facilities, and 21 percent of home health agencies would have implemented EHRs, and that 21–32 percent of office practices, 26–54 percent of hospitals, and 14 percent of skilled nursing facilities would have implemented CPOE (Kaushal et al., 2005). The committee believes this projected rate of adoption is too slow and that efforts should be made to speed it up.

The committee believes the California legislation discussed above is an important step toward the implementation of technologies for reducing medication errors. The committee believes further that this initiative should be expanded. Accordingly, the committee recommends that regulators, accreditors, and legislators set minimum functionality standards for information technology as conditions of participation, accreditation requirements, and licensing requirements, drawing on existing functionality models for electronic prescribing (to meet the 2010 deadline recommended in Chapter 5), CPOE, and EHRs. Several models exist on which to base these minimum functionality standards:

  • The Veterans Health Administration operates one of the largest integrated health information systems in the United States (IOM, 2002). The Veterans Health Information Systems and Technology Architecture (VistA), now known as HealtheVet-VistA, is an EHR system that incorporates CPOE, a clinical ordering and decision-support system providing drug– drug and drug–disease interactions. This system is available as free, public-domain software obtainable under the Freedom of Information Act through e-FOIA at ftp://ftp.va.gov/VistA.2

  • The Medicare Modernization Act of 2003 mandated that the National Committee on Vital and Health Statistics develop recommendations for uniform standards to enable electronic prescribing in ambulatory care. In a September 2004 letter to the secretary of the Department of Health and Human Services (DHHS), the committee addressed message format standards (NCVHS, 2004); in a March 2005 letter, the committee addressed electronic signatures and other issues (NCVHS, 2005).

  • An eHealthInitiative report (eHI, 2004) and several journal articles have outlined functionality standards for electronic prescribing/clinical decision support (Bates et al., 2003; Bell et al., 2004; Teich et al., 2005). The Leapfrog Group, with support from the California Health Care Foundation and The Robert Wood Johnson Foundation, is also active in promoting standards for CPOE (Metzger and Turisco, 2001; Forester et al., 2003), including electronic prescribing in ambulatory care (Classen, 2005).


The Healthe Vet-VistA system may also be obtained on DVD from the following address: Department of Veterans Affairs, VHA Office of Information Field Office, ATTN: National Help Desk (FOIA Request), 3701 Loop Road East, Building 40, Tuscaloosa, AL 35404.

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