phenomenalplace

The February meeting of the HIT Standards Committee included an in depth discussion of the Stage 2 Standards and Certification NPRM , updates from the projects in our 2012 HITSC work plan , and an overview of HITPC plans for 2012.   It was one of the highest energy, most optimistic meetings we've had. We began the meeting with a review of the Standards and Certification NPRM by Steve Posnack and Doug Fridsma.  As I noted in my recent post about the NPRM, most of the HITSC "Summer Camp" recommendations were accepted.   Highlights from their presentation: *In Stage 2, Certified Electronic Health Record Technology (CEHRT) will be "just enough" to support the functions documented during attestation.     In Stage 1, certified technology  was required for menu set items that were not part of an organization's attestation i.e. even if you did not plan to submit syndromic surveillance data, you needed to buy that technology anyway.   *Every eligible professio...

Now that the Stage 2 Standards and Certification NPRM has been released, many people are asking me for the detailed implementation guides that will support it. The S&I Framework website is being enhanced to make their work products easier to find. In the meantime, here are some of the major S&I Framework resources Final DNS/LDAP Hybrid Specification for Direct Project Certificate Discovery Final Data Model for Query/Response to the Provider Directory for electronic service information (implementation guidance forthcoming): Latest Laboratory Reporting Implementation Guide (will be balloted a second time at HL7 this spring) Final Consolidated CDA Implementation Guide We're getting closer to our goal of one stop shopping - a single website with all the content, vocabulary, and transport standards needed for certification.

On Friday, ONC released the Standards and Certification NPRM , the companion to the the CMS Meaningful Use Stage 2 NPRM. Here's a bookmarked PDF  - thanks to Tony Panjamapirom of the Advisory Board. In my view, the NPRM is a work of art, reflecting the work of the HIT Standards Committee, the S&I Framework, and  the multi-stakeholder consensus that fewer, more complete standards with less optionality will lead to greater interoperability. I've always thought of healthcare standards as having three components -  content, vocabulary, and transport. For content, the NPRM specifies HL7 2.51 for lab results, syndromic surveillance, reportable lab, and immunizations (HL7 2.31 is not longer an option).   For summary transactions, the Consolidated CDA is the only recommended standard.   (CCR and CCD/C32 are no longer specified).    NCPDP is specified as standard for the exchange of prescription information between entities, including for discharge me...

I recommend you read John Rother's recent op-ed in the Washington Post, "Five Myths About Medicare."John argues that each of these statements is a myth:Medicare is inefficient and fails to control costs--the CBO has projected that per capita spending will grow only 1% more than inflation over the next decade.The well-off don't pay enough for their Medicare benefits--working age premiums as well

The Meaningful Use Stage 2 Notice of Proposed Rulemaking was released today at 4:15pm.  It represents the work of hundreds of people from every healthcare stakeholder group.   I'll summarize all 455 pages this weekend and give two webinars next week (Greater New York Hospital Association and a special session for the Harvard School of Public Health).   For now, I recommend you read this  summary on pages 156-163 to understand that EPs must meet or qualify for an exclusion to 17 core objectives and 3 of 5 menu objectives.   Also that eligible hospitals and Critical Access Hospitals must meet or qualify for an exclusion to 16 core objectives and 2 of 4 menu objectives. Other key points from the executive summary: *For EPs, we propose a set of clinical quality measures beginning in 2014 that align with existing quality programs such as measures used for the Physician Quality Reporting System (PQRS), CMS Shared Savings Program, and National Council for Quality Assu...

Kathy is now finished with the hardest part of her chemotherapy regimen, Adriamycin/Cytoxan.   Next week, she begins Taxol every week for the next 12 weeks.    Taxol is typically far less fatiguing than AC.    It does have a problem that it is suspended in an solvent that can cause allergic reactions.   Her regimen will include supportive doses of diphenhydramine (benadryl) and dexamethasone (a steroid). At last week's checkup, Kathy's oncologist could no longer locate the tumor. Her breast surgeon will order an MRI at the completion of the Taxol cycles and if the tumor is undetectable, Kathy may be able to have to breast conserving surgery rather than a complete mastectomy. On Taxol, her hair will begin to grow back and her energy is likely to rebound.   However, she is quite concerned about one side effect - a neuropathy causing numbness in her hands.    As an artist, she depends on a keen sense of touch to create her work. She will no long...

On Sunday I returned from a week in Shanghai and Hangzhou.   A remarkable trip that included daily meetings with government, academic, and clinical leaders.   What did I learn? In China, about 5% of the GDP is spent on healthcare per year compared to 16% in the US.    Although there is wide variation in lifespan and other population health measures between rural and urban settings, there are few interesting observations about Chinese healthcare *It's a single payer, publicly funded system that provides universal healthcare via a 14% payroll tax. *There is a single national set of regulations and policies applied to all hospitals, clinics, and doctors *There is a single set of national privacy laws *Immunization is mandatory for the entire population *There's a single national healthcare identifier EHRs are widely used in China, however they are optimized for episodes of care, using templates for capture of selected data elements specific to a disease i.e. hypertensio...