Thoughts on my First Week at an EHR Company

As I gather my thoughts on my first week at Practice Fusion, I’m wondering, “Where do I begin?” It’s hard to divulge all the details of my week on the Community Team here, because I have realized that a working week here is more like a working month. I have accomplished more in a week than I ever thought I would, but let me tell you, my brain is swelling with information and getting stronger every minute. I thought it would be good to share with the EHRBloggers community a few thoughts from a new Practice Fusion hire.

 My fellow EHRBlogger

Coming from the relaxed schedule of a college student (University of Arizona), it feels refreshing to be a part of this team and of the broader Electronic Health Records sector. From a patient stand-point, I can’t thank the IT-Gods enough. I don’t know how many trees have been killed from me filling out form after intake form for my various physician visits throughout the year. Paper is so last year.

It’s exciting to be a part of the growing movement promoting paperless medicine while also doing something good for the environment. Every time I think about what we are doing, I can’t help but feel special to be a part of this “healthcare revolution”.
The Fusionistas, as I think I might start calling my co-workers, beam with love for their company. You can tell it’s not fabricated-love either. They seriously love to work here which only makes them work that much harder. Our blog team of Dr. Laffel and Dr. Rowley are at the front of this charge!

My role at Practice Fusion is social media. I’m a social-media addict, as I am always on Facebook or Twitter, trying to keep up with the world one tweet at a time. As I learn about the health IT sector, this will give me the opportunity to talk about Practice Fusion with the world. Practice Fusion has one of the largest social media communities in the business, driving people to use a service that, in my eyes, has revolutionized the way we see EHR’s. I still ooo and aahh every time I learn more about some of the mind-boggling features of the program.

I’ll be a regular feature on EHRBloggers as I get settled into my new role. What you can expect from me:

• Wit and energy in everything I do
• Social media geekdom at its finest
• Passion for change in healthcare technology and the utilization of EHR’s
• A fresh perspective on daily life at Practice Fusion
• Honest conversations about our business and community

I would love your feedback as I start my health IT journey. Let me know if there are any tips or advice you want to share with me as I start my Practice Fusion adventure and I promise to put your input to good use!

Shea Steinberg
Jr. Social Media Specialist
Practice Fusion

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Do EMRs improve health care?

After reading a recent thoughtful piece by David Kibbe and Brian Klepper on the future of medicine and Health IT after Meaningful Use, and looking at the kinds of comments subsequently posted, the question that came to mind was: what role do Electronic Health Records (EHRs) play in improving the quality of health care, and reducing costs?

Many of the opinions about what EHRs can and cannot do are based on what EHRs have been, not on what they will need to be in a post-Meaningful Use era. In the past, EHRs have been chart-note documentation tools, and often have been billing-maximization assistants that help practitioners thoroughly document the justification for higher-dollar coding. The legacy has been that the data created by these EHRs is kept in practice-centered silos (much like paper charts are). The results from this kind of legacy is what has been the backdrop for opinions that EHRs don’t really change the health care system very much, and in fact get in the way of efficient care.

Do EHRs reduce health care costs? No, not directly. Though they can be a useful tool to avoid duplication of services, when different practice-centered systems are able to “talk” to each other. If a patient sees 5 different doctors, and none of them know much about what the other is doing (other than, maybe and at best, a cursory referral statement indicating the reason for the referrals) – or maybe they don’t even know that each other is involved in the case, in an uncoordinated care setting where the patient initiates each visit on their own – the likelihood that many of the same tests (e.g. blood tests) are duplicated by several of the practitioners is high. Even if several of those consultants have locally-housed EHR systems, the likelihood of duplication is not changed if each one can’t see what the other is doing. Put this into context: typically, a given patient sees 18.7 different physicians, and the odds that multiple such physicians will perform the same tests that others have already done is very high. This is a simple example of medical waste and unnecessary costs that “could” be reduced, if EHRs were to function as envisioned.

Unlike the legacy of EHRs, where most of our experience is based, Meaningful Use and HHS Certification drives new systems to do more than they have in the past. Interoperability (between systems, and also with the patient directly), clinical decision support, and measuring/reporting Clinical Quality Measures are the areas that are spurred by the National Health Priorities which set the stage for Meaningful Use criteria.

