Mark Anderson of the AC Group, Inc. and Robert Gleeman talk about the CCD standard. Click the Play button to watch this interview.
This is a transcript of the above interview.
Gleeman: This is Robert Gleeman with EMR Update. I'm talking on
Casual Friday with Mark Anderson from the AC Group. Mark, thanks for being with
me again, today.
Anderson: Well, thanks for giving me a call, here. It's been awhile
since we've talked, and there's a lot of things going on since that news
There are many things going on in response to the stimulus bill, and you
have some specifics that a person should be mindful of when buying an EMR. You
mentioned to me in an email that one of the main points that you've been
talking about is the requirement to be connected to a community HIE. What is a
community HIE, Mark?
Well, basically, there are three provisions underneath the stimulus act,
the high‑tech act. Obviously, one is certification; one's reporting data. The
second one, really, was being able to be connected to a connected to a
community health information exchange.
goal of the high‑tech act is to get rid of silos of information and getting all
of the doctors connected together. So, an HIE really allows doctors on separate
EMR applications to share clinical information about the patients. The data is
collected once, but all of the doctors in the community who are treating the
patient have access to that information.
So, it seems to all be about connectivity. You mentioned also in your
email that the connectivity goal is PHR, public health record. We've been
hearing about the Google public health record. Is that the same thing? Or is
that a personal health record?
Well again, what the government is talking about is getting all of the
information from all of the different providers that are treating a certain
patient. So, the patient has access to that information. Most people are
calling that a personal health record, one place the patient can go to learn
everything about themselves. Then they can take that information to another
provider in a different city or different state, or at least allow the doctor
access to that information.
there's Google Health, and you also have Microsoft Health involved. These are
kind of like those products. They allow the patient to enter information. But
what we really have to have is the provider information updating into a
location, along with the patient able to put their health‑related information
in. We need data from all sources, so there is truly one personal health record
for that patient, no matter which provider they go to.
Are you finding that the patient wants to be involved in this record‑keeping
process? Are they cooperative?
Well, I think it's just beginning today. Kind of look at it as when a
patient shows up in a doctor's office, the doctor asks the patient to fill out
a number of forms dealing with their social history, the medical history, the
family history, what medications you've been on and what other doctors have you
seen. So they're already asking the patient to fill out information, but it's
way, the patient goes online, fills out the information one time. And no matter
which provider they go to, that doctor has that information. So yeah, the
patients are getting involved. The surveys have shown that about 68 percent of
all patients that have been surveyed would prefer to fill information out
before they showed up in a doctor's office.
So you're saying, as a prerequisite to get these high‑tech funds from
this stimulus bill, you really need to look at connectivity. How are you
supposed to know about how connective this EMR product is? Should you go by
Well, that's a good helping point. CCHIT, based on the 2008 standard,
requires vendors to be interoperable. What they're saying is that you have to
be able to send a document, like a fax. In the 2009 standard, we believe that
they are also going to build in data exchange, discrete data exchange following
the continuity of care document infrastructure, CCD. This is the combination of
the CCR standard plus the HLSMA [sp] standard. So, basically CCR plus CCDA is
the patient care document standard.
believe that to get the stimulus package you're going to have to exchange data
with all providers in the area. Right now, the CCD standard seems to be where
everybody is moving towards. You have to be CCD compliant before the doctor
will be able to get access to the stimulus money.
Now, you said that you're talking about this a lot. Is that what you're
doing right now? You're in Atlanta, Georgia, as I understand it.
Yeah, we're finding that there are probably about 100 of these projects
that have been going on across the country. We used to know them as RIOS. We
kind of joke around that RIOS didn't work because there were four initials. You
really need three initials for everything in healthcare. But there are a lot of
projects going on that are called HIE informations. What a lot of them are
doing today is exchanging information between the hospital and the doctor, or
between the LabCorp/Quest and the doctor.
the future, we're going to be exchanging data between the primary care doctor,
sending information to the cardiologist, who may send them onto the GI doctor.
All that information may get summarized to go to the emergency room doctors, so
they can get access to information about the patient.
nice thing about this is you don't have to be using an EMR to get access to
summary information. If you're a physician that's on paper ‑ there are paper‑based
charts today ‑ when a patient checks in, basically a clerical person, or the
nurse, could go online, find that patient's record, print it out and stick it
on the chart for that physician. That will have on it what medications the
patient's on, what laboratory results, which doctors they've seen, what health
maintenance alerts are they behind on, what chronic diseases do they have.
going to have a wealth of information about the patient in a common format, the
same format no matter where you go in the United States. That same printout
will come out no matter where you go. That's the advantage of having one kind
of standard for sharing information.
What you're saying is that the standard has been selected, and it is CCD.
From all indications we've seen, yes, the CCD is the standard moving
forward. But again, it's really only capturing summary information about the
patient. When you ask doctors what they want, about 90 percent of what they
really need is in the summary document. It's not capturing everything. It
doesn't capture the complete medical record, but it captures the information
that the doctors traditionally want to pass on to another. So, yeah, it's very
strong for the doctors' needs to understand how to treat the patient today.
a great starting point. Ten years from now, we'll have something different
probably. But it is the starting point moving forward.
Does anyone, right now, have CCD compatibility?
There are about 30 EMR vendors that we've tracked right now of the 400
that have the capability of producing a CCD report and then passing it on to
another there. What we don't see today, [inaudible 8:34] another EMR vendor and
it's not really working. They're essentially in the sandbox.
way it's been working is that EMR Vendor No. 1, will send information up to the
HIE, a community portal offered by potentially another company. Then that
information is sent down to the EMR Vendor No. 2. So typically what you see is
some pretty good EMR vendors that can exchange the data and what they portal in
between that information can be exchanged.
we think that's probably the best model because rarely are you going to get
every single doctor in the community using the exact same EMR. And I like to
have a vendor‑neutral HIE sitting on top.
if every doctor in this community has one EMR vendor, then it makes sense. You
can just have one thing. But I think we're going to have a lot of communities
where multiple EMR vendors are going to win out, probably all the specialties.
