U.S. Department of Health and Human Services
Jennie Harvell, MEd
U.S. Department of Health and Human Services
Michelle Dougherty, MA, RHIA, CHP
American Health Information Management Association
Nathan Lake, RN, BSN, MSHA
Sue Mitchell, RHIA
Omnicare Information Solutions
PDF Version: http://aspe.hhs.gov/daltcp/reports/2008/LNEHRSFP1.pdf (186 total PDF pages)
This report was prepared under contract #HHS-100-03-0026 between U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and Abt Associates. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Jennie Harvell, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Her e-mail address is: Jennie.Harvell@hhs.gov.
The opinions and views expressed in this report do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organizations.
Release 1 of the Long-Term Care Nursing Home (LTC-NH) Electronic Health Record System (EHR-S) Functional Profile, based on the Health Level Seven (HL7) EHR-S Functional Model Release 1, February 2007, has been balloted through the LTC-NH EHR-S Functional Profile Workgroup, and will be registered with the HL7 EHR Technical Committee and submitted for balloting at the committee level. The intention is for this functional profile to become an ANSI approved normative standard.
The LTC-NH EHR-S Functional Profile Workgroup was sponsored and facilitated by:
These organizations are indebted to the following workgroup facilitators and members for their contributions to the LTC-NH community and the materials presented in this profile.
The long-term care community is particularly indebted to Sue Mitchell for her leadership and significant contribution to the development of the LTC-NH EHR-S Functional Profile. This Functional Profile would not have been possible without her guidance and assistance.
|Jennie Harvell, MEd||HHS, ASPE|
|Michelle Dougherty, MA, RHIA, CHP||AHIMA|
|Nathan Lake, RN, BSN, MSHA||American HEALTHTECH|
|Sue Mitchell, RHIA||Omnicare Information Solutions|
|Adam Prybyl||Momentum Healthware|
|Amy Killian||Phoebe Services|
|Beth de la Hunt||Achieve Healthcare Technologies|
|Betty Pilous||Ohio KePRO|
|Brian Young||Accu-Med Services, LLC|
|Carla Saxton McSpadden||American Society of Consultant Pharmacists|
|Debra Ann Phillips||Genesis Health Care Corp|
|Denine Hastings||Genesis Health Care Corp|
|Doc DeVore||MDI Achieve|
|Donna Brickey||American HEALTHTECH|
|Eileen Doll||EDHC, Inc.|
|Frank Leonard||Armed Forces Retirement Home|
|Frank McKinney||Achieve Healthcare Technologies|
|Ginna Sloan||Accu-Med Services, LLC|
|James Hancock||QS/1 Data Systems|
|Judy Baker||Accu-Med Services, LLC|
|Karrie Ingram||Citizens Memorial Healthcare|
|Kristine Cerchiara||Healthcare Innovation Partners|
|Linda Lucas||Fulton Manor|
|Linda Spurrell||Keane Care|
|Lorraine Toderash||Momentum Healthware|
|Louis Hyman||eHealth Solutions|
|Marcelle Feltman||Sun Healthcare|
|Margie White||Columbus Colony Elderly Care|
|Maria Moen||Healthware Consulting Services|
|Melanie Brodnik||The Ohio State University|
|Melissa Carter||American Health Care Software Enterprises|
|Mike Crowder||Golden Ventures|
|Nathan Simonis||American Data|
|Peter Kress||ACTS Retirement Life Communities|
|Rhonda Anderson||Anderson Health Information Systems|
|September Stone||National Health Care Learning Center|
|Shelly Spiro||R. Spiro Consulting|
|Sue Lewis||Accu-Med Services, LLC|
|Susan Greenly||Keane Care|
|Tim Smith||Golden Ventures|
|Todd Smith||American Health Care Association|
|Zoe Bolton||Independent Consultant|
|Allan Neoh||Achieve Healthcare Technologies|
|Allan Rosenbloom||Alliance for Quality Nursing Home Care|
|Bill Russell||Erickson Retirement Communities|
|Brenda Parks||Keane Care|
|Bryce Berry||Sunshine Terrace Foundation|
|Chris Thomas||Accu-Med Services, LLC|
|Christa Hojlo||Veterans Administration|
|Craig Baker||Accu-Med Services, LLC|
|Daniel Stein||Columbia University|
|Daniel Wilt||Erickson Retirement Communities|
|Darin Ballweg||American Data|
|Dave Dring||Interactive Aging Network|
|Dave Oatway||Care Track Systems, LLC|
|Debra Sperry||Good Samaritan Society|
|Denise Trcka||Achieve Healthcare Technologies|
|Eric Baker||Innovatix, LLC|
|Gary Schoetmer||RNA Health Information Systems|
|Geoffrey Bunza||Vigilan Inc|
