Continuity of Care, Certification, and Communication Drive the Conversations at TEPR

Reflecting a more focused approach to health information than the scattershots of past, last week’s Towards the Electronic Patient Record (TEPR) conference in Dallas placed a heavy emphasis on real-world examples of interoperability rather than on simply making standards.

Attendees got several first-person accounts of how the Continuity of Care Record (CCR) has been employed in primary care, and at least two other sessions were dedicated to the user-friendly Health PDF (see “Health PDF to Link Healthcare Providers”).

“I think we are wasting our time in developing academic standards,” said C. Peter Waegemann, chief executive of the Medical Records Institute, the Boston-based organizer of TEPR. “I think we will see in the next couple of years practical standards coming out of industry, not coming out of the standards world,” Waegemann forecast, reflecting a change in his own thinking from several years ago.

Though it is an ASTM International standard with roots in academia, the CCR is at heart an XML document, and private industry has noticed. Waegemann indicated that Google, if and when it decides to bring out a consumer healthcare product, will build around a single standard, namely the CCR. It just so happens that Google vice president Adam Bosworth — to date, the only public face of the company’s health efforts — was one of the developers of XML during his days at Microsoft.

Google, as usual, is mum on its plans.

Although the show itself may have been smaller than in past years, the 23rd annual installment of TEPR seemed to make up for quantity with high-quality educational programming. For the second year in a row, all presenters were actual technology users instead of vendor representatives, a particularly important detail since many of the sessions were filled with primary care physicians and practice managers, who would rather hear from peers than salespeople.

Of particular interest this year was asynchronous communication, including secure e-mail between physicians and from patient to provider. Chris Crow, an internist in nearby Plano, Texas, has an online patient portal at his 3-physician practice, which has helped automate appointment scheduling, prescription refills, and the reporting of normal test results. “It evens out your workflow. It doesn’t tie you up,” Crow said.

While most of the vendors of ambulatory electronic health records (EHRs) that have been certified for interoperability by the Certification Commission for Healthcare Information Technology (CCHIT) proudly displayed the CCHIT logo at their booths and on their literature, certification still is rather new in the industry.

Dan Pollard, director of product management for Misys Healthcare Systems (Raleigh, N.C.) said that after a year, certification has had “a fairly neutral effect on Misys but a positive effect on the industry.” According to Pollard, “It’s more about raising the bar for the industry.”

Misys, which tends to release new versions of its products annually, promises to certify the latest release on an ongoing basis rather than renew a certification for the maximum three years. “It is going to represent an ongoing development cost for us,” Pollard said. Several other vendors expressed a similar sentiment.

The exemptions to the Stark physician self-referral restrictions and Medicare anti-kickback regulations that allow healthcare organizations to purchase EHRs for physician practices also are just gaining traction. “Customers are figuring out their internal policies,” Pollard reported. “It’s not a top-line issue yet.”

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