Archive for the ‘Healthcare Standards’ Category

Social media, and twitter in particular, provides the unique opportunity to tune into the voices of leaders across the world for commentary on global events, trends and issues.

Each of the following twitter feeds are the voices of key individuals and organizations involved in the healthcare policy transformation, significant current events and the exciting debates defining the future of the healthcare industry. As social media leaders, they make up the foundation for the health IT information network on the Web and are shaping the future of health IT for all of those involved. Follow what these leaders are saying and join in on their conversations:

1. @HIMSS – HIMSS (or Healthcare Information and Management Systems Society) is a non-profit membership organization dedicated on “providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare.” @HIMSS currently has over 5,000 followers.
2. @HL7 – HL7 International (or Health Level 7) is an international not-for-profit organization, “ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.”
3. @HITECHActHelp – The HITECH Act and Meaningful Use guidelines have stirred up a significant amount of news recently, and most likely will continue to do so as the policies are implemented and enforced. @HITECHActHelp provides regular updates on this Act and how it affects those involved within the health IT industry.
4. @Histalk and @IngaHIStalk – HISTALK is an anonymous social media user who provides insight and opinion on current events in the industry. HISTALK, and his assistant Inga, regularly interview leaders in the industry, sponsor guest bloggers and tweet about current events. Although a self-proclaimed “cynic,” HIStalk provides a valuable perspective for those interested in HIT.
5. @kevinmd – Kevin Pho, M.D. holds an acclaimed social media presence within the healthcare community and has been recognized for his “punchy, prolific” healthcare insights by multiple major media outlets including The Wall Street Journal and The New York Times. @kevinmd provides daily commentary chronicling America’s healthcare system from a providers’ perspective.
6. @ahier – Brian Ahier is an active HIS thought leader in the healthcare community and currently has approximately 4,500 followers on twitter. He provides insights on health IT, healthcare reform and HITECH in addition to other broad technological advancements.
7. @SIIM_Tweets – SIIM (or The Society for Imaging Informatics in Medicine) is an organization dedicated to advancing the health IT industry through education and research. They are widely recognized within the healthcare IT and radiology industry for their SIIM Annual Meeting held each summer.
8. @ehrandhit – This twitter feed stems from the blog EMR and HIPAA that is dedicated to providing aggregated EMR, HER and HIT related content. @ehrandhit is recognized for providing information on health IT integration, HITECH and Meaningful Use.
9. @motorcycle_guy – Keith W. Boone is a thought leader on healthcare standards. He is the author of the Healthcare Standards blog that frequently reflects on current events in healthcare IT. Common topic threads are ARRA, CCD, HITECH, HL7 and healthcare integration.
10. @MedicalQuack – Barbara Duck, a healthcare IT consultant from Orange County, is a leading voice in the healthcare IT social media community. She is the author of one of the most popular health IT blogs online, The Medical Quack, and currently has over 3,000 followers on twitter.

Feel free to follow us on twitter @healthstandards for updates on HL7 standards and other health IT information, and Corepoint Health @corepointhealth for more information on interface engines and healthcare integration.

Who do you follow on twitter for news on healthcare IT?

If you really want to know, Glen Marshall wrote an excellent overview of how Healthcare Standards become Healthcare Standards. It is a paper published by AHIMA, and it is entitled The Standards Value Chain. It provides an excellent overview of the process and result.

Just remember what Mark Victor Hansen has said:

“Don’t wait until everything is just right. It will never be perfect. There will always be challenges, obstacles and less than perfect conditions. So what. Get started now. With each step you take, you will grow stronger and stronger, more and more skilled, more and more self-confident and more and more successful.”

A little Chicken Soup inspiration for healthcare standards makers and implementers, especially as they become even more front-and-center with HITECH and Meaningful Use…

In a recent seminar on Meaningful Use, reference was made to HL7 QRDA or, better known as, HL7 Quality Reporting Document Architecture. HL7 QRDA was new to me, so I went on a search to learn more and thought it would be good to share some key information.

First, a definition of HL7 QRDA is required. From the HL7 Wiki on this topic, it is defined as:

“…a standard for communicating health care quality measurement information. The standard will conform to the requirements of the Health Level Seven (HL7) Clinical Document Architecture Release 2.0 (CDA) and will reuse the templates developed for the ASTM/HL7 Continuity of Care Document (CCD) and other CDA implementation guides. The project started in 2007 with a private collaboration supported by the Alliance for Pediatric Quality (Alliance) – a joint effort of the American Academy of Pediatrics, The American Board of Pediatrics, Child Health Corporation of America, and the National Association of Children’s Hospitals and Related Institutions.”