So, what about health care costs? Will EHR adoption change how physicians are compensated? No – but novel models of healthcare reimbursement, such as Accountable Care Organizations, are based on a presumption of widespread use of modern EHR technology. Expanded coverage of currently-uninsured Americans as addressed in the Patient Protection and Affordable Care Act, is also seen as being deployed through such new and experimental methods.

What about malpractice risk, and the role of “defensive medicine” in creating unnecessary health care cost? Will EHR use change tort reform? No, not directly. Legacy EHR systems have certainly had little or no impact on this issue. However, EHRs under Meaningful Use contain Clinical Quality Measures, which are derived from evidence-based standards drawn from the National Quality Forum (NQF). One could argue that making medical decisions guided by these well-accepted principles will (1) reduce malpractice risk when these guidelines are pursued, and (2) actually improve the quality of care, given that the guidelines have strong evidence that they result in improved outcomes. Leveraging an EHR to bring these guidelines to the point of care is a vision of the future, and not something that EHR legacy has much experience in providing, to date.

Will using an EHR make the daily workflow of a physician easier? Is it faster than paper? Probably not, at least not in the short term. The learning curve will likely slow a physician down, by requiring the lookup of things like diagnosis codes and medications from structured lists – EHR usability is a big factor here. But, like with orthodontia, it’s uncomfortable at first, but the result is (eventually) significantly improved.

EHRs are a tool, and simply that. Our experience with what EHRs have been tend to color our view of what the will become. Bringing things like data sharing between practitioners in order to coordinate care and reduce duplication, and clinical quality measures to the point of care – these are things that we have little experience in doing, so far. Likely, EHRs will make the individual work-day of physicians maybe faster (or, initially, maybe not), but certainly more thorough, more legible, and more portable.

However, on a macro level, EHRs (when used in a widespread, meaningful way) will be an important tool required to move overall health care in a positive direction – measurably improved quality, better outcomes, reduced errors (malpractice), and (as a by-product) reduced cost. Not to be too technology-enamored, certainly other structural issues in health care need to changed in order to make a difference. Compensation change needs to happen in order to encourage a coordinated, less-chaotic and variable health care delivery system, and to stem the tide of frightening attrition in primary care. Tort reform needs to address changes in malpractice, when standard-of-care methods are put into place at the point of care, so that “defensive medicine” can be reduced. These structural changes, long in the talking phase and yet-to-be delivered, are necessary for us to move forward. And the role of EHRs in these changes is central.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR

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ONC Appoints Two EMR Certification Bodies

This Monday, the Office of the National Coordinator for Health Information Technology (ONC) announced that it had designated two organizations, Drummond Group, Inc., and the Certification Commission for Health Information Technology (CCHIT) to serve as Authorized Testing and Certification Bodies (ONC-ATCBs).

The announcement effectively ended CCHIT’s longstanding monopoly on the EMR certification process. It created a market for certification services in which these two organizations, and perhaps others to be designated later, compete on price and service.

With the announcement, ONC empowered both agencies to test and certify that EMRs comply with the standards, implementation specifications, and certification criteria that HHS adopted after receiving recommendations for these criteria from the ONC itself.

The announcement is important because providers must use EMR technology that has been certified by an ONC-ATCB in order to qualify for incentive payments under the HITECH Act. Previous certification by CCHIT—using its own home-grown criteria—does not position EMRs to support providers who want to qualify for these incentives. Only providers using EMRs that are certified using the new HHS criteria can qualify.

“Less than two months following the issuance of final meaningful use rules, we have approved our initial ONC-ATCB certifiers,” said David Blumenthal, the national coordinator for Health Information Technology. “These products will be aligned with one another on key standards…doctors and hospitals can invest with confidence in these certified systems.”

ONC claims that it is reviewing additional applications for the coveted designation. To our knowledge, no other organization has made public its desire to become a certifying agent for comprehensive EMRs.

Certification of EMRs is part of a broad initiative to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including EMRs and private and secure electronic health information exchange. The legislative underpinnings of this initiative are found in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the American Recovery and Reinvestment Act (ARRA) of 2009.

HITECH set aside incentive payments of up to $27 billion for eligible providers who “Meaningfully Use” an EMR that has been certified by an ONC-ATCB. Physicians, nurse practitioners and other eligible providers can receive up to $44,000 through Medicare or $64,000 through Medicaid if they qualify for that latter payout. Hospitals can receive millions. The first incentive payments are to be released in May, 2011.

