HITPC: Query exchange, provider directory recs approved

Recommendations for query exchange and provider directory were approved by the Health IT Policy Committee at their July 9 meeting.

The response to a request for comment on the Query for Patient Record approach indicated that people felt they should be simplified and generalized. Rather than a complex set of back-and-forth transactions and very specific user workflows, more generalizable queries would be best, said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and chair of the information exchange workgroup. “The comments noted that query exchange is happening where there is third-party governance to address policy, legal and technical complexities.”

Single-vendor query exchange solutions are growing rapidly, he said, due to the ability to eliminate technical barriers and facilitate trust frameworks among separate legal entities.

The HITPC recommends for searches for patient information, that EHR systems have the ability to electronically query external EHR systems for patient medical records. For responses to searches for patient information, the committee recommends that EHR systems have the ability to electronically respond to electronic queries for patient medical records from external EHR systems.

The HITPC recommends the following principles for establishing requirements and standards for query-based exchange: continuity; simplification (minimal set of transactions); and generalization (don’t specify so much that doesn’t recognize variation). We don’t want the requirements to be “so brittle that they could break with any of the variation that’s already out there,” said Tripathi.

Tripathi was asked if he really thought the recommendations he presented were doable, especially considering the coding, evaluation, analysis and resolution not yet done. Theresa Cullen, MD, MS, acting deputy director of the Department of Defense/Department of Veterans Affairs Interagency Program Office, expressed concern about the timing. “It’s one thing to accelerate the market by putting standards out there, it’s another thing to do the prework so the market can embrace it. I’m cautious,” she said.

From a certification perspective, Tripathi said, having the confidence that your EHR system has this ability to generate a query and be able to respond to a query system and be able to respond to a query seems like it’s an enabler and ultimately provides greater choices. "It offers flexibility to end users but also provides a base or core capability they can rely on should they need to. We weren’t trying to break any new policy ground.”

Regarding provider directory, the HITPC recommends for provider search, that EHR systems have the ability to query external provider directories to discover and consume addressing and security credential information to support directed and query exchange. For responses to a search, the HITPC recommends that EHR systems have the ability to expose a provider directory containing EPs and EH addressing and security credential information to queries from external systems to support directed and query exchange.

There was much discussion about authentication of providers but the committee eventually approved the recommendations.