|Gloria Bean||TMF Health Quality Institute|
|Heath Boddy||Nebraska Health Care Assocication|
|Hongsoo Kim||NYU College of Nursing|
|Irene Wright||American Health Care Software Enterprises|
|James Kwokon Eng||American Physical Therapy Association|
|Jamie Husher||The Evangelical Lutheran Good Samaritan Society|
|Janet Barber||Veterans Administration|
|Jeanette Kranacs||HHS, Centers for Medicare & Medicaid Services|
|Jeffrey Woodside||INHOUSE Pharmacy Solutions|
|Jerry Gurwitz, MD||Division of Geriatric
University of Massachusetts Medical School
|Jesse Wrenn||Columbia University|
|Jessica Dalton||Park River Estates Care Center|
|Joann Ross||Genesis Health Care Corp|
|Johnine Brooks||HCR Manor Care|
|Joy Thompson||HHS, Centers for Medicare & Medicaid Services|
|Julie Purcell||SavaSeniorCare Administrative Services|
|Julie Thompson||Beacon Partners, Inc|
|Karen Jennings||Ohio Department of Jobs & Family Services|
|Karen Thiel||Patton Boggs LLP|
|Karthik Natarajan||Columbia University|
|Kathy Hurst||SavaSeniorCare Administrative Services|
|Keith Speights||American HEALTHTECH|
|Keith Weaver||Ohio Department of Health|
|Kenneth Brouse||Community Health Systems|
|Kevin McCormack||Keane Care|
|Kevin Unrein||Lake Point|
|Kevin Warren||TMF Health Quality Institute|
|Larry Hillock||Community Health Systems|
|Larry Wolf||Kindred Healthcare|
|Linda Kunz||DART Chart|
|Marcia DeRosia||American Health Care Software Enterprises|
|Maria Arellano||American Association of Nurse Assessment Coordinators|
|Martin Rice||HHS, Centers for Medicare & Medicaid Services|
|Mary Anne Kurowski||Genesis Health Care Corp|
|Mary Guthrie||Veterans Administration|
|Mary Pratt||HHS, Centers for Medicare & Medicaid Services|
|Matthew Mullins||Momentum Healthware|
|Mike Easley||Home Quality Management Inc|
|Murry Mercier||HCR Manor Care|
|Nancy Robinson||American Medical Directors Association|
|Nelwyn Madison||American HEALTHTECH|
|Patty Padula||Myers & Stauffer|
|Rhonda Hamilton||National Government Services (FI)|
|Rich Castor||Genesis Health Care Corp|
|Rich Giddings||Achieve Healthcare Technologies|
|Rob Sutton||Accu-Med Services, LLC|
|Robert Abrams||My ZIVA|
|Roger Smith||Strafford County IT Department|
|Roi Qualls||eHDS Operations|
|Royall Chambers||Eliza Bryant Village|
|Russ Depriest||HCR Manor Care|
|Sheila Dosher||Sun Healthcare|
|Sheila Lambowitz||HHS, Centers for Medicare & Medicaid Services|
|Sherrie Orvis||Veterans Administration|
|Steven Handler||University of Pittsburg School of Medicine|
|Sue Rucinski||Sava Senior Care Administrative Services|
|Suzanne Weaver||Neshaminy Manor|
|Thomas Welch||Eagle Software Group|
|Tydette Tisdell||Veterans Administration|
|Yael Harris||Office of the National Coordination of Health Information Technology|
|This is Release 1 of the Long-Term Care-Nursing Home (LTC-NH) Electronic Health Record System (EHR-S) Functional Profile. Based on, and conformant with, the Health Level Seven (HL7) EHR-S Functional Model (FM) Release 1, February 2007, this document represents the culmination of one year of extensive work by private and public industry representatives and other stakeholders to identify functional requirements for EHR systems in nursing home settings. This document has been balloted by the LTC-NH EHR-S Functional Profile Workgroup and represents industry consensus on system requirements.|
In late 2006, the U.S. Department of Health and Human Services (HHS) authorized and funded the Certification Commission for Healthcare Information Technology (CCHIT) to expand its certification scope of work and begin addressing EHR products to include ambulatory medical specialties and specialized care settings. Key stakeholders in the long-term care community, led by the joint efforts of the American Association of Homes and Services for the Aging (AAHSA), the American Health Care Association (AHCA), and the National Association for the Support of Long-Term Care (NASL), petitioned CCHIT for the inclusion of nursing homes in this expanded scope of certification activity. In March 2007, CCHIT officially announced their Roadmap for expansion of product certification -- and nursing homes were included. Actual certification of nursing home EHR products is anticipated in 2010.
