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Tuesday, March 27, 2012

The March HIT Standards Committee Meeting

The March HIT Standards Committee meeting focused on a review of the Standards and Certification NPRM, as well as planning for our upcoming second quarter work on the NwHIN portfolio, QueryHealth, Radiology image exchange standards, and governance.

Doug Fridsma began with an ONC update.  He described S&I Framework activities in 2011 that resulted in a single lab results implementation guide, merging the work of HITSP and CHCF/ELINCS.   This same approach will be used to create a single lab ordering implementing guide, including a standardized compendium of the most commonly ordered tests.   He described the plans for S&I Framework efforts on Clinical Decision Support standards.    He noted that ONC is looking at RESTful transport standards and the use of TLS for consumer mediated exchange.  He described further refinements to the NPRM that are needed to constrain Consolidated CDA (CCDA) in sufficient detail to ensure interoperability, such as the requirement to have specific templates for transitions of care.  Finally he described the future work needed on Health Insurance Exchanges and NIEM.

A robust discussion followed including the role of CCDA for longitudinal summaries verses episode of care summaries, the use of CCDA for  submission to registries/quality measurement entities,  and the possible use of CCDA for submission of data about multiple individuals in batch.

Next, Liz Johnson and Cris Ross described the Implementation Workgroup evaluation of certification criteria and testing procedures.   Here's a summary and here's the detail.

Highlights include a focus on workflows and testing procedures that are relevant to clinical environments in the domains of CPOE, e-Prescribing, Clinical Decision Support.  – The workgroup offered to develop clinical scenarios for use in testing such as ensuring EMAR implementations support the five rights - Right Medication, Right Dose, Right Patient, Right Time, Right Administration Method.

Jamie Ferguson provided an update on the Clinical Operations Workgroup and Vocabulary task force.    Issues include:
*The use of SNOMED-CT instead of ICD-10 for diagnosis.  If the intent is to gather clinical data, SNOMED-CT is best.    If billing classification is needed ICD-10 can be used.  There needs to be some criteria of usability for data entry of diagnosis.
*When e-Prescribing discharge medications, HL7 is often used inside an organization.  The NPRM does not include an HL7 option.  This may or may not be an issue because the NPRM does not describe workflows within an organization.
*The NPRM should include structured allergy vocabularies such as RxNorm for medications, UNII for individual ingredients, NDF-RT for categories, and SNOMED-CT for non-medications.   Since RxNorm includes UNII and NDF-IT, RxNorm CUI codes may work for all.
*Transmission - the Workgroup recommended both SMIME/SMTP and SOAP be required
*For patient access to view/download/transport, the Workgroup recommended TLS for transport and CCDA for download.
*For Family history, the Workgroup highlighted the adoption of the Surgeon General's Family History XML Format and tools, even though it is incomplete

Jim Walker provided update on the work of the Clinical Quality Workgroup, highlighting the work ahead on the journey to making quality measures easier to compute from existing EHR data.

Leslie Kelly Hall described the charter and work ahead for the Consumer Engagement Power Team.

Dixie Baker provided an update from the Privacy & Security Workgroup.   Highlights include the need to clarify the role of SOAP as an optional transport standards in the transitions of care as described in my recent post about transport.  She also discussed suggested improvements to patient audit log access, record download, and correction to records.

Finally, we emphasized the need for ongoing communication among ONC, workgroup chairs, and members to consolidate and coordinate all the NPRM input over the next month.  Liz Johnson was nominated as a person to serve as the HITSC representative to the HITPC Certification/Adoption Work Group, ensuring cross FACA coordination.

A great discussion and I'm very pleased with the progress we're making on the 2012 HITSC work plan.

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