The February HIT Standards Committee meeting

The February HIT Standards Committee meeting included an overview of our work assignments from from the HIT Policy Committee, the kickoff of new Quality Workgroup initiatives, a preview of upcoming medical device hearings, an update on the Direct Project,  and a rich discussion of the Standards and Interoperability Framework (S&I Framework) including what it is and what it isn't.

The meeting began with an update from Dixie Baker about the charge from the HIT Policy Committee to assist with digital certificate standardization.    In general, the role of the HIT Standards Committee in the S&I Framework is to specify the desirable characteristics of harmonized standards, do environmental scans of existing standards to provide feedback on harmonization work,  and evaluate work products of the S&I Framework, such as the Direct Project.     As a next step, Dixie's Privacy and Security Workgroup will specify the desirable characteristics of X.509 certificates that are needed for the Direct project and the Nationwide Health Information Network.

The Privacy and Security Workgroup has also been charged by the Policy Committee to assist with Provider Directory standards. Walter Suarez will lead that initiative, doing an environmental scan of existing approaches (HL7, IHE, OMG, LDAP, state HIE's, commercial solutions) and developing a list of desirable characteristics as input to the S&I Framework process.

Thomas Tsang from ONC, provided this overview of the work on quality measures to be done in support of Meaningful Use Stage 2.   The Quality Workgroup will be assigned this work.  We'll name a new workgroup chair to guide the process and we'll add additional experts to the workgroup.   As part of quality measure development, we will evaluate the burden of capturing quality data imposed on providers, workflow, and software implementers.  Exclusionary criteria that have little impact on measure performance can be especially burdensome.   The Standards Committee made a consensus statement that exclusionary criteria should be optional, implemented at the discretion of provider organizations if they feel such criteria are significant to their measure computations.   In the case of BIDMC, almost all exclusionary criteria create burden without benefit and we would elect not to include them in our calculations.

Liz Johnson described the March 28 Clinical Operations Workgroup Medical Device Hearing which will include a patient/consumer panel, a provider panel, an Interoperability/ Data Integration panel, a Data Accuracy/Integrity panel, a  Device Security/Data Security Panel and a Universal Device Identification panel.   The Clinical Operations Workgroup will also take on the charge from the Policy Committee to assist with demographic code sets and an evaluation of patient matching strategies.

Arien Malec provided an update on Direct, including a list of the existing live installations (here's an overview of BIDMC's Direct experience).  He'll return at the March 29 Standards Committee meeting to describe lessons learned from production implementations.

Doug Fridsma provided an update on the S&I Framework, including a rich discussion of several concerns about it.

The Standards Committee members recommended

*incorporating experienced experts and their lessons learned in the process

*involving the Standards Committee at the beginning of the process to specify the desirable characteristics of harmonized standards for each project.   Since the first 3 S&I framework projects are related to clinical summaries, labs, and transfers of care, the Clinical Operations Workgroup will be the initial liaison to the S&I process.

*performing a mid project review via the Standards Committee to ensure the work is on track and achieving the desired outcome

*evaluating the deliverables at the end of the process via the Standards Committee to determine if goals have been met

*leveraging the NIEM process without adopting NIEM XML or discarding current standards that are already part of meaningful use stage 1

*engaging the Implementation Workgroup to evaluate NIST test scripts and gather feedback from early pilots to reduce the certification burden

*incorporating vocabularies and code sets recommended by the Standards Committee, leveraging work done to date instead of reinventing what is already in progress

Doug's slides support all of these points, promising to involve the HIT Standards Committee in the S&I Framework to a  much greater extent than in the past.

We summarized the day with plans for the next meeting and a recap of charges to each workgroup

Whole Committee
  On March 29 we'll review the timeline and milestones along the path to the Certification and Standards NPRM for Stage 2 to develop a project plan for April to October
  On March 29, we'll do a final review of the Direct project based on live implementations

Quality Workgroup
  Name a new chair
  Provide eMeasures oversight
  Educate the entire Committee about the information models used to generate quality measures

Privacy/Security Workgroup
  Policy Committee's Certificate charge
  Policy Committee's Provider Directory charge

Clinical Operations Workgroup
   Device hearing
   Policy Committee's Patient matching/demographics code set charge
   Liaison to S&I Framework for Lab, Transfers of Care, and CDA Cleanup efforts

Implementation Workgroup
   Liaison to NIST for test script review and refinement

I look forward to the work ahead!