In creating the certification criteria for nursing home EHR products, CCHIT will draw heavily on the requirements published in the 2007 HL7 EHR-S FM standard, as well as the industry specific requirements identified in the LTC-NH EHR-S Functional Profile.
While the HL7 EHR-S FM provides a reference list of functions that may be present in an EHR-S, the nursing home community has developed this LTC Functional Profile that identifies the subset of functions from the model that reflects the unique aspects and needs for EHR systems in the long-term care setting. CCHIT will use the LTC EHR-S Functional Profile as a reference when they develop the functionality, interoperability, and security requirements for certified NH EHR-S products.
Funding for the development of this LTC EHR-S Functional Profile has been provided by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). Project leadership has been provided by ASPE, the American Health Information Management Association (AHIMA), the Health Level Seven Electronic Health Record Technical Committee (HL7 EHR TC) and the National Council for Prescription Drug Programs (NCPDP).
Extensive volunteer support has been provided by a broad array of LTC industry and stakeholder representatives who have participated in the virtual meetings that were held each week to define the content of the profile.
This document will be registered with the HL7 EHR TC as a conformant profile in July 2008. It will also be made available to appropriate CCHIT staff and committees at that time. In addition, the profile will be submitted to the HL7 EHR TC for the first cycle of balloting as a normative standard. This HL7 balloting will occur in the September 2008 ballot cycle.
In addition to this Overview section, the LTC-NH EHR-S Functional Profile is organized into three sections of system requirements as follows.
|Direct Care||Functions employed in the provision of care to individual patients and to collect information that will comprise the patients EHR. Direct care functions are the subset of functions that enable delivery of health care or offer clinical decision support.|
|Supportive Functions||Functions that support the delivery and optimization of care, but generally do not impact the direct care of an individual patient. These functions assist with the administrative and financial requirements associated with the delivery of health care, provide support for medical research and public health, and improve the global quality of health care.|
|Information Infrastructure||Functions that support the reliability, integrity, security and interoperability of the EHR-S. These functions are not involved in the provision of health care, but are necessary to ensure the integrity and security of the patients electronic health information.|
This profile is based on HL7 EHR-S FM, Release 1, February 2007. Key to the FM and derived profiles is the concept of conformance which may be defined as verification that an implementation faithfully meets the requirements of a standard or specification. A profile can be said to conform to the FM if it adheres to the defined rules identified by the FM specification. The LTC-NH EHR-S Functional Profile adheres to the defined rules of the EHR-S FM. Similarly, an EHR-S may claim conformance to the LTC-NH EHR-S Functional Profile if it meets all the requirements outlined in this profile.
The LTC-NH EHR-S Functional Profile applies to EHR systems developed for nursing homes. This profile makes no distinction regarding implementation -- the EHR-S described in this functional profile may be a single system or a system of systems.
The LTC-NH EHR-S Functional Profile Workgroup recognizes that clinical computing is an evolving field, and that many of the desired functions of EHR systems are not currently available. Nevertheless, it is important for functional profiles to outline major trends and articulate a vision for functionality (especially interoperability) for the future. Furthermore, the delineation of potential functions for future implementation and adoption should guide vendors in system development, and help purchasers develop and articulate to vendors a strategic vision for future functional requirements.
