Commission sets tone for standards work

What makes a standard?

Standards specify technical details that are either widely accepted or sanctioned by a standards body, such as American National Standards Institute. Interoperability is a broader concept that involves both a technical and business context. Health and Human Services Department officials say precise interoperability standards are needed to establish the national health information infrastructure.

Federal efforts in recommending health IT standards include:

Medical Language

The Health and Human Services Department signed an agreement in 2003 to license a standardized medical vocabulary developed by the College of American Pathologists available for free use in the United States. Snomed, the Systematized Nomenclature of Medicine, creates a common clinical language that is a necessary element of a health care information infrastructure. For more information, go to and enter 482 in the box.

Medical Records
At the request of HHS, the international standards-setting organization known as Health Level 7, or HL-7, has established a tentative standard that defines the set of functions needed in an electronic medical record.

Consolidated Health Informatics

HHS and the Defense and Veterans Affairs departments have endorsed 20 sets of data and messaging standards that enable information to be shared across federal health agencies and serve as a model for the private sector.

'Our ultimate goal is a BlackBerry capability where you're doing more functionality than you thought you could.'

' Dana Haza, Commission on Systemic Interoperability

The new public/private American Health Information Community will not start its standards work from scratch. A federally sponsored body, the Commission for Systemic Interoperability, will provide a document to Congress and the Health and Human Services Department in October to guide AHIC. The commission will then dissolve.

The commission will focus on the standards process to get to an electronic drug record, although it will provide strategies and timelines for health IT interoperability in other uses, said commission director Dana Haza.

HHS secretary Michael Leavitt suggested the electronic drug record to the commission.

'We think that [an electronic drug record] is the obvious foundation or building block to get to an electronic medical record. It is the easiest and most interoperable, next to lab results,' Haza said.

The commission, authorized by the Medicare Modernization Act, is composed of private-industry representatives and housed in the National Library of Medicine, part of the National Institutes of Health.

'The milestones are broad enough that they won't prevent the development of, for example, the BlackBerry of medical records, whatever that looks like. Our ultimate goal is a BlackBerry capability where you're doing more functionality than you thought you could,' she said.

Imagining the future

To illustrate the timeline, the commission describes how a doctor would practice in 2006, 2008 and 2010 if standards were implemented and how patients would interact with their own health care data.

The commission describes the steps to get to an electronic drug record, beginning with the primary physician filling in the medications. The patient can add medications prescribed by other doctors. With the next version of an electronic drug record a couple of years later, that information will automatically become available based upon the prescriptions the patient fills.

The drug record could include letting every one of the patient's physicians know who is prescribing the medication, the drug interaction at the time of prescribing and surveillance capabilities after the medication is prescribed.

For example, if there's a recall, the physician can pull up every patient on that medication who should be notified.

'The electronic drug record is a good place to start because so much of the data is already electronic. It's just not in [a] user-friendly, interoperable format,' Haza said.

Most of the standards for connectivity and data format center on billing and claims.

'We want connectivity around health, disease state and wellness,' Haza said.

The report also will list more than 300 ongoing health IT efforts around the country, including regional health information organizations and small, private initiatives, with contact names and phone numbers.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.


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