College of American Pathologists
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February 2007

Raymond D. Aller, MD
Hal Weiner

bullet Broad-based physician office certification an aid, not an answer

The first physician office information systems certified by the Certification Commission for Healthcare Information Technology have been announced.

While broad-based certification is not a panacea, it provides at least some assurance that systems have the functions necessary to support a physician’s office. However, such certification is of value primarily to comprehensive, high-end health care systems.

The CCHIT, an independent, voluntary, private sector initiative, acknowledges on its Web site ( that it doesn’t address specialty areas. A statement on the Web site reads, “Purchasers should not interpret a lack of CCHIT certification as being of significance for specialties and domains not yet addressed by CCHIT criteria.” But this may soon change. The CCHIT recently reported that it is undertaking an “environmental scan” to determine how to address specialty systems. In the meantime, you must evaluate whether the criteria used for CCHIT certification are those most relevant to your needs. If you are seeking a system with capabilities tailored to ophthalmology, dermatology, or another highly specialized area, then the CCHIT’s current list of certified systems is likely to be of little or no value.

Furthermore, modules that extend the usefulness of physician office tools, such as an electronic health record extension to a physician office’s laboratory information system, lack many of the functions required by the CCHIT checklist and therefore can’t achieve certification.

Cost is also a factor. Because CCHIT certification costs $28,000, plus the staff time required to prepare for the review, vendors that provide basic systems for small physician offices may not be able to afford it, leaving a void in the number of certified systems in moderate to low price brackets. Consequently, you may find few or no CCHIT-certified systems in your price range.

Despite the aforementioned limitations, CCHIT certification, coupled with input from system users, should be a worthwhile evaluation tool if you are seeking a comprehensive physician office information system.

—Raymond Aller, MD

bullet UPMC embraces ambitious medical technology projects

In keeping with its role as a leader in the use of advanced medical technologies, the University of Pittsburgh Medical Center has embarked on two ambitious technology initiatives that represent an investment of nearly $100 million.

In the first, UPMC is partnering with DbMotion, an Israel-based provider of integration technology, on an $84 million initiative to create a model of interoperability within its system of 19 hospitals and 400 outpatient sites and doctors’ offices. Rather than replace existing computer systems, UPMC will use a flexible architecture integration platform from DbMotion that will allow physicians and other medical staff to securely access patient information that has been integrated from disparate information systems.

“The vendor solutions, to date, do not provide the level of interoperability that’s needed for adequate and excellent patient care,” says Jay Srini, UPMC’s vice president of emerging technologies. “What we realize is the fact that just having information is not sufficient. What we need to be able to do is aggregate and harmonize the information. Then we can create a longitudinal patient record that is contextually relevant and supported by decision-making tools to ensure the highest quality of care.”

The interoperability system will allow a pathologist examining a biopsy, for instance, to access seamlessly the patient’s history and data from various sources, such as the patient’s hospital, primary care doctor, and outpatient facility. “So, what he or she has is not just point-in-time information about the patient, but the continuum of care supported by decision support and evidence-based medicine,” Srini explains.

The interoperability project will affect pathology in three main ways, says Michael Becich, MD, chairman of the department of biomedical informatics at UPMC.

First, laboratory data will have more structure and context, giving it greater visibility and utility. Current electronic medical records tend to bury lab data, he says. Second, the project will create a vocabulary and broader ontology, which will allow data to be translated from various sources. Third, the project will make use of HL7 version three, which, unlike the point-to-point communication of version two, allows communication from one source to many. This means health care IT staff will spend less time rewriting interface codes as vendors upgrade their software and more time on projects that directly contribute to a safer, higher quality environment for patients, says Dr. Becich.

The project will first include a series of test pilots, which should generate results within the next year, Dr. Becich says. The interoperability project, overall, is expected to take five to 10 years, he adds.

“Everyone’s sitting around and waiting for somebody else to do this,” Dr. Becich explains. “We decided we’re going to take this on. It’s a very daunting task. It’s a risky project. Nothing that has very high rewards is without risk. I think pathology has a lot to benefit from this.”

