Wednesday, September 10, 2014

The September HIT Standards Committee

The September HIT Standards Committee was one of the most important meetings in the history of the group.   We heard pivotal reports from the NWIN Power Team about Query/Response standards as well as from the JASON Task Force.   Together they gave us important guidance to accelerate FHIR, REST, and OAuth, aligning healthcare query/response standards with the technology approaches used in every other industry.  We were also advised to polish existing CCDA standards in the short term while working on the longer term FHIR initiatives.

Dixie Baker and David McCallie presented Query/Response recommendations suggesting that use cases for 2017 certification be limited to:

*Query a named external health care organization for a document containing a specific patient’s data
* Respond to query with requested document, list of documents, or non-availability of
* Allow both synchronous and asynchronous queries

They proposed that certification be based on functional requirements that

* Move the industry in the direction of broad use of RESTful, FHIR-based services, including services to support query for both documents and discrete data elements
* Simple query of a known external entity for a document containing an identified patient’s information

They also recommended that short term efforts should focus on specific improvements  to facilitate query for, and selective retrieval of, a range of clinically useful CCDA documents, including but not limited to implementation specifications to support “on demand” retrieval of a simple current summary (problems, allergies/intolerances, current medications, recent labs, etc.), and specifications for a complete longitudinal summary, in addition to the current encounter-by-encounter documents.

Finally, they voiced strong support of efforts to accelerate development of FHIR-based services and FHIR profiles, consistent with recommendations of the JASON Task Force

Next, Steve Posnack and Mike Lipinski presented the early work on defining the use cases for the data provenance initiative.  They emphasized that no standards have been chosen or evaluated for maturity.   We’re currently in a requirements gather phase.

Next Steve and Mike presented an overview of the 2014 Edition Release 2 EHR Certification Criteria Final Rule.

The press has widely reported that ONC abandoned the 2015 rule, when in fact, they simply changed the nomenclature to name rules based on the year they are finalized.   This new rule offers a very reasonable balance of optional criteria that fix previous certification problems such as the inability for HIEs to certify transport only capabilities.

The NCPDP Real Time Benefit Check Analysis Task Group provided an overview of their efforts to bring cost and benefits information for pharmaceuticals to all stakeholders - payers, providers, and patients - based on the use of common data elements and data sources.

Finally, David McCallie presented a brilliant overview of the JASON Task Force review of the JASON Report.

The key takeaway - the general conclusions of the JASON report, which lack operational workflow details, was turned into a set of concrete recommendations very similar to those of the NwHIN Power Team - FHIR query/response for discrete data elements using RESTful transport and OAuth.

I look forward to the October 15 joint meeting of the Policy and Standards Committees in which we will try to move forward the agenda for the next year, hopefully embracing some of the principles discussed today.

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