CertifyingEHR: AAD takes lead on dermatology-specific criteria -

CertifyingEHR: AAD takes lead on dermatology-specific criteria - - DermatologyTimes

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CertifyingEHR: AAD takes lead on dermatology-specific criteria

Nov 1, 2009
By: John Jesitus
Dermatology Times

Key Points

AAD takes lead role in creating derm-specific EHR certification criteria

Dr. Woodcock

National report — Because commercially available EHR systems have largely ignored the needs of dermatology practices, the American Academy of Dermatology (AAD) has taken a lead role in the creation of dermatology-specific EHR certification criteria, sources say.

The American Reinvestment and Recovery Act (ARRA) offers approximately $63,500 per physician for implementing EHRs by 2014, says Elizabeth W. Woodcock, a practice management author and "Business Consult" columnist for Dermatology Times.

Dr. Kvedar

These funds include up to $44,000 per physician over five years (based on Medicare billings), plus around $19,000 in state funds per physician for heavy Medicaid providers, she says.

Dr. Siegel

For physicians to earn this money, however, the ARRA stipulates that the EHRs be "certified and used in a meaningful way. And neither of those terms has been fully defined yet," says Daniel M. Siegel, M.D., clinical professor of dermatology and procedural dermatology fellowship director, SUNY Downstate, Brooklyn, N.Y.

Dr. Kaufmann

CCHIT and other organizations have been suggesting certification routes and definitions, particularly regarding meaningful use, Dr. Siegel says. However, "No one knows whose definition is going to be accepted," or when this decision will be made, he says.

Standards goal is 2010

The American Academy of Dermatology (AAD) is currently helping CCHIT to develop dermatology-specific certification criteria that CCHIT plans to unveil in 2010.

The AAD got involved with this process because "Though dermatology is a relatively small specialty, it has unique needs that have not been met by the current slate of EHR products on the market," says Mark D. Kaufmann, M.D., co-chairman of the CCHIT dermatology work group and a member of the AAD's practice management task force.

"Certification criteria particular to dermatology will help to improve adoption levels, as better marketplace alternatives would be encouraged," he says.

Although dermatology shares some basic EHR functionalities with other medical specialties, Dr. Kaufmann says, EHRs in dermatology "must be able to support the extensive and varied scope of dermatology practice, which includes medical, surgical and cosmetic dermatology and dermatopathology."

Joseph Kvedar, M.D., associate professor of dermatology, Harvard Medical School, says many EMR products are designed around primary care workflow and don't have the kind of visual tools that would be helpful to dermatologists.

In fact, he says the EMR chosen by the organization in which he works doesn't allow him to draw or annotate images.

"We've learned to deal with it" by linking to a shadow imaging system on a network drive, he says. "We also have a software system that was purchased so doctors could upload and store images."

Dr. Kaufmann says, "As a highly descriptive, visually oriented and procedure-intensive specialty, ... [dermatology] benefits from digital imaging, photo documentation (namely, digital imaging capture, storage, display, management and transmission) and anatomic graphic management capabilities, such as anatomic drawings and mappings."

Efficiency needed

Because dermatology practices generate large numbers of tissue specimens for testing, he adds, interaction between dermatologists and dermatopathologists inside or outside their practices must be efficient.

Ms. Woodcock notes that dermatology's high-volume, short-visit nature creates challenges. If an EMR knocks a dermatologist off schedule, "It's going to be a disaster. The EMR must be as fast as or faster than handwriting. And that's very difficult to do."

When dermatology criteria are finalized, the CCHIT dermatology workgroup will use these criteria to test the capabilities and readiness of various EHR products, according to the AAD.

On Sept. 4, the CCHIT announced that in addition to launching an updated, comprehensive EHR certification called CCHIT Certified 2011 on Oct. 7, the organization planned to offer a modular certification program that is limited to the standards for qualifying EHR technology under the American Recovery and Reinvestment Act.