Product EHR FM

Product Brief - EHR-S FM

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Product Name

Electronic Health Record Systems - Functional Model (EHR-S FM)

Standard Category

Application Functional Specifications

Type

Normative, ANSI Standard, ISO Standard

Releases

• ISO/HL7 10781:2009 Electronic Health Record Systems - Functional Model, Release 1.1 published 11 November 2009.
• ANSI/HL7 EHR, R1-2007
  • See EHR System Functional Model, Normative HL7/ANSI Standard, published Mar 2007 (5 MB)

Summary

The healthcare industry will greatly benefit by adopting a common standard for electronic health record systems (EHR-S). The HL7 EHR-S Functional Model outlines important features and functions that should be contained in an EHR system. Through the creation of functional profiles, this model provides a standard description and common understanding of functions for healthcare settings. To date, HL7 has developed, or is developing, profiles for areas such as child health, emergency care, long term care, behavioral health and vital statistic reporting. The EHR-S Functional Model is also in the final stages of vetting as an international standard through ISO.

The HL7 EHR System Functional Model provides a reference list of functions that may be present in an Electronic Health Record System (EHRS). The function list is described from a user perspective with the intent to enable consistent expression of system functionality. This EHRS Functional Model, through the creation of Functional Profiles for care settings and realms, enables a standardized description and common understanding of functions sought or available in a given setting (e.g., intensive care, cardiology, office practice in one country and primary care in another country.

Description

Providers of care and users of EHR-Ss depend on a definable set of functions to meet the IT needs of their organizations. The purpose of the HL7 EHR-S Functional Model is to provide a superset of the functionalities required to support an EHRS.The EHR-S FM outlines important features and functions that should be contained in an EHR system.

The internationally-oriented EHR-S FM received ANSI accreditation in Frbruary of 2007 and contains a superset of more than 150 functions that facilitate consistent expression of EHR system features and functionality. The model also contains more than 1000 conformance criteria that further clarify system functionality on behalf of EHR system purchasers, vendors, and system integrators. Such a standard becomes the basis for certification of EHRS and may be specific to a realm, a site of care, or a business agreement. The standard has received broad industry input from more than a thousand clinicians, as well as from EHR vendors, payers, researchers, and others across the industry.

The standard’s Functional Model contains approximately 1,000 conformance criteria across 130 functions, including medication history, problem lists, orders, clinical decision support, and those supporting privacy and security. The functions are described from a user perspective and enable consistent expression of EHR system functionality, while the conformance criteria serves as a reference for purchasers of EHR systems and vendors developing EHR software.

The EHR-S FM has already proven to be a powerful tool for the Certification Commission for Health Information Technology (CCHIT). According to Mark Leavitt, MD, PhD, chair of CCHIT, "The HL7 standard for EHR systems has been extremely valuable to us, providing the starting framework for CCHIT’s development of certification criteria. CCHIT and HL7 provide a good example of effective collaboration between different organizations, as we all work toward the goal of accelerating the adoption of robust, interoperable health IT." The EHR-S Functional Model is versatile, adaptable, and applicable across the continuum of care, supporting key advances in EHR systems. HL7 encourages healthcare stakeholders to participate in the development of profiles to support specific uses across the continuum of care.

To date, a number of profiles have been developed.

