The work to harmonize standards used to exchange health data, set in motion by the Department of Health and Human Services (HHS), is continuing apace and will meet its first milestones this year, according to the head of the project.
The Health Information Technology Standards Panel (HITSP), a public-private group created last year under a $3.3 million contract with the Washington, D.C.-based American National Standards Institute, has been hammering through the process of selecting which standards to use in four priority areas, says John Halamka, M.D., CIO at Harvard Medical School who chairs the panel.
This harmonization, he says, will mean that each of the four "use cases," down to the granular level of the event, "will have a complete set of unambiguous guidelines so that all stake holders, all vendors, all doctors, all hospitals, all clinics can implement this interoperable flow of data that we want to empower all of the patients, providers and payers."
The first four "use cases," for which HITSP plans to finalize standards this September, are:
consumer empowerment: electronic clipboard and medication history.
electronic health records: laboratory results.
biosurveillance: emergency room visits.
chronic care coordination: secure messaging between consumers and providers.
HITSP has brought together 155 organizations, including 17 standards development organizations and numerous health care and government groups. Its 23 board members include standards development organizations like Accredited Standards Committee X12, Health Level 7 and SNOMED International.
The first four use cases were designated by the American Health Information Community (AHIC), the group of major health leaders formed to push health information progress, in conjunction with HHS and the Office of the National Coordinator for Health Information.
HITSP started with 570 potential standards for the four areas and the group is winnowing that number down to a few dozen, according to Halamka, in an effort that has required "incredible granular detail and rigor."
He says the process will not always result in one standard for each use. Even for standards where there appears to be overlap, he explains, some standards are good for a specific context or architecture and others have different applications. But, he says, the process will reduce the lists of standards to small numbers that are the most appropriate for a given use case with a particular actor, action and context.
HITSP is also identifying gaps where there are no well-described standards and those are forwarded to standards development organizations for guidance, he says.
The real challenge to the process, Halamka says, is that, "There is emotion in the standards world. There is ownership of standards that have been around for many years."
To get by that emotion, he says, HITSP has created criteria to evaluate the most appropriate standard for a given event. It asked, for example, which standards are most suitable for exchanging medication or laboratory information, which have a transparent process behind them, and which have a robust organization sponsoring them that will continue to be available for updates. It also weighed factors such as the costs of implementing a standard and whether it has good documentation and technical support.
Halamka also notes that because AHIC will be continually giving HITSP new use cases, the panel needs to deal with standards development organizations that can adapt to new needs. Beyond those factors, the panel chooses standards with a grading system based on use.
There has been an outpouring of support from the stakeholder community, with 80 organizations actively involved in the early technical committee meetings, Halamka says.
If there are any gaps in the standards delivered to AHIC this fall, says Halamka, they will be in standards that have been sent back to standards development organizations and are going through those groups' processes for resolution.
Kathryn Foxhall is a contributing writer based in Hyattsville, Md.
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