Halamka: No summer break for standards work
WORCESTER, Mass.—“Go attest to meaningful use Stage 1 now. You’ll get your money faster and it’s not going to hurt you,” said John Halamka, MD, CIO and a professor at the Harvard Medical School in Boston, during his opening remarks on a panel at the Massachusetts Governor’s 2011 Health IT Conference May 9.
Halamka, who is also a co-chair of the Health IT Standards Committee (HITSC) at the Office of the National Coordinator for Health IT (ONC), spoke about the HITSC's upcoming work and gave a prediction for the meaningful use Stage 2 timeframe.
The HITSC will spend the entire summer in Washington, D.C., he said, working to answer critical questions, such as "How do you guarantee who is doing the sending and who is doing the receiving of clinical information [in an HIE]?"
“You need to figure out how to issue digital certificates to every member, patient, provider and payor who is going to exchange data for the security and data integrity and identity of the individuals.” The committee is finishing up a comprehensive specification for certificates at the national level, including how a chain of trust works and what might occur if you are sending clinical data to the government. That work should be finished this month, stated Halamka.
“In this country, we do not have a national patient healthcare identifier. I will argue that in the U.S., probably in my lifetime, we are not going to get a national healthcare identifier, for a whole variety of policy reasons,” Halamka stated.
Left with patient demographic matching, “we better figure out as a country how well that really works and what algorithms you’re going to use so there is some uniform way on how to identify patients if all we are given is a set of demographics to keep your data collected, so when you visit data from multiple institutions you can put the right patients together,” he said.
All interoperability depends on three factors: a content standard, the vocabulary to ensure there is computable interoperability and transmission standards. “We need to figure out for the country one vocabulary standard for lab, one vocabulary standard for medication, one vocabulary standard for problem lists and then code sets for things like gender, and make that package of vocabularies available from a downloadable web site for free,” said Halamka.
The HITSC will have a final set of recommendations in July on vocabulary standards, he added.
Rounding out the “summer camp for standards,” the committee is working on a specification for one way that personal health records (PHRs) can receive EHR data. That specification should be finalized in June, he said.
Halamka also gave his prediction for implementation of Stage 2 meaningful use. “I have no official capacity in government, but I’ll tell you what I think is going to happen. What is going to happen is the recognition that the timeframe of giving vendor specifications in March [2012] and expecting installation and operation in October [2012] is insane. Hence, we will split meaningful use Stage 2 into two pieces: Stage 2A and Stage 2B.”
In October 2012, "Stage 2A" will take existing Stage 1 measures and ramp them up to be a bit more aggressive, Halamka continued. For example, instead of 30 percent computerized provider order entry (CPOE), the standard would now be 60 percent CPOE, with “no change in technology or certification of products,” he predicted.
“Say we have a year period to report on meaningful use Stage 2. Instead of a year, let’s make it 90 days," he suggested. "We will buy ourselves nine months of extra time to implement new technologies so that Stage 2B will begin nine months after Oct. 1 [2012] and that is a reasonable timeframe [for allowing] vendors the opportunity to create and install software that would support the new technology requirements of Stage 2.”
Halamka concluded by saying he believes the Stage 2 meaningful requirements timeframe will be rationalized. “The folks at the [ONC] will ensure that Stage 2 timeframes are safe,” he said.
Halamka, who is also a co-chair of the Health IT Standards Committee (HITSC) at the Office of the National Coordinator for Health IT (ONC), spoke about the HITSC's upcoming work and gave a prediction for the meaningful use Stage 2 timeframe.
The HITSC will spend the entire summer in Washington, D.C., he said, working to answer critical questions, such as "How do you guarantee who is doing the sending and who is doing the receiving of clinical information [in an HIE]?"
“You need to figure out how to issue digital certificates to every member, patient, provider and payor who is going to exchange data for the security and data integrity and identity of the individuals.” The committee is finishing up a comprehensive specification for certificates at the national level, including how a chain of trust works and what might occur if you are sending clinical data to the government. That work should be finished this month, stated Halamka.
“In this country, we do not have a national patient healthcare identifier. I will argue that in the U.S., probably in my lifetime, we are not going to get a national healthcare identifier, for a whole variety of policy reasons,” Halamka stated.
Left with patient demographic matching, “we better figure out as a country how well that really works and what algorithms you’re going to use so there is some uniform way on how to identify patients if all we are given is a set of demographics to keep your data collected, so when you visit data from multiple institutions you can put the right patients together,” he said.
All interoperability depends on three factors: a content standard, the vocabulary to ensure there is computable interoperability and transmission standards. “We need to figure out for the country one vocabulary standard for lab, one vocabulary standard for medication, one vocabulary standard for problem lists and then code sets for things like gender, and make that package of vocabularies available from a downloadable web site for free,” said Halamka.
The HITSC will have a final set of recommendations in July on vocabulary standards, he added.
Rounding out the “summer camp for standards,” the committee is working on a specification for one way that personal health records (PHRs) can receive EHR data. That specification should be finalized in June, he said.
Halamka also gave his prediction for implementation of Stage 2 meaningful use. “I have no official capacity in government, but I’ll tell you what I think is going to happen. What is going to happen is the recognition that the timeframe of giving vendor specifications in March [2012] and expecting installation and operation in October [2012] is insane. Hence, we will split meaningful use Stage 2 into two pieces: Stage 2A and Stage 2B.”
In October 2012, "Stage 2A" will take existing Stage 1 measures and ramp them up to be a bit more aggressive, Halamka continued. For example, instead of 30 percent computerized provider order entry (CPOE), the standard would now be 60 percent CPOE, with “no change in technology or certification of products,” he predicted.
“Say we have a year period to report on meaningful use Stage 2. Instead of a year, let’s make it 90 days," he suggested. "We will buy ourselves nine months of extra time to implement new technologies so that Stage 2B will begin nine months after Oct. 1 [2012] and that is a reasonable timeframe [for allowing] vendors the opportunity to create and install software that would support the new technology requirements of Stage 2.”
Halamka concluded by saying he believes the Stage 2 meaningful requirements timeframe will be rationalized. “The folks at the [ONC] will ensure that Stage 2 timeframes are safe,” he said.