Last October, the medical center also announced a five-year, $10 million agreement to conduct technology research projects with Carnegie Mellon University, also in Pittsburgh. The partners are currently evaluating and prioritizing the projects they will undertake. Some of the areas being considered include medical image processing, medical robotics, and technology-enhanced training and simulation.

The collaboration is necessary, says Srini, because it’s evident that an increasing number of technology breakthroughs occur at the cusp of interdisciplinary skills, especially in the fields of engineering, robotics, and computing. She adds, “The boundaries are where you find the most innovative solutions.”

bullet Antek partners with Wyndgate Technologies

Antek Healthware has entered a partnership with Wyndgate Technologies, a division of Global Med Technologies. Through the partnership, Wyndgate will interface its SafeTrace Tx stand-alone blood bank module with Antek’s LabDaq and newly launched LabDaq+ laboratory information systems. LabDaq+ is Antek’s newest LIS offering for large medical clinics and community hospitals.

bullet Health Level Seven to adopt and maintain ELINCS lab standard

Health Level Seven has announced plans to adopt and maintain the EHR-Lab Interoperability and Connectivity Specification, or ELINCS. After the adoption is completed, the standards development organization HL7 will assume responsibility for the ongoing maintenance and further development of ELINCS as it migrates from the current HL7 version 2.4 standard to the new HL7 version 2.5.1 standard.

The ELINCS standard specification will allow health care providers with electronic health records to integrate and use lab results from various sources. ELINCS also promises to reduce redundancies in the clinical setting and provide a road map for connecting EHR systems with laboratory information systems.

ELINCS was implemented on a pilot basis in 2006 with national health information technology vendors and a variety of health care organizations in California, including commercial laboratories and physician groups. The pilot tests indicated that ELINCS, which was funded by the California HealthCare Foundation, is a useful and widely applicable standard specification for the electronic reporting of lab results. Following the pilot testing, several industry groups, including the Certification Commission for Health Information Technology and the Healthcare Information Technology Standards Panel, called for ELINCS to have a permanent home with a standards development organization.

“Given the high quality of the ELINCS specification and its value to the health care industry, HL7 is pleased to undertake the process of adopting ELINCS and its long-term development and maintenance,” says Bill Braithwaite, HL7 board member. “We feel that HL7’s open, rigorous, and multi-stakeholder standards-development process provides an appropriate home for implementation guides of widespread applicability and national importance, such as ELINCS.”

bullet Contracts

  • 3M Co. has contracted with the Mayo Clinic to provide radio-frequency identification devices that will track patients’ endoscopy tissue samples. The contract calls for 3M to provide RFID tracking tags and scanners for the 41 operating rooms at Mayo where endoscopy and colon procedures are performed.
  • McKesson has implemented its new radio-frequency identification solution, Horizon Real-Time Location System, at Spartanburg (SC) Regional Medical Center. Spartanburg is using the RFID solution to track and record the location history of 550 intravenous infusion pumps facilitywide.
  • Axolotl has announced that Greater Rochester (NY) Regional Health Information Organization has selected its e2 technology and professional services to create a federated, patient-centric health information exchange. The organization has contracted for Axolotl’s integrated record locator service, community-wide master patient index, integrated e-prescribing solution, and secure clinical messaging to receive patient data from multiple hospitals, reference laboratories, and imaging centers.

    Axolotl also reported that Quality Health Network, a regional health information organization in western Colorado funded by local health care groups, is using its Elysium community-wide electronic health record to provide emergency room clinicians with instant access to complete patient data.

  • Medical Information Technology has announced that Norman (Okla.) Regional Health System has contracted for its health care information system, including its financial, clinical, and patient safety applications.
  • The University of Arkansas for Medical Sciences, Little Rock, has licensed Mediware’s HCLL transfusion blood management software.

Dr. Aller is director of bioterrorism preparedness and response for Los Angeles County Public Health Acute Communicable Diseases. He can be reached at Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at