ONC sets sights on Stage 3 HIE standards

Lack of standards has hindered data exchange in Stage 2, may also impede Stage 3 unless remedied
By Anthony Brino
09:45 AM

Health information exchange is emphasized in Meaningful Use Stage 2, and it’s set to get even more priority in Stage 3, as the ONC looks to enable a sort of nationwide health information exchange.

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.

[See also: HIE as a verb: ONC wants to move quickly on data exchange ]

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.

Based on previous HIT Policy Committee recommendations and new feedback, the Workgroup is recommending that several principles guide policies for provider directories — scope, continuity and simplification.

In defining their scope, “Standards must address provider director transactions as well as minimum acceptable provider directory content to enable directed and query exchange,” workgroup officials said.

They should also build on Meaningful Use Stage 1 and 2 approaches and infrastructure for directed exchange and allow use of organized HIE or cross-entity provider directory infrastructures where applicable and available — for example, remaining “agnostic to architecture and implementation approaches,” Tripathi said.

And as with keeping patient record queries simple, the policy should have the goal of provider directory query and response occurring in a single set of transactions, or as a few as possible, Tripathi said.

Much as there is some tension in the healthcare community on the timeline for Stage 3 Meaningful Use, there are growing needs for the type of queries and provider directories the Workgroup is working to help craft standards for.

“The demand for cross-vendor query exchange appears to have grown with the rapid growth of ACOs,” Tripathi said. “Though some channels of query exchange are emerging in the market, such capabilities have generally not kept pace with demand. Directed exchange as required for Stage 2 is starting to take shape.”

However, he said, the “role and function of HISPs is still murky, and lack of standards for provider directories and security certificates appear to be an obstacle to more rapid progress.”