The December HIT Standards Committee meeting

The December meeting of the HIT Standards Committee was a conference call, open to the public, as are all HIT Standards Committee meetings. We discussed four major topics -

*A summary of the security standards recommended thus far and lessons learned from the security issues hearing

*Next steps for the Clinical Operations Task Force on Vocabulary

*An update on the Implementation Workgroup

*A report from the HIT Policy Committee NHIN workgroup

Dixie Baker's excellent discussion of the security standards approved thus far illustrated that they are very manageable and are mostly in widespread use today, so 2011 does not represent a huge barrier for implementers.

Comments from committee members include (note that no changes in recommendations were made at this time)

Rather than mandate a standard for an organizational audit registry (ATNA), instead use Policy to require a list of data elements such as ASTM E2147 to be reported on request

Rather than require the IHE Consistent Time profile, instead specify basic NTP/SNTP (with the time server stratum determined by policy)

Do not require XDS/XDM/XCA/XDR as transport standards.

Do note require CDA as the metadata header for unstructured data such as PDF, TIFF, and CCR.

Allow IPsec with either IPv4 or IPv6 for securing the NHIN "backbone"

Use X.509 for authenticating NHIN nodes

Use TLS for securing transactions that require more finely grained controls than IPsec provides such as authentication of, and secured path to, servers or applications within an organization

When the interim final rule is issued, many public comments will follow and the HIT Standards Committee will consider the public comments and comments of the Committee members to generate its final recommendations to ONC.

The Task Force on Vocabulary discussed those code sets and value sets that would accelerate interoperability such as a universal lab compendium that covers the majority of ordered tests, a SNOMED-CT subset for problem lists, and mappings from SNOMED-CT to ICD and CPT. There is little controversy about vocabularies - everyone on the committee agrees on the need for publicly available code sets and value sets.

The Implementation Workgroup continues to emphasize its mantra - keep standards as simple for the user as possible.

The HIT Policy Committee NHIN Workgroup presented it's early priorities - focus on Push transactions while maintain a vision for widespread use of Pull transactions eventually.

A very productive and positive meeting. Our next steps are to review the comments from the Interim Final Rule which we anticipate being published on or before 12/31/09.