Wednesday, June 24, 2009

The Second Meeting of the HIT Standards Committee

Guest author and co-chair of the HIT Standards Committee John Halamka reports on the HIT Standards Committee working groups' progress on Clinical Operations, Clinical Quality and Privacy/Security.

The Second Meeting of the HIT Standards Committee
by John Halamka

Today, Jonathan Perlin and I ran the second meeting of the HIT Standards Committee.

Here's a report on presentations and the work ahead.

Jamie Ferguson presented the work of the Clinical Operations Working Group. There are three major threads of effort
- Clearly define the standards work to be completed by the Clinical Operations Workgroup and the Clinical Quality Workgroup, since quality measures depend upon clinical operations data
- Select the specific standards and certification criteria supporting Meaningful Use Objectives and Measures
- Create a taxonomy for standards maturity and industry readiness to deploy standards. The draft taxonomy we discussed is:

Category I- Known/Certain for 2011
Standards are well-accepted and generally seen as deployable

Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet

Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015

Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path

David Blumenthal noted that the stimulus may motivate stakeholders to adopt data exchange more quickly than the past, making stretch goals possible. As a group we discussed the challenge of the healthcare ecosystem - motivating just one segment of the industry may not be sufficient to achieve data exchange i.e. standardizing EHRs to accept specific lab data standards is not sufficient unless the labs also agree to send data in a single standard format.

Janet Corrigan presented the work of the Clinical Quality Working Group. Her group is building on the work of the National Quality Forum's Health Information Technology Expert Panel to identify the Quality Data Set needed to support measurement and reporting. They are not choosing new standards or vocabularies, instead they are developing a framework of datatypes that enable the measures to be expressed in terms of EHR capabilities. For example

% of Hypertensive Patients with BP under Control [OP] requires EHR datatypes for

Hypertension diagnosis
Ambulatory encounter
Systolic blood pressure result
Systolic blood pressure result

The Clinical Quality Workgroup will spend the next month specifying the precise measures in terms of datatypes that will meet the quality measurement requirements of meaningful use. They will work closely with the Clinical Operations Workgroup to ensure the needed data exchanges supporting collection of these datatypes are included in the standards chosen.

Dixie Baker presented the work of the Privacy and Security Working Group. Her group identified three categories of standards and best practices supporting security:

1) Products that can be purchased (certified by CCHIT outside the real-life setting)
2) IT infrastructure necessary to enable the product to be meaningfully used
3) Operational environment in which the product will be used meaningfully

She also described recommended wording improvements to the meaningful use matrix items that will be forwarded to the HIT Policy Committee.

Their work over the next month will be to name the security standards and best practices for each meaningful use item and the ARRA 8 items.

The entire Committee discussed some of the existing gaps in standards. These included
-Standards for ordering including lab orders
-Standards for supporting electronic reporting of some of the meaningful use measures i.e. what percentage of prescriptions were written electronically - how do you calculate the number of prescriptions written manually?
-Standards supporting some of the patient/family engagement provisions of meaningful use

Our plan is to complete the efforts of our 3 Workgroups by the next meeting of the HIT Standards Committee on July 21. The end result will be a matrix of standards, an estimate of the readiness for deployment of each standard, quality measures, and privacy/security best practices for each meaningful use objective.

This work will give ONC and HHS the lead time they need for legal review, budget impact, and rule writing by the appropriate federal agencies.

The next month will be a whirlwind of activity. My thanks and appreciation to everyone involved!

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