The national Health IT initiative “is on an aggressive schedule to meet the urgent targets set by Congress and the President toward realizing the quality and safety improvements that we can achieve through health information technology,” Blumenthal said.

"Drummond Group has been working for months to meet the stringent criteria set forth by ONC to become certified as an ONC-ATCB, and we are very pleased that ONC has recognized our efforts and our competency to be an approved testing and certification body," said Rik Drummond, CEO Drummond Group Inc.

"We are pleased to offer over ten years of software testing and certification experience in other industries to Healthcare,” Drummond added. “After executing several pilots on existing EHR products and working with industry consultants, our organization is more than prepared to test and certify healthcare products. With our approval as an ONC-ATCB, EHR vendors and implementers can have full confidence in our testing and certification services."

“We are gratified to be among the first organizations authorized to certify EHRs by ONC,” said Karen Bell, the chair of CCHIT. “As the originator of EHR certification, CCHIT has tested and certified hundreds of EHRs. Our experience has enabled us to promptly adapt our processes to accommodate the certification and standards adopted by HHS to support the meaningful use of EHRs by healthcare providers.”

Glenn Laffel, MD, PhD
Sr VP Clinical Affairs
Practice Fusion EMR

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EMR Meaningful Use remains difficult for hospitals

Hospitals will be hard pressed to meet Meaningful Use standards for Electronic Health Record (EHR) implementation. Small and rural hospitals are especially affected. Such is the finding of a recent survey of 3,101 hospitals surveyed by the American Hospital Association. The report, published in Health Affairs on August 26th, reveals that only 11.9% of U.S. hospitals had adopted at least basic electronic medical records at the time of the survey (2009), and only about 2% had done enough to quality for government financial incentives (as anticipated from the questions, matched against the now-know criteria).

Of course, hospitals and “eligible providers” (i.e. doctors) can wait until the end of 2011 and still receive full funding, so a ramp-up of purchase and adoption of EHRs is likely in 2010 and 2011. The study’s lead author, Ashish Jha (associate professor of public health at Harvard School of Public Health and senior advisor to under-secretary for health at the Veterans Health Administration), told the Wall Street Journal that it is not surprising that such a low adoption in 2009 was seen – given horrible economic conditions, difficulty raising money for capital investments, and uncertainty over what the final government requirements would be.

However, Jha stated, it is unlikely that adoption will jump from 2% to 40%. More likely, we will see adoption of hospital Meaningful Use-compliant EHR systems go from 2% to 5% in 2010, to 15% or 20% by 2011.

The findings in the survey also point out a widening gap among hospitals. Among larger, nonprofit, urban hospitals, 7.5% would have met the criteria. However, critical-access, small or medium-sized, public or rural hospitals only showed a 1.2% Meaningful Use readiness rate.

These figures show that hospitals are more challenged by Meaningful Use than physicians and other “eligible providers.” Largely, this comes from the fact that the main thrust of the EHR vendor legacy has been to create locally-installed enterprise products centered in large institutions, with heavy IT budgets, and the capability to pull all the systems together – at a very steep price.

Small hospitals, on the other hand, are still grappling with trying to knit their own internal systems together – labs, x-ray/imaging, pharmacy, order entry and management, and medical records. These systems have historically been separate, department-focused legacy systems purchased by each department for its own internal use. Getting them all coordinated, on a single platform, has been difficult, and mainly large-budget hospitals is where this has been achieved more-or-less successfully.

Given that this is where many small hospitals are still focused, Meaningful Use can seem overwhelming. As is true for “eligible providers” also, the EHR needs to maintain up-to-date problem lists, active medications, active allergies, vital signs, automatic BMI calculation and growth chart plots, keep track of formulary and drug-drug and drug-allergy interactions. Medication reconciliation, submission of vaccination events to immunization registries, and generation of patient lists selected for demographics, diagnosis, medications and lab findings – these must also take place. Hospital-specific criteria include a Computer Physician Order Entry (CPOE) system that can (at a minimum) track orders for medications, laboratory and radiology/imaging; must provide an electronic copy of discharge summaries; and must track 15 Clinical Quality Metrics around the domains of Emergency Room throughput, management of stroke, and management of venous thromboembolism.

