Standards Evolve to Aid Government-wide Healthcare Provision

By Barbara DePompa

There’s new urgency to create and improve standards for electronic health records and related applications as federal agencies strive to balance the need to modernize healthcare services to reduce costs, with regulatory requirements to maintain health information privacy.

Perhaps the biggest driver behind the acceleration of new standards is the impact of the economic stimulus law, which will provide billions of dollars to assist in achieving long-sought healthcare reforms.  Important to standards development now are the Health Information Technology (HIT) Policy Committee and HIT Standards Committee, both formed under the American Recovery and Reinvestment Act of 2009. Both committees report to the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services (HHS). Both committees are helping develop HIT data standards and implementation specifications and certification criteria for electronic health record systems that will be subsidizeby payment under the stimulus law. Policy committee members met on May 11, to address six priority areas: establishing meaningful use; certification; infrastructure; privacy and security; health information exchange; and public health. As a result of their discussion, four working groups were formed to focus on specific issues, including:

*Meaningful use;

*Certification and adoption, including infrastructure issues, workforce and facilitation strategy;

*Information exchange;

*Cross-cutting issues, such as privacy and security, patient centeredness and measurement.

The second of the two committees, the HIT Standards Committee, was formed to make recommendations to the National Coordinator for Health Information Technology on standards, implementation specifications and certification criteria for the electronic exchange and use of health information.

During its May 15 meeting, the standards committee pledged to expedite the development of effective health IT standards that support the practical daily work of physicians and hospitals. Members addressed a number of issues including: deadlines for deliverables; mandates and compliance requirements already imposed on healthcare stakeholders; consistent use of key vocabulary; capabilities of smaller and more rural providers; and the evolving nature of ‘meaningful use’ and relevant technologies. Three work groups were formed to focus on the following areas:

*Clinical operations;

*Clinical quality;

*Privacy and security to further the Committee’s goals.

At the Standards Committee meeting, Dr. David Blumenthal, National Coordinator for Health Information Technology, expressed the value of the work already done by the Healthcare Information Technology Standards Panel (HITSP). "We have to get a lot of work done, and HITSP will continue to be a very important resource," he said.

Operating under contract to the U.S. Department of Health and Human Services (HHS), HITSP is a cooperative partnership between the public and private sectors that works to ensure the interoperability of electronic health records in the U.S. Administered by the American National Standards Institute (ANSI) in cooperation with strategic partners including the Healthcare Information and Management Systems Society (HIMSS), the Advanced Technology Institute (ATI) and Booz Allen Hamilton, HITSP is currently working to create streamlined electronic standards implementation guides reorganized around the milestones and priorities defined in the economic stimulus law. The HITSP’s goal is to deliver compact, easy-to-implement and flexible guidance that supports the meaningful use of EHRs, as well as the protection of privacy.

According to John D. Halamka, MD and chairman of HITSP, in a recent speech in Washington D.C., HITSP has quickly shifted focus to work on meaningful use and ARRA’s eight priorities, which include:

*Technologies that protect the privacy of health information;

*A nationwide health information technology infrastructure;

*Use of a certified electronic record for each person in the U.S. by 2014;

*Technologies that support accounting of disclosures made by a covered entity;

*The use of electronic records to improve quality;

*Technologies that enable identifiable health information to be rendered unusable/unreadable;

*Demographic data collection including race, ethnicity, primary language and gender;

*Technologies that address the needs of children and other vulnerable populations.

Other Developments

Meanwhile, the Certification Commission for Healthcare Information Technology (CCHIT) is transitioning its certification program timelines to adapt to new requirements of the economic stimulus law. CHIT is a private, 501(c)3 nonprofit organization that has been recognized by the federal government as an official certification body for electronic health records. Its mission is to accelerate the adoption of robust, interoperable health information technology by creating a credible, efficient certification process. Certification requirements are based on widely accepted industry standards and involve the work of hundreds of expert volunteers and input from a variety of stakeholders throughout the health care industry. Commission-approved criteria and test scripts, developed during the 09 development cycle, have been published on the web site, www.cchit.org.

The organization has also submitted its 2009/10 certification criteria to the Health Information Technology Standards Committee for review, anticipating feedback by August 26, after which CCHIT will work to quickly resolve any gaps and begin accepting applications for the 2009-10 certification programs. “We will be very busy updating our policies and testing new ideas with the goal of offering an array of certification programs to support more rapid, widespread adoption and meaningful use of EHR technologies,” said Mark Leavitt, M.D., Ph.D., and chairman of CCHIT, in a prepared statement.