Wednesday, April 28, 2010

The April HIT Standards Committee Meeting

The April HIT Standards Committee today had a rich agenda and very active discussion.

We began with an update from the Implementation Workgroup and their desire to make toolkits, accelerators, and best practices available via the web. They'll align their efforts with the Tools and Standards Repository RFP described in my earlier blog.

We next discussed healthcare reform and its requirements for comprehensive insurance plan enrollment standards support as written in SEC. 3021. HEALTH INFORMATION TECHNOLOGY ENROLLMENT STANDARDS AND PROTOCOLS.

"Not later than 180 days after the date of enactment of this title, the Secretary, in consultation with the HIT Policy Committee and the HIT Standards Committee, shall develop interoperable and secure standards and protocols that facilitate enrollment of individuals in Federal and State health and human services programs, as determined by the Secretary."

As David Blumenthal described it, the intent of this provision is to make signing up for insurance as easy as using an ATM card. All the supportive transactions including identity documentation, eligibility checking, and matching identity among diverse databases needs to be specified over the next 6 months. To do this, it is clear that the Policy and Standards Committees will need to work together. Doug Fridsma and ONC was charged with recommending a process, a structure, and a framework for us to do this work.

Dixie Baker and Steve Findlay updated us on consent standards and the suite of consumer focused domain standards. The industry is asking for more specificity in the patient engagement portions of meaningful use - when producing an electronic copy of a health record, what should be included? What fields are required for an outpatient summary? The HIT Standards Committee working with ONC has more work to do in this area.

Janet Corrigan and Floyd Eisenberg described the ongoing efforts by the Quality workgroup to retool existing metrics to be EHR friendly and their project to catalog existing electronic quality measures already in use.

After lunch, Jamie Ferguson outlined two recommendations of the Vocabulary Task Force. The need for a single government office or agency to coordinate vocabulary subsets/codesets and the need to make them available via "one stop shopping" in a single repository. The committee endorsed these recommendations and they were forwarded to ONC.

Arien Malec and Doug Fridsma presented an update on the NHIN Direct effort and its short timeline to produce reference implementation. NEHEN will work to connect Massachusetts with other states as a demonstration of the NHIN Direct protocols. The HIT Standards Committee agreed that we need to coordinate all the privacy/security efforts of the HIT Policy Committee, HIT Standards Committee, NHIN Connect, and NHIN Direct efforts to ensure consistency.

Finally, Jodi Daniel from ONC and Michelle Ferritto from the Drug Enforcement Administration/Office of Diversion Control presented all the requirements for e-Prescribing controlled substances. Identity proofing is key to reducing fraud, so two factor authentication is required. Audit trails are required. Certification of software is required. e-Prescribing of controlled substances is not required as part of meaningful use at this point, but it is likely clinicians will want to do it so that they have the same workflows for prescribing Lipitor (a non-controlled substance) as Valium (a controlled substance).

The work ahead for the next few months will include

Content standards - administrative transactions such as enrollment and claims attachments in support of healthcare reform

Vocabulary standards - all the subsets/codesets required for meaningful use

Transmission standards - supporting the NHIN Direct effort

Privacy/Security - continuing our work on consent standards and the specificity needed for patient engagement

All of this will be done in the context of evolving harmonization frameworks which are supported by new RFPs.

I look forward to the work ahead!


Keith W. Boone said...

Any idea when we'll know more about the new RFP's (specifically Standards Harmonization)?

Anonymous said...

Speaking of "transmission" standards - I assume the two hospitals in Boston that you are affiliated with Harvard and Beth Israel currently exchange electronic medical records but how many of the other local hospitals and clinics (if any) can you exchange clinical data with?

Do your patients also have the ability to view their records (labs, radiology results, discharge summaries etc) online? If not when will we be able to?

Unknown said...

Good thing the DEA is coming around on narco e-prescribing. Any timing on getting that fixed?

John Halamka said...

No word yet on the RFP announcements.

Just about all hospitals in Boston support PHRs. BIDMC has done so for 10 years.

The DEA Interim Final Rule becomes law on June 1.