody: This is one of the problems.

Tony McCOrmick: This is problematic if they don't have coverage especially when they are referred out for expensive testing.

13) Percentage of patients w/ access to personal health info:
- database driven
- idea: smart card swipe at patient arrival complete w/ rsync of patient data and alert staff of their arrival.
- this grants them access to their personal record and records in the database with time stamp
- patient can opt out of data transfer but still use the checkin/alert system.
- usb drive or smart card will not work without the owner's knowledge (password?)

14) Percentage of patients with access to educational resources
- brouchures in the office qualifies
- do not have to be electronic

15) Percentage of encounters that clinical summaries are given to the patient
- need tool to log summaries on each encounter
- need a button to generate a clinical summary.
- new tool in progress to generate this report from the encounter screen

Logging needs to robust enough to track all interactions, dates and changes in the system

16) Medicine reconciliation
- need a medication reconciliation “popup” or check box "are you still taking these medications" yes/no

17) Percentage of encounters where a document summary is shared with other physicians or insitutiuons
- need to talk to a health information exchange
- Does this mean tracking incoming or outgoing sharing (or both) Patient Care summary:
- log submission of summary as well as the reception to ensure the summary is sent and correctly recieved.
- There seems to be a misunderstanding of the nature of the feature. Suggested to back burner for 1-2 months.

18) Percentage of Up to Date immunizations:
- Work is begun (Chris) on a data interchange for florida “SHOTS” immunizations to be reported to the state.
- adult immunizations need to be added (only children currently) -

Michael Brody this need s database design of N+1.

19) Percentage of lab results submitted electronically
- difficult to track because of so-called opaque data

20) Percentage of HIPPA compliance needs to be measured.
Micke Brody: OEMR can't measure HIPPA compliance because most of HIPPA compliance is inter-office practices.
- when you apply for hippa funds, you have to check the box manually and verify that you are hippa compliant.
- OEMR won't have to worry about it because it's outside the scope of the software.

Selvi: We have done extensive study on the technical requirements of the HIPPA and security rules. Not all of them can be implemented technically. What technical complaints should we focus on with OpenEMR?

Brody: Administrative – deletion of inactive user accounts.
Encryption of information duriong transcryption such as SSL
Health Information Exchange encryption

Mike Brody: I will get this together and deliver this information our next meeting.

Electronic medication prescribing:
- Phyaura - $300 connection fee, $69 per month per dr.
- fred trotter $25-30 per prescriber per month with drug-drug
interaction checking, and other more advanced features. - David Uhlman from clear health $10 per year

Chris Lucena – Allscripts won't talk to me and this is not working out.

Mike Brody: e prescribing should be standardized in lieu of a la cart
- fredd trotter's solution is affordable and can provide all the functionality we need.
- consensus: Fred trotter's solution.

Laboratory module:
- Chris Lucena has a module working using “Hypersend”
- uses hypersend to report the hl7 information
- there is documentation to import the data back into emr,
- but it only works in windows. <- problematic and likely unacceptable
- jude pierre is working on a labcore module - dr bowen has offered to pay for the code to integrate to the project. So far Jude Pierre's group has not accepted this model

Tentative assignment of OpenEMR Modules:
- Tony
- Administrative Billing Support
- wants to rewrite the reporting module due to inadequacies for larger databases
- reporting needs to be logged
- will follow the method used for custom forms
- Computerized physician order entry

Structured Data
- lab results are mapped as a 1 to 1 relationship
- Labcorp provides an sdk to assist with modules.
- Requires pulling a compendium from the Laboratory
- shouldn't require a database change
- the project needs a laboratory module
- Mike is going to contact labcorp to get their sdk and report back for next meeting.

Chris, I don't have available resources for new modules right now. I plan to get with Tony to coordinate efforts. We are working on similar projects.

Disease Management: Yijin Woo described his project which uses Java, Tomcat and Swing with a MySQL back end. In the system a “bunch of tasks” are assigned and then tracked. He is unsure of how this will work with OpenEMR and his role in this. Integration of the disease management with OpenEMR may be difficult. The product identifies patients who need preventive care and enroll in to the preventive care registry or disease registry. The Patient structure data is complicated - comes in different types and in different ranges. It may be possible to share the data schema with OpenEMR.

Yijin Woo: Maviq does not talk to disease registries. Clinical alerts could be generic

John Williams - Garden state health systems and the data exchange
- HIE health care systems integrations shop
- Very familiar with XDS, PIX/PDQ
- willing to contribute knowledge/skills in terms of interoperability to open EMR

Nominations for Board Postitions:
President - Sam Bowen, MD
Vice President - Rod Roark
Secretary - Tony McCormick
Treasurer - David Herman, CPA
Michael Brody
Chris Lucena - interested in a Project Management role
John Williams
Sena Pelanasami - interested in a project management role and technical aspects of the project
Jason Morrill

Project Management:
Chris Lucena (lead manager)
Tony McCormick
John Williams
Sena Pelanasami

Chris Lucena has a background in Project management and volunteered for this position.

Dr Bowen: It may be helpful to work in coordination with Tony McCormick with and John Williams.

We are setting up a Dotproject server at oemr.org to help with this project coordination.

Sena Palanasami: We need a good Architecture coordination. I also need to understand the “Business requirement”. Rod I would like to work with you on the Architecture requirements.

Next Meeting: 2 weeks on Friday 28 Aug 2009 @ 1PM EDT

-- Jeremy Wallace oemr.org