Much progress has been made to develop data and transport standards for Stages 1 and 2 of meaningful use, but as the National eHealth Collaborative (NeHC) webinar held September 13 pointed out, there is still much work left to be done to harmonize standards in healthcare.
As part of the activities for National Health IT week, NeHC hosted a webinar devoted to the discussing the current Standards and Interoperability (S&I) Framework pilots and how its activities apply to current work being done in the industry with transitions of care, health information exchange, and population health.
“Without the standards for innovation, you might see a 1,000 flowers bloom, and they may each be beautiful, but the question is, will they all operate and act in concert,” asked David Muntz, principal deputy national coordinator for health IT, Office of the National Coordinator (ONC). “Will innovation without standards achieve the goals of HITECH as enumerated? I don’t think so.”
Muntz said the ONC has been using standards for the basis for innovation, and the S&I Framework that launched in January 2011 represents one investment and approach adopted by the Office of Science and Technology to fulfill its charge of prescribing health IT standards and specifications to support nation health outcomes and healthcare priorities. Currently, there are more than 500 committed members and 376 organizations working with the S&I Framework to develop standards.
Standards as a Platform for Meaningful Use Certification
Much of the work that has been completed by the S&I Framework is embedded into meaningful use Stage 2 certification standards, such as requiring electronic health records (EHRs) to share information including a care summary and relevant documentation, as well as giving patients the ability to view, download, and transmit their personal health record.
“Certification of health information technology provides a certain assurance to purchasers and other users that an EHR system offers necessary technological capability and has the right functions to do what’s right for themselves,” said Muntz. “Certification also provides patients and providers confidence that the products and the systems they are using are secure and will work with other systems. All of these things together ensure that meaningful use is real and doable.”
The S&I Framework is an example of how government can create a collaborative process to implement standards and harness the expertise of the community to empower it to create better solutions, said Doug Fridsma, M.D., director, Office of Standards and Interoperability, ONC.
“Our hope is as they [S&I Framework workgroups] think about the questions they need to answer to achieve interoperability, they have to make sure they’re standardizing meaning, standardizing structure, standardizing transport, standardizing security, and standardizing those services that help enable all those pieces to fit together effectively,” said Fridsma. “By doing those [things] we begin to create building blocks that are reusable so that a transitions of care structure can use different vocabularies and value sets to define problems or medications and can be transported in different ways depending on the kind of technology available and the kind of information that needs to move.”
Doug Fridsma, M.D
Fridsma detailed the many ongoing projects (click figure above) that the S&I initiative is working on, including three projects, the Direct project, transitions of care, and lab results interface, that are included in the 2014 standards and certification for meaningful use. The ONC is also working with the California HealthCare Foundation to develop a new standard for lab ordering interfaces, and with the VA to further the Blue Button initiative.
Standards in Transitions of Care
Holly Miller, M.D., chief medical officer at MedAllies Inc., has been working with the S&I Framework to develop standards for Direct messaging to support transitions of care, which she emphasizes is a significant clinical problem because close to 75 percent of primary care physicians (PCP) have no information about a patient’s hospitalization post-discharge.
MedAllies is a EHR/HIE implementation-focused consulting firm and operates in Fishkill, N.Y. in the Hudson Valley, which has an 80 percent EHR adoption. It was one of the original Direct pilots that focused on two transitions of care use cases: hospital discharge to the primary care physician and the closed loop referral.
“We determined to best support clinician workflows we wanted pushed electronic health record to electronic health record real-time direct messages,” said Miller. “Therefore, when the patient is discharged from the hospital, the message arrives in the primary care physician’s electronic health record before the patient is even out the hospital door. This gives the patient-centered medical home team appropriate access to the information.”
Holly said a critical aspect of physician adoption of Direct messaging is tailoring the message to the purpose of the transmission. “Too much information is a dump truck,” she added. “The doctor has to dig through vital pieces of information and risk missing something important or vital. Too little information and appropriate care cannot be provided.”
For example, when a PCP sends a cardiologist referral, she recommends the PCP to modify the message from the EHR to only send cardiology-specific notes and lab results that are relevant to that visit.