Overview of National HIT Standards a presentation to the Seminar Series on Integrated Surveillance

1
Overview of National HIT Standards a
presentation to the Seminar Series on Integrated
Surveillance

• Presented bySteven J Steindel, Ph.D.
• National Center for Public Health Informatics
  (NCPHI), CDC

2
Non-Government
Government
LAWS
MARKET NEEDS
Voluntary standards Consensus standards Industry
standards Consortia Standards Etc.
Regulatory standards Levels of
Protection Health, Safety Environment
When applicable and appropriate, voluntary
standards may be referenced in mandatory
regulations.
3

• Regulations
• Based on Health Welfare (Legitimate Objectives)
• Development Process (openness, public comment,
  transparency, timely notification)
• Mandatory

• Voluntary Standards
• Based on Market and Business Relevance (Demands
  or Needs)
• Development Process (much the same as regulatory
  regulators are among the participants in
  standards development bodies)
• Voluntary

4
Consideration for Standards

• Flow - where, when, and how data move
• Format - mechanics of data transfer
• Content - which data elements

5
Schematic Public Health Data Flow Example
Laboratory Reporting
Standards
Standard CodesH7 Messages
Architecture
Systematic Report
Text Report
Encoding
6
Acronym Soup!

• AHIC
• American Health Information Community
• ONC
• Office of the National Coordinator for Health
  Information Technology (IT)
• HL7
• Health Level 7
• CCHIT
• Certification Commission for Health IT
• HITSP
• Health IT Standards Panel
• NHIN
• Nationwide Health Information Exchange Network

7
ONC Major Initiatives
In 2004, President Bush called for the widespread
use of electronic health records (EHRS) within 10
years. ONC has set the foundation for
interoperable EHRs though the following
initiatives

• American Health Information Community
• Standards Harmonization Process
• Certification of HIT
• Privacy and Security Solutions
• Nationwide Health Information Systems Prototypes

• Health Information Technology and Health-care
  Anti-fraud
• Health IT Adoption Initiative
• Gulf Coast Task Force
• State RHIO Best Practices

For more information http//www.hhs.gov/healthit/
8
AHIC a Public and Private Sector Collaborative
AHIC is the public-private collaborative that
sets priorities and oversees and/or endorses HIT
Standards, certification, the NHIN, and polices
on a national level.

• AHIC American Health Information Community
• HITSP Health Information Standards Panel
• CCHIT Certification Commission for Health IT
• NHIN Nationwide Health Information Community
• HISPC Health Information Security and Privacy
  Collaboration
• State-Level HIE Initiatives State-level Health
  Information Exchange Initiatives

For More information http//www.hhs.gov/healthit/
community/background/
9
AHIC Workgroups (1/07)

• Population Health and Clinical Care
• Subsumes work of the Biosurveillance WG
• Includes Data Content Steering Group
• Consumer Empowerment
• Chronic Care
• Electronic Health Records
• Laboratory Reporting
• Emergency Preparedness
• Privacy and Security
• Quality
• Personalized Healthcare

For more information http//www.hhs.gov/healthit/
ahic/index.html
10
Health Information Technology Deployment
Coordination
11
Standards Harmonization Process

• Health Information Standards Panel (HITSP)
• Business driven standards harmonization process
• Coordinated with AHIC Use Cases
• Funded for 3 years by ONC self-sustaining
  thereafter
• Published Implementation Guidance 10/06
• Consumer Empowerment
• Biosurveillance
• EHR Laboratory Reporting

For more information http//www.ansi.org/standard
s_activities/standards_boards_panels/hisb/hitsp.as
px?menuid3
12
HITSP Technical Committees

• Cross-Technical Committee Coordination
• Care Delivery
• Consumer Empowerment
• Population Health
• Security and Privacy
• Emergency Responder-EHR