Key points are that this is still a developing standard, and it is using HL7 CDA.

Second, although there are many organizations involved in drafting this healthcare standard, three organizations involved – which are not on the HL7 wiki list mentioned above – include the  American Health Information Management Association (AHIMA), the Health Information Technology Standards Panel (HITSP), and Integrating the Healthcare Enterprise (IHE).

Two key resources to review:

1. HITSP:  HITSP Patient Level Quality Data Document Using HL7 QRDA Component
2. AHIMA:  A Standard for Quality Reporting

What does this all mean? Although the picture is incomplete, HL7 QRDA may play a role in quality reporting requirements for HITECH & Meaningful Use. From John Halamka’s blog post entitled The Interim Final Rule on Standards (i.e., Meaningful Use proposed rules), point 5 is the important one on this topic:

“The adopted content standard for quality reporting is the CMS PQRI 2008 Registry XML Specification, (note that this means it was suggested by the HIT Standards Committee and not by HITSP, it’s not an SDO product but was produced by CMS). The candidate standards are those to be suggested by the HIT Standards Committee. We debated this at the HIT Standards Committee because QRDA is an emerging standard for quality reporting but not a widely implemented one. This glide path is reasonable, but does require implementers to change course – implementing PQRI XML now and possibly QRDA or other standards later. It will be interesting to follow the comments on this one – maybe PQRI and QRDA should be allowed now to prevent this rework.”

As always, more to come later…

As pointed out in previous posts, there is an ongoing drumbeat of discussion on the best way to realize Meaningful Use in the new HITECH world. Recently, HL7′s CEO and CTO wrote a column for Government Health IT entitled Leverage Today’s Standards for Meaningful Use. A key portion of the column states:

“To discard the existing data interchange standards and to replace them with something new and ‘simpler,’ as some are proposing, would be counterproductive.

Instead, we need updated and simplified tools and processes that leverage the existing standards and produce the needed interoperability.”

There is an obvious cynical angle that could be made of this column, since it is the HL7 leadership stating that the healthcare standards are just fine. The problem is the tools and processes, and the Federal government, according to this column, is doing great at building these tools and processes. Making that cynical argument may not be the most productive.

Granted the column was placed in Government Health IT magazine, so the expectation may be a more government focused article. Reading the column several times now, it is still unclear what is being advocated. It seems the arguments being advanced are:

• Keep HL7 and other standards as is, especially since it would be very costly to take a different approach in defining Meaningful Use.
• The government is using existing healthcare standards effectively today, and the government is building software applications to work with those standards. The government will “spur innovation.”

The HL7 column seems awkward. The first point is a compelling perspective to be taken into account in the formulation of Meaningful Use, especially with the aggressive time schedules. The second point on the government spurring innovation is more questionable. There is no doubt that the government is spurring the healthcare industry to action on implementing EHRs and facilitating greater healthcare interoperability. Do we really want government-developed applications as the standard though?

Two points should not be lost in the Meaningful Use discussion.

First, there should be a constant focus on how the changes will impact the delivery of patient care. High quality and efficient delivery of patient care should be paramount.

Second, the private sector needs to step up to the challenges and continue to drive innovation in the applications and devices being developed and offered. Unquestionably, the government has placed incentives and regulations into the market to motivate and constrain at the same time.

Sorting through these elements will be a challenge, and most healthcare application vendors are ready to take it on.

During the past few weeks, the debate and discussion on healthcare standards have been interesting. Outlined below are a few highlights.

Highlight 1: In NextGov, an article entitled “Keep Health IT Standards Simple, Says Chief Technology Officer” highlights an exchange on how healthcare standards need to be “easy-to-understand,” unlike today’s HL7. HL7 was described as not the ideal model for implementing the objectives of HITECH. A specific quote about HL7:

“A person attempting to comprehend, let alone use the current Health Level 7 standards, would end up with ’17 documents on their desk that all point to each other,’ Halamka said. They need to be simplified and posted online, he said.”

