Wednesday, April 20, 2011

The April HIT Standards Committee meeting

The April HIT Standards committee included important discussions about the timeline for the work ahead, how we'll organize to do that work, and how the HIT Standards Committee will interact with the HIT Policy Committee and the S&I Framework to ensure ONC has the final certification and standards criteria needed for meaningful use stage 2.

The meeting began with an overview by Farzad Mostashari, the new National Coordinator.  He described the perfect storm of events we have in healthcare now - Meaningful Use Stage 2 from the HITECH Act, Accountable Care Organizations from the Affordable Care Act, and the Partnership for Patients: Better Care, Lower Cost from HHS.

Paul Tang then reviewed the likely characteristics of Stage 2.   He summarized the public comment on stage 2 noting strong support for eRx of discharge medications, electronic progress notes, electronic medication administration records, secure messaging, and recording patient preferences for communications.   He noted mixed support for other initiatives such as the list of care team members and longitudinal care plans.  He highlighted the concerns about timelines for stage 2, especially the lead time required to create and widely implement new functionality.  Options include reducing the reporting period for Stage 2 from 1 year to 90 days resulting in a 9 month delay, deferring stage 2 for a year,  and splitting Stage 2 into 2a for increased thresholds on existing measures and 2b for introducing new technology.   We discussed the need for detailed descriptions of the new stage 2 functionality so that we can determine where new standards are needed. The committee had a robust discussion about the need to work on   certification criteria and testing criteria for stage 2, since the committee's stage 1 input was limited to standards alone.

Doug Fridsma then discussed the process we'll use this Summer to complete the necessary standards work in support of MU Stage 2.   Steve Posnak provided a visual representation of the interactions among the HIT Policy Committee, Standards Committee and ONC described in the HITECH Act.

Doug outlined a very practical idea - as the HIT Standards Committee studies the standards to support stage 2, it should divide them into buckets as follows

A) Those meaningful use criteria for which no standards are needed - they are process goals
B) Those meaningful use criteria for which one existing standard exists and is a perfect fit
C) Those meaningful use criteria for which standards exist, but they are imperfect and need work
D) Those meaningful use criteria for which no mature standards exist

In the next few weeks, the Standards Committee will develop a detailed workplan for May and June by placing meaningful use stage 2 priorities into these buckets and then assigning them to ad hoc workgroups ("power teams") to rapidly analyze.   We'll handoff those in buckets C and D to the S&I framework for further deliberation.    The S&I groups will return their finished work to the Standards Committee for review and final polish.

Jamie Ferguson provided an update on the vocabulary task force, noting its efforts to specify one major vocabulary for each domain area (labs, problems, allergies, medications etc.), identify vocabulary subsets/codesets that will accelerate interoperability, and  ensuring mappings between vocabularies are available where necessary.

Paul Egerman presented an overview of the PCAST Workgroup recommendations.   Doug Fridsma discussed an analysis of existing metadata standards prepared by Mitre.

Paul's work as facilitator of the PCAST Workgroup effort was truly remarkable and his energy resulted in a comprehensive report that suggests a very reasonable path forward.   One early pilot we discussed was the use of the Universal Exchange Language to send data from EHRs to PHRs.   An existing CCR or CCD could be wrapped with patient identification and provenance (who generated the data in what setting) metadata and incorporated into PHRs, assuming existing PHR vendors can be convinced to accept a universal format.

Jim Walker provided an overview of the Clinical Quality Workgroup  including their plan for supporting meaningful use stage 2 measures.

Dixie Baker and Walter Suarez presented their plan for Provider Directory work.    Upcoming testimony will enable them to make recommendations at the May Standards Committee meeting.

A great meeting.   As next step, we'll set up a group to evaluate the metadata possibilities for a PCAST pilot.  We'll complete the workplace for the Summer and begin assigning that work.    The next few months will be a sprint as we complete all the work needed to support the next level of Meaningful Use.

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