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A Busy Summer for HIT Standards Committee

April 20, 2011
by David Raths
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‘Summer camp’ to identify standards gaps tied to Stage 2 MU proposals

The ambitious agenda and compressed timeline of the Health IT Policy Committee regarding Stage 2 of meaningful use will translate into a very busy summer for the federal Health IT Standards Committee. The standards group is charged with identifying and further developing standards tied to specific Stage 2 proposals around topics such as transitions of care, advance directives, care team member lists and family history.

Addressing the April 20 meeting of the standards group, Meaningful Use Workgroup Chairman Paul Tang, M.D., vice president and chief medical information officer at the Palo Alto Medical Foundation in California, described some of the comments it has received to its initial proposals.

Paul Tang, M.D.

He noted that commenting organizations expressed strong support for several objectives, including:
• E-prescribing for discharge prescriptions
• Electronic clinical progress notes
• Electronic medication administration record
• Patient-provider secure messaging
• Recording patient preferences for communications

Tang said there is mixed support for these new objectives:
• Advanced directives for eligible providers (from menu to core is the proposal)
• View and download longitudinal record
• List of care team members
• Longitudinal care plan

Tang said that concerns about new objectives often related to the clarity of definitions and the timelines for developing and implementing new functionality.

The MU Workgroup appears to be moving toward a phase-in approach that separates existing functionalities from new functionalities. In this model 2013 would be Stage2a, using existing certified EHR functions with all-core objectives, increased performance thresholds and new quality measures; 2014 would bring Stage 2b objectives requiring new EHR functionalities.

“Dividing Stage 2 would raise the ante in terms of thresholds to qualify, while recognizing the implications of implementing new functionality,” Tang added. Final Stage 2 MU recommendations will be presented for Policy Committee approval on June 8.

Doug Fridsma, M.D., Ph.D., the director of the Office of Standards and Interoperability in the Office of the National Coordinator for Health Information Technology, said he was convening a “summer camp” for standards teams to grapple with the goals policymakers have identified as they move from Stage 1 to Stage 2. The work, he said, would include identifying gaps in standards and doing triage work.

Doug Fridsma, M.D., Ph.D.

Fridsma divided the objectives that the policy workgroup has identified into four “buckets”:
• Performance measure only – no standards needed;
• Sufficient standard and implementation guide identified;
• Existing standard, but no implementation guide identified; or existing standards/ implementation guide but additional public input needed;
• No standard or implementation guide identified; or existing standard/ implementation guide, but substantial public input needed.

The committee hopes to review its work on these and other standards and interoperability issues by September, Fridsma said.