Tuesday, September 15, 2009

The Latest Deliverables from the HIT Standards Committee

Today, the HIT Standards Committee received the latest deliverables from its workgroups.

The Quality Workgroup presented its updated matrix of measures, data types and recommendations. Of the 29 measures listed, 17 are measures of quality which are being retooled by quality measure authors to be based on data elements captured in an EHR. Two are privacy/security related (Full compliance with HIPAA Privacy and Security Rules, Conduct or update a security risk assessment and implement security updates as necessary) and 10 are related to the adoption of EHR function (i.e. % of orders for medications, lab tests, procedures, radiology, and referrals entered directly by physicians through CPOE). The actual data standards needed to measure quality and the implementation guidance for these standards are summarized in the Clinical Operations matrix discussed below.

A very important discussion about quality measurement reporting is summarized on slide 3 in this presentation. There are a number of stakeholders for quality data exchange

Measure definition entities such as the National Quality Forum or its associated measure authoring groups.

Providers who record clinical data in electronic health records.

Data Collection Assistant entities such as Healthcare Information Exchanges which gather data from EHRs and transport it for a multitude of purposes.

Quality Report Processing entities such as registry providers, performance analysis companies, or specialty societies which gather benchmarking data.

Receiver entities which collect quality reports as part of a reimbursement process.

Among these stakeholders, you can imagine 5 kinds of data exchange

1. Transport of measure definitions from measure authors to all the other stakeholders

2. Transport of patient level quality data from EHRs to HIEs

3. Transport of data from HIEs to a quality registry

4. Transport of quality reports to CMS in patient level detail format

5. Transport of quality reports to CMS in summary (numerator/denominator) format.

The HIT Standards Committee has recommended standards for 2-5, but these standards have varying degrees of maturity. The work of the next several months will be to work with ONC, HITSP, and SDOs to fill gaps and accelerate adoption of the standards needed for these exchanges.
The Security Workgroup presented its latest standards selection, certification criteria, and implementation guidance. The first matrix includes functionality, standards, a timeframe for adoption, and certification criteria. The second matrix includes functionality, standards, implementation guidance, and gaps.

The importance difference in these documents from previous work is the reformatting to clarify where options exist – standards that are required jointly (standard A + standard B) and standards for which the implementer is given a choice (standard A or standard B)

The Clinical Operations Workgroup presented two matrices - a summary of the standards required for meaningful use (subject area, 2011 standards, 2013 standards, future trajectory) and the detailed implementation guidance (health outcomes priority, meaningful use measure, subject area, 2011 implementation guidance, 2013 implementation guidance, and future trajectory),

The standards selected do not vary significantly from previous matrices, but the implementation guidance is significantly expanded and clarified based on input from many stakeholders.

What are the next steps for the workgroups?

For privacy and security we will incorporate guidance from existing NIST documents regarding the capabilities required in products to implement the standards selected in a manner that supports security best practices.

For clinical quality we need to ensure all 5 transaction types (described above) among quality measurement stakeholders are supported

For clinical operations, we need to ensure vocabulary gaps are closed (Orderable laboratory compendium, SNOMED-CT subsets, SNOMED crossmaps to ICD-9, ICD-10 and LOINC. We need to provide additional guidance to support patient access to electronic records and work on implementation guidance for 2013 meaningful use measures.

As helpful background to all the HIT Standards Committee members, Lee Jones presented an overview of the implementation guidance efforts of HITSP which aim to provide as much specificity and as little optionality as possible, to enhance interoperability by reducing variably.

A very positive meeting. We have now provided all of this guidance to ONC and HHS as input to the interim final rule regulations which will be issued in December. I look forward to seeing those regulations as they represent the culmination of 4 years of HITSP work and nearly a year of HIT Standards Committee work.

I also know that there is much work to do providing the additional guidance necessary to achieve 2013 and 2015 meaningful use goals. Onward!


Ahier said...

Thanks to the committee for all the hard work, and thank you for your leadership John. I think it is important to note that, except staff, the members of this committee are volunteers. They have done remarkable work in short order. I again want to make mention of the excellent crowd-sourcing of the HITSP Tiger Team model, which leveraged so many talented and dedicated individuals.

I have again posted the rough draft transcript of the meeting here:

HIT Standards Transcript 9-15

Anonymous said...

Who can we contact to gain more details on some of the HITSP interoperability requirements for the CCD-C32 (e.g., how the "Result Type" codified in in LOINC and SNOMED-CT is derived?)?