STANDARDS
Standards Focus on Meaningful Use of EHR Systems
Noam H. Arzt
By Noam H. Arzt, PhD, FHIMSS
In January, 2010, the Interim Final Rule for Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology was published by the Office of the National Coordinator for Health Information Technology (ONC). It contains an initial set of standards for electronic health record systems (EHR-S) relevant to meaningful use. It builds upon earlier work by the Healthcare Information Technology Standards Panel (HITSP) and other organizations.
Many of the selected standards are displayed in a number of key tables:
| Table in Document | Federal Register Page Numbers | Contents |
| Table 1 | 2025-2028 | Certification criteria for each Stage 1 meaningful use objective |
| Table 2A | 2033-2034 | Content and vocabulary (semantic) interoperability standards |
| Table 2B | 2035 | Privacy and security standards |
| n/a | 2043 | Transport standards |
The Interim Final Rule is in many ways a companion guide for the Notice of Proposed Rulemaking for the Medicare and Medicaid Programs Electronic Health Record Incentive Program released at roughly the same time. The Notice (among other things) describes which HIE transactions are expected to be implemented to achieve meaningful use; the Interim Final Rule identifies which standards should be used to implement them. There appear to be only modest expectations on the part of CMS and ONC for HIE in the initial “Stage 1” rules. But it will take many HIEs years to position the necessary infrastructure, policies, and standards to fulfill these requirements even several years down the line.
There are no real surprises in the Interim Final Rule when it comes to standards. Many of the elements have been in active use for years (e.g., HL7 CCD and v2 messages, code sets like ICD-9-CM and SNOMED-CT®, transport standards like SOAP and REST). Just about all of them are incorporated in HITSP Interoperability Specifications currently published. These standards represent the culmination of years of work, and it seems appropriate that they should be released in the same month that the current contract between ONC and HITSP is due to end. For nearly five years, HITSP volunteers and staff worked countless hours to collect, analyze, and harmonize health information technology standards from many different standards development organizations and recommend selected standards for recognition by the U.S. government. ONC will be soliciting proposals in the coming months for a successor to HITSP so that the work of standards harmonization can continue.
Technology Corner
Engaged in Interoperability at IHE 2010 North America Connectathon
Now in its 11th year, the Integrating the Healthcare Enterprise (IHE) 2010 North America Connectathon, Jan. 11-15 at the Hyatt Regency Hotel Chicago, provided a detailed implementation and testing process to promote the adoption of standards-based interoperability. Focused on EHR system connectivity and interoperable exchange of patient health data with standards-based systems, the IHE 2010 North America Connectathon brought together:
- 498 system engineers…who were testing
- More than 150 health IT systems…from
- 104 participating companies/organizations
At this year’s IHE North America Connectathon, engineers filled the Hyatt Regency’s basement ballroom and exchanged information with complementary systems from multiple vendors and organizations.
The IHE Connectathon is the healthcare IT industry's only large-scale interoperability testing event. Connectathons are held annually in Asia, Europe and North America. During the Connectathon, systems exchange information with complementary systems from multiple vendors, performing all of the transactions required for the roles they have selected, called IHE Actors, in support of defined clinical use cases, called IHE Profiles. These Profiles then provide exact definitions of how standards can be implemented to meet specific clinical needs.
HIMSS10 Interoperability Showcase™
As a connectivity test-run, the IHE 2010 North America Connectathon is considered as mandatory preparation for upcoming Interoperability Showcase events, including the HIMSS 2010 Interoperability Showcase on March 1-3 in Atlanta, Ga. during HIMSS10. With 73 participating vendors and organizations, the HIMSS 2010 Interoperability Showcase illustrates how interoperability drives improvements in the quality, safety and efficiency of care. As in previous years, the Showcase highlights IHE's common framework and Healthcare Information Technology Standards Panel (HITSP) Interoperability Specifications for delivering interoperability across local, regional and national health information exchanges.
Additional details on the IHE 2010 North America Connectathon are available online. Click here for more information on IHE.
HIE NEWS
CAQH Resources Complement Federal Requirements for HIE Funding
CAQH®, a nonprofit alliance of health plans and trade associations, is a catalyst for industry collaboration on initiatives that simplify healthcare administration. The Universal Provider Datasource® (UPD) and the Committee on Operating Rules for Information Exchange® (CORE), two CAQH initiatives, are helping address national healthcare priorities.
