LA County MHSA Contract Provider Fund Request Forms' Terminology

Many of you have asked for assistance with the definition of EHR-S project category terms used on the MHSA Exhibits DMH/LA sent you to complete by May 15th. Here is what I have been able to find and some thoughts on interpretation. By all means, read them yourself and use your own judgement.

The EHR-S project category terms used are from the California State EHR Roadmap. The definitions in the most recent State MHSA document are as follows:

1. Infrastructure Function Requirements:
   Includes hardware and software with basic level of security and systems ready to deploy software. Interoperable EHRs require a structure for sharing information—a secure network. This group is tasked with refining the requirements in this functional area.
   
2. Practice Management Function Requirements:
   Includes registration, eligibility, accounts receivable, accounts payable, billing, documentation, and reporting. These requirements address the complex financial and administrative needs of physician practices. These requirements will help County Mental Health Departments formulate the criteria needed to provide critical support for practice management functions to increase productivity, improve financial performance, financial management and compliance programs, and determine legal implications of business arrangements.
   
3. Clinical Data Function Requirements:
   Includes clinical documentation such as assessment, treatment notes and other clinical measures, such as data elements and corresponding definitions that can be used in the measurement of patient clinical management and outcomes, and for research and assessment.
   I am not clear what they really mean the difference to be between the 'documentation' supported in Practice Management versus the 'clinical documentation' included in Clinic Data Function.
   
4. Computerized Provider Order Entry (CPOE) Function Requirements:
   Includes internal and external laboratory, pharmacy and/or radiology ordering and history display. These requirements address optimizing physician ordering of medications, laboratory tests with interactive decision support system. Integration with other hospital information technology systems including electronic patient records, pharmacy, laboratory, and other services provides the prescriber with all information necessary to develop and transmit an effective, error-free order.
   
5. Full EHR Requirements:
   Includes infrastructure, health record capture, decision support, reporting, data transfer and CPOE components that are interoperable with external systems such as those used by contracted providers using industry standards.
   I understand some of you were given guidance by DMH to use the "Full EHRS" check box, but this new document seems to indicate this includes automated/electronic CPOE functions.
   
   Full EHR and PHR Requirements:
   Includes Full EHR functionality and interoperability with a Personal Health Record system. These requirements will encompass the minimum statewide standards.
   

This indicates that a "Full EHRS" should include CPOE, and CPOE includes "interactive decision support" and the ability to "transmit" orders. I know that most of you do not intend to implement CPOE or what we have been calling "e-prescriptions / e-labs / and contraindictation support", due to the cost of these add-ons. Therefore, this leads me to believe that most LA contract providers should not check the "Full EHR-S" box on Exhibit 2, unless they have purchased, or intend to purchase the add-on for automated electronic CPOE.

Here are some links to other references to these terms that may be helpful to you:
http://www.officeofrustyselix.org/email/CCCMHA/Info/May%20Formal%20Task%20Groups%204_21_08_JC.pdf (see last page for definitions)
http://www.dmh.ca.gov/DMHDocs/2008_Notices.asp
http://www.dmh.ca.gov/Prop_63/MHSA/Technology/docs/Meetings/2008/Mar/MHSA_BH_RM_All_Requirements.pdf
and other docs listed here: http://www.dmh.ca.gov/Prop_63/MHSA/Technology/default.asp?county=Los+Angeles&view=View

by Keely McGeehan, Sahara Management Solutions, Inc.