Monday, June 2, 2008

The Next Round of Standards for the Country

Tomorrow morning I present the latest round of standards harmonization to Secretary Leavitt and the American Health Information Community. Here's a preview.

Medication Management, HITSP Interoperability Specification IS07, defines specific standards to facilitate access to medication and allergy information for consumers, pharmacists, health insurance agencies, clinicians and other stakeholders.

Includes four new HITSP constructs
T40 Patient Generic Health Plan Eligibility Verification
T42 Medication Dispensing Status
TP43 Medication Orders
TP46 Medication Formulary and Benefits Information

HITSP worked with the Center for Medicare and Medicaid services (CMS) to ensure IS07 is consistent with the ePrescribing federal initiative led by CMS including adherence to standards required for ePrescribing under Part D of the Medicare Modernization Act (MMA)

IS07 uses the version of the NCPDP SCRIPT Standard Implementation Guide cited in MMA (currently Version 8.1) in most circumstances and Version 10.1 to include specialized data elements not included in Version 8.1 . To obtain and exchange local patient identifiers for communication between prescriber, dispenser, and payer organizations, IS07 defined a bridge between standards typically used in prescriber settings (HL7) with those typically used in payer and dispenser settings (NCPDP and X12N)

For exchange of a patient’s medication history, IS07 uses standards consistent with MMA to exchange medication history detail (NCPDP SCRIPT) and standards to include medication history in a clinical summary that also includes allergies, problem lists, etc. (HITSP C32, the Continuity of Care Document)

These standards are mature and already are widely used. Given the maturity of e-Prescribing standards, I signed a letter to Congress supporting the Medicare Electronic Medication and Safety Protection Act of 2007, noting that standards are no longer a barrier to medication management and e-prescribing.

I'll also present "Document reliable interchange", HITSP Technical Note T31, which provides a standards-based mechanism for exchanging medical documents securely over a network. This includes interchange among EHRs, PHRs, Quality Measurement Organizations, Public Health Authorities and other healthcare IT systems. This simplified document exchange and sharing mechanism does not require the use of XDS, the document sharing infrastructure described by the Integrating the Healthcare Enterprise (IHE) IT Infrastructure Technical Framework. Instead it uses IHE Cross-Enterprise Document Reliable Interchange (XDR) Integration Profile, which is very easy to implement.

In the current Beth Israel Deaconess pilot project with the Social Security administration to exchange medical records for disability benefits adjudication, we will be using this set of standards. T31 provides the specifics to use SOAP and HTTPS, mature standards that are used for many web 2.0 data exchanges.

If I were to forecast where all this standards effort is leading, over the next few years, I'd summarize our progress as

*Standardize point to point messaging by harmonizing the work standards development organizations have done for the past 10 years
*Standardize security

*Begin transition to persistent document formats with CCD/CDA Document summary, transmitting legally non-repudiable document summaries instead of just transient messages.

2009 Continue to add data elements to the CCD/CD Document Summary
*Further consolidate vocabularies used across SDOs
*SDOs begin developing standards collaboratively so that they arrive at HITSP with some pre-harmonization

*Vendor products produced with document exchange and security constructs built in
*Regional exchanges built with these standards

It's a great time for standards in the US and I believe the 500 organizations in HITSP are making a real difference on the path toward interoperability.


Unknown said...

Will you be including Seedie?


Unknown said...

While I realize that you are in a large hospital and thus have some bias to that view, was quite surprised that you made no mention at all of CCR when looking forward. Is this just because it does not fall under your purview or is there something else here.

Please elucidate.

John Halamka said...

CCD was built by taking the best of CCR and CDA and putting them together in one package. Hence we're using CCD in our hospital and community efforts so that we get the best of both standards.