Wednesday, May 18, 2011

The May HIT Standards Committee meeting

The May HIT Standards Committee meeting focused on the schedule of work ahead to provide ONC with the standards needed for Meaningful Use Stage 2 regulation writing.

We began the meeting by reviewing the meeting topics for April to September, shown in the table below.

To ensure all the necessary standards are included in our project plan, we asked Paul Tang to present the latest proposed MU stage 2 criteria. His presentation included several new recommendations:

*CPOE requirements should be expanded to 60% of medication and lab orders as well as demonstration of radiology orders
*Clinicians should be able to refine drug/drug interaction alerts so that alerts are accurate and actionable.  In Stage 3, EHRs should be able to access national lists of drug/drug interaction rules
*20% of hospital discharge medication orders should be e-prescribed
*Demographic capture should include expanded race/ethnicity as noted in the IOM Report Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement.
*Stage 3 should include second hand smoke exposure as a tobacco use type
*40% of hospital labs sent to outpatient providers should be electronic and include LOINC vocabularies
*Eligible professionals should document electronic notes on 30% of visits.  Hospitals should have electronic notes for 30% of patient days
*The Electronic Medication Administration Record should be in use 
*Standards-based Family History documentation should be included in stage 3
*For Hospitals, greater than 25 patients should receive electronic discharge instructions and 10% of patients should view and download information about a hospital admission
*For Eligible Professionals, 10% of patients should view and download their health information
*10% of all patients should receive educational materials
*Eligible Professionals should use secure messaging with greater than 25 patients 
*Eligible Professionals should record communication preferences (secure email, PHR, snail mail etc) for 20% of patients
*Stage 3 should include a mechanism for capturing patient entered data in the EHR
*Medication reconciliation should be done for 50% of care transitions
*Hospitals should send summary of care records to professionals or long term care facilities for 10% of all discharges 
*Eligible professionals should send at least 25 care summaries to other providers electronically
*10% of patients should have a list of care team members (unstructured text for now, structured data for stage 3) 
*A care plan should be included with summary of care transmissions
*Hospitals and eligible professionals should submit at least one live immunization transaction
*Hospitals should submit at least one live reportable lab transaction
*Hospitals should submit at least one live syndromic surveillance transaction
*Cancer conditions should be reported to registries by eligible professionals 
*Data on mobile devices should be encrypted

These new Stage 2 requirements require new standards for

*Extended race/ethnicity codesets
*Discharge medication e-prescribing
*Extended smoking codeset  
*Possible new data exchanges supporting electronic medication administration record workflow (need to  clarify the scope of the EMAR requirement)
*Representing care plans
*Reporting cancer conditions
*Encrypting mobile devices

These will be assigned to workgroups and power teams.

Dixie Baker presented the Privacy and Security Workgroup report focusing on provider directories.   The scope of this work includes entity (i.e. organization) level directory queries from EHRs.   After much discussion, we concluded that the Direct project protocols for DNS query in support of certificate exchange are good enough for the short term, while web-based query/response connections to enterprise LDAP queries is a reasonable future direction.   We'll work with the Policy Committee and ONC to refine the business requirements then produce a series of standards requirements as input to the S&I framework.   The consensus of the committee is that a community based directory is helpful but not necessary for exchange, just as there is no national directory of email addresses, but yet we successfully exchange billions of email per year.

Jim Walker presented the Clinical Quality Workgroup report outlining the work ahead to provide CMS with the standards needed to support quality measures by August.

Judy Murphy and Liz Johnson presented Implementation Workgroup report including their certification experience survey.        

Jamie Ferguson presented Clinical Operations Vocabulary Task Force report.  The Task Force is specifying the vocabulary and codesets needed to accelerate semantic interoperability.  The Implementation Workgroup and the Vocabulary Task Force will also make statements about certification queries such as support for Postel's Law - if a new vocabulary term is introduced, existing systems should continue to function.
Doug Fridsma led a discussion of the Summer Power Team activities

Stan Huff presented the Metadata Analysis Power Team report.   There was general consensus that simple XML forms which support patient identity and provenance (who sent the message, when was it sent etc) using CDA R2 and X.509 signatures was good enough.

Marc Overhage submitted the Patient Matching Power Team report.

We will get updates on the Surveillance Implementation Guide (Chris Chute), e-prescribing of discharge needs (Jamie Ferguson) and NwHIN (Dixie Baker) at the next meeting.

A very productive meeting.   The HIT Standards Committee is truly an effective team, representing varied interests but always able to chart a path forward that balances all points of view.


Corvin said...

Thanks for sharing.

I wonder what this means:

"Clinicians should be able to refine drug/drug interaction alerts so that alerts are accurate and actionable."

Are the alerts strictly defined now?

David said...

Excellent summary. The term "power teams" is new to me. These appear to be subsets of the HIT SC workgroups, supplemented by some invited guests. I suppose that a "divide and conquer" approach is necessary given the diversity of topics. What are the deliverables of each Power Team? Are the Power Team meetings open to the public like the WG meetings are?

Peter Bachman said...

As you said a couple of years ago, John, knowing the parties on both ends of a health transaction is a critical requirement.

I see the S&P WG clarifying the situation on requirements, with a nice summary but with some more work to do to understand how X.500/LDAP functions in a national scope such as the U.S. and how DNS is a global root, rather than a federated model. Also I see they are anticipating how they will integrate with NSTIC, but providing for some immediate functionality.

Good work so far on a complicated topic.

Peter Bachman said...

I missed the consensus statement of helpful but not necessary related to messages. DNS is very useful for sending SPAM, since it is cheap and easily replaced with new bot domain names.

Billions of insecure messages sent of which a significant portion are spam or have malware, as a result of not being able to simply look up public keys in a national Directory, in which both parties could be verified.

That kind of growth is not useful to PHI in Healthcare and is closer to metastasis.