At the April HIT Standards Committee meeting, Doug Fridsma kicked off the Summer of standards - an accelerated effort to support the regulation requirements of Meaningful Use Stage 2.
We've been hard at work with meetings and phone calls since then. The schedule for standards deliverables has crystalized and here's what we've done and we're doing:
April
Certificate Recommendations
May
Metadata preliminary recommendations
Provider preliminary recommendations
Vocabulary preliminary recommendations
June
Metadata recommendations
Provider Directory recommendations
Patient Matching preliminary recommendations
Vocabulary recommendations
July
Patient Matching recommendations
ePrescribing of discharged medications recommendations
Syndromic Surveillance recommendations
Quality Measurement recommendations
August
Simple Lab Results recommendations
Transitions of Care recommendations
CDA Cleanup recommendations
NwHIN preliminary recommendations
September
NwHIN recommendations
Summary of all recommendations from Summer Camp
The June HIT Standards Committee will include reports from
a. the metadata workgroup on patient identifiers, data provenance, and privacy flags
b. evaluation of competing provider directory approaches - LDAP, DNS, and microformats
c. an early look at strategies for patient matching
We'll also have to consider the implications of recent Policy Committee debate on Meaningful Use Stage 2. As you'll see in their presentation, there are many requests for new standards.
We'll have an exciting few months ahead. When our handoff is complete in September, ONC will turn our recommendations into a Notice of Proposed Rulemaking by December/January and the country will have a complete set of Meaningful Use, Standards and Certification regulations finalized in mid-2012.
Given that Meaningful Use Stage 2 will likely be deferred a year (organizations who attest in 2011, can begin the measurement period for stage 2 on October 1, 2013 with attestation on October 1,2014, receiving three years of payment based on stage 1 requirements), this timing should give the industry 18 months to rollout the software changes needed.
Assessing US National Healthcare IT Efforts
As I travel the world speaking about the Health Information Technology for Economic and Clinical Health (HITECH) Act, I'm often asked to present objective evidence that it is making a difference.
Here's the progress thus far:
1. The HITECH program has elevated our national consciousness about Electronic Health Records (EHR) and moved the market considerably forward. Every hospital CEO knows the term Meaningful Use and believes it is an important 2011 goal. On my plane back from Scotland two weeks ago, the person sitting next to me (a scanning software engineer), asked about the impact on Meaningful Use on the scanning software market. With every strategic affiliation BIDMC proposes, the first question asked is how Health Information Exchange (HIE) will support care coordination and the analytics which support the evolving payment models of healthcare reform. It's clear that EHR and HIE have become commonplace topics of conversation.
2. State HIE plans require a focus on e-prescribing, electronic lab result messaging, and clinical summary exchange. State will have to report metrics. With publicly reported metrics, you can be sure states will be motivated to accelerate adoption.
3. Every recipient of federal HIE funds had to create a strategic and operational plan, which is a great step forward. Those plans are publicly available. As Beacon community and HIE success stories become widely known, it's likely these HIE plans will be revised so that a network of networks connecting state HIEs together will evolve.
4. Kaiser recently podcast an interview with Farzad Mostashari, National Coordinator, highlighting the progress thus far.
5. According to the National Health Information Technology Research Center (HITRC), the HIT Regional Extension Centers nationwide have enrolled more than 50,000 Priority Primary Care Providers (PPCPs) to begin the process of achieving Meaningful Use.
6. Doug Fridsma notes that Direct Project for health information exchange has support from vendors which constitute 90% of the US IT market share.
7. For the first time in history, patients are telling me they will not go to a doctor without an EHR, since they view it as essential for quality, safety, and efficiency.
Yes, we'll need to wait a few more months before concrete numbers on Meaningful Use attestation are available. However, I believe the cultural transformation, leading to widespread support for EHRs in the US, has already happened as a result of the US national healthcare IT efforts.
Here's the progress thus far:
1. The HITECH program has elevated our national consciousness about Electronic Health Records (EHR) and moved the market considerably forward. Every hospital CEO knows the term Meaningful Use and believes it is an important 2011 goal. On my plane back from Scotland two weeks ago, the person sitting next to me (a scanning software engineer), asked about the impact on Meaningful Use on the scanning software market. With every strategic affiliation BIDMC proposes, the first question asked is how Health Information Exchange (HIE) will support care coordination and the analytics which support the evolving payment models of healthcare reform. It's clear that EHR and HIE have become commonplace topics of conversation.
