Wednesday, December 28, 2011

Unfinished HIT Business

Happy New Year! Typically it’s a time for reflection and looking ahead. But since Keith Boone already blogged about the Top 10 HIT Standards efforts of 2011 and John Halamka predicted the Top 16 HIT Standards Committee Topics for 2012, where does that leave me? I’ll try blending 2011 and 2012, since many things started in 2011 but haven’t yet come to conclusion.

In the hilarious comedy Throw Momma from the Train, Billy Crystal plays a writer who is so obsessed with his ex-wife, that he has serious writer’s block and can’t get past the first sentence of his new novel (“The night was humid…”). He eventually gets his writing groove back (“A writer writes, always”), and doesn’t leave unfinished business. Sometimes I feel like I can’t get a blog started either, so I’m going to just start writing and close out the year!

Here are 11 items of HIT standards unfinished business that I hope reach some closure in ‘12.
  1. Meaningful Use Stage 2. More than a hope, it’s a safe bet that this will reach closure in 2012. I predict that items #3, 5, 6, and #8 below will be partially resolved by MU2, but most won’t because they’re complex and/or outside the scope of MU2.
  2. Sustainability of federal standards initiatives. HITSP was the previous ONC’s sanctioned standards harmonization effort, but it is gone. Some wheels were reinvented. Now the ONC S&I Framework is here, but an election year and budget cuts loom. What are the chances for national continuity of direction beyond 2012?
  3. Sensible certification rules. The HIT SC’s Implementation Workgroup made recommendations based on testimony from the difficult Stage 1 experiences. What practical improvements will be made to certification? 
  4. CDA. Just when we thought there was convergence on Consolidated CDA and achievement of a critical mass of CDA-capable products (driven largely by Stage 1 certification), significant CDA changes are being discussed: Detailed Clinical Models (CIMI) and Green CDA standards. What is the path forward that achieves simplification and yet doesn’t send everyone back to the drawing board?
  5. Transitions of care. ONC put a lot of effort into the ToC initiative, and some fine clinical recommendations were issued, but they haven’t been fully connected to the Consolidated CDA work yet. How will the MU standards be adjusted so that they truly help clinicians in care coordination?
  6. Vocabularies. What appear to be strong recommendations for singular standard vocabularies were made, but seemingly watered down by statements that they are “for quality measures only.” Will converged vocabularies be a reality for interoperability as well as quality measures?
  7. Patient-sourced information. Let’s face it, much data in EHRs comes straight from the patient already, yet patient-sourced information seems to be controversial. What HIT standards, will enable patient information (from devices, interviews, messages, PHRs) to have their proper place?
  8. Lab reporting and ordering. I hope that the ONC Laboratory Reporting Initiative has achieved widespread consensus.  Will these standards finally result in standardized interfaces in the real world, vs. just on paper?
  9. Holistic view of exchange patterns. ONC has focused heavily on the specifications that it commissioned. But will ONC recognize the role of community-based HIEs using standards such as IHE XDS, and not leave a “hole in the middle” by considering only Direct and cross-community NwHIN Exchange?
  10. Certificate and/or Provider Directory. Much effort has been poured into supporting only the Direct Project. Will the limited use case of certificate discovery given a Direct address be enough to push Direct into mainstream use? Will there be robust universal certificate directories and provider directories?
  11. Query Health. This is not likely to be in MU2, and with so many other priorities, there may not be many organizations geared up to be query responders. What critical mass of industry adoption is necessary in order for population health queries to be statistically significant?

3 comments:

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  2. I'd add a twelfth item: Continued funding. The HITECH Act was a down-payment, not just a stimulus. How can the US government either provide funds directly or limit the risk of investing in health IT, without regard to possible political leadership changes?

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  3. Thanks Glen. Can you tell me how you concluded that HITECH was really a down-payment and not just a stimulus? I didn't see promises that there would be more direct government investment in HIT beyond HITECH. While I believe that continuity and sustainability are important (item #2 in my list), that would be covered by funding for coordination and convening activities as performed by ONC, S&I Framework, etc., which is different (and orders of magnitude less investment) than giving billions in incentives to providers.

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