On the ambulatory-EHR side of the house, small practices have found web-based EHRs very appealing and popular. Practice Fusion has experienced very rapid adoption, now with tens of thousands of physicians seeing several million patients. Larger practice settings, like clinics, closely hospital-affiliated doctors, and coherent medical groups, have still thought in terms of locally installed (and expensive) legacy systems. But smaller practices don’t want the cost and maintenance headaches of servers, local networks, and all the infrastructure needed to run such an EHR – the appeal of a web-based system is compelling.

Unfortunately, the current state of products available for hospital-based EHRs has not enjoyed the option of web-based products. This is unfortunate, and is an opportunity for companies to create such products for the smaller and rural hospitals who are not in a position to purchase and maintain a locally-installed system. As seen with ambulatory EHRs, the only realistic pathway for small hospitals to achieve Meaningful Use may well be via web-based systems. Numerous observers felt that small physician practices would “never” adopt ambulatory EHRs, thinking only in terms of the expensive legacy systems that were focused on large-group customers. But web-based options have challenged that paradigm. The same may turn out to be true for small hospitals as well.


Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR

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Entrepreneurship, Philanthropy and American Capitalism

Last month, 40 US billionaires including Bill Gates and Warren Buffett agreed to donate at least half their fortunes to worthwhile causes. Their actions reflect a keen sense of social responsibility and follow a tradition first established by Andrew Carnegie, John Rockefeller and other successful entrepreneurs of the past 2 centuries.

In the broadest sense, these behaviors can be seen as part of a virtuous cycle of American capitalism, in which our uniquely entrepreneurial culture creates both wealth and the philanthropic mechanisms by which that wealth can be recycled.

Some suggest that this cycle is the defining characteristic of American capitalism. In fact, many conservatives and supporters of private enterprise believe this is single most important mechanism by which our economy differs from socialist economies, in which government takes responsibility for recycling wealth, and the economies of developing nations, in which the fortunes of those in control are almost never recycled.

These are the same people that believe low tax rates, small government, and light-handed regulatory strategies are the proper elixir for long-term economic growth.

The problem with this approach, according to Washington Post columnist Steven Pearlstein, is that it ignores other mechanisms that serve to buffer the economic inequalities that inevitably result from the US brand of capitalism. Pearlstein cites unions, “which ensured a fair distribution of corporate profits,” as well as antitrust laws which prevent large companies “from snuffing out entrepreneurial competition,” for example. He also mentions “tax-supported schools, playgrounds and hospitals that were good enough to be used by rich and poor alike.”

Pearlstein contends that regardless of which party has governed our country in the past 2 decades, the American political system has progressively savaged these other buffers to a point where economic inequalities in the US are greater than they have been in the last century. CBO data from 2007 show for example, that the richest 20% of US households amassed 52% of the country’s after-tax income. The top 1% earned a whopping 17% of such income. In the 2 decades before 2007, “the average after-tax, inflation-adjusted income of households in the middle of the ladder increased 25%; for the top 1 percent, it rose 281 percent,” Pearlstein wrote.

As these inequalities increase, poor people find it increasingly difficult to improve their economic position. In fact, a recent study by Isabel Sawhill and Ron Haskins of the Brookings Institution showed that while US citizens born into the middle class remain quite mobile economically, those born into wealth and poverty tend to stay there throughout their lives. Shockingly, US citizens nowadays enjoy less economic mobility their counterparts in France, Germany and Canada, at least according to some measures.

“The idea that equality of opportunity is a distinctly American strength is a myth,” concluded Sawhill and Haskins.

The endemic problem of economic “stickiness” was easier to swallow when the US economy was growing robustly, creating jobs and income opportunities for much of our population, but the Great Recession of 2008-2010 has changed that. It has imperiled the most fundamental American dream: that with hard work and some old fashioned ingenuity, people, or at least their children, might be able to improve their standing in society.

No one argues that Gates, Buffett and their wealthy contemporaries did a marvelous thing last month. Their generosity will help millions of people. But as Pearlstein says, “it will take much more to revive the virtuous cycle by which wealth begets opportunity which in turn begets more wealth. Whether at an individual company or in the country at large, it is the feeling that we are all in it together that creates the basis for a truly vibrant economy and just society. Trickle-down alone won’t cut it.”

Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs
Practice Fusion EMR

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Science Fiction Becoming Health IT Reality

Robot nurses?  Virtual doctor's visits? Face recognition sign-on?  Tablet computers with Clinical Decision Support?  These concepts have existed in science fiction for decades. And unlike flying cars, they're quickly becoming a reality in the healthcare sector.

A group from Practice Fusion was invited to tour the Kaiser Permanente Garfield Innovation Center earlier this week and saw these innovations in person (we have an innovation lab at Practice Fusion too, albeit much much smaller).  Along with a general shift towards higher-quality service for patients such as single bed hospital rooms that look like four star hotels, Kaiser was testing cutting edge technology including:

• RFID trackers for patients and hospital staff with real-time monitors and alerts
• In-flight-style TV interface for patients to see their daily schedule, control lighting, order food, and watch videos about their procedures and diagnoses
• Kiosk check in with integrated intake and payment processing
• Internet connected operating rooms for sharing images, accessing records and getting advice from specialists in real-time
• Portable tablet computers for nurses and doctors on hospital wards
• Facial recognition to speed up provider login to computer systems
• Telemedicine systems for connecting patients at home or the office to providers
• Wireless home health devices like bloodpressure monitors and scales. 
• Virtual laser keyboards to reduce infection risks
• Robots that deliver supplies, medications and blankets around a hospital facility

Kaiser is easily a leader in testing and implementing new technology for the hospital setting. And there were innovations on the ambulatory side too, but fewer. New exam room layouts didn't look much different than the exam rooms we're used to seeing from the past decade. Instead of some of the creative computer installation we've seen from the Practice Fusion community - mounted flat screen TVs as monitors, digital cameras, wireless keyboards, desks where patients and providers can interact - the exam rooms had laptops on bulky "COW" carts. The connected devices and imaging tools seen in the hospital rooms, weren't present in the test clinics.

All this to say - not that Kaiser isn't a visionary role model for the health IT sector - but that it was amazing to realize Practice Fusion users are advancing technology in the clinical setting even faster than this titan of medicine.

We have users who practice entirely without an office, making housecalls with a 3G card and laptop, other users who have created bright, modern paperless practices. The level of innovation in our community of 43,000 medical professionals rivals even a medical system with $42 billion a year in operating revenue.

We like to say "free changes everything" - and it's proven in the Practice Fusion community. When you replace a bulky $50,000/year EMR system with a free, web-based EHR, even the smallest medical practice has the budget and the time to implement cutting edge technology. 

Emily Peters
Director of Communications
Practice Fusion

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EMRs need to report public health information

The ability of an Electronic Health Record (EHR) to submit syndrome-based public health surveillance information is one of the key elements for HHS Certification, and is needed for Meaningful Use bonus money access. It is one of the 5 policy priorities, upon which the Meaningful Use criteria are based.

So what, exactly, does this mean? A careful look at the certification criterion shows that an EHR needs to be able to manage and package public health syndrome information into a standard output format (HL7 v2.5.1). However, the certification document does not define exactly what kinds of events should trigger this reporting – it is left up to the vendor to define what kinds of things result in generating such an HL7 file.

To the public, that means that the kinds of events that trigger the standard-format reporting can vary, depending on the EHR system that is purchased or used.

There are two different kinds of health information that are addressed by the Centers for Disease Control (CDC) – (1) Nationally Notifiable Diseases and Other Conditions, and (2) Syndromic Surveillance. They are managed by two different branches of the CDC, and appear to have little overlap.

Notifiable conditions
The Nationally Notifiable Disease Surveillance (NNDS) consists of a collection of conditions which must be reported. These conditions change from year to year, and for 2010 consist of 96 conditions that need to be reported – these are the kinds of things that physicians are used to reporting (via paper reports) to local county health agencies, such as tuberculosis cases, salmonella outbreaks, etc. The CDC assigns an NNDS Code for each of these events – however, these codes are local to NNDS and are not shared with any other common coding system such as ICD9 or LOINC.

Identification of reportable illnesses has generally been manual, and therefore results in significant under-reporting of conditions as they are seen “in the field.” The burden is on the clinician or the laboratory to recognize that a Notifiable Condition exists – for example, when a reference lab reports a positive tuberculosis culture, they notify the local public health agency directly. There have been studies of ways to map lab-based LOINC codes (the standardized codes used by laboratories to identify test types) to the Notifiable Conditions codes, which is relevant to lab systems. As yet, the CDC does not offer such a mapping cross-walk (it would be good if they did).