2. State HIE plans require a focus on e-prescribing, electronic lab result messaging, and clinical summary exchange. State will have to report metrics. With publicly reported metrics, you can be sure states will be motivated to accelerate adoption.
3. Every recipient of federal HIE funds had to create a strategic and operational plan, which is a great step forward. Those plans are publicly available. As Beacon community and HIE success stories become widely known, it's likely these HIE plans will be revised so that a network of networks connecting state HIEs together will evolve.
4. Kaiser recently podcast an interview with Farzad Mostashari, National Coordinator, highlighting the progress thus far.
5. According to the National Health Information Technology Research Center (HITRC), the HIT Regional Extension Centers nationwide have enrolled more than 50,000 Priority Primary Care Providers (PPCPs) to begin the process of achieving Meaningful Use.
6. Doug Fridsma notes that Direct Project for health information exchange has support from vendors which constitute 90% of the US IT market share.
7. For the first time in history, patients are telling me they will not go to a doctor without an EHR, since they view it as essential for quality, safety, and efficiency.
Yes, we'll need to wait a few more months before concrete numbers on Meaningful Use attestation are available. However, I believe the cultural transformation, leading to widespread support for EHRs in the US, has already happened as a result of the US national healthcare IT efforts.
Cool Technology of the Week
Stolen laptops can have a cost that far exceeds the repurchase or hardware or software.
There is lost work, lost important personal media (such as photographs of family), and possibly confidential data. Hopefully any mobile device hosting patient data is encrypted.
Hidden App makes software that is analogous to a nanny cam. Pictures and screen prints of your mobile device are secretly sent to a cloud-based server to assist in recovery of the device. The cost is $15.00/year.
Here's a great USA Today case study that describes a successful laptop recovery.
A nanny cam for your mobile devices. That's cool!
There is lost work, lost important personal media (such as photographs of family), and possibly confidential data. Hopefully any mobile device hosting patient data is encrypted.
Hidden App makes software that is analogous to a nanny cam. Pictures and screen prints of your mobile device are secretly sent to a cloud-based server to assist in recovery of the device. The cost is $15.00/year.
Here's a great USA Today case study that describes a successful laptop recovery.
A nanny cam for your mobile devices. That's cool!
Thoughts on my Daughter's Graduation
Just as it was a milestone for her, it was a pivotal life event for her parents.
Lara was born 18 years ago. We had no idea who she would be or what she would become.
During her early years, I was an Emergency Medicine resident. The nature of shift work meant that I could spent at least 12 hours of every 24 hour cycle with her - reading, walking on the beach, going to the park, strolling the Los Angeles zoo, and playing her favorite computer games - Pajama Sam, Freddie Fish, and Spy Fox.
We moved to Massachusetts when she was 3, exactly 15 years ago this week. My Emergency Medicine faculty and Informatics Fellow schedule enabled us to explore nature, hunt geocaches, and camp on the Boston Harbor Islands.
As I became a CIO, life became a bit more complicated, but every weekend we went to Drumlin Farm, Broadmoor, and other Audubon sites.
By the time she was an adolescent the time spent together evolved to time spent with her friends, extracurricular activities, and schoolwork. I served as her transportation, advisor, and editor.
As she blossomed into an adult, we became peers, having honest and open dialog about relationships, world events, and the challenges ahead.
All along the path, we tried to give her the latitude to celebrate her own successes, learn from her own mistakes, and experience the many facets of the 21st century world - within limits that kept her from going seriously off track.
She begins college in just 2 short months, making decisions about when to sleep, what to eat, and how to study, all on her own. Her house will be here whenever she wants to visit and her parents will be available whenever she wants to call. We'll not have the pitter-patter of her feet on the stairs, the ebb and flow of her friends, or the vibrant but sometimes unpredictable schedules she added to our lives.
Her parents will garden, travel, rekindle their 30 years of romance together, plan for the future, and write checks for college.
Based on all my conversations with other parents, I know that this transition is truly not saying goodbye and declaring the end of parenthood. It's the beginning of another chapter filled with new demands, more complex issues, and expanded possibilities.
As she graduates, the most important thing I can offer is my love and support, including a clear expectation of what I believe will constitute success in her next phase of life. This poem by Ralph Waldo Emerson says it better than I can:
Success
To laugh often and much;
To win the respect of intelligent;
people and the affection of children;
To earn the appreciation of honest
critics and endure the betrayal of false friends;
To appreciate beauty, to find the best in others;
To leave the world a bit better,
whether by a healthy child, a garden patch,
or a redeemed social condition;
To know even one life has breathed
easier because you have lived.
