On Feb. 25, the Chicago-based American Health Information Management Association (AHIMA), the 61,000-member national association for health information management (HIM) professionals, joined an increasingly crowded field of healthcare associations providing input to the Office of the National Coordinator for Health Information Technology (ONC) regarding the proposed meaningful use requirements under Stage 2 under the federal ARRA-HITECH (American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health) Act.
The letter, authored by Dan Rode, vice president, policy and government relations, for AHIMA, made a number of substantive suggestions to ONC officials, among them, requesting strongly that ONC and the HIT Policy Committee adopt “recognized terminologies and classifications” to “limit confusion and misunderstanding of facts”; adopt vocabulary standards; “use a combination of nomenclature standards, such as SNOMED-CT, LOINC, and ICD-10-CM/PCS, along with additional national and internationally recognized standards in complementary roles in health records systems”; employ “standard terms for data elements… so database fields can employ a ‘collect once use many times’ approach to ensure the ability to share and compare data with others”; and consider that “global interoperability for information exchange is facilitated by use of internationally recognized terminologies and classifications.”
Allison Viola, AHIMA’s director of federal relations, who works out of AHIMA’s Washington, D.C. office, recently articulated the concerns and perspectives that she and AHIMA’s members share, in an interview with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.
Healthcare Informatics: Where are your organization’s deepest and broadest concerns within the set of recommendations you made to ONC last month?
Allison Viola: I think one of our big concerns is addressing the workflow challenges. It’s about bringing that awareness to CMS [the federal Centers for Medicare and Medicaid Services] and ONC, because there’s so much emphasis on the idea that you implement health information technology, and it will give you proven quality improvement; but the vulnerability in this is that if it’s not aligned with the hospital’s or provider’s workflow, it will create frustrations and lack of use on the part of eligible providers or hospitals. So there needs to be a little bit more emphasis on integrating this into clinician workflow. We don’t dispute that we need to move toward greater electronic adoption, we support that; but it’s more than just slamming systems in there and walking away.
Another issue is the use of standards. In one area, where they’re allowing the scanning of documents—that’s not really where we want to go. If you’re going electronic, you want to allow the entry of data into data fields, and if you scan a document, you can’t achieve that. So addressing gaps in standards is critical in helping the industry forward; and allowing scanning is not going to help.
HCI: Would it be accurate to say you approve of the overall thrust, but that you see a lot of missing or problematic details?
Viola: Yes. We want them to be prescriptive, such as, what’s in the longitudinal record, and what is the appropriate evidence for particular objectives? Don’t be too prescriptive where there’s no flexibility, but they need to provide some framework to enable you to know where your boundaries are, in terms of functions and reporting.
HCI: What are a couple of examples of your concerns that we could talk about, and that might be of particular interest to CIOs and other healthcare IT leaders?