By John D. Halamka, MD

The 42nd meeting of the HIT Standards Committee began with an inspirational introduction from Farzad Mostashari. He told us that the HIT Standards Committee members should keep their  "eyes on the prize and feet on the ground".

We should be aspirational in reviewing the Meaningful Use Stage 3 criteria, identifying standards recommendations for 2016 which are likely, which are possible with focus, and which are unrealistic.

We should not be intimated by all the ideas in the Meaningful Use Stage 3 request for comment, but realize that unless all ideas are considered, we’ll regret not thinking broadly about important safety, quality, and efficiency improvements. As the request for comments process progresses, the doable priorities will emerge. The public release of the Stage 3 request for comment will occur later this week, with comments due in January.

Michelle Nelson, ONC Meaningful Use Workgroup Lead, presented the Meaningful Use Stage 3 recommendations, assisted by Doug Fridsma and Jodi Daniel. We reviewed the Stage 3 recommendations line by line, noting that the Policy Committee had included some data exchanges that the Standards Committee suggested were unlikely to occur by 2016. Although most of the Standards Committee advice was incorporated, the Policy Committee felt some goals were so important they were worth pushing. Overall, the Standards Committee commented that the Meaningful Use Stage 3 recommendations need to be grouped into common policy goals, be less workflow prescriptive and more outcomes oriented, take into account the burden of implementation, and focus on a few significant improvements to EHRs that would accelerate several goals. For example, if all EHRs became QueryHealth compliant then clinical trials, quality measures, and population health reporting would all be simplified. As a next step, ONC will reorganize the Stage 3 material into policy clusters and themes for assignment to the Standards Committee for detailed standards recommendations.

Next, Dixie Baker presented a Privacy and Security Workgroup Update regarding security and privacy criteria for modular EHR certification. Their concern is that without security and privacy guidelines, we could end up with a module that weakens protections and data integrity of the enterprise. Dixie suggested several paths forward and the Committee decided that Modular EHRs should be required to demonstrate compliance with the Meaningful Use security criteria by either including features within the module or by making calls (standards-based or non-standards based) to other applications which provide the needed security.

Doug Fridsma provided an update on S&I Framework projects and focused on the Automate Blue Button initiative to support patient "subscription" to their healthcare data or automated requests for delivery of their data.

Kate Goodrich from CMS provided an overview of efforts to "re-boot" Clinical Quality Measures by
*Eliminating abstracting and skip methods that based on paper
*Using new measures that are EHR-based, not old measures that are retooled to work with EHRs
*Reducing complex exclusionary criteria in numerators and denominators
*Consolidating measures across various programs – ACO, PQRS, CMS Core etc.

We then heard three presentations that are part of efforts to simplify future stages of Meaningful Use by providing national infrastructure.

Ivor D’Souza from the National Library of Medicine presented theValue Set Authority Center, which is now open for business. This valuable resource provides downloadable/searchable vocabularies and code sets that support Meaningful Use Stage 2.

Christopher Chute from Mayo Clinic presented Common Terminology Services 2 (CTS2) which provide an easy way to exchange code sets in batch from sources such as the Value Set Authority Center. I’ve posted previously about CTS2.

Michael Fitzmaurice presented the United States Health Information Knowledgebase.  It includes access to Chris Chute’s Value Set Authority Center Common Terminology Services application. I’ve posted previously about USHIK.

Lastly, we heard from Carol Bean about the Meaningful Use Stage 2 Testing and Certification details. We look forward to piloting the scripts before they are placed into production.

An important meeting that set the stage for deliberations on Stage 3. I look forward to simplifying the Stage 3 recommendations into common themes that reduce the burden on implementers.

In addition to his CIO role at BIDMC, Dr. Halamka blogs at GeekDoctor.blogspot.com.