Wednesday, June 24, 2009

The Second Meeting of the HIT Standards Committee

Today, Jonathan Perlin and I ran the second meeting of the HIT Standards Committee.

Here's a report on presentations and the work ahead.

Jamie Ferguson presented the work of the Clinical Operations Working Group. There are three major threads of effort
- Clearly define the standards work to be completed by the Clinical Operations Workgroup and the Clinical Quality Workgroup, since quality measures depend upon clinical operations data
- Select the specific standards and certification criteria supporting Meaningful Use Objectives and Measures
- Create a taxonomy for standards maturity and industry readiness to deploy standards. The draft taxonomy we discussed is:

Category I- Known/Certain for 2011
Standards are well-accepted and generally seen as deployable

Category II- Known/Certain for 2013
Standards exist, are determined, but are not in the market yet

Category III- Work In Process for 2013 or 2015
Need to converge/refine standards for 2013 or develop for 2015

Category IV- Standards to be determined
“Gleam in the eye,” some concepts exist but no clear path

David Blumenthal noted that the stimulus may motivate stakeholders to adopt data exchange more quickly than the past, making stretch goals possible. As a group we discussed the challenge of the healthcare ecosystem - motivating just one segment of the industry may not be sufficient to achieve data exchange i.e. standardizing EHRs to accept specific lab data standards is not sufficient unless the labs also agree to send data in a single standard format.

Janet Corrigan presented the work of the Clinical Quality Working Group. Her group is building on the work of the National Quality Forum's Health Information Technology Expert Panel to identify the Quality Data Set needed to support measurement and reporting. They are not choosing new standards or vocabularies, instead they are developing a framework of datatypes that enable the measures to be expressed in terms of EHR capabilities. For example

% of Hypertensive Patients with BP under Control [OP] requires EHR datatypes for

Hypertension diagnosis
Ambulatory encounter
Systolic blood pressure result
Systolic blood pressure result

The Clinical Quality Workgroup will spend the next month specifying the precise measures in terms of datatypes that will meet the quality measurement requirements of meaningful use. They will work closely with the Clinical Operations Workgroup to ensure the needed data exchanges supporting collection of these datatypes are included in the standards chosen.

Dixie Baker presented the work of the Privacy and Security Working Group. Her group identified three categories of standards and best practices supporting security:

1) Products that can be purchased (certified by CCHIT outside the real-life setting)
2) IT infrastructure necessary to enable the product to be meaningfully used
3) Operational environment in which the product will be used meaningfully

She also described recommended wording improvements to the meaningful use matrix items that will be forwarded to the HIT Policy Committee.

Their work over the next month will be to name the security standards and best practices for each meaningful use item and the ARRA 8 items.

The entire Committee discussed some of the existing gaps in standards. These included
-Standards for ordering including lab orders
-Standards for supporting electronic reporting of some of the meaningful use measures i.e. what percentage of prescriptions were written electronically - how do you calculate the number of prescriptions written manually?
-Standards supporting some of the patient/family engagement provisions of meaningful use

Our plan is to complete the efforts of our 3 Workgroups by the next meeting of the HIT Standards Committee on July 21. The end result will be a matrix of standards, an estimate of the readiness for deployment of each standard, quality measures, and privacy/security best practices for each meaningful use objective.

This work will give ONC and HHS the lead time they need for legal review, budget impact, and rule writing by the appropriate federal agencies.

The next month will be a whirlwind of activity. My thanks and appreciation to everyone involved!


Unknown said...

I read the slides for the MU definitions with great interest and then the next day I read a story the MU work group being asked to go back to the drawing board here:

Can someone clarify why? Thanks.

Ahier said...

John, thank you for your insights into the meeting. Rajiv, I think that the title "back to the drawing board" might be slightly misleading. I believe that they are building on previous work, not starting from scratch. In case you missed the 6/23 HIT Standards meeting I have posted the draft transcript at:

HIT Standards Meeting

Ramya said...


Thanks for the information..

Healthy Lifestyle

Peter Bachman said...

