HIT Standards Committee

Overview and Progress ReportMarch 17, 2010

Structure•Clinical Operations Workgroup –

Jamie Ferguson, Chair

•Clinical Quality Workgroup – Janet Corrigan, Chair

•Privacy and Security Workgroup – Dixie Baker, Chair

•Implementation Workgroup – Aneesh Chopra, Chair

Clinical Operations

•Content and Vocabulary Standards - the package that is sent for meaningful use

•Includes Administrative transactions

•Vocabulary Task Force

•Provides technical guidance to Quality workgroup on data element/data type content standards

•Current focus is comment response, vocabulary starter sets, implementation guidance

Comments on the IFR

•Broad Families of Standards• Patient Summary - HL7 Version 3 Clinical Document Architecture (of which CCD is one example) and the ASTM E2369 CCR

• Medications - NCPDP Script

• Administrative Transactions - X12 4010 and 5010

• Quality Reporting - XML

• Population Health including labs, biosurveillance and immunizations - HL7 Version 2

•Implementation Guide Floors

•Vocabulary Starter Sets and Maps

•Vital Signs

•Scope of Interoperability is between organizations

Clinical Quality

•2011 Proposed Measures

• Measure Retooling – Update

•Identification of types of “value sets” that need to be specified

•2013 and Beyond

•Importance of moving expeditiously to identify potential MU measures

•Timeline for measure development, testing and evaluation

Comments on the IFR

•Allergy vocabulary

•Vital Signs vocabulary

•Units of Measure vocabulary

•CCR v. CCD For Quality Data gathering

•PQRI XML v. QRDA for Quality Data reporting

Privacy and Security

• User and entity authentication, access control, auditing, encryption, data integrity, accounting for disclosures, consumer access

• Technology standards and certification criteria to support privacy and security policy

• Priorities aligned with Privacy and Security Policy Workgroup

• Launching educational sessions on consent-related standards

Comments on the IFR• Agree that certification program should include EHR Modules,

but presents challenges w.r.t. enterprise-wide privacy and security

• Recommended approach that would treat security certification criteria as “addressable” for EHR Modules

• Example (“e.g.”) standards are helpful but difficult to maintain current

• Recommended having body of certifiers maintain current list of acceptable standards

• ARRA requirement for “electronic access” for consumers needs policy clarification

• “Online” may imply “real-time” & would be difficult for small providers

• Consumers want a copy of their record that can be stored and printed

Comments on the IFR

• Encryption needs to be specific – Advanced Encryption Algorithm (AES)

• Authentication of both ends of trusted link – not single-sign on between organizations

• Accounting for disclosures needs to be brought into alignment with realistic, consistent timeline

• Operational and workflow changes required only by enterprises who have adopted EHR

• Meaningful-use target is 2015

• Recommended discussion between HIT Policy and Standards Committees to coordinate recommendation to ONC

Implementation

• Accelerators and enablers

• Guiding Principles

• Keep it simple

• Think big, but start small

• Don’t let “perfect” be the enemy of “good enough”

• Keep the implementation cost as low as possible

• Do not try to create a one-size-fits-all standard

• Separate content and transmission standards

• Create publicly available vocabularies & code sets

• Leverage the web for transport (“health internet”)

• Position quality measures so they motivate standards adoption

• Support implementers

• Current Focus is Implementation Starter Kit

Coordination with the HIT Policy Committee

•Joint workgroup meetings as needed

•Address gaps for standards harmonization and standards commissioning as prioritized by the HIT Policy Committee

•Current issues - Labs, Disclosures, Patient Summary standards, NHIN Direct