Notes from the Chairs

The founding principles for the HIMSS Electronic Health Record Vendors Association (EHRVA) set a clear path for the organization that can only be lauded as noble - serving the greater good by advancing EHR adoption through the collaboration of EHR vendors to positively affect issues crucial to achieving improvements in patient care delivery and outcomes. Who was to know when we set this course that our first year would give us every chance to live up to our goals?!

New leadership, new board members, new members, unrealistic timelines on deliverables - there were many new challenges - yet somehow the mix worked and it has been an amazing first year. Typically, when new organizations form, there is a period time needed for the group to hit its stride. The membership of EHRVA came out of the gate in a full gallop, however, and has not slowed down since our first meeting over a year ago.

While action is important, making a difference is what counts. In our first year, we can be proud of growing our membership, gaining recognition as an organization with a vendor-neutral collaborative spirit, providing a collective voice and representation, and increasing EHR vendor leadership and participation in key industry forums. We achieved these accomplishments by working hard and being unified - yielding benefits for our members and our customers.

Some of the member benefits include involvement in certification and standards activities, more awareness and involvement in national initiatives, smart use of resources, and a better understanding of future roles and responsibilities in the EHR arena. Hopefully, the benefits for our customers will come as our systems become certified and increasingly interoperable and affordable.

While the theme for our first year focused on building a base for vendor collaboration and participation, next year promises to yield plenty of opportunities to create even greater impact. Whereas this year, we worked hard on alignment to achieve an interoperability roadmap and satisfaction with the certification processes, next year we will work with funded and formally chartered organizations to achieve these goals. Our members are engaged in leadership and development roles in significant initiatives such as:

• ANSI Healthcare Information Technology Standards Panel (HITSP): The outcome of much collaboration with IHE to promote a new way to harmonize standards, this is clearly where use case development will be engaged.
• Certification Commission for Health Information Technology (CCHIT): This initiative has now transformed into a formally funded organization charged with certifying not only EHRs for physician practices, but EHRs for acute care settings.

Our thanks go out to each of you for your contributions this year and willingness to be a part what promises to be a better future for healthcare. And our request goes out to you to be part of our "every member makes a difference" campaign in the coming year so we can achieve even more.

Charlene Underwood,
Chairperson, EHRVA
Director, Government & Industry Affairs,
Siemens

Andy Ury, MD
Co-Chairperson, EHRVA
President & CEO,
Physician Micro Systems

Government & Industry Relations

Work Group Chair: Hugh Zettel, GE Healthcare/ EHRVA Board Member

The goal of the Government and Industry Work Group is to provide advocacy and education covering legislative, regulatory and external organization actions that affect our industry. We’re working to establish EHRVA as the resource for both members and the industry at large on all EHR-related issues. Government & Industry Work Group Members are:

• Travis Bond, Bond Technologies
• Carl Dvorak, Epic Systems Corporation
• Sandy Hubbell, Noteworthy Medical Systems, Inc.
• Mike Kappel, McKesson Provider Technologies
• David Kates, Emdeon
• Girish Kumar Navani, eClinicalWorks
• Dennis P Niebergal, CHARTCARE Inc.
• Distie Profit, Cerner Corporation
• Kim Seffrood, Epic Systems Corporation
• Chad Sundell, Epic Systems Corporation
• Liddy West, Misys Healthcare Systems
• Andrea Zalewski, digiChart
• Bill Zelman, PowerMed

During our first year, the Government and Industry Affairs (GIA) Work Group created EHRVA impact in several areas.

We worked collaboratively to respond to the Office of the National Coordinator for HIT's (ONC) National Health Information Network Request for Information (RFI). We were successful in establishing focus on ‘edge’ systems such as EHRs, as well as introducing an Interoperability Roadmap which has since become a reference point for other initiatives. In addition, our response was included in the Connecting for Health Collaborative Response to the ONC RFI. And we’ve been recognized by HIMSS and Connecting for Health for our collaborative participation and thought leadership.

CCHIT has kept us busy during the past year, beginning with our initial efforts last fall to create an EHRVA Work Group Candidate Slate. That effort was successful, with 14 members selected, representing 33% of total Work Group membership. Two EHRVA members are workgroup co-chairs, and two EHRVA firms have commission seats. We organized member involvement in CCHIT Work Product review processes in April and July, and have succeeded in establishing a dialog with CCHIT as a trusted source of expertise with EHRs. We’ve also conducted educational sessions and expect to be very active with our members as we enter the CCHIT beta testing phase in December.

EHRVA, through GIA, was the EHR vendor voice in response to ONC’s RFP for a standards harmonization entity. This successful bid resulted in the HIT Standards Panel (HITSP). Most EHRVA member firms responded quickly to sign on as corporate members and EHRVA member Charles Parisot/GE was named to the HITSP board. EHRVA also partnered with Connecting for Health to respond to the ONC RFP for national health information network demonstration projects. We worked on architecture, use-cases, and identifying ambulatory EHR vendors engaged in local geographies. The bid was one of four that were announced in mid-November as winning ONC contracts. The geographies on which we focus are Massachusetts, Mendocino County and Indianapolis. Once AHIC issues use cases to each contractor, we’ll know more about how EHRVA members can participate. Stay tuned.