The American Recovery and Reinvestment Act of 2009 (ARRA) and its provision, the Health Information Technology for Economic and Clinical Health Act (HITECH), offer incentives to establish HIEs that facilitate the movement of administrative and clinical information and improve quality programs. The Funding Opportunity Announcement (FOA) issued by the Office of the National Coordinator (ONC) regarding state HIE requires states to detail strategic and operational data exchange activities. Among the technical infrastructure requirements, states must build services that support the development of statewide provider directories.
State HIEs and UPD
UPD is the industry standard for provider data collection. It eliminates the need to complete multiple forms by enabling providers to enter their information once through a secure, Web-based, centralized database. The service is trusted by nearly 800,000 providers and over 550 private and public organizations; thirteen states have designated the use of UPD for credentialing. State Medicaid agencies, such as those in Kentucky, New York, and Pennsylvania, are also actively adopting UPD. The FOA technical infrastructure requirement for provider directories stipulates that HIEs will aggregate provider practice locations, specialties, health plan participation, and disciplinary actions. UPD can support this specification. It can also support emergency responder registries to meet state disaster planning and recovery efforts. Additionally, UPD offers states an option to track provider sanctions, continuously monitoring more than 400 state licensing boards, Medicare, Medicaid, OIG and OPM for disciplinary actions. Integrating this functionality into state information exchanges is a natural extension of the HIE value proposition.
Based on a study by MGMA, UPD has eliminated nearly 2.3 million paper applications and reduced provider administrative costs by almost $90 million per year.
For more information on UPD, contact Sorin Davis at sdavis@caqh.org.
HIE Summit for Community-Based Healthcare Organizations
MCHC HIE Summit participants (from left to right): Terri Jacobsen, Director of HIE, MCHC; Cheryl Whitaker, Senior Program Officer, Chicago Community Trust; Mary Anne Kelly, Vice President of HIE, MCHC; Pam Matthews, Senior Director, Business & Financial Information Systems, HIMSS; and Gina Perez, Executive Director, Delaware Health Information Network.
On Jan. 11, the Metropolitan Chicago Healthcare Council* (MCHC) hosted an HIE Summit for community-based healthcare organizations sponsored by The Chicago Community Trust. The summit’s purpose was to convene the Chicago area community-based healthcare organizations and Federally Qualified Health Centers (FQHCs) to determine their current resources and state of readiness for HIE and broadband technology, so that these organizations can be better prepared for the HIE and broadband initiatives and better serve their vulnerable populations, which will ultimately improve patient outcomes within their communities.
Presentation topics included:
- National overview of HIEs, presented by Pam Matthews, Senior Director of Business & Financial Information Systems, HIMSS. Topics covered included ARRA, a historical context of HIEs, and examples of successful HIEs.
- Case studies of successful community-based HIEs presented by Dr. Fred Rachman, CEO of Alliance of Chicago Community Health Services. Dr. Rachman provided specific examples of how HIE applies to community-based organizations and the impact on workflow and care delivery.
- HIE from the State of Illinois’ perspective, presented by Laura Zaremba, Illinois Department of Healthcare and Family Services. Topics discussed included future direction, current state of federal and state funding, and plans for establishing State OHIT.
- FQHC HIE case study, presented by Gina Perez, Delaware Health Information Network (DHIN). Ms. Perez discussed how HIEs positively impacted FQHCs in their delivery of care communities.
Representatives from the State of Illinois Department of Healthcare and Family Services, along with MCHC, facilitated discussions on the factors for success which included identifying the current state of preparedness – based on hardware, software, IT infrastructure, IT staff, number of staff trained, and IT operating budget; the resources and strengths, as well as barriers, to health IT and HIE; and the needs to facilitate success.
Participants stated the need for direction and support to become involved in an HIE due to the lack of clarity with regard to behavioral health, long term care and other community organizations that do not qualify for meaningful use incentives. The Summit was attended by representatives across the community-based spectrum including public health, FQHCs, behavioral health, free clinics, and homeless shelter providers. In addition, MCHC is working on a white paper consisting of recommendations for community-based health organizations.
*MCHC is a membership and service association comprising more than 150 hospitals and healthcare organizations working together, since 1935, to improve the delivery of healthcare services in the Chicago area. The Council's Institutional members consist of hospitals (and their integrated delivery systems) in the eight-county Chicago area. Associate members include hospitals outside these counties, as well as physician groups, nursing homes, outpatient treatment centers, insurers, medical schools and other healthcare organizations.
