The First Meeting of the HIT Standards Committee

Today, Jonathan Perlin and I ran the first meeting of the new HIT Standards Committee. The members are:

Jonathan Perlin, MD, Chair
Healthcare Corporation of America

John Halamka, MD. Vice-Chair
Harvard Medical School

Dixie Baker, PhD
Science Applications International Corporation

Anne Castro
BlueCross BlueShield of South Carolina

Christopher Chute, MD
Mayo Clinic College of Medicine

Janet Corrigan, PhD
National Quality Forum

John Derr, R.Ph.
Golden Living, LLC

Linda Dillman
Wal-Mart Stores, Inc.

James Ferguson
Kaiser Permanente

Steven Findlay, MPH
Consumers Union

Douglas Fridsma, MD, PhD
Arizona Biomedical Collaborataive 1

C. Martin Harris, MD, MBA
Cleveland Clinic Foundation

Stanley M. Huff, MD
Intermountain Healthcare

Kevin Hutchinson
Prematics, Inc.

Elizabeth O. Johnson, RN
Tenet Health

John Klimek, R.Ph.
National Council for Prescription Drug Programs

David McCallie, Jr., MD
Cerner Corporation

Judy Murphy, RN
Aurora Health Care

J. Marc Overhage, MD, PhD
Regenstrief Institute

Gina Perez, MPA
Delaware Health Information Network

Wes Rishel
Gartner, Inc.

Richard Stephens
Boeing

Sharon Terry, MA
Genetic Alliance

James Walker, MD
Geisinger Health System

We began the meeting with introductory remarks from Dr. Blumenthal. He emphasized the need to improve care quality, efficiency, and the scope of healthcare coverage. He noted that technology is a tool that facilitates meaningful use and leads to better care. The goal is better health, not implementation of IT for technology's sake.

Jodi Daniel provided us with important statutory background on the committee. Here are few key points from her presentation and the discussion which followed

1. The purpose of the committee is to recommend standards, implementation specifications, and certification criteria to the National Coordinator for the electronic exchange and use of health information. The committee is not limited to standards selection, it covers the process from end to end - standards, implementation, and certification criteria. It will gather input from standards harmonization and development organizations, implementation guide writers, and certifying organizations to make recommendations which enable data exchange in support of meaningful use.

2. There are 8 areas of policy focus
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations

You'll see a great deal of discussion in the HIT Policy and Standards Committees about these issues. These 8 areas are our guiding principles!

3. The HIT Standards Committee will have two standards adoption processes
- expedited, in support of the statutory deadline for HHS to publish an interim file rule on initial standards, implementation specifications and certification criteria by 12/31/09. For this process, we'll leverage the already approved/recognized standards.

- normal, the committee will receive guidance from the HIT Policy Committee and typically within 90 days will make recommendations. Note that these recommendations may include naming standards, identifying gaps, and asking standards harmonization/development organizations to do further work.

4. NIST will serve a role to test the standards. To clarify, this work is to ensure the standards are appropriately documented and technically adequate for their intended purpose. NIST will not certify products - that will be left to certification organizations.

5. The summary of the entire process is illustrated in picture above.

We then discussed the types of data exchanges which might constitute meaningful use. ONC and HHS have not yet provided official guidance on meaningful use, so these are contingencies - our best guess as to the data exchanges likely to enable meaningful use.

Clinical Operations - ePrescribing/medication management, lab ordering/resulting, clinical summary exchange (problem list, medication list, allergies, text based reports including op notes, diagnostic testing reports, discharge summaries)

Quality - Process, outcomes, treatment plans, medical decisionmaking, health behaviors

Security - Transport, secure messaging, authentication, authorization, auditing

We elected to form three working groups to focus on these areas. These groups will conduct phone meetings and include additional experts as needed.

In the discussion that followed a few major themes emerged:

a. We need a high level roadmap of milestones to ensure we meet our statuary deadlines for initial deliverables in time for the 12/31/09 interim rule.
b. We also need a roadmap which takes into account the other mandates/compliance requirements already imposed on healthcare stakeholders such as ICD-10 and X12 5010. We need to ensure our clinical work is in synch with administrative data exchange activities already in progress.
c. Although we should provide for the exchange of basic text, we should strive for semantic interoperability whenever possible, using controlled vocabularies which are foundational to decision support and quality reporting.
d. We should set the bar for interoperability higher than the status quo but also make it achievable, realizing that rural providers and small clinician offices have less capabilities than large academic health centers. We'll need to retrofit many existing systems - healthcare IT is not a greenfield and thus we need to be realistic about the capabilities of existing software, while also encouraging forward progress and innovation.
e. Meaningful use will change over time. Data exchange and the standards we select must evolve. To ensure successful adoption throughout the industry, our work must be continuous incremental progress with phased adoption of standards.

I will serve as Chair of HITSP and Vice-Chair of the HIT Standards Committee simultaneously, coordinating communication between these two organizations. I look forward to the work ahead.

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