Wednesday, March 18, 2015

The March HIT Standards Committee

The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had.    No, it was not the release of Meaningful Use Stage 3 or the certification rule.   It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC.   Thanks to Arien Malec for yeoman’s work in both areas.

We started the day with an overview of current security risk presented by Ron Ross, National Institute of Standards and Technology (NIST).    Admittedly I missed that presentation.   Although my flight from Dubai to Washington was early, Metro was shutdown due to an equipment failure at the Rosslyn station.     I’m told it was a sobering overview of the increased threats we all are facing.

Next, Dawn Heisey-Grove provided an overview of progress on the most difficult aspects of Meaningful Use Stage 2 - transitions of care, patient/family engagement, electronic medication administration records, and public health data submission.   Progress is being made in all areas.

Evelyn Gallego-Haag presented a progress update on the Electronic Long Term Support Services (eLTSS).    Committee members offered two kinds of advice.  Care plan development and exchange maybe an “app” and not a standard.   If a standard is needed, existing standards should be leveraged instead of creating a new approach.

Stan Huff and Arien Malec presented a work of art - the Standards and Interoperability (S&I) Initiative Task Force Recommendations .   Their guiding principles were welcomed by all - ONC does need a convening function for aligning SDO work and national priorities, but standards making should be left to SDOs.   Prioritization must be multi-stakeholder and not dominated by any one entity.   We must align demand with the reality of the supply of mature standards.     The S&I Framework can be re-chartered with these new guidelines and will represent the third generation of standards harmonization efforts, building on the lessons learned from HITSP and the existing S&I efforts.

Next we heard a series of reports from workgroups reviewing the ONC Interoperability roadmap.

Liz Johnson and Cris Ross provided the perspective of the Implementation, Certification, and Testing workgroup.  The most important aspect of the presentation was the cleanup of CCDA, reducing optionality.    CCDA R2 will be much easier to parse than CCDA R1.

Andy Wiesenthal and Rich Elmore summarized the work of the Content Standards workgroup.

Jamie Ferguson presented the work of the Semantic Standards workgroup.

Dixie Baker and Lisa Gallager presented the recommendations of the Transport and Security Standards workgroup.

Next we heard the most important presentation thus far in 2015, Arien Malec and David McCallie presenting the work of the Architecture, Services, and APIs workgroup.   The key recommendation was aligning healthcare standards with the approach that has been used by the groups creating internet standards - bring running code and embrace phased improvement in real world implementations.    They elegantly categorized the work to be done on existing standards while transitioning to a broad implementation of future standards - FHIR, OAuth2, and REST.   The entire Standards Committee applauded the effort which contains enough detail to implement now.   It provides all the interoperability planning detail that Congress has been asking for.    We declared the effort, a yellow brick road leading to standards nirvana, with courage, wisdom and heart (ending with finished FHIR specifications from the land of Oz)

The day ended with a roadmap for Quality Measurement standards presented by Julia Skapik.

After the Standards Committee meeting, many joined the Argonauts steering committee meeting to hear and updated on the accelerated effort to bring FHIR/OAuth2/RESTful application program interfaces to most mainstream EHRs.   It’s on track through the diligent efforts of many dedicated participants.

Today was a banner day for healthcare interoperability.    In the next days to weeks as Meaningful Use Stage 3 NPRMs are released, we all hope that the frameworks presented today can be applied to the policy goals of emerging regulations.

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