Setting standards takes true grit

Countless volunteers have made progress possible over 10 years
By Bernie Monegain
12:00 AM

Anyone who thinks John Halamka, MD, does not have an affinity for detail, probably has not read his blog posts nor considered HITSP, Halamka’s standards brainchild.

Founded in 2005, the Healthcare Information Technology Standards Panel came before the federal advisory Health IT Standards Committee that is in place today.

For years, Halamka, CIO at Beth Israel Deaconess Medical Center in Boston, and a cadre of volunteers worked on developing standards based on use cases. When meaningful use came along, the panel changed its focus to create standards surrounding meaningful use requirements.

The volume of work skyrocketed.

HITSP is “working triple time” on preparing to help providers and vendors apply the stimulus package requirements, he told an audience at a town hall meeting at HIMSS09 in Chicago.

He told them HITSP would focus over the next 90 days on simplifying its recognized use case work into "lightweight interoperability specifications" that should be easily understood and available online. The new instructions, he said, should help users speed their preparation for meaningful use by removing the context specificity found in the original use cases.

The work of HITSP continued through April 30, 2010. Today, Halamka serves as vice chair of the Health IT Policy Committee. Jonathan Perlin of Hospital Corporation of America is chair of the 28-member panel.

The Health IT Standards Committee created under the American Recovery and Reinvestment Act, held its first meeting May 15, 2009.

The first set of standards was slated to be completed by Dec. 31. Recommendations on meaningful use – required by providers to be paid bonuses under Medicare – were due within a month.

ONC chief David Blumenthal, MD, said the panel would be looking at HITSP as a good place to start.

Fast-forward to 2013, and ONC chief Farzad Mostashari, MD, who had announced he would step down from his post, offered the panel advice before leaving.
Halamka summarized it this way in his September 24 blog:

• Do not slow implementation of FY14 standards. We've worked too hard to get this far
• Offering more time for Meaningful Use Stage 2 attestation may be appropriate
• New standards are coming but we can make progress today. Do not let the perfect be the enemy of the good
• We need to create the standards and interoperability that people want, have value, and are appropriate for purpose

“The key question for the HIT Standards Committee,” Halamka wrote, “is how to balance scope, time, and resources over the next year to deliver those key standards needed to support national priorities: Care Coordination, Improving Quality, Engaging Patients/Family, and Population Health. Using the matrix, we will prioritize the most important and most urgent projects over the next few weeks.”

Halamka has had the discipline to stay with standards development for years – indeed, over the entire decade, and he’s learned a thing or two along the way.
In a Feb. 2, 2010, blog, he shared lessons learned:

• It's important to engage the community of experts, break down barriers, and encourage ongoing communication. When people talk, they learn to trust each other and this leads to collaboration rather than competition.
• Standards harmonization happens best when there are clearly articulated priorities such as the workflow required for meaningful use.
• Once standards are harmonized and implementation guides written, everything needs to be accessible in an easily searchable electronic format, including vocabularies/codesets.
• Adoption of standards is the best measure of success. Expert advice and education are important to ease the learning curve.
• Build progressively and keep standards as simple as possible, just as suggested by the HIT Standards Committee's guiding principles.

“Consensus based decision-making requires hard work and substantial amounts of diplomacy,” Halamka concluded. “The 50,000 hours of volunteer time from HITSP's members has been priceless.”