Section 1.2 Assess

Readiness Assessment for e-Health Adoption in Local Public Health

Use this tool to assess your local public health (LPH) department’s readiness to adopt electronic health records (EHR), health information exchange (HIE), and other health information technology (HIT). Readiness considerations include support for investment, incentives, interoperability, and addressing myths and realities.

Time needed: 4 hoursSuggested other tools: NA

How to Use

1. Review the categories of readiness to assess where your organization needs to focus some attention.

2. Create a plan for shoring up your organization’s readiness to go forward with planning, selection, and implementation.

3. Appreciate that there are no absolute answers or quick fixes. Adopting HIT is a continuing journey that will benefit from adoption of standards but is still very unique to each organization.

Technology Investment Readiness“Investment” typically leads people to think about how much something costs; but when considering HIT, investment also involves the perceived value of the investment as compared to both cost and time to plan, select, implement, maintain, and optimize use of the technology.

Cost of HIT has an enormous range depending on what you buy. (See Section 1.12 Financial Assessment Financing Resources, and Acquisition Models for EHR, HIE and other HIT for information about how to finance the investment.)

Perhaps the best way to consider cost relates to the federal incentives for meaningful use (MU) of EHR. Although LPH departments generally are not in a position to earn these incentives, the publicly available data surrounding the incentive amount is a useful reference point. Under Medicare, each eligible professional (EP) can earn up to $44,000 in five years if the EP started attesting by 2012. The Centers for Medicare & Medicaid Services (CMS) determined this was the appropriate amount based on the following average costs:

Initial average cost of EHR software and its implementationspent in year 1 for one EP $25,000

Maintenance fees of 18% for the remaining 4 years 18,000 Cost of personal computer 1,000

$44,000

The above costs do not include any ongoing Internet Service Provider (ISP) fees (average $50 per month) or other overhead costs. Realistically for an LPH department, the $25,000 figure is at the high end of the cost spectrum for EHR.

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Interoperability ReadinessAssess your readiness for standards adoption. Consider any HIT vendor’s compliance with applicable standards that will support the ability of your organization’s applications to exchange data electronically. The Office of the National Coordinator for Health Information Technology (ONC) describes interoperability as “the ability of two or more systems or components to exchange information and use the information that has been exchanged.” The predominant standards development organization in health care, Health Level Seven (HL7), in its 2007 report “Coming to Terms: Scoping Interoperability for Health Care,” further broke down interoperability into three principles:

1. Technical interoperability is the basic, hardware-based form of interoperability that focuses on data transmission. For example, if the standard way to express a person’s name in an EHR is “Last, First”, then “Smith, Susan” could be correctly exchanged between two systems. However, if there is no specification, “Smith, Susan” and “Susan Smith” could both be acceptable alternatives. When name information is exchanged between a provider’s EHR and the e-prescribing (e-Rx) system, for example, the e-Rx could be confused and would require a conversion process to reconcile differences. While standards are being adopted in order to

improve exchange of data, many intermediary processes currently are required to make technical interoperability work between the various components of the industry.

2. Semantic interoperability is the ability for information exchanged across systems to be understood by using a standard vocabulary. Just as in technical interoperability standards, however, there are many standard terminologies that need to be converted from one to another (a process called mapping) in order to achieve true interoperability. Users must also be

willing to adopt the standard terminology or terminologies that apply to them.

For example, if an order for a lab test in the physician’s EHR uses the Current Procedural Terminology (CPT) (also used to bill for physician services), the code 82150 would be understood to mean 24-hour urine amylase. However, if the receiving system was using the Logical Observation Identifiers Names and Codes (LOINC) vocabulary, it would not interpret

the nature of the test correctly unless a mapping process supported reconciliation.

Physicians and hospitals also very commonly use the RxNorm system. It is a naming system for generic and brand name drugs, as well as a tool for supporting semantic interoperability between drug terminologies and drug knowledge base systems that support the provision of alerts and reminders about drug contraindications as providers enter drug orders/prescriptions into EHRs or e-Rx systems.

In the example below, a nursing diagnosis is made by a hospital nurse using the North America Nursing Diagnosis Association (NANDA) terminology. It may be desirable to send this

to an LPH department, but the department uses the Omaha System of nursing terminology. In addition, both the hospital and LPH may need to convert the NANDA code to the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9- CM) for billing. To facilitate these conversions, the hospital, LPH department, and others may send the information to the HIE organization (HIO) where a terminology server can map all of these codes to SNOMED CT and back to other terminologies depending on how they will be used. SNOMED-CT is an internationally recognized vocabulary standard (also required by the U.S. MU program for documenting a patient’s problem list in the EHR). The SNOMED CT codes can support various types of analytics and reporting that can feed back into EHRs and other HIT systems as new health care protocols.

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Finally, for mental health services, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is frequently used to convey diagnostic information. It is compatible with ICD-9-CM for billing purposes, and also includes the ICD- 10-

CM codes in parentheses for use when ICD-10-CM is adopted.

3. Process interoperability is an emerging concept that addresses methods for optimal integration of HIT into health care work. This concept includes:

Explicit user role specification.

Useful, friendly, and efficient human-machine interface.

Data presentation/flow that supports work setting.

Engineered work design.

Proven effectiveness in actual use.

Standardized consent forms that allow all persons to make choices about disclosures of their health information.

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Copyright © 2014 Stratis Health. Updated 03-10-14

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