CHICAGO – As the government works to draft a “meaningful use” definition by the end of December, stakeholders expressed their concerns about the difficulties of collecting data and exchanging it.
At a recent hearing hosted by the Health IT Standards Committee implementation workgroup, Mark Segal, vice chairman of the Healthcare Information and Management Systems Society’s Electronic Health Record Association emphasized the importance of a single standard for exchanging clinical data.
“The use of the powerful and flexible CCD standard, which has been accepted by major standards organizations and federal agencies, is central to data liquidity, vendor neutrality and interoperability,” he said.
Providers also expressed concerns.
Andrew M. Wiesenthal, MD, associate executive director of the Permanente Federation, who testified on behalf of the Kaiser Permanente Medical Care Program said HITSP standards have been enormously helpful because they promise a consistent basis for the use of SNOMED-CT and HL7 standards across multiple geographies and jurisdictions.
The Permanente Medical Group operates in nine states and the District of Columbia, using electronic health records. “Because we operate in many states and in different jurisdictions, implementing national and international standards is extremely important to us,” Wiesenthal said.
Wiesenthal cautioned the federal advisory committee to maintain current standards.
“If our long-term national goal is to implement interoperability standards that enable all patients to obtain the quality and safety benefits of HIT, allowing interim variation, even if it seems expedient, will delay and seriously undermine that ultimate goal, reduce efficiency, and increase the total cost of implementing the standards,” he said.
Janet Wright, MD, senior vice president of Science and Quality at the American College of Cardiology, said data collection would not be as easy as it sounds. “The degree of variation between EHR systems is bewildering,” she said.
The American College of Cardiology’s National Cardiovascular Data Registry (NCDR), one of the largest clinical data repositories in the United States, has more than 180 practices participating in its program to collect data on cardiac care for the purposes of improving outcomes. Collectively, the participating practices have submitted more than 350,000 patient records in well less than a year of active data collection, she said.
“There is presently insufficient standardization within practices and EHRs – both in terms of what should be collected and how it is stored – to allow for the efficient exchange of clinical information and assessment of performance on a national scale,” Wright said.
The standards that do exist for structuring data – such as CCR and CCD – are also insufficient, she said. “Not only do most of them lack the detail necessary to construct scientifically valid performance measures, but there are so many of them, each further customized by the various HIT vendors, that even calling them standards is misleading.”
