HL7 Announces Second Ballot Opening of Electronic Health Record

Ann Arbor, Mich. – March 11, 2004 – Health Level Seven (HL7) a not-for-profit, ANSI-accredited standards developing organization, recently announced that the second ballot on the HL7 Electronic Health Record-System Functional Model Draft Standard for Trial Use (EHR-S DSTU) is slated to open on March 18, 2004. The ballot will be available for comment until April 16 and the results will be announced during HL7's upcoming working group meeting, May 2-7, 2004 in San Antonio, TX.

The current (second) version of the HL7 EHR-S DSTU contains about 130 functions- a dramatic decrease from the first ballot- significantly simplifying the functional outline. This improvement is based on input from both internal HL7 activities and external HL7 participants. The EHR Collaborative, a group of organizations representing key stakeholders in healthcare, was instrumental in showcasing the new HL7 EHR-S Model and soliciting provider and vendor input during last month's 2004 Annual HIMSS Conference and Exhibition.

The HL7 EHR-S Model has stirred unprecedented interest and input from all segments of the health care industry. The first ballot prompted a record-setting 223 votes from industry stakeholders. One reason for the dramatic voter turnout was an educational outreach program. In August 2003, the first draft ballot document was introduced to the provider community- a segment of the health care industry that is typically underrepresented in standards organizations and processes- through a series of six cross-country meetings sponsored by the EHR Collaborative.

Many industry leaders have participated in the validation of the simplified and improved HL7 EHR-S DSTU. According to John E. Fishbeck, associate director, division of standards and survey methods at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), "This model could provide a great value by establishing guidelines for an Electronic Health Record that can improve the quality and safety of care, increase collaboration and information sharing to enhance patient care, potentially lower costs, and provide better clinical data upon which to base future policy and research."

"The HL7 EHR-S Model will provide a common language for the provider community to help guide their planning, acquisition, and transition to electronic systems; and it will facilitate a more effective dialogue between providers and vendors," said Don Mon, PhD, vice president of practice leadership for the American Health Information Management Association (AHIMA).

Concerns expressed by some in the industry that the model was to be used as a compliance tool for the US Government are unfounded. "The HL7 EHR-S Model is not a conformance tool," said Linda Fischetti, co-chair of the HL7 EHR Special Interest Group (SIG). "It is a means to provide a foundation so that all stakeholders involved in describing EHR-System behavior will have a common understanding of the functions."

The HL7 EHR-S Model can also be likened to a dictionary that provides meanings to all of the words contained within it and, put simply, provides a long list of words from which the user can choose to use in a composition. From a user perspective, it can be used to enable consistent expression of system functionality; and like a dictionary, it is expected to evolve over time to match the needs of users.

It is important to note that compliance with the standard does not mean that every function of the model be addressed by every vendor immediately. There are three main reasons for this:

1. Some of the functions are visionary (e.g., evidence-based medicine, or real time monitoring of public health). Very few, if any, vendors will have the ability to incorporate these functions right away. A two-year DSTU period will provide the industry time to decide how functions like these should be implemented and what priority they carry.
   
2. Some of the functions are more important to one care setting than to another. Vendors that sell to the home health market will most likely not utilize the same functions as those that sell to the inpatient acute hospital. In both cases, the vendor will get its standard functions from the functional outline, but they don't have to use 100 percent of the functions contained within that outline.
   
3. The standard is voluntary. Vendors can choose which of the EHR functions they include in their products, and by what timeline they will include them. Thus, two vendors in the same industry segment may have different EHR functions implemented in their products, but what functions they have all come from, or are mapped to, the EHR standard.

Assuming the second ballot is successful, the document will then be submitted to the American National Standards Institute (ANSI) as a DSTU for a period of up to 24 months. This will be announced to the industry at large and HL7 will encourage the industry to download and use the draft standard and report their findings back to HL7. Once industry feedback has been included, the document will be updated and re-balloted and then published as a normative standard and submitted to ANSI for approval.

Individuals interested in participating in the second ballot of the HL7 Electronic Health Record-System Functional Model can register to vote at http://www.hl7.org/ehr/ballot/signup.asp. Additional information about the draft standard is available from the dedicated EHR section of the HL7.org website.