• In April 2007, the Emergency Care Functional Profile, which can be used to develop, refine and evaluate EHR systems for emergency departments, was registered.
• The Child Health Functional Profile, which provides critical electronic health record system functions to care for children in the United States, was developed in August 2007, and became an ANSI-approved standard in December 2008.
• The Behavioral Health Functional Profile can be used by treatment provider organizations to select or build their own EHR systems; EHR software developers to guide their future product development efforts; certification organizations to certify EHR software; and healthcare payers as part of their criteria for pay-for-performance and other incentives. It also became an ANSI-approved standard in December 2008.
• The Long-Term Care Functional Profile reflects the unique mandates and practices of the long-term care setting. This end product is an invaluable tool as LTC providers and IT vendors work to advance technology that enhances: patient safety; quality of care; efficiency; and continuity of care. This profile was approved as a normative standard in January 2009 and accepted by ANSI in September 2010.
• The Electronic Health Record (EHR)/Clinical Research (CR) Profile provides high-level requirements necessary for using electronic health record data for regulated clinical research, as well as a roadmap for integrating the data collection for both patient care and clinical research (“collect once, re-purpose many times.”). This functional profile encourages EHR vendors to incorporate functions into their products so that electronic health records can be a direct data source for clinical studies as appropriate. This profile was approved as an ANSI standard in January 2009.
• The Records Management and Evidentiary Support Functional Profile provides functions in an EHR system that can help an organization maintain a legal record for business and disclosure purposes, help reduce a provider’s administrative burden, and reduce costs and inefficiencies caused by redundant paper and electronic record keeping. The profile, registered in 2008, became a fully ANSI accredited standard in August 2010.
• The development of the Vital Reporting Functional Profile is now underway. The first profile to focus on secondary data use, this profile outlines the functions for collecting data at the point of care that can support the reporting of births and deaths.
• The development of the Ambulatory Oncology Functional Profile is also in process, balloting as DSTU 2010May. This Functional Profile for an ambulatory oncology setting based on, and conformant to, the ANSI approved June 2009 EHR-S Functional Model release 1.1.
• The development of the Electronic Nutrition Care Process Record System Functional Profile creates a standard list of functions and criteria needed for full integration of both the nutrition care process and the International Dietetics and Nutrition Terminology (IDNT) for nutrition care in the ENCPRS into the EHRS, which leverages the placement of the IDNT terminology in UMLS, LOINC and/or SNOMED

As the first joint standard between the International Organization of Standards (ISO) and HL7, the EHR-S FM is in the final stages of vetting as an international standard. If and when the EHR-S FM is approved as an ISO standard, it will be referenced by HL7 as EHR-S FM Release 1.1 and by ISO as ISO 10781. The HL7 EHR Work Group is now planning the next major release of the EHR-S FM, which will be designated Release 1.2 or Release 2.0, depending on the level of enhancements to the current Functional Model. Work to actively revise the Functional Model will commence in the second half of 2009. Those interested in both the planning and development efforts are welcome to participate. Contact the HL7 office for more information.

For those thinking about creating a profile, the How to Guide for Creating Functional Profiles is available on the Work Group’s Functional Profile webpage (www.Hl7.org/ehr). In addition, the HL7 EHR Work Group is available to provide further guidance.

Any functional profile that conforms to the EHR System Functional Model standard can be registered with HL7. This registration involves self-attestation of conformance by those submitting the functional profile for registration via a questionnaire that is completed at submission time. Registration can facilitate the adoption of the profile by making it publicly available for use. All registered profiles are available to the public through a searchable registry at: http://www.nist.gov/profileregistry.

Business Case (Intended Use, Customers)

• EHR system purchasers
• Vendors
• System integrators

Benefits

EHR-S functions can be used to:

• Facilitate describing end user defined benefits such as patient safety, quality outcomes and cost efficiencies in terms of standard EHR-S functions.
• Promote a common understanding of EHR functions upon which developers, vendors, users and other interested parties can plan and evaluate EHR-S functions.
• Provide the necessary framework to drive the requirements and applications of next level standards, such as EHR content, coding, information models, constructs and interoperability for information portability between sub-systems of an EHR-S and across EHR-S’.
• Establish a standards-based method by which each realm (country) can apply these EHR functions to care settings, uses, and priorities.
• Inform those concerned with secondary use of EHR data and national infrastructure what functions can be expected in an EHR System.

Implementations/ Case Studies (Actual Users)

• U.S. National Institute of Standards and Technology (NIST)

Resources

• For more information on the EHR-S FM and the HL7 Electronic Health Records Work Group, please visit: http://www.HL7.org/ehr.
• EHR Work Group Wiki page

Work Groups

• EHR WG

Education

• http://xreg2.nist.gov:8080/ehrsRegistry/view/listFunctionalProfiles.jsp?filter=ehrs
• See more at http://www.hl7.org/implement/training.cfm

Presentations

• See http://wiki.hl7.org/index.php?title=Product_EHR_FM#Presentations.

From HIMSS 2009

• EHR-S FM and Standard
• Advanced EHR-S FM and Standard: Profiles Against the EHR & PHR S FM

Links to current projects in development

• Project Insight # 551, EHR Release II
• Project Insight # 480, HL7 EHR System Functional Model Release 1 (ISO Ballot Project)