A 20-year-old study (published 1990) of mapping diagnosis codes (ICD9-CM codes) from billing systems to Notifiable Conditions codes showed such an approach to be inaccurate. However, technology has changed, EHRs have come into center stage, and using EHR-based diagnoses (rather than billing-system codes) to create a prompt may be just what the intended HHS Certification had in mind.

Perhaps the best way forward for EHRs is to create an alert when a new diagnosis is entered that maps to a Notifiable Condition, and prompts a question like: “this diagnosis is a reportable condition. Do you want to generate a report to public health authorities?” The clinician is therefore prompted, and can exercise clinical judgment on generating reports. The Certified EHR will therefore be able to create the HL7 output required for certification and for Meaningful Use demonstration.

Exactly how such reports should be routed to local health agencies is still unclear. Traditionally, it is the local county public health agency who receives reports of Notifiable Conditions (on paper, or sometimes by a manual web interface), and they turn around and report their findings to the CDC. Will EHRs be expected to send directly to the local public health agency (assuming they have the capacity to receive and digest these HL7 reports)? Will this go through a local Health Information Exchange (HIE)? HIEs are regional or state-wide; public health agencies are at the county level. Will the onus be on the individual physician to make the electronic connection with the local health agency, or route it through the local HIE? These questions are still uncertain, and should become clearer as the public health capabilities of local agencies matures with time.

Syndromic surveillance
As opposed to reporting Notifiable Conditions, which has a long public health legacy, “syndromic surveillance” is newer. It mainly comes from bioterrorism preparedness, and the CDC documents date from 2003 (and have not been updated since). The CDC describes this activity thusly: The term “syndromic surveillance” applies to surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response. Though historically syndromic surveillance has been utilized to target investigation of potential cases, its utility for detecting outbreaks associated with bioterrorism is increasingly being explored by public health officials.

The CDC has published lists of ICD9-CM codes which should be reported. These data contain some very common conditions, which can thus result in very large volumes of data being reported. The data is not patient-identified – it is merely the appearance of a diagnosis and its location. The intent is to do this in the background, without an item-by-item alert being popped up by an EHR.

To date, such “syndromic surveillance” has been carried out in demonstration sites, and are not widely implemented. It is certainly not clear whether the CDC is able to absorb these kinds of data volumes, and whether the HL7 v2.5.1 file specification is appropriate for such reporting (given that the HL7 specification includes patient-identifying data). Unlike Notifiable Conditions reporting, which is to the local county public health agency, the “syndromic surveillance” reporting is directly to the CDC at the national level.

The emergence of web-based technology in the EHR realm also challenges such efforts. Likely, the thinking behind such “syndromic surveillance” pilots was that health data is locally installed into data silos within institutions, and therefore making a series of one-to-one connections between a health institution’s EHR system and the CDC is a long, tedious process. Hence, the emergence of pilot demonstration sites. However, web-based EHRs are not locally deployed, and are not based on a one-on-one connection between each physician office and the CDC. Web technology implies a single connection to the web vendor is all that is needed for reporting, which will instantaneously channel a flood of data from all users everywhere to the recipient. Is the CDC ready for a data feed of hundreds of thousands of data points being submitted every single day, from all across the country? This would more likely be better handled through a web-services API connection than through the HL7 method, but this is not addressed in the Certification documentation.

Conclusions

• Public Health reporting is a national priority, and is part of Meaningful Use, and Certification.

• The Certification requirements focus on packaging output documents from the EHR in a standard HL7 format, not on what kinds of events should trigger such a report

• It is up to the vendors to decide what kinds of events should trigger a public health report. Therefore, the experience of a physician can vary, depending on what EHR system is deployed

• Reporting of Notifiable Conditions is likely the best approach for such an implementation. Routing such reports to local public health authorities is still uncertain – direct reporting vs. reporting via local HIEs has yet to be worked out

• Syndromic Surveillance at a national level is still out of reach for current technology – the CDC hasn’t updated the issue since 2003, and their ability to accept such data can be overwhelmed by web-based EHR technology. HL7 data-passing may not be the best way to report such data, once the capability is built.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR

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