HIT Standards Committee: Interoperability standards become clearer

Doug Fridsma, MD, PhD,  Image source: Department of Health and Human Services

Certification standards have been clarified in the meaningful use final rule, and when possible, standards allow “flow-through” from meaningful use requirements, said Doug Fridsma, MD, PhD, acting director of the Office of Interoperability and Standards at the Office of the National Coordinator for Health IT (ONC), speaking at the July 27 HIT Standards Committee meeting.

Based on the feedback ONC received, the rules have been organized and clarified, according to Fridsma. The final rule includes more detailed specificity for some certification criteria, as well as “consistency between the rules we have within standards and certification criteria and those with meaningful use,” he said.

According to the meaningful use final rules for Stage 1, EHRs must be capable of producing a patient-care summary record. The adopted standard there remains a continuity of care document (CCD) and continuity of care record (CCR,) but ONC added increased specificity via Healthcare IT Standards Panel C32 for CCD and CCR.

"Just the standard itself is detailed enough that it works as our implementation specification. Certification requires a legitimate C32 and there’s a lot of optionality,” he said. “We’ve constrained it a little bit by the criteria we have, [but] as we look forward to Stage 2 and actually thinking about exchange, we may have to get input from this group as to how further refine that.

Gone from the final rule are transport standards of SOAP and Rest because HL7 and others use different standards, Fridsma explained. “Experience with [the NHIN Direct project] has told us there may be ways to achieve interoperability without dictating, at this time, what those transport standards should be," he said. "We will continue to work with this committee to make sure we get the right balance of specificity and allowing flexibility within the marketplace.”

With laboratory reporting, display of LOINC codes is no longer required. “The issue there was if a lab returns LOINC codes and doesn’t return the name, it would require everybody to have the ability to map that. Clearly, we are interested in having the lab interchange supported, but we didn’t want, in the short term, for people to have to manage those mappings within providers,” Fridsma said.

Medication reconciliation criteria have also been modified, so people don’t have to have all that internal mapping worked out in advance” for multiple medication vocabularies from multiple sources, he said.

In addition, Fridsma provided two updates related to the Nationwide Health Information Network (NHIN). First, the NHIN Direct team is working closely with the CMS' Tiger Team on security and policy, and working to develop pilots and other activities, he said. Second, the Virtual Lifetime Electronic Record (VLER) project, a White House initiative that ONC is supporting through NHIN and via an operations and infrastructure grant, continues to be an important project “because it foreshadows many of the things we can expect coming up in Stage 2 certification,” he said.

“We’re moving away from the connect-a-thon approach, where people get together, connect up their computers and see if they work, to a more standards-based approach [where] we can certify that people meet certain interoperability criteria, and whether interoperability can occur. There are lots of challenges because things that are underspecified can sometimes get us into trouble. So the VLER project and the work going on in the NHIN Exchange has been an important project in terms of foreshadowing,” said Fridsma. “I see them as our interoperability exchange Beacon Community—they’re trying to tackle some of the hard problems.”