ONC to fine tune technical guides for standards in stage 2

By Mary Mosquera
03:52 PM
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The Office of the National Coordinator for Health IT intends to fine tune standards involved in realizing stage 2 meaningful use recommendations and fill in where missing details exist during the next four months.  
ONC plans to “refresh and reload” adopted certification criteria and new or updated technical descriptions to guide vendors to establish standards, said Dr. Doug Fridsma, ONC director of standards and interoperability. He described it as ONC’s health IT “summer camp.”
The goal is to make it easier for vendors to effectively encode standard functions in electronic health records (EHRs) so healthcare providers can apply the standards to meet measures in meaningful use stage 2, he said at the Health IT Standards Committee meeting April 20.
“We can’t wait until June to get the final draft recommendations for stage 2 and then begin our work. We need to start now to have a good interplay between the goals of the policy committee in what they recommend and the way in which that can be supported through standards, implementation specifications and certification criteria,” he said.
In May, ONC plans to review the existing standards for drug formulary checks and electronic prescribing and emerging standards for directories, and certificate interoperability.
In June, ONC will consider how providers can electronically compile a list of care team members, weigh hospital portals vs. personal health records for sharing patient information, and look at value sets for advance directives, among other issues.
The agency also will have some outcomes to evaluate from its Standards and Interoperability Framework efforts to harmonize standards for exchanging lab results and transitions of care and improving specifications for the nationwide health information network, Fridsma said.
ONC will be able to review “boots-on-the-ground experience” of early users of the Direct Project protocols for simple exchange, a streamlined version of the nationwide health information network.
“You want to have what will make users be successful,” he said, especially in supporting the exchange of health information that will be incorporated in various measures.
Sufficient standards and guidance already exist for potential recommendations, such as for recording demographics and submitting immunization data measures.
Standards also are available to incorporate lab results, provide an electronic copy of information to the patient and share patient summary data for transitions of care, but these standards need better technical guidance to be able to share them successfully.
Much more work needs to be done around standards and technical descriptions for measures that include exchange, such as for secure messaging, patient portals, testing health information exchange and provider directories, he said.
[John Loonsk's PCAST Review part 3 - A failure of information exchange? And contributing writer Jeff Rowe asks: Is it enough just to 'kickstart' the PCAST vision?]
ONC will also consider including some recommendations of the President’s Council of Advisors on Science and Technology (PCAST) that make sense for stage 2 of meaningful use. The PCAST report in December advocated for a universal exchange language and the ability to break down health information into smaller data elements to share.
The policy committee suggested that providers give patients options for receiving their summary data with tags so that they can share specific data elements.
ONC will look at metadata standards for patient matching; privacy and consent; and provenance, or “the who, what, where and how of the data,” Fridsma said.   
Dr. John Halamka, co-chair of the standards committee, explained how sharing metadata would work in a potential policy measure that EHRs share their data with patients. Commercial personal health record providers currently all have different interfaces through which to link the information.  
The payload or content can vary, for instance, either standard format for clinical summary. Regardless, the metadata will say who the patient is, where the data is from and what the specific privacy and consent tags are around it, he said.
“That singular envelope is sent in a consistent fashion to each PHR vendor. That enables any EHR to wrap up content for consumption by any PHR. Seems like it would be a good idea, even achievable, to allow the transport of the metadata,” he said. Halamka is also chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center.