The August HIT Standards Committee Meeting

john halamkaAccelerating Interoperability

By John Halamka, MD
Twitter: @jhalamka

The August HIT Standards Committee focused on the work ahead to accelerate interoperability. It’s no longer about Meaningful Use, it’s about Meaningful healthcare information exchange.

I offered my opinion about the work ahead. ONC is in the middle of regulation writing for Meaningful Use Stage 3, so the standards work of the next 10 weeks is not going to be incorporated into the NPRM.

Regulation is not the only way that health IT standards are defined, selected, or adopted by industry.

Learning from Stage 2, it’s critical that we decouple regulation writing from creating test procedures and scripts for certification. I’m confident that our upcoming standards work will result in implementation guides and certification criteria outside the initial NPRM process. Also, it’s important to remember that the NPRM is a proposal. If the final rule needs to incorporate the standards work of the next few months, HITSC can recommend specific standards in its formal review of the NPRM.

All of the presentations at the August meeting explored different aspects of interoperability.

Jacob Reider offered opening remarks, reflecting on the timeline and staging of the work ahead, including the transition of workgroups to a new structure that will make us more agile

Steve Posnack presented an update specifically focusing on the new Standards Implementation and Testing Environment that enables robust testing of interoperability including CCDA, QRDA, Provider Directory and Transport (Direct) standards.

Erica Galvez, ONC Interoperability Portfolio Manager, described the interoperability portfolio and timeline for ONC work including the building blocks of the ONC 10 year vision:

  1. Core technical standards and functions
  2. Certification to support adoption and optimization of health IT products and services
  3. Privacy and security protections for health information
  4. Supportive business, clinical, cultural, and regulatory environments
  5. Rules of engagement and governance

Vaishali Patel presented a data update on interoperability, highlighting growth in exchange capability and activity. Interoperability measurement will be a key focus going forward.

Finally, Liz Johnson presented the Implementation Workgroup review of the CCDA, identifying issues such as heterogeneity of CCDAs from different vendors, excessive optionality, mixture of structure/unstructured data, challenges with usability, and a need to evolve to something simpler such as FHIR. The Standards Committee approved a resolution for the Steering Committee to assemble experts and recommend CCDA improvements or its replacement.

With every Standards Committee meeting we’re getting closer to creating a national “Automated Teller Machine” for healthcare. CCDA and Direct with a few supporting standards such as provenance, provider directory, and query/response will get us started. FHIR, REST and OAuth2 will take us to the finish line.

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.