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D.C. Report: NHIN, Quality Reporting, State IT Implementation

July 7, 2010
by Sharon Canner
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NHIN vs. NHIN Direct is a Focus at Standards Committee Meeting. National Coordinator Dr. David Blumenthal, in opening remarks to the Health Information Technology (HIT) Standards Committee on June 30, (scroll down) noted he took seriously concerns about lack of compatibility between the National Health Information Network (NHIN) Direct and NHIN Exchange programs. He encouraged the committee and others in the field to identify the barriers and resolutions to incompatibility, and work together to resolve these issues. There is growing concern that NHIN Direct, which would enable point-to-point sharing of health data, could undermine the overall NHIN Exchange effort that has been underway since 2005. As currently being pilot-tested by the Office of the National Coordinator for Health Information Technology (ONC), NHIN Direct is intended as a short term solution until the more robust NHIN Exchange is mature enough to handle exchange of health information and related necessary functions.

On a related issue, ONC outlined plans for governance of the NHIN with attention to such areas as transparent oversight; enforcement and accountability; identity assurance; and technical requirements. ONC anticipates having a final rule in place by the summer of 2011. Public input will be requested via a request for information in August 2010, to be followed by additional input from the HIT Policy and HIT Standards Committees in late fall 2010. A Notice of Proposed Rule Making will be released in early 2011, to be followed by the final rule.

Developing IT solutions for enrollment in public programs is required under the health reform law and is a new task for the Standards Committee. As required by Section 1561, the federal government is required to “develop interoperable and secure standards and protocols that facilitate enrollment in Federal and State health AND human services programs through methods that include providing individuals and authorized third parties notification of eligibility and verification of eligibility.”

As explained by Enrollment Workgroup Chair U.S. Chief Technology Officer, Aneesh Chopra, the Workgroup is exploring a base use case with a consumer-facing web portal that would allow applicants access to tools that will identify available services; conduct initial screening and enrollment checks; retrieve electronic verification information; and store and reuse eligibility information. Chopra indicated that various health facilities and jurisdictions may already have developed tools and resources that could assist eligible individuals and families. He requested Standards Committee members with ties to hospitals to reach out to their billing departments for the following information:

“If a person arrives at the hospital for care AND is uninsured, are there innovative IT-based techniques and tools that the billing department staff or IT staff have developed to help: (a) identify local, state, and federal programs the person is eligible to participate—insurance-based programs, pharmaceutical purchasing support, WIC, food stamp programs, etc.; (b) equally innovative ways to get the person enrolled in the program(s)” (excerpted from HIMSS-prepared summary).

Test Procedure for Reporting Quality Measures. The National Institute of Standards and Technology (NIST) recently released a draft test procedure for evaluating electronic health records (EHRs) and their ability to report quality measures. CHIME responded to this draft by endorsing comments submitted by the American Hospital Association (AHA). As noted in the AHA statement, there are “serious concerns that the draft testing procedures for the reporting of quality measures are not sufficient to ensure that the EHR products passing the test can accurately calculate the hospital quality measures.”

To ensure accurate quality measurement, AHA urges NIST to revise the draft test procedure to meet the following criteria:
1. The test procedure should ascertain that the EHR can calculate ALL required quality measures.
2. NIST or the Centers for Medicare & Medicaid Services (CMS) should develop a common testing dataset to be run through the algorithms of all EHRs.
3. The results of the testing procedure using the common dataset should be submitted by each vendor back to NIST or CMS for review and confirmation that the algorithm can accurately calculate each quality measure.

For further details on the AHA recommendations, click here.

ONC Provider Call to be Re-scheduled. As part of outreach efforts to educate on the Final Rule for the Temporary Certification Program, ONC held two calls Friday: one for providers who are also health IT developers (who may seek certification of systems developed in-house); and two, for providers, including clinicians, hospitals and other provider organizations. Due to an error with the call-in number for the 11:00 a.m. session, most callers were unable to access the event. ONC plans to reschedule. Meanwhile, you may want access the ONC website, which posts a transcript 48 hours following each call.