In July 2010, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology each published documents establishing the requirements that hospitals and eligible professionals must meet to achieve "Meaningful Use" of electronic health record (EHR) solutions and thus qualify for financial incentives as stipulated in the health information technology provisions of the American Recovery and Reinvestment Act of 2009. The tenets of Meaningful Use include the implementation and utilization of certified EHR solutions in a manner that promotes interoperable health information, improves the quality of health care and care coordination, and reports on quality measures.
A key foundational principle of Meaningful Use is the interoperable interchange of data. To further this agenda with respect to cardiovascular data, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) has released the ACCF/AHA Key Data Elements and Definitions of a Base Cardiovascular Vocabulary for Electronic Health Records. According to the writing committee, data element terms were selected because they fulfilled at least one of four criteria: the term represents a waypoint in care, is used in quality reporting, describes an implanted device and/or is included in models of risk or outcome.
James E. Tcheng, MD, FACC, vice chair of the writing committee and professor of medicine and professor of family medicine (informatics) at Duke University Medical Center, called the report groundbreaking work that brings the medical community together by identifying a very limited, parsimonious vocabulary to serve as the base “language of cardiology.”
Included in the report:
- The writing committee explicitly elected not to include patient identification, demographic, and administrative information such as patient sex or site of service, diagnosis, and other fundamental concept terms, including data by specific medication, as defined data elements, which are expected to be generically available in all EHR solutions.
- The data elements chosen for inclusion in the “History and Physical Examination” table are those with predictive value in risk models of acute and chronic cardiovascular disease, particularly acute coronary syndromes, ST-segment elevation acute myocardial infarction, heart failure, and sudden death. Information about the medical history and risk factors is key in appropriate use assessment, quality performance measurement, clinical research, and clinical care. The elements chosen are purposely intended to replicate commonly collected data elements and reflect current consensus guidelines on the classification of disease states.
- Only 11 laboratory testing elements are listed, reflecting the laboratory tests most likely to be followed longitudinally by cardiologists for the purpose of cardiovascular risk mitigation via direct interventional management of the laboratory abnormalities.
- While the list includes nearly 100 terms, physicians will likely be directly capturing only three to five of the terms as data per typical cardiovascular encounter, said Tcheng. Many of the terms are intended to be derived automatically by the EHR system and will not explicitly require input from the physician. Ideally these terms should be used by all clinicians in all EHR systems when documenting the evaluation and follow-up of patients with cardiovascular disease, he said.
To learn more, read the Journal Scan summary or the full study.