HIT Policy Committee: Stage 2 is focus for 2013

“Stage 3 rulemaking is not happening until next year. Let’s spend 2013 on implementation of Stage 2 capabilities,” recommended Farzad Mostashari, MD, ScM, national coordinator of health IT during the March 14 Health IT Policy Committee meeting. “We need to learn from what’s working and what’s not working.”

Commenting on the recent Healthcare Information and Management Systems Society (HIMSS) 2013 annual convention, Mostashari said, “It’s quite remarkable to see the way the industry is responding to the market forces around interoperability and exchange.” Concepts such as patient engagement, business intelligence and population health management are migrating away from being buzz words to being solutions, he said.

Mostashari also cited the message from Centers for Medicare & Medicaid Services' (CMS) Director Marilyn Tavenner that 2013 will be the year of implementation. He also discussed the recent CMS-ONC joint announcement about the policy intent to use all the available tools “to encourage data sharing over data hoarding.” The agencies have proposed a number of potential payment and policy actions the administration could take to change the context and make it “ever more profitable to share and exchange information.” He encouraged participants and listeners to spread the word about the request for information so that everyone understands the policy intent.

Claudia Williams, director of ONC’s State HIE [Health Information Exchange] Program, discussed the state of exchange and the emerging technical, business and governance issues “that might create a roadmap of work” for the appropriate committees and ONC.

“There is a lot of exchange happening,” she said. Three of the biggest EHR vendors are each exchanging millions of patient records a month within and outside their own networks. “We’re seeing both rapid acceleration of a very diverse range of sources of exchange and a lot of growth.” Meanwhile, she said market needs are bubbling up through the demands of customers with a diverse set of needs. “There is not a single pillar use case the way we thought at one point there would be. People are looking for functionality that’s cheap enough to be very scalable.”

Patient-mediated exchange will be a growing focus, she said. “People feel like we’re on a real tipping point in terms of not just patient engagement driven by payment reform but fundamentally a new world of data liquidity in which patients could really, in an automated way, have their medical information go from an EHR into a platform of their own choosing.” Vendors have announced that they are going to support an automated, triggered flow of information to patient-selected endpoints this calendar year. “That’s not a requirement in Meaningful Use but it’s an incredibly important step to really allow data liquidity for patients.”

Williams reiterated the focus on Stage 2 this year. “The big task is to make Stage 2 work and have it serve as a data liquidity innovation and exchange engine. We’re not solving all the problems but we want to simplify and reduce the cost of exchange across the nation.”

Jodi Daniel, JD, MPH, director of ONC’s Office of Policy and Planning, said the new accountable care workgroup for the Health IT Policy Committee plans to hold its first meeting by early April. She also discussed the FDA Safety & Innovation Act, which was passed last summer. The statute requires ONC to work with the FDA and FCC to provide recommendations and report to Congress on a risk-based regulatory framework for promoting the safety and innovation of health IT and also reduce regulatory duplication.

Daniel’s office has begun creating a workgroup for this initiative and hopes to kick off the committee in April. “The report is due in early 2014 so this will be an aggressive timeframe.”

She discussed the National HIE Governance Forum which is designed to reduce cost and complexity and increase trust. While they are not pursuing regulations at this time, her office is working on several activities, such as a framework with policy guidelines, grants related to HIE governance issues, ongoing monitoring of the market to see if there are activities that would benefit from federal activity and generally determine “where we can be most effective.”

Daniel also reported on efforts to link prescription drug monitoring programs (PDMPs) to health IT pilots. “We are collaborating with organizations and looking at how to get PDMP data to EHRs so that that data is available in real time to those either prescribing medications or dispensing medications.” The goal, she said, is to figure out how to bring the data more into physicians’ normal workflow at the point of care. “We knew that PDMP data was not always available at the point of care.”

Electronic submission of medical documentation is the most recent initiative for his staff, said Doug Fridsma, MD, PhD, director of the ONC’s Office of Standards and Interoperability. The fraud and detection audit piece requires sufficient integration of the standards and specifications “that allow us to do clinical documentation and provide things like author of record—a digital signature that can be applied to a documenter or a request. We need to figure out the right way to integrate our transport standards into this process.”

The long-term care community has been “incredibly enthusiastic” about longitudinal coordination of care, he said. “It’s an important community not to forget. They may not be eligible for incentive pay but they don’t want to be left out of the ecosystem of HIE. We’re trying to get to a point where we have the ability to look at individual elements of care plans and route and use that information electronically.”

The lab orders interface project is nearly completed, Fridsma reported. This is important because “if we combine this with lab results, we can have the 360 degrees we’d like to see.” Staff are working on collecting the most commonly ordered tests and seeing how those can be automatically ordered, language standardized and getting information back into EHRs for “a nice ecosystem that connects the EHR to our lab systems.”

An effort to automate the Blue Button is aimed at helping providers meet the Meaningful Use requirement to have patients view, download and transmit their EHRs. “By combining the Blue Button specification with the standard we use for clinical summaries and tying that together with the Direct protocols we’re able to describe and pilot implementation guides” to satisfy the requirement.

Another recent initiative of his office, Fridsma said, focuses on structured data capture. “We’re trying to figure out how we can link together data collected for purposes of clinical research or needs to be captured for patient safety reporting and supplement that with information drawn from the EHR.” The project is geared to creating standard descriptions of data elements and allowing EHRs to interact with both an individual data element as well as a collection of data to simplify and easily integrate clinical research capabilities into an EHR.

Fridsma said near-term goals include working out additional ways of doing transports, image exchange, securing data at rest and standards that support measurement of EHR usability by the end of the year. “There may not be a standard but we certainly want some consistency in which we can support EHR usability.”