The June HIT Standards Committee

The June HIT Standards Committee focused on several important issues related to the real world implementation of healthcare information exchange.

Judy Murphy, Deputy National Coordinator, began the meeting by announcing the progress we've all made on EHR adoption and use of federally mandated standards.    110,000 clinicians have attested to meaningful use and 2400 hospitals have achieved this milestone.    $5.7 billion in stimulus payments have been made.

We then began a detailed review of the Governance RFI by the NwHIN Power Team.   Dixie Baker presented useful background on the Governance RFI defining the terms "Conditions for Trusted Exchange", "Accreditation Body", "Validation Body", "NwHIN Validated Entity", and "Readiness Classification".   With that foundation, she presented the two key recommendations from the NwHIN Power Team

*Safeguards Conditions for Trusted Exchange, which are basic policies ensuring trust that do not change often, should be codified in federal regulations
*Interoperability Conditions for Trusted Exchange, which are the technologies that ensure the security of the trust fabric, will evolve rapidly and in the interest of agility should be established collaboratively by the Validation Bodies with oversight by ONC.

A robust discussion followed and we concluded that the validation bodies should not choose the interoperability conditions for trusted exchange.  Instead, a public/private body, such as the HIT Standards Committee should perform this task, similar in concept to certification criteria.   Certification bodies do not set standards and certification criteria, they look to federal regulation for those details.

Dixie discussed in detail the 21 questions from the RFI that were assigned to the NwHIN Power Team.   The Standards Committee agreed with most of the recommendations, but had a lengthly discussion about three concepts
*Need to be careful to respect existing laws such as HIPAA.   This can be accomplished by enumerating current HIPAA addressable criteria as individual conditions for trusted exchange
*Need to be consider a modular approach to validation, given that different network participants may offer different services that have different conditions for trusted exchange
*Need to be careful about the scope of the conditions for trusted exchange.  Does it require all payers to establish new agreements with existing administrative trading partners?   Although the Governance RFI is a real enabler for clinical data exchange which is largely a work in progress, it could be burden on existing administrative data exchange.

Dixie also presented the comments from the Privacy and Security Workgroup.

Jamie Ferguson and Betsy Humphreys presented a summary of the Vocabulary task force recommendations for value and code sets.    The announced the culmination of two years of work - CMS has agreed to fund a curated national vocabulary repository to be hosted at NLM which will make all the necessary meaningful use code sets and crosswalks available to all stakeholders at no charge.   A true milestone in inoperability that addresses all the Vocabulary Task Force recommendations.

Next, Majorie Rollins and Leslie Kelly Hall presented a summary of the Hearings on Clinical Quality and Patient-Generated Data.  There is a great deal of excitement about creating quality measures that are based on current EHR data elements that are captured as  part of normal clinical workflows.   Similarly, there was universal agreement on the importance of patient sourced data regarding functional status, symptoms, care preferences and consent.

Doug Fridsma presented an update on the S&I Framework, highlighting the work in progress, the new initiatives, and the plans post ARRA funding that will ensure tighter integration of the Standards Committee, the Standards Development Organizations, and the S&I Framework teams.   We'll discuss this topic in more detail at the July meeting.

Finally, John Derr and John Feikema updated the committee on the status of  Long-Term and Post-Acute Care (LTPAC) Initiatives.   All agreed that LTPAC workflows should be incorporated into future Federal meaningful programs.     I highlighted the work of Larry Garber in Massachusetts to accelerate LTPAC integration into the state HIE.  http://www.nehcc.com/_documents/_session_handouts/garber-improving-massachusetts-post-acute-care-transfers.pdf

A powerful meeting with many debates, but consensus on the recommendations needed to accelerate real world interoperability.