We need that neutral community vendor to tie everything together going forward.
again, that's what's going to be required to meet the stimulus money. Remember,
the goal of the stimulus in high tech, is to eliminate silos of information.
And a silo of information would be for instance, what?
Any doctor who has an EMR in their office that's not connected with
anybody else, is really a silo. A doctor that has paper charts that's not
connected to anybody else is a silo of information. We want to find out that
Hayden had a lab report and you're a treating physician, you want to get access
to that report, at least be able to read it.
know that that helps reduce the duplicate paid entry by about 72%. It's also
proven to eliminate a lot of duplicate tests. It's going to help save costs,
it's going to help provide much better heath care because now we have real
information about the patient at the point of care.
about that patient showing up at the emergency room? Right now you show up
there, the ER doctor knows nothing about you. Now, the EMR doctor's going to
have a history of what's going on with you, which physicians you've seen, what
medications you have had, if you have had heart problems in the past, if you're
a diabetic. That information will be available to another physician in a nice
printed a copy and they don't have to go on the computer to look at it. We can
just print it out and stick it on front of the chart, just like most doctors
want. I want a summary page on the front of the chart so I know the patient, I
don't have to collect data myself.
Is this what you're talking about over there in Atlanta?
Yes, I've actually given four speeches this week alone on the subject,
"Creating the Community EHR, " basically, a community EHR. I kind of
call it a Grady Community EHR, we kind of joke around, are you ready for the
ice age, the ice age is coming. So, what we're looking at is how can a group of
physicians in a community pick different EMRs but still be able to share the
information no matter where the patient goes. So, we're doing a lot of talks on
it and probably about 80% of the calls I've been getting on our consulting
business is how to set up a community integrated EHR with multiple EMR
Would you say that it's possible for a non‑CCHIT certified EMR to be CCG
Yes, there are a few of the vendors that we know do know about who have
not gone through CCHIT certification, but they can generate a CCD record. They
already can prove inner wrapper ability. They just haven't gone through in
doing everything for somebody. It works really good for some of the
specialties, for the dermatology, for the orthopedic doctors, so they don't
need to collect everything that's been on the CCHIT requirements.
again, I think if we can provide the right information at the right time, to
the right caregiver, that's what we really need.
CCHIT I think is a good starting point, but there are a number of vendors that
[inaudible] CCD data exchange that have not come through the process of getting
CCHIT certified. Or if they were certified, it would only be on 2006. The real
determining point is going to be is what is the final decision on when to the
product has to be certified to meet the High‑Tech Act so the doctors can get
the money. Does that mean they have to be CCHIT 2010 or 2009 certified? Or if
they only have to be certified that they can exchange data following a common
format like CCD. No one really knows yet.
Well, that's one question that comes up a lot in EMR update in the forum, is
that there are so called anti‑CCHIT sentiments. That there's some very good
small vendors who could never afford the $36, 000 or whatever they charge, is
there any talk or any hope do you think, of that going down, so that a small
vendor could afford it?
That's a good question. Now that the CCHIT Office is going to be given $2
billion to create a lot of these standards, to me it would seem if they've got
$2 billion they might not have to charge that much to go the standard process.
They've got the money to pay for it.
when CCHIT go set up, they were only given a $5 million grant. Now, they've got
$2 billion. Now, obviously, they're not going to allocate all of it, but they
could allocate some of that money and bring that cost down.
challenge ends up being, do every single specialty really need a full CCHIT
server to find product or do they need the CCHIT requirements. Because every
specialty doesn't need everything that's in there. And a lot of the vendors are
getting [garbled], they're also going after pediatrics, the cardiology and, in
the future, OB‑GYN, and dermatology and orthopedics. They're going to create
standards for all of these.
think it's a good point to have but we've got to go back and what is the
reality? We need to share common data. You have to be CCHIT certified to share
common data. We'll have to see what the government comes out with. They may
Well, someone once said that the greatest accomplishment of technology
has been connectivity, that it is the thing, the single‑most, society changing
advancement in technology. And you are bearing that out in what you're saying
about the EHR, the EMR, the personal health record. It all seems to come
together into that concept of connectivity.
And that is exactly what you do not have with paper records.
And even standalone EMRs were not connected. Think of another three
letter initial, ATMs. I can go to any bank ATM machine now, put my little card
in and get access to my money and bank. It doesn't matter which bank I'm
connected to, the ATMs all connect everybody. We need the same type of health
care ATM and we're calling those Healthcare Information Exchanges, HIEs.
That's the best analogy I've heard all day, Mark. I think it's a good
place to end until our next meeting.
And I'll see you next Friday.
Let's do that. We've had a few sound problems, but I think we've got it
is Mark Anderson with the AC Group. Mark, I want to give your cell phone
number, as I often do, (281) 413‑5572, if you want to call Mark Anderson. And,
Mark, thank you very much for being with me on "Casual Friday." It
looks like I'm the more casual of the two today, but we have matching shirts.
OK, talk to you later.
Robert: Bye, bye.
For more information about the subjects discussed here you can contact Mark Anderson at the details listed below.
See our other Getting Started resources here and other EMR Interviews here.
Mark R. Anderson CPHIMS, FHIMSS
CEO and Healthcare IT Futurist
AC Group, Inc.
118 Lyndsey Drive
Montgomery, TX 77316
May 13 2009, 01:19 PM