Panel advances standards for clinical quality, hospital discharge meds

By Mary Mosquera
02:45 PM

The Health IT Standards Committee has been wrestling this summer with identifying standards for electronic prescribing of medications at hospital discharge, vocabulary for clinical quality coordination, and others to support stage 2 of meaningful use.

The challenge is to come up with technical approaches that are simple yet specific enough for healthcare providers to adopt and vendors to incorporate as part of certification of their electronic health records (EHRs), according to standards committee members at its meeting July 20

Standards provide the common technical methods that can be installed in EHRs to support functions that improve care and help physicians and hospitals meet meaningful use.

A committee panel has recommended as minimal a number of vocabulary and code sets as possible, primarily SNOMED-CT and LOINC, to demonstrate meaningful use measures, such as for allergy and adverse drug effects, patient characteristics, diagnosis, patient functional status, patient experience and communications. These code sets would be included for EHR certification, said Jim Walker, chair of the committee’s clinical quality work group and chief health information officer at Geisinger Health System.

The Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) is a standard medical vocabulary for use in electronic health records for sharing information across specialties and sites of care. SNOMED-CT is considered a requirement for more advanced forms of health information exchange and analysis. The Logical Observation Identifiers Names and Codes (LOINC) is used for lab and clinical identifiers.

For another thorny health IT challenge, a panel recommended using existing electronic prescribing standards for sending medication orders at a patient’s discharge to hospital pharmacies and to retail pharmacies.

The National Council for Prescription Drug Programs (NCPDP) script standard is widely used for electronic prescribing, especially in physician office settings and retail and mail order pharmacies, said Dr. John Halamka, co-chair of the standards committee and CIO of Beth Israel Deaconess Medical Center. 

Hospitals, however, often have a different system and workflow, and they may have an in-house pharmacy.
The challenge is “to do everything electronic, how do you support both workflows, in-house hospital pharmacy and retail or mail-order pharmacy, and do it with the smallest number of standards that will meet Medicare Part D existing infrastructure practice,” he said. 

The panel examined the discharge medication workflow to identify areas that health IT standards could affect, such as e-prescribing and discharge standards as well as those outside the discharge process because it involves care coordination, said Scott Robertson, Pharm.D , principal technology consultant in health IT strategy and policy for Kaiser Permanente and a member of the small group tackling this problem.

For example, “medications may need to be re-ordered at discharge, but formulary and health benefits may differ between in-patient and ambulatory for prescription benefits,” he said.

Dr. Farzad Mostashari, the national health IT coordinator, noted the tensions involved in harmonizing standards between the maturity of standards and their adoptability. Simplicity can also make a standard more adoptable, he said at the meeting.

[Q&A: ONC's Mostashari on the innovation electronic data will spark.]

But he also suggested that policymakers should look ahead and “think of other ways to innovate and move standards forward” and recognize those that are suited to specific use cases but not yet widely adopted and be aware of evolving broader Internet standards and other areas of technology that may not yet apply to health care, but establish a process for them.