Monday, June 8, 2009

The National HIT organizations - How it all works

Several blog readers have asked me to take a fresh look at all the organizations related to ARRA and explain how it all works. Here's my understanding:

Office of the National Coordinator
The Obama administration's ONC is different from the Bush administration's ONC in several ways. It's now funded with $2 billion to accelerate healthcare IT adoption. Its new leader, Dr. David Blumenthal has a policy focus, so we'll see broad policy guidance and specific healthcare outcome goals rather than technology for technology's sake. It has regulation - ARRA is law and there are several new privacy, standards, and implementation requirements that were only voluntary or market-driven previously. You can expect that ONC will have a major role in coordinating federal agencies' use of healthcare IT as well as adoption in the private sector. By controlling the definition of meaningful use of healthcare IT as the gatekeeping function for paying stimulus dollars to clinicians, ONC has real power.

HIT Standards Committee
The Health IT Standards Committee is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Initially, the HIT Standards Committee will focus on the policies developed by the Health IT Policy Committee’s initial eight areas (listed below). The HIT Standards Committee will also provide for the testing of standards by the National Institute for Standards and Technology (NIST). In its first meeting, the HIT Standards Committee created three workgroups. Below are their Broad and Specific charges:

Clinical Operations Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification criteria related to EHRs and clinical operations.

Specific Charge –
Make recommendations to the HIT Standards Committee on the role of EHRs and e-prescribing, clinical summaries, laboratory and radiology report functionality within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.

Clinical Quality Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on quality measures that should be included in the Meaningful Use definition and for future EHR requirements. Make recommendations to the HIT Standards Committee on requirements for standards, implementation specifications, and certification related to EHRs and clinical quality.

Specific Charge –
Make recommendations to the HIT Standards Committee on specific quality measures that should be included in the definition of Meaningful Use for 2011 within two (2) months of the workgroup’s first meeting. The workgroup will also take into consideration the eight (8) areas listed in Section 3002(b)(2)(B) when developing recommendations for the committee.

Privacy and Security Workgroup:
Broad Charge –
Make recommendations to the HIT Standards Committee on privacy and security requirements for standards, implementation specifications, and certification criteria.

Specific Charge –
Make recommendations to the HIT Standards Committee on specific privacy and security safeguards that should be included in the definition of Meaningful Use, with a specific focus on the eight (8) areas listed in Section 3002(b)(2)(B), within two (2) months of the workgroup’s first meeting.


HIT Policy Committee
The Health IT Policy Committee will make recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. The American Recovery and Reinvestment Act of 2009 (ARRA) provides that the HIT Policy Committee shall at least make recommendations on standards, implementation specifications, and certifications criteria in eight specific areas:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations

At it's first meeting, The HIT Policy Committee created three workgroups - Meaningful Use, Information Exchange, and Certification.

Here's the broad and specific charge for the Information Exchange workgroup. I'll add the details for the others as soon as I receive it.

Information Exchange Workgroup:
Broad Charge-
Make recommendations to the HIT Policy Committee on policies, guidance governance, sustainability, and architectural, and implementation approaches to enable the exchange of health information and increase capacity for health information exchange over time.

Specific Charge-
Make recommendations to the HIT Policy Committee within six (6) months regarding priority policy areas and other issues that are necessary in the short term to advance the exchange of health information through implementation of HITECH. Make recommendations to the HIT Policy Committee to inform and provide guidance on the implementation of the Nationwide Health Information Network (NHIN)


Health Information Technology Standards Panel

HITSP provides an important consultative role to the HIT Standards Committee. As the HIT Standards Committee and its workgroups prioritize the transactions needed to support meaningful use, they will consult standards harmonization organizations (HITSP), Standards Development Organizations, and Implementation Guide writers. HITSP volunteers and staff have been placed on each of the HIT Standards Committee workgroups to provide technical assistance.

National eHealth Collaborative
NeHC, based on their recent meeting, will focus on implementation topics such as regional healthcare IT extension centers and the reality of increasing EHR adoption in the country.

Certification Commission for Health Information Technology
I'm confident that CCHIT will continue to be the leading HIT certification organization in the US, but its certification criteria will evolve. The HIT Policy Committee's workgroup on certification is likely to provide valuable input about certification by the Fall.

I hope this helps clarify how all these organizations relate to one another as they all work together to support ARRA, improve healthcare quality, and enhance efficiency, all through the implementation of interoperable healthcare IT.

9 comments:

Brian Ahier said...

I am glad that you are confident that CCHIT will continue to be the leading HIT certification organization. I have to admit this has been one of my biggest concerns.

GreenLeaves said...

Based on your understanding of the development and testing that has been done with NHIN; how much of this work could be used as a foundation for HIE?
My understanding was that NHIN was designed to act as model for HIE and appears to have achieved many of those goals. Is the HITECH scope broader or narrower than what NHIN can deliver?

Alliance4Health said...

There is a great overview of many of the other alphabet soup of organizations on the HHS - Health IT web site. http://healthit.hhs.gov/portal/server.pt?open=512&objID=1141&parentname=CommunityPage&parentid=3&mode=2&in_hi_userid=10741&cached=true

Both the Agency for Healthcare Research and Quality(AHQR) which will define "meaingful use" for example and NIST (National Institute of Standards and Technology)will play key roles in testing EMR's.

The most important player that you need to add is the most obvious, The Center for Medicare and Medicaid will administer and operationalize the $46 billion that will eventually flow though it to providers and hospitals.

I also anticipate that the National eHealth Collaborative with its bi-partisian and very power board will play a much more important role in engaging the broader community (consumers, patients, employers, public health, state government, health 2.0) in the design, implementation and adoption of technology and ensuring that we stay focused on effective, high quality, patient centered care.

Sherry Reynolds
Alliance4Health

e-Older American said...

I recently came across a work of harmonic art, related to HIT organizations, that I would to share. On his blog, Dr. Ross Martin performs an original work entitled: "HITECH: An Interoperetta in Three Acts". It's an absolutely marvelous performance!

http://www.rossmartinmd.com/2009/05/hitech-interoperetta-in-three-acts.htm

Steve Buck said...

I'm stuck on the stated goal of "The use of electronic records to improve quality".

Centralizing all the data and information about a patient is a fantastic goal and will likely deliver the value we anticipate plus more. However, I'm wondering how long it will take to add logic to data to turn it into recommended actions/treatments. Some things are easy (such as drug/drug interactions). However, for patients with multiple physicians and more complex situations, it is going to take some time to develop the right "balance of power" between expert systems and good 'ol fashion physician judgement.

While it has been covered in other posts, I would say that the path for realizing benefits from HIT will mirror other technology innovation cycles, with rapid booms and lulls.

GreenLeaves said...

Steve,
I believe the data mining will come over time but it will need much more structure to the reports and standardization of the semantics. I believe Dr. Halamka has written a blog on this last month.

PilotTech said...

John,
Thanks for contributing to the standardization effort. My concerns with organizations such as CCHIT and NCPDP are the fact that they are both paid models. CCHIT is not cheap and NCPDP, although not expensive, there is nothing that stops them from charging $10K for the standard next year. This is akin to the US Govt. charging $25 per person for following the US Constitution. My hopes are that these efforts will be truly open. If the HTTP standard wasn't freely available, I doubt we would have made such progress with the internet.

lekha said...

Ensure that your organization's productivity is not hampered due to misuse. Check out IT Governance tools here: http://tinyurl.com/mmhqm5

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