Midwest Interoperability Crusade, HL7 CCOW, EMPI, and Single Sign-On (SSO)

It's been a great week! I also have to admit that I am happy that it's coming to an end by tomorrow. Yes, I said tomorrow since I'm heading back to Arizona to celebrate the 4th of July with my family and friends. But I still have pending 2 more stops: one more in Detroit and another one in Ann Harbor, Michigan.

I never thought I could visit so many cities in such a short period of time. The good thing about the Midwest is that all the cities are relatively close to each other.

In this trip my favorite visit has been to the Wind City, Chicago, Illinois. During the past RSNA, the Connectathon, and HIMSS09 I didn't get to enjoy it as much as I wished, mainly because of how wicked cold it was during the first 2 events and then for the latter I was too busy. By the way, in Maine wicked means extremely good but I am using the opposite definition of it!

I've been exhilarated by the enthusiasm I find among everyone with the new challenges that face us. It's been mainly lengthy meetings where people keep asking me what "Meaningful Use" is about, how we can plan for the new CCHIT certification processes, and what should be the most immediate actions to take that guarantee that they will be going in the right track. I am also amazed about how mislead some are with all the information that is going on out there. I have to admit that even keeping close track of it can be overwhelming at times.

The CCHIT certification has become a concern for many hospitals that have best of breed environments mixed in with some in-house development and some wonder if they are going to have to change everything in such a short notice. They were very relieved when I explained how CCHIT has come up with 3 different certification models and that the 2 newly introduced ones would resolve their concerns and frustrations.

The EHR-M is the certification process that the vendors of the different BoB (Best of Breed) applications they have installed should request directly to CCHIT. This certification process is aimed specifically for modules (e.g. Laboratory applications, ePrescribing, Computer Provider Order Entry or CPOE, Patient Charts, etc.) Most hospitals that I have been to have applications from various vendors (e.g. Cerner, AllScripts, MEDITECH, etc.) and they are going to have to get their functionality harmonized in a way that in unison they act as an Electronic Health Record (EHR).

The EHR-S is the certification of a sites' functionality. This is entirely in the hands of the facilities. They have to demonstrate that there home-brewed solutions integrate and perform as an Electronic Health Record. Most will most likely have to play together with BoB modules.

Something that I have noticed is that this combination of certification processes will trigger the interest in HL7 CCOW and Single Sign-On. Reasoning: You can virtually present to the clinician an Electronic Health Record on the point of care delivery workstations by binding together the disparate applications that reside on them. If you have ever been involved with a Clinical Context Management implementation you have certainly witnessed some magic.

Single Sign-On comes to the aid in helping CCOW manage the User subject (this is how the standard names the user of the applications). Most applications, having been implemented by different vendors and at different times, enforce their own credential management practices. This resulted in clinicians having to carry a piece of paper with many user names and passwords on them. Huge security breach isn't it?

Enterprise Master Patient Index, or EMPI, technology implementations will also be on the rise. This technology addresses a resolution to a huge problem many IDNs and standalone facilities face. Many have been deploying applications throughout the years, each module having been implemented in different times and with different technology paradigms, and mainly when these paradigms were in the period of rapid growth and evolution. This caused many facilities to create patient identifiers that conformed to the uniqueness of each application. Now that information is breaking out of the silos they have lived in for a long period of time they have to be able to unravel this mess. The EMPI helps match the differing patient identifiers from the various applications into a universal or unique identifier.

Thanks for reading!

The EHR Guy