Each function in the profile is assigned a single priority as follows:
|EN||Essential Now||Indicates that the implementation of the function is mandatory and SHALL be implemented in EHR systems claiming conformance to this profile.|
|EF xxxx||Essential Future||Indicates that the function has significant importance but is not widely available. The function will become mandatory and SHALL be implemented in EHR systems claiming conformance to this profile by the end of the year identified.|
|O||Optional||Indicates that, while the function may have value to some organizations, it is not viewed as being essential.|
|N/A||Not Applicable||Function not applicable in the nursing home setting and rejected for purposes of the LTC-NH EHR-S Functional Profile.|
The key words SHALL, SHALL NOT, SHOULD, and MAY in this document are to be interpreted as described in HL7 EHR-S Functional Model, Release 1, February 2007 Chapter 2: Conformance Clause:
|SHALL||Indicates a mandatory requirement to be followed (implemented) in order to conform. Synonymous with "is required to" and "must".|
|SHALL NOT||Indicates a prohibited action. Synonymous with "prohibited" and "must not".|
|SHOULD||Indicates an optional recommended action, one that is particularly suitable, without mentioning or excluding others. Synonymous with "is permitted and recommended".|
|MAY||Indicates an optional, permissible action. Synonymous with "is permitted".|
The following provisions apply to claims of conformance to the LTC-NH EHR-S Functional Profile:
|Systems claiming conformance to this Profile SHALL||Implement all functions designated Essential Now. Fulfill (i.e., meet or satisfy) all the SHALL criteria for each implemented function.|
|Systems claiming conformance to this Profile MAY||Implement functions designated Essential Future. Fulfill any of the SHOULD or MAY criteria associated with an implemented function.|
|Systems claiming conformance to this Profile SHALL NOT||Negate or contradict defined functionality of this profile when including additional functionality beyond what is specified in this profile.|
|Derived profiles claiming conformance to this Profile SHALL||Inherit all functions designated Essential Now. Inherit all SHALL criteria for functions included in the derived profile. Follow the rules for profiles in Chapter 2, Section 6.1 of the HL7 EHR-S FM standard. Adhere to the rules for creating new functions in Chapter 2, Section 6.3 of the HL7 EHR-S FM standard.|
|Derived profiles claiming conformance to this Profile MAY||Change SHOULD and MAY criteria to SHALL, SHOULD or MAY criteria.|
|Derived profiles claiming conformance to this Profile SHALL NOT||Change the functions name or statement.|
In some instances a SHALL criterion in a function may require conformance with another function in the profile that has a different timing priority (i.e., a criterion in an Essential Now (EN) function may require conformance with a function designated as Essential Future (EF) 2011). This situation would arise when HL7 requirements regarding profiles adopting mandatory requirements from the FM did not harmonize well with timing priorities for functions identified by profile developers. It is important to understand that the priority timing of a referencing function DOES NOT supersede the timing priority established for the referenced function. Examples include:
|Example #1 (Referencing Function EN, Referenced Function EF)|
|ID/Name:||DC.3.2.3 (Support for Communications Between Provider and Patient )|
|SHALL Criteria for This Function:||
|ID/Name:||IN.1.4 (Patient Access Management)|
|Priority:||Essential Future 2010|
|Example #2 (Referencing Function EF, Referenced Function EN)|
|ID/Name:||DC.2.2.2 (Support Consistent Healthcare Mgt of Patient Groups or Populations)|
|Priority:||Essential Future 2012|
|SHALL Criteria for This Function:||
|ID/Name:||DC.220.127.116.11 (Support for Context-Sensitive Care Plans, Guidelines, Protocols)|
|ID/Name:||S.2.2.2 (Standard Report Generation)|
Additional clarification is necessary to understand the standardized nomenclature used to describe the functions of a system. The following chart, adapted from the EHR-S FM How to Guide for Creating Functional Profiles, illustrates the hierarchy of nomenclature. For example, capture is used to describe a function that includes both direct entry create and indirect entry through another device input. Similarly, maintain is used to describe a function that entails reading, updating, or removal of data.
| Input Device
Each function in the LTC-NH EHR-S Functional Profile is identified and described using a set of elements or components as detailed below.