EHRVA has been engaged with the Executive Branch as well. Our members were invited to a private discussion with David Brailer, MD, National Coordinator for HIT, at HIMSS 2005. During the year, we shared our Interoperability Roadmap and participated in the post-Katrina response. Our input on the E-prescribing proposed rule and the personal health record (PHR) RFI was clearly heard. And with the naming of the American Health Information Community in August, EHRVA has yet another opportunity to speak with a united voice on issues important to us all. Working with HIMSS, we have already established a dialog with Craig Barrett, PhD, Chairperson of Intel, who has been tapped to represent the HIT industry.

Our work with the Legislative Branch this year included participation in the HIMSS Capitol Hill Advocacy Day in April and the HIMSS Policy Session on Interoperability in September. EHRVA was asked to take an ad hoc seat on the HIMSS Advocacy Steering Committee which adds our collective voice to a variety of legislative initiatives. EHRVA members were called on to provide Congressional testimony, and several members hosted site-visits to Washington-area physicians’ practices so Congressional staff could see EHRs in action.

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Standards & Interoperability

Work Group Chair: Charles Parisot, GE Healthcare

The Standards and Interoperability Work Group has attracted a variety of EHRVA members, depending on the topics addressed. Regular attendees include:

• George Cole, Allscripts
• Glen Marshall, Siemens
• Didi Davis, Eclipsys
• Corey Spears, PMSI
• Dan Russler, McKesson

The Work Group also has a large email distribution, allowing us to reach the breadth of EHRVA member companies.

The Work Group has developed the initial EHRVA interoperability roadmap that was used as one of the elements of the collaborative EHRVA response to the ONCHIT RFI in January 2005. We expanded our activities throughout 2005 by providing consensus input to the EHRVA membership regarding several initiatives related to standards (e.g., HL7, ASTM) and interoperability (e.g., IHE, ELINCS). Contrary to the perception of some within the market, we have proven an effective ability to develop a consistent and affective approach to identifying key standards and the means to profile them for actual interoperability.

Our outreach activities have been focused on shaping EHRVA positions and responses to various governmental RFIs and RFPs, as well the CCHIT comment phases –all of which have contained aspects related to interoperability. We have also supported the efforts of the Government and Industry Relations Work Group and of the Executive Committee (e.g., Hurricane Katrina Response, CCR/CDA dialogues). We have also closely tracked progress and issues related to external interoperability initiatives such as IHE and ELINCS in the EHR to Lab area.

Response to ONCHIT Katrina Relief effort
A small team within the Work Group was asked by the Executive Committee to prepare a high-level proposal for a Gulf State Emergency Health Information Exchange based on an accelerated version of the current interoperability strategy of EHRVA. This proposal was reviewed by the Work Group membership and subsequently shared with HL7 and Connecting for Health.

IHE Collaboration (ihe.net & interoperabilityshowcase.org)
A large number of EHRVA members participated to the IHE Workshop in June and about 10 have responded positively to the call for participation to the January 2006 Connectathon and February HIMSS Interoperability Showcase Demonstration. As demonstrated last year, this event has a significant impact not only on healthcare providers, but also on the government leaders (Dr. Brailer, members of Congress, etc.). The Work Group reviewed the progress and demonstration requirements set for creating a functional and secured RHIO on the show floor. Feedback from EHRVA members that participation requirements were not sufficiently clear resulted in HIMSS offering a second participation opportunity for EHRVA member companies.

Status of CDA/CCR
The tension between ASTM and HL7 about competing standards resulted in strong positions made by EHRVA on the necessity for convergence between the two efforts. Some progress has now been made with a truce declared between the two parties; this is a step in the right direction. EHRVA has taken note that IHE has evaluated both standards in the context of medical summaries used for referral to specialists and hospital discharge and decided to use CDA Care Record Summary (XDS-MS).

HITSP
The Health Information Technology Standard Panel (HITSP) has been created with the award of the ONCHIT Standards Harmonization RFP to ANSI, along with a collaborative RFP response team on which EHRVA participated. This new body will be focusing on interoperability in order to drive a more coherent standard development process. In focus is also the adoption of “Integration Profiles” to address use cases defined under the leadership of AHIC, including Secretary Leavitt and his health community representatives. AHIC met for the first time and identified some high-level breakthrough areas (i.e., chronic disease management, patient empowerment, ePrescribing, public health surveillance, quality).

HITSP met for the first time on September 27-28 and elected its Chair, John Halamka, as well as a board that includes Standards Development Organizations (SDO) and non-SDO stakeholders, but where vendors hold only one seat. The physician community has criticized this under-representation. Charles Parisot, GE Healthcare, and Chair of the EHRVA Standards and Interoperability Work Group, was elected to represent the entire vendor community. An interim HITSP Use Case Committee has identified four use cases that have been provided to ONCHIT as part of the first contract deliverable at the end of October. EHRVA members actively participated in the identification of the proposed interoperability solutions.