Highlight 2: On iHealthBeat, an article entitled “Work Group Stumps for Simplicity in Health IT Certification Standards” outlines the key recommendations for EHR certification:

“Begin with small and simple standards;

Create easily downloadable vocabularies and code sets;

Do not pursue perfect standards at the cost of sufficient ones;

Do not strive for a complex universal system;

Keep costs low by eliminating licensing fees and other expenses;

Leverage standards that already function effectively on the Internet;

Promote measures that spur standards adoption and quality reporting;

Provide implementation assistance to small physician practices;

Separate content and transmission standards; and

Support implementation with guides and reference materials.”

Highlight 3: Charles Jaffe, MD, PhD, CEO, Health Level 7, Inc., testified before the Health IT Standards Committee and offered a concession in the “keep it simple” debate. As was highlighted in the Federal Advisory Committee blog:

“Perhaps most important, HL7 saw an opportunity to further reduce the barriers to implementation. We have submitted a proposal to HHS that would allow the licensing of HL7 intellectual property (including the standards and the supporting technology) free of charge for use in the United States. We have further proposed coupling this with several initiatives to streamline standards development and standards harmonization, while retaining our open, collaborative ANSI-approved process. As this moves forward, we expect to add momentum to the process of enabling ‘meaningful use’ for all of our stakeholders.”

What can we take from all of this? Three points:

1. Keep healthcare standards simple – a worthy objective which should – and needs to – be done. Having said that, keeping it simple when the Federal government plus many, many healthcare standards organizations mixed in with the other special interests are all involved, this will be a near impossible task.
2. Keep it like the Internet. Using the Internet as the guide for EHR certification and healthcare standards is a popular statement and discussion to have. However, see point number 1, and see the healthcare XML post.
3. Keep it cheap. Yes, access to healthcare standards, like HL7, should be free, if the objective is to simplify and use standards more easily. There will be a cost to implement the new world of healthcare data exchanges. Cheap, free, low costs, etc. will probably not be the enablers to make this happen. Logical, supportable, and easy-to-comprehend and use technology and process solutions will be, mixed in with reasonable people to make this all happen.

All of the above is a great discussion. Simplicity, Internet-like, and Cheap will meet reality and, hopefully, at least simplicity will still prevail.

There is an excellent post – Talking to DC – by Adam Bosworth, highlighting his testimony to the HIT Standards Committee. Adam has been involved in several successful standards, so he offers his lessons learned as the new, new world of healthcare data exchanges and standards unrolls in the next several years.

Read the post, as it is worth the time. To entice you, outlined below are the seven key points discussed by Adam.

1. Keep the standard as simple and stupid as possible.
2. The data being exchanged should be human readable and easy to understand.
3. Standards work best when they are focused.
4. Standards should have precise encodings.
5. Always have real implementations that are actually being used as part of design of any standard.
6. Put in hysteresis for the unexpected.
7. Make the spec itself free, public on the web, and include lots of simple examples on the web site.

My favorite quote in this healthcare standards post is:

“Don’t build an 18 wheeler to drive a city block.”

This concept seems to be often ignored in the world of healthcare standards.

Recently, several experts testified at a hearing of the information exchange work group of the Federal Health IT Policy Committee. This generated several news articles highlighting the challenges in electronically sending lab test results to EMRs and, specifically, the meeting the new Meaningful Use guidelines under HITECH. Below are links to three articles which are worth reading.

• Government Health IT article:  Experts call for widening scope of lab test exchange.
• FederalComputerWeek article:  HHS faces hurdles on electronic exchange of medical lab results.
• ModernHealthcare.com article:  Panel tackles privacy restrictions regarding lab data. (Note: Registration may be required to access this article.)

Key summary points from the lab test distribution articles include:

• Patient privacy issues are typically covered by HIPAA – Health Insurance Portability and Accountability Act of 1996; however, there are exceptions for certain lab test orders and results which are covered by CLIA – Clinical Laboratory Improvement Act.
• CLIA states that lab results should be protected but can be released to the person who is “using” or, in other words, ordered the test or to an “authorized person,” defined as an “individual authorized under state law to order tests or receive tests, or both.”
• Several who testified stated that CLIA and HIPAA need to be changed enable more efficient exchange of lab orders and results.
• Another issue highlighted was the importance of having clear healthcare standards and more efficient way to implement interfaces between the various providers. It was highlighted that many lab test results are scanned and faxed to physicians today. The current process of implementing a lab interface can be timely, resource-intensive, and costly. Greater standardization is one way to improve the ability to implement lab interfaces.

