July meeting of the HIT Standards Committee

john halamkaDiscussions on Certification for Post Acute Care and Behavioral Health

By John Halamka, MD
Twitter: @jhalamka

The July meeting of the HIT Standards Committee included important discussions of certification for post acute care and behavior health applications, review of data segmentation for privacy, analysis of provider directory standards, an update on the standards/interoperability framework projects, and a first look at the new subcommittee co-chairs of the Standards Committee.

We started the meeting with a review of attestation data by Jennifer King. Jacob Reider reminded us not to judge the trajectory of the project based on the those who attested early. The data indicates that the bulk of attestations were completed using just a few vendor products, implying that 2014 certified products from multiple vendors are not yet widely implemented. I asked if any updates were available about the NPRM to offer more flexibility for stage 2 attestation. HHS is still reviewing the comments, so there is no specific new information that the NPRM will be finalized and we all should continue our work on existing stage 2 criteria during this last federal quarter of 2014.

We next heard from Larry Wolf about the multi-stakeholder effort to specify certification criteria for long term post acute care and behavioral health. The motivation for this work is to create interoperability and standardization, bringing LTPAC/BH stakeholders into the same ecosystem as those providers participating in the meaningful use program. Thus far LTPAC/BH vendors have been very interested in the reputational benefits and possible market share gains available from having certified software. The workgroup did an amazing job specifying high value certification criteria.

Next we heard from Deven McGraw about advances in standards work for Data Segmentation that enables more granular patient control over healthcare information exchange. An important motivator for this effort is 42 CFR Part 2 which protects the privacy of substance abuse treatment records. The workgroup was very practical and presented a multi-phased approach that incrementally improves EHR technology. The first step would be to add a “lockbox” that receives content that cannot be redistributed without additional consent. If a patient consents to disclose substance abuse treatment from institution A for transmission to institution B, then institution B cannot share that information with institution C unless the patient is re-consented. The Standards Committee will review the recommendations and standards for for their implementability. I hope there are early industry pilots that help us learn how best to implement novel consent and privacy controls.

Next, Dixie Baker presented a Provider Directory standards update. The committee adopted their recommendations which were – no mature standards for provider directory query exist, ONC should organize pilots of simple RESTful/FHIR approaches, and the National Provider Identifier database should be considered as a potential infrastructure to host provider Direct addresses.

Next, Steve Posnack presented an update on S&I Framework projects. He also announced that ONC would be encouraging industry and provider stakeholder groups to develop test procedures so that we do not repeat the experience of Stage 2 – test procedures and scripts that are burdensome and not aligned with real world workflow.

Finally, Jacob Reider reviewed the new subcommittee structure of the HIT Standards Committee including co-chairs. The co-chair of the steering committee is still a work in process.

A very productive meeting. I look forward to the work ahead as we focus our attention on standards needed to support Stage 3 of meaningful use focusing on fewer use cases in greater depth.

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.