WASHINGTON – The federal advisory panel on health IT standards has approved refined recommendations on how providers may electronically record a physician's observations to qualify for federal recovery bonuses.

The HIT Standards Committee endorsed recommendations to call for SNOMED CT for physician's clinical observations by 2015. In 2010, providers must use ICD-9 or SNOMED CT to qualify, and in 2013 they must use ICD-10 or SNOMED CT.

According to John Halamka, co-chairman of the Clinical Operation Workgroup, ICD-9 and ICD-10 were created for billing purposes and are not suitable in the long term for denoting physician observations in an electronic health record.

Halamka said he is pleased with the progress made since July, when the recommendations were initially approved.

"What we're going to see is more and more clarity and more restraint. Controversies are getting fewer and the glide path is clear," he said.

The recommendations, along with others the committee approved Thursday, will be used by the Centers for Medicare and Medicaid Services to develop the "meaningful use" regulation with which providers must comply to qualify for bonuses by 2011.

According to Jodi Daniel, director of the Office of Policy and Research in the Office of the National Coordinator for Health Information Technology (ONC), both the ONC and CMS will "strongly consider" the recommendations made by the HIT Standards Committee. In December, the ONC will issue a rule on certification and standards, while the CMS will issue a final rule on how providers can qualify for bonuses under the economic recovery law. The CMS will take comments after the rule is published, but is not bound to make any changes to the rule based on them, Daniel said.

"We will be looking very closely at the input from this committee," Daniel said. "We are expected to by our statute and we intend to give a lot of credibility to these groups. But I can't say whether the recommendations will or will not be identical to what you see here."

Daniel said vendors and providers who want to get a jump on preparations for meaningful use will have to make a business decision on whether to go forward with the recommendations made so far.

The standards committee also endorsed updates to the 30 performance measures approved July 21 by its Clinical Quality Workgroup. Those include 23 National Quality Forum measures already used by providers, but which will be retooled for electronic health records, and seven measures that include ways to collect data for public health surveillance, patient access to educational resources and percentage of orders entered through computerized physician order entry (CPOE).

According to Janet Corrigan, co-chairwoman of the Clinical Quality workgroup, the measures will start in 2011 and gradually become more complex by 2015 as CMS pays out bonuses during that period.

The Privacy and Security Workgroup updated its July 21 recommendations on how providers should comply with HIPAA standards for an electronic health record. Recommendations advise providers to conduct a security and privacy risk assessment. Providers should also implement procedures necessary for use with electronic health records. Security both within an organization and outside an organization must be secure for data transfer.

Organizations should periodically review the audit trails of their electronic health records. Other recommendations included screenlocking capabilities and encryption of all personal health information transmissions, with special consideration given to wireless networks.