The CMS and ONC Meaningful Use Stage 2 rules we just issued represent a massive step forward in advancing the secure exchange of information between providers and patients to support better care across the nation. Getting the right information to the right person at the right time can be a matter of life and death. Unfortunately, anyone who has been a patient or cared for a patient understands that it’s simply not happening today.
Back in 2009 when we were drafting the initial set of meaningful use criteria and required standards, our hopes and expectations were subdued by the reality we faced. Different vendor products used different proprietary or local codes, there were strong disagreements about how laboratory results or patient summaries should be packaged, and there was simply no consensus on how the Internet could be used to securely send patient information. Over the past two years, thanks to the initial steps we took in Stage 1 and the relentless work of almost 1,000 volunteers in ONC’s standards and implementation activities, we can now leap towards interoperability and exchange in Stage 2.
Meaningful Use Stage 2 and Health Information Exchange Highlights
- Common Standards and Implementation Specifications for Electronic Exchange of Information: The Meaningful Use Stage 2 final rules define a common dataset for all summary of care records, including an impressive array of structured and coded data to be formatted uniformly and sent securely during transitions of care, upon discharge, and to be shared with the patient themselves. These include:
- Patient name and demographic information including preferred language (ISO 639-2 alpha-3), sex, race/ethnicity (OMB Ethnicity) and date of birth
- Vital signs including height, weight, blood pressure, and smoking status (SNOMED CT)
- Encounter diagnosis (SNOMED CT or ICD-10-CM)
- Procedures (SNOMED CT)
- Medications (RxNorm) and medication allergies (RxNorm)
- Laboratory test results (LOINC)
- Immunizations (CVX)
- Functional status including activities of daily living, cognitive and disability status
- Care plan field including goals and instructions
- Care team including primary care provider of record
- Reason for referral and referring provider’s name and office contact information (for providers)
- Discharge instructions (for hospitals)
In addition, there are a host of detailed standards and implementation specifications for a number of other transactions including quality reporting, laboratory results, electronic prescribing, immunizations, cancer registries, and syndromic surveillance.
What does this mean? It means that we are able to break down barriers to the electronic exchange of information and decrease the cost and complexity of building interfaces between different systems while ensuring providers with certified electronic health record (EHR) technology have the tools in place to share, understand, and incorporate critical patient information. It also means that providers can improve workflow and dig deeper into the data. Certified EHR technology must be able to support identity reconciliation—matching the right record to the right person—and will give doctors the tools to reconcile a new document with the information already on file, for instance by incorporating medications and problems identified by another provider into a patient’s record, thus creating a single source of truth. The Stage 2 regulations also require developers to build systems that allow each segment of the patient summary, whether it is procedures or lab results, to be retrievable by the end user, getting us closer to the goal of being able to efficiently search and assemble individual data elements through metadata tags.
- Rigorous Testing of Exchange for Stage 2: To ensure certified EHR technology supports providers in exchanging health information with greater frequency and across vendor boundaries, ONC will work with NIST to develop an interoperability testing platform for Stage 2 that will rigorously test that EHR technology can send, receive, and incorporate standardized data using the specified standards and protocols. Any EHR technology that meets the demanding testing requirements should be able to send and receive standardized information with other certified EHRs. We will need your help over the coming months to develop and vet the Stage 2 certification test scripts. Check back to www.healthit.gov soon for additional information on this initiative.
- Actual Electronic Exchange of Clinical Information: By 2014, providers will have to demonstrate, and vendors will have to support, the actual exchange of structured care summaries with other providers—including across vendor boundaries—and with patients. Whether through “push” or “query” methods, the requirements in the rule assure exchange isoccurring while avoiding undue burden on providers and vendors to track and measure this exchange. As we stated unequivocally in the final rule (a dramatic reading of which is available ), we will pay close attention to whether the requirements in the rule are sufficient to make vendor-to-vendor exchange attainable for providers. If there is not sufficient progress or we continue to see barriers that create data silos or “walled gardens ,” we will revisit our meaningful use approach and consider other options to achieve our policy intent.
While any rule-making includes some compromises between the aspirational goals we want to achieve and the reality of where the market is, we continue to make progress toward the ultimate goal of nationwide health information exchanges. By setting ambitious, but achievable targets for providers and vendors alike, I’m confident that we’ll see the same hockey stick progress we’ve seen for adoption of EHRs for information exchange. The push on standards-based information exchange and other Meaningful Use Stage 2 requirements will allow the country to make meaningful use of the meaningful use roadmap for more coordinated, safer, and better care.
Farzad Mostashari, MD, ScM serves as National Coordinator for Health Information Technology within the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. This article was originally posted on the HealthITBuzz blog. Farzad joined ONC in July 2009. Previously, he served at the New York City Department of Health and Mental Hygiene as Assistant Commissioner for the Primary Care Information Project, where he facilitated the adoption of prevention-oriented health information technology by over 1,500 providers in underserved communities.