As the Health IT Policy Committee prepares proposals for Stage 3, which at the earliest will start in 2016, the committee’s Information Exchange Workgroup has issued preliminary recommendations on patient record queries and provider directories.
[See also: Stage 3 goes for more rigor]
Micky Tripathi, founding CEO of the Massachusetts eHealth Collaborative and chair of the Information Exchange Workgroup, will be making formal recommendations to the HIT Policy Committee in August on queries, directories and data portability. But the Workgroup has mostly developed suggestions for record queries and provider directories, and shared them at a recent HIT Policy Committee meeting.
In the 102 comments the Workgroup received on patient record queries, the themes of simplification and generalization emerged, Tripathi said.
Based on the principle of simplification, he said, the Workgroup is recommending that Meaningful Use Stage 3 set a goal for query and response of patient records to happen in a single transaction, or at least a minimal transaction process.
For generalization, he said, the focus should be on flexibility — in accommodating use cases, workflows, and legal and policy variations across states.
That flexibility given, there are still minimum transaction standards for queries that should be set, the Workgroup suggests.
Querying systems, most likely EHRs (and likely connected with HIEs), should be able to discover the address and security of a clinical source, show authenticating credentials, present patient-identifying information, assert authorization for specific patient requests, and log requesting transactions, the Workgroup is recommending.
Systems at the organization being queried that are responding to the request should be able to validate the requester’s authenticating credentials, match patient information, assess the “robustness of authorization for specific patient-level request,” automate responses based on that robustness, check for and respond with patient records or with a notice that no patient record information will be sent, and finally log the transaction and disclosure.
For provider directories — a foundation to query-based exchange — a “lack of standards appears to be an obstacle to faster progress in Stage 2 directed exchange, and unless remedied, may impede Stage 3 query exchange as well,” Tripathi said.