Tuesday, May 12, 2009

The First Meeting of the HIT Policy Committee

Today, the HIT Policy Committee met for the first time. Dr. Walter Suarez, CEO of the Institute for HIPAA/HIT Education, and the co-leader of the HITSP Education and Communication Committee, attended on my behalf. Here are his notes.

The meeting began with an introduction by Dr. David Blumenthal. He highlighted six priority areas for the HIT Policy Committee
* Meaningful Use
* Certification
* Infrastructure
* Privacy and Security
* Health Information Exchange
* Public Health

A question was asked about the recent NCVHS meaningful use hearings. Dr. Blumenthal responded that the HIT Policy Committee will be the venue for discussion of the NCVHS report.

A question was asked about the Office of National Coordinator (ONC) Strategic Plan. Dr. Blumenthal responded that ONC must revise its plan to reflect the statuary requirements of ARRA. For example, by May 18 it must establish a process for identifying Regional Healthcare IT Extension Centers.

Jodi Daniels, ONC Director of Office for Policy and Research, briefed the Committee about ARRA.

* The HIT Policy Committee is expected to advise ONC on priorities
* The National Coordinator will ensure communication with the HIT Standards Committee
* ARRA calls for two standards-related activities for the HIT Policy Committee
- Identify where standards are needed, not setting standards
- Recommend a policy framework for adoption of electronic standards, including:
Meaningful use
Utilization of EHRs
Accounting for Disclosure
Using certified EHRs for quality improvement and patient safety
Technologies that render protected healthcare information unusable
Collection of demographic data including race and ethnicity
Data to benefit vulnerable populations including children
HIT and telemedicine
HIT and public health
HIT and home health care

Dr. Blumenthal discussed the priorities for early work
* ARRA includes an enormous mandate that extends from privacy and security to monitoring public health threats to getting doctors and hospitals to adopt certified qualified EHRs
* It is impossible to do everything at once. We need to set priorities.
* Congress has given guidance by setting some priority topics and deadlines, but also by allocating billions of dollars in payments to help support adoption, starting 2011 and extending through 2018
* These funds focus attention and create important benefits/risks
* This is the first time in history that Congress has acted to correct some of the market errors in the healthcare information technology industry
* There are a series of tasks that need to be accomplished to make meaningful use a meaningful idea
- First, define meaningful use. This is an unprecedented task. The HIT Policy Committee will need to pick-up where NCVHS left off. ONC also has an internal group working on this.
- Second, review certification, which is tied to meaningful use.
- Third, infrastructure. Congress has allocated billions to accelerate industry adoption including extension centers, money to support information exchanges, training workers, training health professionals who will use these technologies and funding to states to help providers not eligible for Medicare/Medicaid payments.
- Fourth, privacy and security. ONC will appoint a privacy officer
- Fifth, public health and disease surveillance

There were a few questions:
*Shall we build upon activities already in progress?
Dr. Blumenthal noted that the NCVHS work on neaningful use is important; Certification needs to be reviewed; privacy and security – a lot of work done; HIE – modest literature about RHIOs and local adoption.

*What happens when the HIT Standards Committee receives input from the HIT Policy Committee?
Dr. Blumenthal noted this is something ONC is working on. The Standards Committee must recommend to the HHS Secretary the standards to achieve meaningful use. The Secretary will publish interim rules by end of year. The HIT Policy Committee is charged with the areas where standards are needed and perhaps the general approach to standards but not to define the standards.

*Summary of Priorities
- First, privacy and security
- Second, how to define meaningful use in an effective way
- Third, designing a certification process that facilitates adoption
- Others:
Supporting research
Measuring quality
Training and education of workforce (such as extension centers)
Demonstrating and documenting success. Show Congress, the industry, and the public that this does make a difference
Need to keep an eye on implementation via an incremental approach
Need to involve the workforce from the beginning. Workforce training is a priority.

* Discussion of Goals and Principles of Working Groups
- HIT Policy committee is charged to make recommendation to ONC
- Workgroups will support the detail work that needs to be done, then brought back to the full Committee

*Is Meaningful Use, for example, a time-limited issue? As it deals with the immediate needs to define and set parameters and metrics, yes; but it will also need to be reviewed periodically

*Where are we putting HIEs? Meaningful Use or Infrastructure?
- There is an aspect of HIE that comes under infrastructure (there is funding tied to it, question is for what)
- There is also a Meaningful Use aspect – that is, what are the requirements HIE for meaningful use
- There is also a Certification component – that is, what are the certification aspects of HIE that are tied to Meaningful Use and EHRs