Under the Privacy WG, "Identity Management for IT Infrastructure necessary for the product to be meaningfully used." I appreciate this now being on the agenda for the 2011 matrix.

Identity Management is a key enabler of many of the HIT standards.

Brian Armstrong said...

Hi John,

Thanks for this post and for all your posts regarding standards and the process the committees in the US are attempting to establish. I am in Canada and we are going through a similar process, with apparently no agreement across our 10 provinces, and with only three provinces having done any substantive work in this regard. The National level work being subsidized by Canada Health Infoway is developed an interoperability framework (EHRs Blueprint), but it has yet to surface in a substantive way in the provincial psyche.

I am project managing a Data Conversion Strategy to migrate data from legacy systems into "approved" systems under a government led and funded project here in British Columbia (PITO,, and we are currently developing a standardized data specification (how novel), which we hope will be at least a foundation for a province to province discussion. The model we have chosen to follow is that of the CDA (CCD/CCR), and will soon be testing some of early prototyping using open source EHR/EMR technologies (e.g. OpenVista and OpenMRS), and interface engines (Mirth, Tolven, etc.), and hope to test these using Laika. It is a bit ambitious, but we figure if we don't start thinking about this in a scientific fashion about small developments with appropriate testing/validation toolsets and interoperability engines, we may yet revisit this discussion again and again. Our hopes is that we can tier the discussion by building upon strengths and accomplishments and raising the dialogue systematically and exponentially as we move forward.

As I mentioned to you in offline communication, the desire is to raise the bar and seek the high road, the desires for short term gains will be met when we can actually demonstrate through smaller component projects the effectiveness of interoperability.

(NOTE: In your post you mention "Systolic blood pressure result" twice, and you probably meant to say "Diastolic blood pressure result" as one of the items.)


P.S. Great admirer of your prolific posting.

John Halamka said...

Regarding the definition of meaningful use, it's not tabled or being revised from scratch. I believe that we'll see some 2011 criteria moved to 2013 and some 2013 criteria moved to 2011, not a wholesale revision.

Ahier said...

Thanks for that clarification John. I did get the impression that the bar had been lowered for the early years, and there was going to be a phased approach to criteria for meaningful use.
Your willingness to share this information and insight, and provide transparency to the process is commendable. Thank you.

Unknown said...


ONC will advise CMS on Meaningful use the Standards and Policy Committee are an advisory group to ONC

Today at a Congressional Hearing David Blumenthal in answer to a question about "meaningful use" said.

"The regulation will be a CMS and they will run the regulatory rule making process and ONC will be advising them on that definition and helping them come to a conclusion on that."

"We will hold another hearing of our Health Information Technology Policy committee on July 16th. That group heard from a working group on a definition of meaningful use on June 16th".

"We are still in the process of a public comment period on that definition which I want to make clear is a definition by a working group of an advisory committee not by the Dept and that advisory committee after the July 16th hearing will make some recommendations to the National Coordinator "

Johnnysmooth said...

Somewhat surprised to see Dixie's workgroup come out in direct support of CCHIT. I didn't know that ONC has blessed CCHIT for all things certified EHR, though CCHIT sure sure is pushing hard for that blessing.

Unknown said...


Thanks for keeping us up to date on HIT happenings.

The MU criteria as they stand are somewhat light on use of evidence-based guidelines (CPOE and decision support in later years). Not much about support for chronic condition management.

Am I missing something? Thanks.

Unknown said...

The quality reporting based on EMR entered results worries me. As a practicing physician, I have many patients who check ambulatory blood pressures, dutifully bring in their written results, all of which are well controlled. Yet their office blood pressure reading is high (what we commonly call white coat hypertension). I consider these patients to be well-controlled, but an EMR quality based report would not. There needs to be room in the standards to report control outside the office-based setting.

Mark Schlack said...

Your blog and comment seem to suggest that people shooting for Oct. 2010 compliance may not really get a clear target to shoot for in reasonable time. Do you foresee that? Many people will be doing budgeting and planning in a few months for that date -- what's the safest way for them to proceed?

Mark Schlack
VP, Editorial