Thursday, August 20, 2009

The Next Deliverables of the HIT Standards Committee

Today in Washington the HIT Standards Committee met to discuss the latest deliverables from its workgroups - Clinical Quality, Clinical Operations and Privacy/Security.

A few highlights:

*The workgroups presented the standards needed to support meaningful use and certification criteria. A certified EHR must meet the functionality criteria currently being developed by ONC but also must be capable of supporting the standards defined by the HIT Standards Committee workgroups.

*The standards themselves apply to capabilities that need to be included in the products for certification, and the use of those capabilities to codify patient data, and to calculate and report quality measures constitutes the 'meaningful use'.

*The theme for the meeting was convergence - after countless hours of work, today's deliverables included the synthesis of the efforts of all three workgroups, recommendations of the policy committee, and public comment.

The Clinical Quality workgroup presented 30 measures of quality and the data types required for each. Working collaboratively with Clinical Operations, specific content and vocabulary standards were selected all but 6 data elements, 3 of which are for one quality measure.

The Clinical Operations workgroup presented the content and vocabulary standards supporting meaningful use. Importantly, there were no gaps in standards needed to support all 2011 meaningful use criteria. The workgroup was very thoughtful about the maturity of standards and presented a gradual transition plan, allowing some variation (PDF, document images, free text) in 2011, but eliminating these unstructured documents for 2013. Their work included messaging formats (such as HL7 2.51) and document formats (such CDA/CCD), and all the vocabularies necessary for semantic interoperability (such as SNOMED-CT, RXNORM, UNII for allergies, and LOINC for labs). Note that the work of Clinical Operations describes the exchange of data between organizations, not the data model, architecture or implementation details within an organization.

The Privacy and Security workgroup presented the authentication, authorization, auditing and secure data transmission standards. Note that Privacy and Security includes standards for use in EHR products, the infrastructure that hosts them and best practices. Their work does include protecting data inside an enterprise as well as data exchange between enterprises because security is an end to end process. Security is as strong as the weakest link in the data exchange. Just as with the Clinical Operations workgroup, a great deal of thought went into the timeline when standards should be adopted, enabling a glide path from the present to stronger security. There were no gaps in the standards needed for 2011, although additional work on consent management and consumer preferences will be done to support later years, ONC, the Standards Committee and HITSP will work on consumer preference standards together in upcoming meetings.

The HIT Standards Committee also decided to establish a workgroup to focus on adoption/implementation issues.

All of the workgroup deliverables were accepted by the Committee and have been submitted to ONC as guidance for the regulation writing process.

A very impressive body of work. Thanks to all the workgroup members, the HITSP tiger teams, and ONC for making it all possible.


Ahier said...

A very impressive work indeed. I think the Tiger Team model should be emulated throughout government.
Thanks for coming back for the meeting John :-D
I did not hear much from the Privacy and Security workgroup on issues surrounding PHR and other web based health record solutions. Is this being addressed at that level?

Also I published the rough draft transcript at:

GreenLeaves said...

I agree that today’s discussion did present a synthesis of the work presented in prior meetings. Listening to the presenters, I was heartened to hear that they are focusing on being flexible to start with and then expanding and tightening the requirements as time progress. It would be marvelous if HH&S can promulgate its version prior to December 2009 to allow vendors and users to avail themselves of all available time to modify/implement the HIT applications.

Hope you enjoyed your visit to Japan and welcome back..

Martin Kappeyne

GreenLeaves said...


I would be most interested in a blog discussing what sets SNOMED apart from ICD-10 for recording clinical observations. An understanding of this distinction would help the more technical folks understand the needs of the clinical community when selecting and implementing new applications.

Bill Baar said...

What exactly are the efficiency standards proposed for 2015 implementation?

krowwolf said...

From the introduction, paragraph 2.1, page 3, volume 2 of ICD-10 Second Edition. I'll repeat the second last sentence here for emphasis: "The ICD is neither intended, nor suitable for indexing of distinct clinical entities."

"The purpose of ICD is to permit the systematic recording analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times.... In practice, ICD has become the international standard diagnostic classification for all general epidemiological and many health management purposes. These include the analysis of the general health situation of population groups and the monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables, such as the characteristics and circumstances of the individuals affected. The ICD is neither intended, nor suitable for indexing of distinct clinical entities. There are also some constraints on the use of ICD for studies of financial aspects, such as billing or resource allocation."

Alex I said...

Where particularly on the HHS website can I track their formalization of the Meaningful Use recommendations? They are supposed to publish a Draft on Aug 26th? Am I correct?

Ahier said...

Alex - keep checking this site:

Alex I said...


Thanks. I appreciate the feedback. I use your transcripts to see if I missed anything from the Webinars.

By the way the link you gave me is the site I use to cover HIT Policy and Standards activities. I'll stay tuned there for more news.