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Recruitment & Membership

Recruiting and Membership Committee and Nominating Committee Chair: Justin Barnes, Greenway Medical Technologies/EHRVA Board Member

• David Kates, Emdeon
• Hugh Zettel, GE Healthcare was voted to second year as Board Member
• Don Schoen, MediNotes, will serve the second year of his Board Member term
• Liddy West, Misys Healthcare was voted in as Board Member

In the year since the EHRVA foundation on November 3, 2004 we have almost doubled in size. We’ve grown from 21 Founding Member Companies to 39 Member Companies as of November 7, 2005 (86% annual growth)!

Our ongoing objectives include the following:

• Refine membership criteria
• Direct recruiting activity
• Recommend new companies for approval to membership

To encourage continued growth, the committee sent an EHRVA Recruiting Mailer on October 20th to 334 self-designated EHR companies (44 of which are current HIMSS Members). We’ll report on the results of that campaign in the next newsletter.

Following are the results of the Executive Board elections at our annual meeting on November 7, 2005.

• Charlene Underwood, Siemens was voted to second year as Board Chair
• Andy Ury, PMSI was voted to second year as Board Vice Chair
• Hugh Zettel, GE Healthcare was voted to second year as Board Member
• Dan Michelson, Allscripts, was voted to second year as Board Member
• Don Schoen, MediNotes, will serve the second year of his Board Member term
• Justin Barnes, Greenway Medical, will serve the second year of his Board Member term
• Liddy West, Misys Healthcare was voted to in as Board Member
• Peter DeVault, Epic Systems, was voted to in as Board Member

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Outreach & Communications

Work Group Chair: Liddy West, Misys Healthcare Systems/ EHRVA Board Member

Thanks to our Communications Workgroup members for their work this year. It’s been exciting and challenging to keep up with all the opportunities for EHRVA to participate and speak out, but with the invaluable support of Julia Zarb of Zarb Consulting, I think we’ve done a great job. Comms Workgroup members are:

• Sonja Baro, McKesson Provider Technologies
• Judy Friedman, iMedica
• Harris Gilbert, DigiChart
• Jennifer Lewis, A4 Health Systems
• David Winn, MD, eMDs

We’ve also been fortunate to have Gail Arnett and Patricia Wise working with us to lead and facilitate HIMSS’ contributions to our communications efforts.

Our overriding objective this year has been to get EHRVA noticed. The EHRVA Communications Plan published in September (http://himss.ehrvendorassoc.webexone.com/default.asp) clearly describes our mission and guiding principles – collaboration, representation and education – and I hope you’ll agree that we’ve hit those marks.

Underlying these principles has been an aggressive outreach program to organizations like AMIA, eHealth Initiative, the Markle Foundation, ONCHIT, HL7, IHE and HIMSS, among others. With so many opportunities, and the need for vendors to be represented with a unified message, we’re attempting to focus on fewer, more strategic relationships. But, with the increasing awareness of EHRVA and the growing appreciation for our expertise and understanding of EHRs, we’re challenged to meet the demand for our involvement.

Press Releases
We issued ten press releases (http://himssehrva.org/ASP/releases.asp) over the past eleven months and are beginning to see good results as requests for comments and interviews with EHRVA representatives continue to increase. Increasingly an area of focus, we will see more media coverage in the coming year.

White Papers & Position Statements
We’ve published four white papers (http://himssehrva.org/ASP/statements.asp), which have been invaluable in our outreach efforts to clearly state EHRVA positions on important topics like interoperability, standards and PHRs.

Outreach & Collaboration
We collaborated with AMIA at HIMSS 2005 on the “Got EHR?” campaign. Look for more on that as HIMSS 2006 approaches.

We worked with ONCHIT, Markle, HIMSS and HL7 on their post-Hurricane Katrina responses and will be part of the “lessons learned” debriefing to be hosted by Markle later in November. Look for follow-up activities to come out of that.

We’re working closely with HL7 on their communications and education plan to help continue the good progress they’re making with ASTM on harmonization of patient care summary standards.

And, we’re supporting IHE’s communications efforts as they work toward the RHIO demonstration at HIMSS 2006. Since so many EHRVA member firms are involved in this voluntary effort, we want to ensure that this great collaboration is visible to everyone who is engaged in the effort to achieve true interoperability.

The communications group worked closely with the HIMSS team to develop the EHRVA Internet as a primary communication tool for the organization. We have also worked with all EHRVA Work Groups throughout the year to ensure consistency of messaging in our public materials.

Your ideas are always welcome, as is your participation in our communications work. Pass this newsletter to others in your organization to spread the word on EHRVA!

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Calendar of Events

• EHRVA All-Member Call — second Tuesday of every month, 12:30-2:00pm/Eastern, 1.877.352.0183, participant code — 391436#
• HIMSS Annual Conference, San Diego — February 12-16, 2006
  • Various EHRVA events will be scheduled during this meeting, so stay tuned!

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