13
HITSP Harmonization Process
Harmonization Process Steps
ReceiveRequest

• I
• Harmonization Request

• II
• RequirementsAnalysis

• III
• Identificationof CandidateStandards

IV Gaps,Duplicationsand Overlaps Resolution

• V
• Standards Selection

• VI
• ConstructionofInteroperabilitySpecification

VII InspectionTest

• VIIIInteroperabilitySpecificationReleaseandD
  issemination

IXProgram Management
BeginSupport
14
HITSP Framework
15
Work Plan and Schedule Overview
HITSP 2007 Timeline
10/09/07 HITSP Board
04/23/07 HITSP Board
07/09/07 HITSP Board
02/05/07 HITSP Board
09/07/07 HITSP Panel
03/19/07 HITSP Panel
10/15/07 HITSP Panel
07/16/07 HITSP Panel
02/12/07 HITSP Panel
05/11/07 HITSP Panel
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
6/18 6/20 TC Face to Face San Diego CA
5/08 5/10 TC Face to Face Arlington VA
09/04 09/06 TC Face to Face Arlington VA
03/06 03/08 TC Face to Face Chicago IL
Activity 1 Version 2.0 of Existing EHR, CE, BIO
ISs
EHR, CE and BIO v 2.0
On-going Support
Implementation Support and Testing (includes
minor document updates)
Activity 2 Security and Privacy for All Use
Cases Activity 3 New Emergency Responder EHR
Use Case
SP and EHR-ER v 1.0
04/13 05/16
05/17 06/14
Implementation Support and Testing (with annual
updates as required)
Public Comment
Inspect Test and Public Comment
Comment Resolution and Panel Approval
Public Input on SP
Requirements, Design, Standards Selection
IS Construct Development
02/15 05/16
05/17 07/19
07/20 08/16
08/17 10/15
Activity 4 New Use Cases from AHIC
Detail Schedule to be Established Upon Review of
the Use Cases
16
Coordinated Timeline
17
Certification of EHRs

• Certification Commission for Health IT (CCHIT)
• Privately founded and funded 11/04
• ONC funding for three years
• First certified Ambulatory EHRs 7/06
• 37 systems certified 1/07
• Inpatient EHR Certification 6/07
• Network Certification 6/08

For more information http//www.cchit.org/
18
CCHIT History and Status

• Sept 2004 AHIMA, HIMSS, and the Alliance partner
  to launch CCHIT
• June 2005 Eight organizations add 325k funding
  support
• Sept 2005 CCHIT awarded 3-year, 7.5M HHS
  contract to develop compliance criteria and
  inspection process
• Ambulatory EHRs (2006)
• Inpatient EHRs (2007)
• Infrastructure and Networks through which EHRs
  interoperate (2008)
• July 18, 2006 First batch of certified
  ambulatory EHRs announced

• Goals of Product Certification
• Reduce the risks of investing in HIT
• Facilitate interoperability of HIT products
• Enhance availability of adoption incentives
• Ensure that the privacy of personal health
  information is protected

19
CCHIT Development Process
Develop Inspection Process
Launch Certification Program
Gather Data
Develop Criteria
Finalize
Pilot Test

• Methods
• Self-attestation
• Juror observation
• Laboratory testing
• Test scenarios
• Step-by-step test scripts
• Release for public comment

• Respond to comments
• Final adjustments
• Commission review and approve
• Publish final materials

• Stakeholder priorities
• Availability in vendor marketplace
• Practicality of certification
• Release for public comment

• Criteria for next year
• Functionality
• Security/ reliability
• Interoperability
• Roadmap for
• Next year 1
• Next year 2
• Release for public comment

• Call for participants
• Random selection for each market segment
• Conduct pilot
• Release for public comment
• Results
• Final criteria
• Final test process and scripts
• Certification handbook and agreement

20
CCHIT Myths and Realities
21
HL7 Groups of Importance

• New
• Public Health and Emergency Response
• Patient Safety
• Established
• Vocabulary
• Government Projects
• Laboratory
• Attachments
• Structured Documents (CDA/Templates)

For more information http//www.hl7.org/
22
Key Terminologies

• LOINC
• Lab Result Names
• SNOMED
• Clinical Terminology
• Organisms
• Both distributed free for use
• http//www.regenstrief.org/medinformatics/loinc/
• http//www.nlm.nih.gov/research/umls/Snomed/snomed
  _main.html

23
Get Involved!

• No restrictions just join
• HL7
• HITSP
• Selected Membership
• CCHIT
• NCVHS

• Open Meetings
• AHIC
• NCVHS
• CCHIT Town Halls
• Registration
• LOINC
• SNOMED (IHTSDO)

24
Contact Information

• Steven J Steindel, Ph.D.
• Director, Data Standards and Vocabulary
• Centers for Disease Control and Prevention
• National Center for Public Health Informatics
• U.S. Department of Health and Human Services
• 1600 Clifton Road, MS E-78
• Atlanta, GA 30333
• (tel) 404-498-2444
• sns6_at_cdc.gov