Wednesday, February 29, 2012

The February HIT Standards Committee Meeting

The February meeting of the HIT Standards Committee included an in depth discussion of the Stage 2 Standards and Certification NPRM, updates from the projects in our 2012 HITSC work plan, and an overview of HITPC plans for 2012.   It was one of the highest energy, most optimistic meetings we've had.

We began the meeting with a review of the Standards and Certification NPRM by Steve Posnack and Doug Fridsma.  As I noted in my recent post about the NPRM, most of the HITSC "Summer Camp" recommendations were accepted.   Highlights from their presentation:

*In Stage 2, Certified Electronic Health Record Technology (CEHRT) will be "just enough" to support the functions documented during attestation.     In Stage 1, certified technology  was required for menu set items that were not part of an organization's attestation i.e. even if you did not plan to submit syndromic surveillance data, you needed to buy that technology anyway.  
*Every eligible professional/eligible hospital/critical access hospital (EP/EH/CAH)  must have a "base EHR"  that includes the ability to capture demographic data/patient history/problem lists, provide decision support, support provider order entry, record data needed to report quality, exchange electronic information, and protect confidentiality
*In addition to this base EHR, every EP/EH/CAH should have the EHR technology with capabilities for the MU core and menu set objectives they seek to achieve.  These can be a collection of modules or a complete EHR.
*Clinical Quality certification includes the ability to capture, calculate, and report clinical quality measures.   It's completely fine to use certified EHR technology to capture the data, then export it to another certified technology for calculation and reporting.   This is what BIDMC does today and to achieve it we had to do self-certification.   Now, anyone can use this approach, assembling certified components from vendors.
*The Standards specified in the 2014 Criteria include
  Content - Consolidated CDA for summaries, NCPDP for eRx, HL7 2.5.1 for public health
  Vocabulary - CVX for immunizations, SNOMED-CT for problem lists, ICD10-CM for diagnoses, LOINC for labs, RxNorm for meds, OMB, ISO639-1 for spoken language, CDA for cancer submissions 
  Transport - Direct Specifications and NwHIN Exchange
  Security - FIPS for encryption, NTP for time
*The MU Stage 2 Menu set includes  several functions with evolving standards such as Imaging display in EHRs, transmission to clinical registries, cancer case information, and family health history.  That's why they are menu set

Initial reactions from the HIT Standards Committee included

   TLS should be listed as an acceptable transmission standard for data exchange with patients
   Organizations with internal pharmacies should be allowed to use HL7 for eRx of discharge meds
   Quality reporting XML needs additional work on content, vocabularies, data model
   Imaging in MU should be clarified (view/access/transmit in an EHR or via an EHR)
   Allergy terminology should be included in the Standards Final Rule - RxNorm for meds, NDF-RT for drug classes, SNOMED-CT for non-meds
   Our focus should be the adoption of SNOMED-CT as the clinician facing vocabulary, not ICD-10
   XDR as a transport standard should be optional, as was defined in the Direct Project
   Patient Portals - Direct should be used with patients i.e. EHRs should be able to "cc the patient"
Next, Betsy Humphreys presented the Vocabulary and Code Sets update  focusing on SNOMED0CT, LOINC and RxNorm tools.  A new API to access cloud hosted SNOMED-CT resources from NLM will be available in March 2012.

Next, Dixie Baker presented the NwHIN Power Team review of NwHIN Exchange implementers comments.   Major themes included
*Complexity seems to be related to the specifications themselves which include optionality and layers of references to other specifications (indirection).  There was no specific complaint about SOAP or the need for REST
*No current Exchange implementation is being used for large scale production except the SSA's disability determination project
*The Exchange Patient Discovery architecdture lacks scalability

Next, Paul Tang presented the 2012 HITPC work plan.  He reviewed the 5 year vision with 2011being capture of structured data, 2013 being HIE/Care Coordination, and  2015 being outcomes measurement and improvement.   The 2012 work plan includes
*Q1 discussion of MU Stage 3 principles, review of the MU Stage 2 NPRM, governance, next generation quality measures
*Q2  Quality measure lifecycle, patent generated data, information exchange, EHR safety
*Q3  Stage 3 draft recommendations, long term and post-acute care, governance NPRM
*Q4   Reconcile MU3 Recs with Stage 2 Final rule,  HITSC feedback on stage 3 , Consumer eHealth, Strategic plan revisions

Next, Jim Walker presented the work plan for the Clinical Quality Workgroup.

Finally, Doug Fridsma presented the S&I Framework update identifying the levels of support currently available - Self Service, Limited Service, Strategic Support and Full support.  S&I portfolio of new work includes longitudinal coordination of care, electronic submission of medical documentation signatures and content, query health, and data segmentation for privacy.

Thus, the HIT Standards Committee is on track for our 2012 work plan, the first quarter of which includes 4 projects

a.   NPRM review
b.  Quality measurement
c.  NwHIN Exchange refinement
d.  Value sets/vocabulary mapping

At the next meeting, we'll review our collective comments on the NPRM (gathered from each of our workgroups) and ensure we're on the right trajectory for our next quarter's work on standards governance, Query Health, Radiology Standards and NwHIN supporting components (Provider Directories, PKI).

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