June 25, 2007

TEPR’s Standard ‘Berras’
By Lee DeOrio
For The Record
Vol. 19 No. 13 P. 34

If there was one healthcare conference that malaprop master Yogi Berra would have felt at home, it was this year’s TEPR (Towards the Electronic Patient Record) get-together in Dallas.

Among the topics garnering the most buzz was standards— any kind for just about any
application. The seemingly endless stream of potential standards brought out Yogi-like comments
such as, “The thing I like about standards is there are so many to choose from.” Who could argue?

An overflow crowd attended the session titled “A Conversation: The Future of Standards” featuring the musings of Medical Records Institute CEO C. Peter Waegemann and noted informatics expert W. Ed Hammond, PhD, old friends who chidingly sparred over several complex issues.

Hammond mentioned that the process is being impeded by implementation concerns—vendors don’t implement the standards as written—and politics. “Most standards are made by volunteers who don’t take well to top-down authority,” he said, adding that there are too many chiefs and it’s time to bring together all the standards organizations.

Other key points raised during the conversation included the following:

• Is there a commitment to SNOMED? It’s going to require substantial funding to maintain.

• Clinical standards are of utmost importance. It’s absolutely necessary to create precise definitions—you can’t have 46 types of unstable angina, said Hammond—and data elements must be coordinated.

• Health Level Seven needs a vision, according to Waegemann. “Convince me that version 3 will work,” he said.

• There is a need for a unique personal health identifier.

• The government’s lack of backing for standards did not sit well with Hammond. He cited the American Medical Association’s powerful lobby and how it was able to deflect legislation on CPT codes.

Putting aside the standards situation, healthcare leader Maggie Mahar made the case for investing in informatics. At the opening session, Mahar, the author of Money-Driven Medicine, pointed out that many hospitals are looking for immediate return on their IT investments. Such short-term thinking leads to competition rather than collaboration, she said.

The system must change so that providers are rewarded for outcomes and efficiency (using fewer resources), according to Mahar. In such a system, there would be less treatment to less people.

Following Mahar, John Wilson, MD, engaged the audience with a story of how his quality of life took an upswing when he left a group practice to fly solo. With the help of an assistant and an electronic medical record (EMR), Wilson has carved out what seems to be the ideal practice in which he has cut his workload in half while nearly doubling his income. He cited speech recognition as one of the best and most fun aspects of adopting an EMR and gave a Letterman-like top 10 reasons why physicians shy away from the technology.

Dennis Morrison, PhD, MD, of the Center for Behavioral Health in Bloomington, Ind., concluded the session with a rapid-fire—things were behind schedule—humorous, and informative dissertation on how EMR developers have ignored the behavioral health field.

Morrison backed his contention that behavioral health deserved more than a casual mention in the plans of HIT honchos by presenting a number of statistics on mental health treatment. He noted that primary care physicians treat behavioral health more frequently than psychologists. In fact, he said, primary care is the de facto mental healthcare system for 70% of patients.

Prior to the speakers taking the stage at the opening session, Medical Records Institute Vice President Claudia Tessier, CAE, RHIA, announced the winners of the 2007 TEPR Awards, which honor the best vendor products in several categories. Judged to be the best were the following:

• Mobile applications for healthcare — PatientKeeper;

• Stand-alone e-prescribing systems — Purkinje;

• Personal health records — CapMed;
• Document imaging — Medical Communications Systems;

• Hot products — PhyTel;

• Continuity of Care Record (CCR) for vendors — EMD and Medical Communications Systems; and

• CCR for implementers — New Orleans Health Department.

New this year to TEPR was EMRCompare, a two-day symposium designed to provide information to physicians and others interested in adopting EMR systems. Focusing on functionality, cost, and usability, the initiative required participating vendors—of which there were roughly 15—to submit data on one or more of their products prior to TEPR. The demonstrations were organized according to office size, specialty, and desired price range, although some vendors left attendees scratching their heads over exact costs.

Each vendor was given approximately 10 minutes to demonstrate its system as it applied to a specific office visit. Participants also showed how it was possible to manage patient care when not in the office and how the system could improve the office’s overall performance.

The conference also launched the Hospital IT Strategy Challenge, which featured the chief information officers of small, medium, and large hospitals sharing how their institutions have incorporated innovative IT strategies and discussing how they have influenced competitiveness, marketing, patient satisfaction, reduction of medical errors, and quality of care. A panel of judges doled out awards to the following hospitals:

• Small and Medium Hospitals (less than 200 beds) — Saint Clare's Hospital, Weston, Wis.;

• Large Hospitals (200 or more beds) — Texoma Medical Center, Denison, Tex.; and

• Integrated Delivery Networks — Intermountain Healthcare, Salt Lake City.

The conference drew to a close with much accomplished but still a lot to be done. As Berra would have said, “It’s never over ‘til it’s over.”

— Lee DeOrio is the editor of For The Record.