Physicians who are planning to implement or replace electronic health record systems for their office practice face a myriad of options. When selecting EHR systems, the ability of these systems to interoperate with other ambulatory and hospital-based systems is an increasingly important consideration. The president's 2004 State of the Union address calling for the establishment of a national health information infrastructure launched a movement toward enabling health information technology to accommodate data interchange. The building blocks for the eventual national health information network are local, community-based efforts called regional health information organizations, or RHIOs.

An effort to develop a RHIO in the Dallas-Fort Worth metropolitan area is underway and represents a collaborative venture involving the Dallas and Tarrant County medical societies and the Dallas-Fort Worth Hospital Council. To fully realize the benefits of an electronic health record system, a physician's EHR must be able to connect with the RHIO.

To achieve this interoperability, certain standards are required. The most important ones are SNOMED, HL7, and CCR.

Many of these standards are complex and highly technical, and a few still are evolving. Consequently, assessing a vendor's compliance with industry standards can be challenging. The Certification Commission for Healthcare Information Technology was created to address this challenge. In September 2005, the US Department of Health and Human Services awarded CCHIT a three-year contract to develop and evaluate certification criteria, and to create an inspection process for EHR systems. The goals of CCHIT product certification are to:

• Reduce the risk of health IT investment by physicians and other providers.

• Ensure interoperability (compatibility) of health IT products.

• Ensure that the return on investment for payers and purchasers who provide incentives for EHR adoption will include improved quality.

• Protect the privacy of patients' personal health information.

CCHIT initially is focusing on ambulatory EHR products for the office-based physician and provider. Earlier this year, the first EHR products certified by CCHIT were announced.

Physicians in the market for an EHR solution who use CCHIT CertifiedSM products are taking an important first step toward ensuring that what they install for their practice meets basic requirements for:

• functionality (ability to carry out specific tasks)

• interoperability (compatibility with other products)

• security (ability to keep patients' information safe)

To learn more about CCHIT and see which products have achieved certification, visit www.chit.org.

Selected Health IT Standards
SNOMED® (www.snomed.org)
Systematized Nomenclature of Medicine is a system of standardized medical terminology developed by the College of American Pathologists. It began as a terminology system for pathology in 1965 and over the next 40 years evolved into SNOMED Clinical Terms®, or SNOMED CT®, a comprehensive computerized clinical terminology covering clinical data for diseases, clinical findings, and procedures.

HL7: Health Level Seven
Health Level Seven (www.hl7.org) is a Standards Developing Organization that is accredited by the American National Standards Institute. Founded in 1987 to produce a standard for hospital information systems, HL7 is the selected standard for the interfacing of clinical data in most healthcare organizations. HL7 represents a comprehensive framework for the exchange, integration, sharing, and retrieval of electronic health information.

CCR: Continuity of Care Record
The Continuity of Care Record is a patient health summary standard developed jointly by several medical professional societies and health informatics organizations. The CCR standard specifies how to create flexible documents that contain the most relevant and timely core health information about a patient and to send these documents electronically from one caregiver to another. It contains sections on patient demographics, insurance information, diagnosis and problem list, medications, allergies, and care plan. The ASTM CCR standard is designed to permit easy creation by a physician using an electronic health record system at the end of an encounter.