This document provides the optimal functional criteria recommended by the ACC Health IT Committee for members interested in obtaining an EHR. It is a brief checklist and not meant to be an exhaustive review. The field of health IT is rapidly evolving and it is expected that this selection tool will need future revision.
Some of the functionality in this list is not yet established. It is suggested that you get from your EHR vendor both a timetable and contractual commitment in your EHR purchase contract to incorporate the missing functionality once it is established. Additionally, usability (also called the user interface) is a major selection factor that can only be determined by experience from others and a “hands-on” trial of the EHR. The ACC cannot endorse specific health IT products and the selection process for an individual practice is highly dependent on an in-depth needs assessment.
Optimal Criteria
Additional Features to Consider
Additional Questions to Ask Your Vendor
Optimal Criteria
1. CCHIT Certification
EHRs should have received Ambulatory EHR Certification per the requirements of the Certification Commission for Health Information Technology (CCHIT). In addition, CCHIT’s Cardiovascular Medicine certification for Ambulatory EHRs is highly desirable. The CCHIT Ambulatory certification process focuses on both required and desired functionality for the office setting. The objective testing conducted by CCHIT requires 100 percent compliance spanning the areas of functionality, interoperability, and security and privacy. Certification should be for the most recent criteria released as prior year criteria may be less stringent. The term of certification is currently two years. The benefit of a CCHIT-Certified EHR is that you know the application will meet minimum standards and you should insist that your vendor commits to maintaining CCHIT certification.
2. Use an Application Service Provider (ASP) solution
Unless you have very specific needs, select a vendor that provides the EHR via an application service provider (ASP) model. An ASP vendor hosts the servers, maintains the software, and takes care of all the IT issues related to the operation of the application. For example, Web-based email solutions provided by Yahoo, Gmail, and Hotmail follow the ASP model – all you need is a Web-browser and a connection to the Internet. With an ASP solution, there is typically only a nominal start-up charge, and monthly maintenance fees are determined by usage. The alternative, the traditional “client-server” solution, should be considered only if you are in a large practice (>12-15 cardiologists). The client-server approach requires substantial capital outlay as you will be hosting your own hardware, purchasing the software, and will need IT staff to maintain, service, update and troubleshoot the system.
3. Integrated e-Prescribing
e-Prescribing is a foundational component of any EHR solution. Functionality of the e-Prescribing module is assured if the EHR has received CCHIT certification. This will include bidirectional electronic transmission of prescription data (via SureScripts/RxHub) and compliance with the Medicare Modernization Act of 2003 Part D prescription drug program.
4. Compliance with IHE Profiles specific to your practice
Vendors who actively participate in the Integrating the Healthcare Enterprise (IHE) survey and certification process have a proven commitment to interoperability. IHE is a non-profit organization that works with HIT vendors to define and demonstrate data transfer and information exchange between devices and health IT systems as well as the modeling of system to system interfaces. There are a number of profiles applicable to typically cardiology workflows. The importance of data interchange and interoperability among systems cannot be overstated.
5. Compliance with HIPAA
HIPAA is central to US legal requirements regarding patient privacy, system security, and transaction processing.
6. Eligibility for ARRA Stimulus funds
Meaningful use of the EHR solution should allow the practice to be eligible for EHR Incentive Program. Requirements of “qualified” EHR solutions include the following:
• Certified as meeting standards pursuant to ARRA
• Manages patient demographic & clinical health information, including medications and the problem list
• Has the capacity to:
– Provide clinical decision support
– Support order entry
– Capture, query, and report on health care quality
– Participate in e-Exchange / integration of health information from other sources
7. Minimum installed base of 100 active practices.
The EHR should be established in the marketplace and there should be a minimum installed base of 100 active physician office environments currently using the product. This helps ensure that the vendor has demonstrated viability in the marketplace and is large enough to provide customer support and business continuity at a level adequate for ACC members. Also, ask about the characteristics of the physician practices cited. Are they large groups, small groups, exclusively cardiology or mixed specialty groups?
8. The EHR can be integrated with your practice management system (PMS).
The ability to exchange data with your office PM system is essential for a successful EHR implementation. The simplest approach is to use a single vendor for both PMS and EHR solutions; the alternative is to have separately vended solutions that share the requisite data seamlessly.
9. The practice should “own” the EHR data.
The practice must be the sole legal entity with ownership control over the data. This includes the export of data from the EHR solution into any other EHR in the event that you decide to change vendors. The export format should be in a generalized format such as CDA (clinical data architecture) that can be imported into another vendor’s product. The EHR must also be able to export a report of an individual patient’s data in both paper and electronic formats upon patient request or in the event that the patient leaves the practice.
10. Ancillary system connectivity
Ask the vendor for a list of all ancillary systems such as laboratory vendors (e.g., LabCorp, Quest) ECG systems, PACs systems, and office practice management systems from which information can be automatically imported. Make sure the ancillary systems with which your practice wants to connect are supported and included in the software contract.
11. EHR upgrades
Does the vendor provide free upgrades required as a result of changes in government-mandated programs and registries, or will the client have to purchase such required upgrades?
12. Support
Make sure the EHR vendor support hours match your practices hours of operation.
Additional EHR features and functionality to consider depending on your specific practice needs:
1. The ability to interface with dictation vendors and/or speech recognition software.
2. The ability to create ad hoc reports at both the physician and practice levels for practice management, quality improvement, and compliance.
3. The ability to allow for remote secure access 24/hour day.
4. Cardiology specific templates for physical examination, data review and consultations, including fields for discrete data elements.
5. The ability to generate high quality professional consultation letters from within the EHR.
6. Ability to scan documents and reports.
7. Capacity for the autofaxing of documents.
Additional questions to ask EHR vendor:
1. Does (or will) your EHR support “automatic” PQRI reporting without requiring specific intervention by the provider?
2. Does your EHR have interoperability plug-ins available for labs, clinical messaging, etc.?
3. As of January 2009, protected health information is no longer protected by HIPAA exemptions for Treatment, Payment or Operations. Can an audit trail be created of all protected health information use?
4. When accessing the EHR from a remote site or public computer, how does vendor ensure security?
5. If you have a local Regional Health Information Organization or Health Information Exchange with which you want to share patient information, is the EHR interoperable with the RHIO or HIE?