Keith W. Boone is a Standards Geek for GE Healthcare. He is a member of the HL7 Board, and co-chairs the Patient Care Coordination Planning Committee for Integrating the Healthcare Enterprise. Keith writes regularly on his blog Healthcare Standards, where this post originally appeared.
The key challenge for this project will be differentiating between information coming from patients directly, and data coming from home health monitoring devices. My advice is to attack these as separate use cases, but from the same project. The data coming from home health monitoring devices is rather different from self-reported information on symptoms, allergies, social and family history, et cetera.
The HL7 FHIR Protocols that I've been using for ABBI also have a simplified method by which patients (or devices) can post data to a PHR. The key issue is not transport protocols, but rather content. I suspect that we could use the CCD 1.1 in C-CDA to record patient generated content just as readily as it is used for provider generated content, and we could also use the HL7 Patient Authored Documents specification being balloted now. As for medical device data, I suspect we could look at the HL7 Personal Health Monitoring Report, and work from IHE Patient Care Devices and Continua for possible content solutions.
eMeasures in HQMF Release 2
I know the folks at MITRE have already been looking at transforms from HQMF Release 1 format to Release 2. There's some interest in specifying HQMF R2 for Quality Measures in MU Stage 3. A long term result of this effort would be to propose HQMF R2 as a required standard for the 2016 Edition EHR certification criteria.
We've done quite a bit of work on HQMF Release 2, and I suspect it's "nearly ready" for prime time. However, the most critical effort at this point will be to deliver eMeasure specifications in HQMF R2 for use by pilots, get implementer feedback, and either tweak it, or develop an IG that makes it ready for use in the 2016 criteria. Without that, I expect ONC will be scrambling to make it happen anyway, and the quality of our quality measurement tools will suffer.
Clinical Decision Support Standards
If you've been paying attention, you are already aware of the Health eDecisions work going on in S&I Framework. Use Case 1 is finishing up, dealing with content formats for CDS rules, forms and order sets. This is now being balloted in HL7. They will soon be moving on to Use Case 2 (of much greater interest to me), which is how to integrate CDS web services with an EHR. You can see that they haven't gotten very far on this use case. Again, looking at Stage 3 proposals, it seems obvious that its about time for this work to really heat up.
My goal here will be to make sure that the proposed standards link up well with HQMF, and C-CDA specifications for content. The link between quality measurement and CDS has already been made.
EHR Adoption Slows
Also easy to guess if you've been paying attention. As I show in this post, there are three stages to technology adoption, exponential growth, linear growth, and saturation. I think we are about halfway done.