HITSP Going Forward

On January 25, HITSP's 900 members approved their 2009 standards harmonization work for submission to ONC. I announced that ONC had extended HITSP's contract to April. (Originally the HITSP contract term ran until January 31, 2010)

During my opening remarks I summarized HITSP's accomplishments, impact on the regulations, lessons learned, and next steps.

Here are a few major themes:

1. HITSP Accomplishments 2005-2010

CCD - HITSP, HL7, and ASTM worked together to create the C32 implementation guide which has been widely implemented for the exchange of structured and unstructured healthcare data.

Lab - HITSP and HL7 worked closely to develop implementation guidance for lab results, including controlled vocabularies.

Vocabularies - HITSP worked with the National Library of Medicine and Standards Development Organizations to create codesets and implementation guidance to accelerate adoption of LOINC, SNOMED-CT, and RxNorm.

Devices - HITSP convened meetings of IEEE, IHE, and Continua to harmonize a single set of device interfacing standards for institutions and consumer applications.

Family History - HITSP worked closely with HL7 to develop implementation guidance for the structured documentation of family history.

Clinical Research - HITSP worked with CDISC, government agencies, and stakeholders to draft implementation guidance for support of clinical research.

Quality - HITSP worked with NQF HITEP and numerous experts to develop implementation guidance for quality measurement and reporting.

2. HITSP and the future of Standards Harmonization

The HIT Standards Committee, working in partnership with the HIT Policy Committee, is charged with making standards recommendations to ONC. As it considers public testimony and debates the path forward in its workgroups, the HIT Standards Committee identifies standards gaps that need harmonization and suggests the need for new standards where none exist. Multi-stakeholder technical committees are needed to do the detailed coordination with the SDOs and standards implementers. Hence there is an ongoing need for harmonization activities.

As part of the Grant Programs from ONC , there will be $64.3 million allocated for Standards Harmonization, Certification and the NHIN. Soon, an RFP will be issued for standards harmonization and ANSI will likely bid. HITSP members agreed to stay engaged as we await the RFP.

3. HITSP and the Interim Final Rule

Some have asked about the lack of HITSP specific guidance in the Interim Final Rule. I noted that most of the base standards recommendations from HITSP were included in the IFR.

Summaries - CCD

Problem Lists - SNOMED-CT

Medications - NCPDP Script 8.1, RxNorm

Allergies - UNII

Labs - HL7 2.5.1, LOINC, UCUM, SNOMED-CT

Immunizations - HL7 2.3.1, CVX

Biosurveillance - HL7 2.5.1

Public Health Reporting of Labs - HL7 2.5.1

The IFR is a regulation, which means that the details provided in it are hard to change. By providing base standards but enabling implementation guidance to be published separately from the regulation itself, ONC allowed evolution and refinement of more specific guidance.

HITSP is mentioned extensively in the Notice of Proposed Rulemaking, since the HITSP work done with the NQF provides the basis for the quality measures described in the NPRM.

4. Lessons learned

A few thoughts on 4 years of chairing standards harmonization activities

a. It's important to engage the community of experts, break down barriers, and encourage ongoing communication. When people talk, they learn to trust each other and this leads to collaboration rather than competition.

b. Standards Harmonization happens best when there are clearly articulated priorities such as the workflow required for meaningful use.

c. Once standards are harmonized and implementation guides written, everything needs to be accessible in an easily searchable electronic format, including vocabularies/codesets.

d. Adoption of standards is the best measure of success. Expert advice and education are important to ease the learning curve.

e. Build progressively and keep standards as simple as possible, just as suggested by the HIT Standards Committee's guiding principles.

5. Consensus based decision making requires hard work and substantial amounts of diplomacy. The 50,000 hours of volunteer time from HITSP's members has been priceless.

I look forward to ongoing HITSP monthly check in/education calls, the RFP, and the standards harmonization to come.