November HIT Standards Committee Recap

john halamka

By John Halamka, MD
Twitter: @jhalamka

The November HIT Standards Committee focused on “asynchronous bilateral cutover” – the compatibility of different CCDA payloads, healthcare IT that supports long term services and support, an update on the Standards & Interoperability projects, a discussion of data provenance efforts, and the HITSC workgroup organization.

We started the meeting by thanking Jacob Reider, Deputy National Coordinator, for his chairmanship of the Standards Committee. He’s leaving ONC at the end of the month. He will be missed.

Charles Parisot provided an analysis of Consolidated-Clinical Document Architecture (C-CDA) Version Migration and Cutover Findings. The good news – many vendors can successfully generate and parse different CCDA versions. We discussed two key takeaways. When new versions of standards are introduced attention needs to be paid to backwards compatibility. A bit of planning now can save significant EHR engineering complexity later. Also, at some point, certification will need to codify what it means to be backward compatible. Are older versions stored as human readable documents instead of structured data? The HITSC members recommended to ONC that they seek the input of the EHR vendors as to the appropriate path for historical CDA variants (CCD, C32, CCDAr1, CCDAr2).

Next, Evelyn Gallego briefed us on the S&I Framework Initiative Electronic Long-Term Services and Support (eLTSS). This is a new initiative and it seeks to provide electronic tools for individuals with physical, cognitive, and/or mental impairments who never acquired, or have lost, the ability to function independently. The committee discussion recommended that this work be done as “apps” outside the EHR, since it will likely incorporate data from several data sources and be used by stakeholders other than clinicians.

Steve Posnack updated us on Standards and Technology activities including new certification refinements. He also provided valuable summary of ONC’s FHIR related efforts. The alignment of government, industry, and academia around FHIR is truly a perfect storm for innovation.

Julie Chua and Jonathan Coleman presented the S&I Framework Data Provenance Use Case. The committee recommended that this work be significantly narrowed in scope to achieve an implementable single use case which will inform the technology path forward.

Finally, Steve Posnack presented a HITSC Workgroups and Operations Discussion. When the workgroups were reorganized there was concern about siloing – how do we avoid multiple duplicative work streams in the various workgroups. Steve’s answer is to draw members from each workgroup into an ad hoc task force when multi-disciplinary problems need to be solved. Thus, going forward, we’ll have some projects that are driven by workgroups and others addressed via ad hoc task forces of experts.

A good meeting. We all look forward to the upcoming 2015 meetings in which we’ll review ONC’s 10 year interoperability roadmap and the next Notice of Proposed Rulemaking for Certification.

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.