In order to meet the Meaningful Use guidelines, other regulatory changes will need to occur. Lab interfaces have received the attention of the HL7 organization, and ELINCS may provide one way to “better” define the data exchange standards. From these articles and the discussion, one thing is clear — much more work needs to be done to meet the goals of HITECH.

To gain insights on using ELINCS to streamlining lab connectivity to Physician EHRs, read the following white paper:  Accelerating EMR Interoperability with ELINCS.

In the world of healthcare standards, the Health IT Standards Committee met today as it continues it discussions and advice to the Office of the National Coordinator (ONC) on health IT reform. A few interesting articles and blog posts have been published this week from several leaders involved in moving Meaningful Use and the adoption of healthcare standards forward.

• Life as a CIO Blog by John D. Halamka MD:  Adoption and Implementation of Standards post. This blog post came the day before the Health IT Standards Committee meeting.
• iHealthBeat article:  Standards Panel Looks to Different Industries for Data Sharing Tips. This article highlights the U.S. Chief Technology Officer and chair of the committee’s standards implementation work group, Aneesh Chopra, direction in reviewing how other industries have implemented data sharing standards and apply those insights to the healthcare industry.
• Healthcare IT News blog by John D. Halamka MD:  The October HIT Standards Committee meeting. The blog post highlights the Health IT Standards Committee meeting which just took place.

The above information is helpful to track as the continuing debate, decision, and implementation occurs to pursue the Meaningful Use objectives defined in the HITECH legistion.

What is ICD? ICD stands for International Classification of Diseases and is designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics. These codes are published by the World Health Organization and serve as another healthcare standard.

Moving to ICD-10 is about to happen. Two blog posts to read and understand the shift taking place:

• Preparing for ICD-10, John Halamka, MD, CIO, CareGroup Health System, Harvard Medical School
• Summary of ICD-10, Dave Shaver, CTO, Corepoint Health

ICD Resources:

• Wikipedia – International Statistical Classification of Diseases and Related Health Problems
• Centers for Disease Control and Prevention – Classification of Diseases, Functioning, and Disability
• AHIMA – Why ICD-10 Is Worth the Trouble
• AHIMA – Preparing for ICD-10

National Quality Forum (NQF) joined with HL7, AHIMA and consulting firm Alschuler Associates to develop a draft standard called Health Quality Measure Format (HQMF).  To read more about HQMF, the following press release was issued by the HL7 organization -
Automating Performance Measurement Using Electronic Health Records (PDF).

The HL7 ballot for HQMF offers the following definition and structure outline:

“…is a standard for representing a health quality measure as an electronic document. A quality measure is a quantitative tool that provides an indication of an individual or organization’s performance in relation to a specified process or outcome via the measurement of an action, process or outcome of clinical care. Quality measures are often derived from clinical guidelines and are designed to determine whether the appropriate care has been provided given a set of clinical criteria and an evidence base. Quality measures are also often referred to as performance measures or quality indicators.

Through standardization of a measure’s structure, metadata, definitions, and logic, the HQMF provides for quality measure consistency and unambiguous interpretation. A health quality measure encoded in the HQMF format is referred to as an “eMeasure”.

Standardization of document structure (e.g. sections), metadata (e.g. author, verifier), and definitions (e.g. “numerator”, “initial patient population”) enables a wide range of measures, currently existing in a variety of formats, to achieve at least a minimal level of consistency and readability, even if not fully machine processable.”

As is the case these days, one of the reasons for HQMF is to support “meaningful use” of electronic health records as described by the American Recovery and Reinvestment Act (ARRA). In the HL7 press release, the following explanation is offered:

“‘This work will make it easier for physicians and other clinicians to monitor and evaluate the care they are providing patients based on data routinely captured during care processes,’ said Floyd Eisenberg, NQF senior vice president of health information technology. ‘This new format standard will enhance the use of nationally-recognized performance measures at the point of care to enable greater transparency for providers and consumers.’”

HL7 is receiving comments on this new format and will make a determination if it ready to become a draft standards by December. Another article which outlines HQMF was recently in Modern Healthcare entitled Quality measure format could change EHR analysis.