This is to have succeeded
So Lara, congratulations on an extraordinary high school career. Now, go define your own success. We'll be here to beam with pride.
Harmonizing Provider Directory Standards
Two weeks ago, I wrote about a strawman for embracing internet-based standards to support the provider directory services needed by health information exchanges.
Wes Rishel wrote a blog post about a related approach to creating provider directories and exchange certificates using microformats embedded in web pages that are protected by Extended Validation Certificates to provide assurance that the information is trustworthy.
Microformats are a simple idea - using standard tags embedded in simple web pages to create semantic interoperability, empower search, and enable standard visualization of data. Microformats are already in use for calendaring and have been proposed for other standard information sources such as recipes and resumes. Extended Validation Certificates are standard X.509 digital certificates issued using strict identity-verification criteria.
As we prepare for the next HIT standards committee meeting, many people are thinking about the best approach for building an industry-wide provider-directory capability using simple web standards. A guiding principle of the HIT Standards Committee is to “Keep it simple; think big, but start small; recommend standards as minimal as possible to support the business goal and then build as you go” . This eliminates most complex implementation guides based on assembling esoteric, seldomly implemented, non-internet friendly standards.
The committee will find use of generalized internet standards such as DNS and simple XML tagging structures such as microformats very appealing.
Is there a combination of the approach I suggested on my blog and the approach suggested by Wes that works?
I think so.
As Wes notes in his blog, exchanging health information using Direct requires a “Direct Address.” Nationwide Health Information Network (NwHIN) enterprises other than those using Direct have no common addressing scheme. Creating a .HEALTH Top Level Domain with an entry for each entity participating in health information exchange would create an easily recognizable addressing scheme for the industry. These addresses could point to highly trusted microformatted web pages containing directory information and certificate data, creating a directory solution without changing existing business models or processes. This could be a winning approach.
Direct has chosen DNS for certificate distribution and although the DNS standard supports this function, no one other than Direct has used this approach for certificate management. Indeed, not all Direct participants use this approach.
The NwHIN, including but not limited to Direct participants, requires routing information to exchange information between entities.
Would it be much cleaner to have a top level domain that encompasses all entities which exchange health information, including but not limited to NwHIN Exchange and Direct participants, and that provides an index of secure microformatted web pages containing certificates and other directory information for all participants in health information exchange?
We'll have several calls and meetings on this subject over the next few weeks. Expect a convergence and recommendations soon.
Wes Rishel wrote a blog post about a related approach to creating provider directories and exchange certificates using microformats embedded in web pages that are protected by Extended Validation Certificates to provide assurance that the information is trustworthy.
Microformats are a simple idea - using standard tags embedded in simple web pages to create semantic interoperability, empower search, and enable standard visualization of data. Microformats are already in use for calendaring and have been proposed for other standard information sources such as recipes and resumes. Extended Validation Certificates are standard X.509 digital certificates issued using strict identity-verification criteria.
As we prepare for the next HIT standards committee meeting, many people are thinking about the best approach for building an industry-wide provider-directory capability using simple web standards. A guiding principle of the HIT Standards Committee is to “Keep it simple; think big, but start small; recommend standards as minimal as possible to support the business goal and then build as you go” . This eliminates most complex implementation guides based on assembling esoteric, seldomly implemented, non-internet friendly standards.
The committee will find use of generalized internet standards such as DNS and simple XML tagging structures such as microformats very appealing.
Is there a combination of the approach I suggested on my blog and the approach suggested by Wes that works?
I think so.
As Wes notes in his blog, exchanging health information using Direct requires a “Direct Address.” Nationwide Health Information Network (NwHIN) enterprises other than those using Direct have no common addressing scheme. Creating a .HEALTH Top Level Domain with an entry for each entity participating in health information exchange would create an easily recognizable addressing scheme for the industry. These addresses could point to highly trusted microformatted web pages containing directory information and certificate data, creating a directory solution without changing existing business models or processes. This could be a winning approach.
Direct has chosen DNS for certificate distribution and although the DNS standard supports this function, no one other than Direct has used this approach for certificate management. Indeed, not all Direct participants use this approach.
The NwHIN, including but not limited to Direct participants, requires routing information to exchange information between entities.
Would it be much cleaner to have a top level domain that encompasses all entities which exchange health information, including but not limited to NwHIN Exchange and Direct participants, and that provides an index of secure microformatted web pages containing certificates and other directory information for all participants in health information exchange?
We'll have several calls and meetings on this subject over the next few weeks. Expect a convergence and recommendations soon.
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