Requirements need to be ‘clear and balanced’
At the committee’s April 4 meeting, the group hashed out some of the HIE requirements as part of their preparations for providing recommendations to the Office of the National Coordinator for Health Information Technology by May 7.
The proposed regulation, released Feb. 23, calls for prescriptions and lab results to be shared electronically. It also calls for electronic communication among providers across care settings.
It is important to make the requirements clear and balanced so providers will have a better chance at accomplishing them, according to Micky Tripathi, chair of the committee’s information exchange panel. He is also president and CEO of the Massachusetts eHealth Collaborative.
Health information exchange is a critical aspect of this next stage of meaningful use to start using data to coordinate care and improve patient outcomes.
Among the differences with the meaningful use proposed rule, the committee wants to restore its recommended requirement for hospitals to send structured lab data, Tripathi said. The Centers for Medicare and Medicaid Services did not follow that recommendation in its proposed rule released in February.
CMS noted that this might be a burden on hospitals, but Tripathi said in his conversations, many hospitals do not see this as a burden – and some might find it beneficial to have a standard rather than a lot of optionality that exists today both within the organization and in dealing with EHR vendors.
“We’re requiring that EHRs be certified to receive according to a set of standards. We’re also requiring that clinicians have a certain amount of their labs be structured labs. But we’re not requiring that the last piece of puzzle that is responsible for a large fraction of the results delivery meet that standard,” he said.
Hospitals sending lab information in standardized data format directly affects the ability of physicians to achieve their structured lab result requirement and will also affect clinical quality measure capabilities, Tripathi said.
The panel also recommended removing a cross-vendor requirement that 10 percent of electronic exchange of transition care summaries be transmitted to organizations that they are not affiliated with and that are on a different vendor platform.
While the panel agreed with the first part, it did not agree with cross-vendor exchange requirement. In many markets, there is often a single vendor that has high penetration.
“What we want to do is create an incentive for vendors to incorporate the national standards deeply into their products,” he said.
The cross-vendor exchange requirement instead provides an incentive to artificially create a two tier system by deeply integrating proprietary technology with the EHR product but then do this other tier with lower integration for the national standard.
Farzad Mostashari, MD the national coordinator for health IT, said that the rationale for the cross-vendor requirement was to avoid a “walled garden” scenario where providers could meet the exchange requirement within their own vendor’s context yet never share data outside of it.
“From a policy view, is there comfort that without the cross-vendor requirement we won’t end up in a situation where there is a significant number of providers not exchanging information outside of their vendor boundaries?” Mostashari asked.
Tripathi said providers “are going to exchange with whom they need to exchange from a patient care and business perspective independent of what platform they are on. So you should create and enforce the standards for the platforms that they are on regardless of whom they are exchanging with in terms of vendors.”