On September 28 2011, the HIT Standards Committee (HITSC) will officially deliver to ONC its 6 months of hard work from Standards Summer Camp. HITSC subcommittees and workgroups have met every other day since April to prepare the standards recommendations needed to support Meaningful Use Stage 2 rule making.
The S&I Framework teams have been working in parallel on important issues – Certificates, Provider Directories, Lab Result Reporting, and Transfer of Care Summaries.
Here’s how it all fits together.
Certificate Recommendations – HITSC recommended specific implementation guidance for X.509 certificates. The S&I Framework teams developed a strategy for certificate authorities to issue trusted credentials that will eventually be cross-certified with the Federal Bridge Certificate Authority (FBCA), enabling exchange with Federal agencies.
Metadata recommendations – HITSC recommended CDA R2 headers for patient, provenance, and security metadata. These were included in the Advanced Notice of Proposed Rulemaking. HIEs should use these standards as metadata envelopes for content payloads that are sent between different organizations.
Provider Directory recommendations – HITSC considered LDAP but noted that federated LDAP directories and internet-based LDAP queries between organizations have not yet been widely deployed. HITSC also considered microdata and web search engine retrieval of structured directory data. The S&I Framework teams concluded that pilots of federated LDAP queries and microdata are a reasonable next step, because no provider directory standard is mature. Additionally the S&I Framework teams recommended DNS for certificate distribution with the addition of LDAP if an organization’s implementation of DNS does not support certificate discovery.
Vocabulary recommendations – HITSC recommended a parsimonious set of standards for vocabularies supporting quality measures including SNOMED-CT for problems, LOINC for labs, and RxNorm for medications. The September HITSC meeting will include a transition plan for those vocabulary standards required for Stage 1 that are being retired/replaced in Stage 2.
Patient Matching recommendations – HITSC recommended a set of best practices that will guide implementors who want to match patients using demographic data elements with appropriate specificity and sensitivity.
ePrescribing of Discharged Medications recommendations – HITSC recommended NCPDP and HL7 standards that are widely implemented and compliant with Medicare Part D requirements.
Public Health recommendations – HITSC recommended HL7 2.51 implementation guides for syndromic surveillance, reportable lab, and immunizations – one highly constrained implementation guide for each transaction.
NwHIN recommendations – At September’s meeting, HITSC will recommend one set of building blocks to support Nationwide Health Information Network Exchange transactions (pull/push) and Direct transactions (push).
Lab Results recommendations – The S&I Framework teams recommended an HL7 2.51 transaction that is very similar to the public health implementation guides already approved by HITSC. It also includes vocabularies and code sets that constrain the optionality of the transaction. The Implementation Guide is broadly supported by ELINCS developers, commercial labs, and numerous informatics experts. It will be balloted by HL7 in the next few weeks and then piloted before any regulations are written.
Transitions of Care recommendations – The S&I Framework teams recommended a transfer of care summary that is a natural stepwise evolution of the work we’ve done for the past 10 years – CDA –> CCD –> C32 –> transfer of care CDA templates. These CDA templates are easier to implement than C32 and more flexible, Given that CCR is a declining standard (little new work is being done on it), CDA templates are a reasonable next step. The HITSC will be asked to comment on the trajectory of this work and will evaluate the results of pilot testing.
At the September meeting of the HITSC, we’ll review all the work we’ve done as well as the S&I Framework efforts on Certificates, Provider Directories, Reportable Lab and Transfers of Care.
What evaluation criteria should we use? In the words of Doug Fridsma, who oversees the ONC Office of Standards and Interoperability
"While it might not be perfect, does it represent the best we have so far?
Does it point us in the right direction?
Is it the next step in an incremental approach to refining the standards and implementation guides?
Does it support our policy objectives?
Can we update it as needed through the SDO community?
All standards, even those that have wide-spread uptake, require constant updating and refinement. Vocabularies, terminologies, and other existing standards will require piloting to make sure that we maintain relevance.
We can’t let the perfect be the enemy of good. Standards will require continued support and community refinement. If we can generally answer ‘yes’ to the questions above, then we need to continue to push forward toward the goals of interoperable health exchange."
I look forward to the September meeting and the delivery of all the great work done by the HITSC and S&I framework teams, bringing closure to this phase of Stage 2 preparation activities.
In addition to his CIO role at BIDMC, Dr. Halamka blogs at GeekDoctor.blogspot.com.