The final question posed in the recent request for information posted by ONC reads as follows:
What specific HHS policy changes would significantly increase standards based electronic exchange of laboratory results?
Keith Boone, aka @motorcycle_guy, self-proclaimed GE standards geek and fellow member of the Society for Participatory Medicine, blogged about his thoughts on the subject in a post entitled: Promoting Laboratory Result Exchange through CLIA. Farzad Mostashari, aka @Farzad_ONC, the National Coordinator of Health IT, tweeted a link to Keith's post, asking lawyers whether this would work:
Jodi Daniel (Director of the Office of Policy Planning at ONC) and Keith (among others) retweeted the request, and Keith tweeted it directly to me, so I thought I'd weigh in on the question.
Keith observes in his post that labs do not receive any meaningful use incentive payments for making their reports standards-compliant, and suggests that other incentives might be useful:
Currently, laboratories covered under CLIA do not receive incentives for using standards specified under meaningful use. One of the requirements of clinical laboratories under CLIA is the production of a test report that meets requirements under 42 CFR 493, subsection 1291.
One possible way to promote use of the standards would be to providing a deeming clause in subsection 1291 such that if transmission of test results is performed with Health Information technology that has been certified to conform to the criteria in 45 CFR 170, subsection 314(b)(6) [ . . . ] could be an incentive for laboratories to use those standards.
I have a three-part response:
1. ONC, in its RFI, specifically requested suggestions for sub-regulatory policy changes that could catalyze interoperability of EHRs. Keith's suggestion is a regulatory amendment. However, since Farzad and Jodi have expressed an interest in this suggestion, and since there is a long-pending proposed rulemaking process out there connected to lab test results (see Lab Results for All! Of Data Liberation, Participatory Medicine, and Government 2.0), this flaw is not fatal, and the recommended change could be made through that rulemaking. In fact, it could help move that rulemaking along (it's been stalled since late 2011) by identifying a mechanism through which the lab test results may be communicated.