This is the unique outline identification of a function. Functions inherited from the HL7 EHR-S FM retain the ID assigned in the model. New functions added by the authors of the LTC-NH Functional Profile are underscored and shown in blue font.
Indication of the line item as being a header (H) or function (F).
Indication that implementation of the function is Essential Now (EN), Essential Future (EFxxxx), Optional (O), or Not Applicable (N/A). The definitions for these priorities are found above.
The name of the Function (Example: Entity Authentication). Functions inherited from the HL7 EHR-S FM retain the Function Name as stated in the model. Names for new functions added by the authors of the LTC-NH EHR-S Functional Profile are underscored and shown in blue font.
Brief statement of the purpose of this function (Example: Authenticate EHR-S users and/or entities before allowing access to an EHR-S). Functions inherited from the HL7 EHR-S FM retain the Function Statement as shown in the model. Statements for new functions added by the authors of the LTC-NH EHR-S Functional Profile are underscored and shown in blue font.
Detailed description of the function, including examples if needed (Example: Both users and applications are subject to authentication. The EHR-S must provide mechanisms for users and applications to be authenticated. Users will have to be authenticated when they attempt to use the application, the applications must authenticate themselves before accessing EHR information managed by other applications or remote EHR-S...) Functions inherited from the HL7 EHR-S FM retain the portions of the Description shown in the model that are relevant to the nursing home setting, with additional industry-specific explanation being underscored and shown in blue font. Descriptions for new functions added by the authors of the LTC-NH EHR-S Functional Profile are underscored and shown in blue font.
This element is intended to identify relationships between functions.
This element displays valuable statements used to determine if a particular function is met (Example: The system SHALL authenticate principals prior to accessing an EHR-S application or EHR-S data). Modifications to conformance criteria inherited from the HL7 EHR-S FM are underscored and shown in blue font. Conformance criteria added to functions inherited from the functional model are indicated by an alpha designation (e.g., criterion #4a) and are underscored and shown in blue font. This numbering method allowed developers to display criteria in a logical sequence -- there is no relationship implied in regards to other criterion for the function. Finally, for new functions added to the LTC-NH EHR-S Functional Profile, criterion are underscored and shown in blue font.
This element is provided to help users when navigating the various sections (i.e., a user can reference row #38 of the IN section versus stating function IN.1.6, criterion #5).
This element is intended to assist with tracing profile content back to the HL7 EHR-S FM. The column displays the ID# for the source function from the model, or is blank if the function was added by the authors of the LTC-NH EHR-S Functional Profile.
This element is intended to assist with tracing profile content back to the HL7 EHR-S FM. The column displays the number for the source criterion from the model, or is blank if the criterion was added by the authors of the LTC-NH EHR-S Functional Profile.
This element is intended to assist with tracing profile content back to the HL7 EHR-S FM. The following codes are used to convey the status of the profiles criteria in relation to the FM:
N/C (No Change) -- the criterion is exactly the same as in the FM.
A (Added) -- the criterion was added by the EHR-S Functional Profile authors and is not found in the FM.
M (Modified) -- the criterion has been modified and is not the same as in the FM. Modifications to the FM text are underscored and shown in blue font.
D (Deleted) -- the criterion from the FM was determined to be inappropriate for the profile and was deleted. Only SHOULD and MAY criterion can be deleted -- SHALL criteria from the FM must be inherited by the profile.
|LIST OF REPORT FILES:
To obtain a printed copy of this report, send the full report title and your mailing information to:
U.S. Department of Health and Human Services
Office of Disability, Aging and Long-Term Care Policy
Room 424E, H.H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201
Office of Disability, Aging and
Long-Term Care Policy (DALTCP) Home [http://aspe.hhs.gov/_/office_specific/daltcp.cfm]
Assistant Secretary for Planning and Evaluation (ASPE) Home [http://aspe.hhs.gov]
U.S. Department of Health and Human Services Home [http://www.hhs.gov]