The January HIT Standards Committee

john halamkaBy John Halamka, MD

Twitter: @jhalamka

The January HIT Standards Committee focused on two important topics, the future of the Standards and Interoperability (S&I) Framework and the standards needed for provenance i.e. who generated the data and I can I trust it?

Stan Huff and Arien Malec presented the process that the Standards & Interoperability Task Force will use to evaluate the best way to harmonize standards in the future. Typically Standards Development Organizations (SDOs) create and curate standards but sometimes there is a need to select among competing standards or combine the work of multiple SDOs into an implementation guide. The Healthcare IT Standards Panel (HITSP) did this kind of harmonization. When HITSP was sunsetted during the transition from the Bush to the Obama administration, the S&I Framework was created to fill the harmonization role, since the Healthcare IT Standards Committee (HITSC) served in advisory capacity to ONC, not doing the granular work of implementation guide writing. Questions to be asked by the Task Force include:

Is there a continued need for the S&I Framework (or an equivalent process) to advance standards and implementation specification development?

The task force will evaluate the “What” (what should be done) and the “How” (by whom, in what forum, with what processes).

We all look forward to their work.

Lisa Gallagher presented the work of the Data Provenance Task Force. Their remarkable set of recommendations that were applauded by all.

The Task Force recommended that the Data Provenance Initiative should focus on the following:

  • Where did the data come from? (“source provenance”)
  • Has it been changed?
  • Can I trust the data?

The Task Force recommended that these questions be answered using 4 transaction types, in the following order of priority (although they are roughly equal in priority):

  • With exchange of data between EHRs
  • At the point of origin/data creation in an EHR or HIE
  • With the transfer of data from a Patient Controlled Device (PCD) or a Personal Health Record (PHR) to an EHR system
  • At the point of data creation in a PCD or PHR

They recommended that the CCDA and FHIR be the target technologies for provenance standards taking into account existing work including:

  • CDA/C-CDA Provenance
  • FHIR Provence Project
  • Privacy on FHIR Projects

Finally, they recommended that for health information exchange, both push (Direct) and pull (SOAP/REST query/response), that the provenance of the content should be lossless ie. there is data integrity from the point of origin to the point of use.

Much discussion followed and the Committee agreed that we needed to define lossless i.e. what if the data is mapped into a different vocabulary or different format? Arien Malec agreed to prepare a straw man definition of lossless.

The committee voted to support these recommendations and formally deliver them to ONC.

The next few months will be very busy for the HIT Standards Committee as we review the Federal HIT Stategic Plan, the Ten Year Interoperability Roadmap, and the Meaningful Use Stage 3 Notice of Proposed Rulemaking. Exciting times ahead.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.