- Some concern expressed about creating a privacy and security workgroup, it should be foundational across all groups
- But perhaps it should be immersed into an Information Sharing Workgroup which covers architectural, functionality and covers also privacy and security

*Another cross-cutting element for all workgroups: Patient centeredness

*Summary of discussion: recommendation for four working groups
-Meaningful Use
-Certification/Adoption including infrastructure issues, workforce, adoption strategy
-Information Exchange/Sharing
-Cross-cutting issues - Privacy and Security, Patient centeredness, Measurement

*Message to the HIT Standards Committee
Tell the HIT Standards Committee that the HIT Policy Committee is working on Meaningful Use, Certification/Adoption, and Information Sharing. The HIT Standards Committee can identify standards to support these goals.

I look forward to the first meeting of the HIT Standards Committee on Friday. I'll summarize the meeting on my blog.


IAMPLE said...

Good summary. This was my first meeting as a member of a government committee, and I wasn't sure what to expect. In particular, I was impressed by the public interest in the meeting. Many local people attended, and every seat in the meeting room was filled. There were probably many more people listening over the Internet. The public comments were extremely thoughtful and very much appreciated.

I hope that this public interest continues as future meetings begin to wrestle with the detailed complexities of this vitally important effort.

Paul Egerman

Mark Pileski said...

I cannot tell you how helpful blogs like this and twittering are for the healthcare IT community. I sit in meeting after meeting, and attend health IT conferences and the attendees are always complaining about the lack of real time information. The government is notoriously slow, they must be having a heart attack with these real time technologies. Keep up the real time info., we are all ecstatic about it.
Mark Pileski
IntePros Consulting

GreenLeaves said...

Putting privacy and security ahead of “significant use” and certification concerns me. If anything can slow things down, its getting people to agree on privacy and security. Witness what happened with a national healthcare ID. We still need it for HIE but are no closer to getting it.

Hospitals and physicians are dying to get the skinny on what constitutes “significant use” or what is a certified product so they can decide if where they should spend the money to implement.

HIPAA has already established what actions need to be taken to safeguard patient data. Yes, HIPAA could do with some fine-tuning and interpretation to help individuals and institutions understand what and how to share data.

Medical Quack said...

Great posts as always and there's a lot on the agenda by all counts.

Meaningful use is a huge topic on utilization. One big concern of mine is who gets to use the data and when, relative to risk management and insurance coverage and how far wellness and guidance can go before it begin to erode the patient/MD relationship.

Maybe something that is not discussed at much as other items, but definitely at work in the background today. I believe in the PHR to be the focus point and not having a consumer tied to a number of devices outside a PHR to have to prove levels of activity, etc. to maintain or qualify for insurance coverage and some of that is beginning to make it's presence.

Just my rambling thoughts on the subject so we don't end up being tied to multiple systems and devices which would end up making us crazy in time.

It should be gathered and centered around the patient and physician and not just statistical data collected to rationalize cost only and the PHR is the place for all of this to happen to have one common gathering place to hold the information from vendors and devices and the patient can choose to share.

Ahier said...

I was a little frustrated during the meeting that there was not enough focus, but with a group this size it takes a while to get settled. I think we will see much more granular efforts at the working group level.
I also got the impression that CCHIT was not going to be the certification body going forward. You can read my views on the meeting here and let me know where I might be off track...

GreenLeaves said...

Brian, if what you say is true, it will scare the dickens out of everyone banking on CCHIT. Short of a miracle, I do not see how another organization could take over from CCHIT and certify in prescribed timeframe. This makes no valuation of whether CCHIT is hitting the mark in its certifications. The concern is more how one could set up an organization, establish the certification criteria and certify hundreds of products before the 2011 deadline arrives.

Perhaps one scenario is to take CCHIT and run it through the equivalence of bankruptcy…..keep the people, keep the cert processes but change the charter and structure.

Unknown said...

It is a great first step. Standards and Policy aet the back drop to make the systems work as needed (if everyone follows them).

You will need an equal effort to get your collegues to actually buy these systems

e-Older American said...

I was delighted to hear the committee set privacy and security as their first priority. In order to facilitate the development of clear,concise and doable requirements, I suggest that both the Policy and the Standards Committees consider having the USHIK Team added as staff resources. It seems to me that it would be better to develop definitions that will be loaded into the USHIK, at the beginning of the process rather than at the end.

Unknown said...

Electronic health records, (EHR) enable providers to accomplish tasks that are not possible with paper recorElectronic health records software holds the promise of increased efficiency and workflow, leading to better careds.