Wednesday, June 30, 2010

The June HIT Standards Committee meeting

Today's HIT Standards Committee meeting had a rich agenda.

The recurring themes were the importance of governance, the interdependency of policy and technology, and the need for objective criteria to measure the appropriateness of standards choices.

We began our discussion with a presentation by Doug Fridsma of the ONC Standards and Interoperability Framework which includes use case development, harmonization of core concepts, implementation specifications, reference implementation/pilots, certification, and testing.

The intent of the Framework is to ensure standards gaps are filled as necessary to support meaningful use and healthcare reform. The Framework provides the means for managing the standards lifecycle, enabling re-use, and ensuring standards meet functional requirements. Although the Framework is comprised of 11 RFPs, it will function as a single process, guided by a Concept of Operations plan (ConOps). The principles driving the ConOps include representative participation, transparency and openness, responsiveness, accountability, and measurable/planned results.

Next, Arien Malec reviewed the NHIN Direct consensus proposal of the NHIN Direct effort. The NHIN Direct groups have suggested SMTP/TLS as the backbone with SMTP/TLS, REST or SOAP at the edges to communicate with a Health Internet Service Provider, which provides backbone exchange services.

After hearing the NHIN Direct presentation, the committee emphasized the importance of providing policy guidance to constrain the NHIN Direct technology implementations, the need for the HIT Standards Committee to serve as a "Board of Directors" reviewing NHIN Direct progress at key checkpoints, and the need to communicate the scope of the NHIN Direct project - what is considered part of the NHIN Direct effort and what is an additional service provided outside the scope of the project.

A policy example includes the notion that a HISP routing service need not examine the contents of the message during the routing process. Technology should be chosen that makes this policy possible.

A scope example includes the idea that a SOAP/XDR to SMTP or SMTP to SOAP/XDR converter should be something provided by NHIN Connect or the EHR vendor and not by the NHIN Direct project which is simple point to point communication, not standards conversion.

Next, Mary Jo Deering discussed NHIN Governance. The important takeaway from her presentation is that there will be a unified approach to NHIN Governance - not a collection of disconnected NHIN projects with their own governance. There will be hearings and ultimately regulation issued in 2011 to define NHIN Governance. The Standards Committee applauded this approach as it addressed the governance concerns we had with the NHIN Direct project.

Next, Deven McGraw presented the Privacy & Security Tiger Team Update. She outlined the general principles enumerated by the Tiger Team to ensure data exchange, especially NHIN Direct routing, discloses the least amount of data possible during transport. The Tiger Team created a framework describing 4 different kinds of intermediaries which support data exchanges. The Standards Committee recommended that the concept of intermediaries be replaced by the notion of "services" and that policies should apply to the types of services offered.

Aneesh Chopra presented the Enrollment Workgroup Update, a comprehensive plan to specify the eligibility and enrollment standards needed to support Healthcare Reform. Numerous new tools will be available to payers, providers, and patients to streamline administrative data flows. An early example of the kind of tools that will be created is, a new website that makes insurance information available to patients and will soon include comparative costs of insurance.

Janet Corrigan presented the Clinical Quality Workgroup Update outlining the progress on retooling existing 2011 quality measures and selecting 2013 measures.

Jamie Ferguson presented the Clinical Operations Workgroup Update: Electronic Document Standards for Discharge Summary & Other Encounter Summaries, describing a means to reuse templates for the creation of summary documents which support meaningful use data exchanges. Keith Boone provided an excellent summary of the discussion on his blog.

Finally, Steve Posnack and Carol Bean updated the Committee on the Temporary Certification Program. Numerous organizations have expressed interest in serving as Authorized Certification and Testing Bodies, so unlike the past there will be multiple bodies with market competition on price and service quality for certification services.

A great meeting which clarified many aspects of the NHIN Direct project, the Interoperability Framework plan, and the evolving governance of healthcare information exchange in the US.

I look forward to our July meeting, which will hopefully review the final standards rule and final meaningful use rule.


David said...

Thanks John. It was a very informative meeting. I didn't catch whether the Standards and Interoperability ConOps is actually available as a published document yet, or whether it's still a work in progress as represented by Doug's presentation. Do you know?

BTW, I can access the PDFs but the Powerpoints all give an error message about "no text converter." I've heard that others are having problems opening the PPTs as well. Is that being addressed?

David Tao

John Weiler said...

The HIT Committee really has its act together, and could be the model by which the Obama Administration drives IT Acquisition Reform Govt wide. With the Electronic Health Record and Health IT initiatives tracking the best minds in IT, we have a unique opportunity to fundamentally change how govt drives open systems and interoperability.

As Vice Chair and Co-Founder of the IT Acquisition Advisory Council, we have examined some 35 reports on failures of govt IT and Health IT in particular. Over the past 10 years, the federal govt has wasted over $30 Billion per year in failed IT programs and cost overruns, mostly due to a failure to embrace open architecture, standards and commercial best practices.

If HHS, OSD Health Affairs and VA are going to overcome past failure patterns, they will need a rigorous certification process that helps govt move away from proprietary, design to spec approaches driven my our big defense contractors and FFRDCs.

Change is coming, and HITSP can lead the way.