A Sustainable, Collaborative Approach to HIE Creates Value for Providers
Jim Bodenbender
By Jim Bodenbender
Last month, another RHIO announced that it was closing. This announcement comes after the release of meaningful use guidelines that lead us toward the secure exchange of health information. It also comes at a time when patient-centered medical home (PCMH) pilot programs are increasing, providers are expanding collaborative care initiatives within their communities and the industry as a whole is making cautious movements toward a bundled-payment model. The convergence of these events demonstrates that a sustainable model for HIE is crucial to the success of healthcare information technology incentives.
A clue contained within the meaningful use guidelines suggests a pathway to creating sustainable HIE models. While the focus of the meaningful use standard is on the sharing of clinical information, these guidelines also require that providers send 80 percent of their claims electronically and that they be able to check eligibility electronically. The advanced administrative or financially focused transactions and tools that enable this portion of the meaningful use guidelines can also create value for providers—and are the key to creating sustainable HIE.
This combination of needs—the ability to share clinical information regardless of system, the ability to share financial and administrative information regardless of system and the need for sustainability of information exchange programs—demonstrates that we must look beyond our current individual systems toward a category of meaningfully connected care.
What is this new category of products and services? Meaningfully connected care provides all of the aspects of interoperable connectivity that providers need to achieve meaningful use. It also provides the specialized tools that bring financial value to the provider organization, enabling the sustained exchange of health information. Finally, meaningfully connected care allows for collaborative care throughout a community— and beyond into the nation as a whole.
As this model is duplicated across the nation, HIE will become a sustainable reality and enable a new level of efficiency for all healthcare constituents.
Jim Bodenbender is president of RelayHealth’s Provider and Consumer Solutions. He has responsibility for the operational management and strategic direction of the business, which includes research and development, sales and channel management, business development, product management, customer support, and account management. Mr. Bodenbender has more than 25 years’ experience in healthcare information systems and services. He can be reached at Jim.Bodenbender@RelayHealth.com.
New Medicare Quality Demonstrations in North Carolina, Indiana to Address Quality Improvement Efforts
Two demonstrations comprised of a community-wide HIE in Indiana and a consortium of several community care physician networks in North Carolina are being implemented to encourage the delivery of improved quality care to an estimated 130,000 beneficiaries in those states, according to the Centers for Medicare & Medicaid Services (CMS). The demonstrations are part of the national, five-year Medicare Health Care Quality (MHCQ) demonstration mandated by Congress in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The Indiana and North Carolina demonstrations will make more effective use of best practice guidelines, encouraging shared decision making between providers and patients, and altering incentives for care delivery.
Each demonstration uses a different approach but each is intended to improve quality of care received by Medicare beneficiaries at less cost to Medicare. Both CMS demonstrations allow the organizations to share in a portion of Medicare savings achieved once quality of care and cost objectives are met.
Click here for more details on the demonstrations.
CCSNPC Plans for Roll-out of HIE Pilot Project
Located in Savannah, Georgia, the Chatham County Safety Net Planning Council (CCSNPC) is a collaboration of local providers, government representatives, advocates and consumers charged with assisting the Chatham County Commission in addressing the healthcare needs of the uninsured and underinsured. CCSNPC goals include strengthening local partnerships to build healthcare infrastructure, increasing access to care through enhanced capacity and improving efficiency within their community's Safety Net system through ongoing collaboration and evaluation. A critical piece recognized by CCSNPC in achieving these goals is establishing an HIE beginning with a Pilot Project connecting Memorial Health University Medical Center’s Emergency Department and one Federally Qualified Health Center, J.C. Lewis Health Center. Funding for the Pilot Project came through the Georgia Department of Community Health, the CCSNPC HIE having been selected as one of three state demonstration projects, and a Health Resources and Services Administration earmark for equipment and software purchasing.
Through its upcoming Pilot Project, CCSNPC’s long term goal is to expand the Chatham County Health Information Exchange (HIE) to serve the more than 250,000 people in the Southeast Coastal Georgia County. The focus of the HIE infrastructure deployment was to create an infrastructure that allows for secure data exchange, messaging, a clinical data repository, a master patient index and a web-based portal for Safety Net providers, consumers, and others involved in supporting the communities’ healthcare. The anticipated go-live date for the Pilot Project is March 31. CCSNPC’s future aspirations extend to the participation of all regional healthcare providers including the rest of the Safety Net providers, regional hospitals, private providers and public health.
Call for Participation for Public Comment Process
On Dec. 30, 2009, the Department of Health & Human Services released the Notice of Proposed Rule Making establishing the Electronic Health Record Incentive Program, better known as ‘meaningful use,’ and the Interim Final Rule establishing the Initial Set of Standards, Implementation Specifications and Certification Criteria for EHR Technology. HIMSS has responded with a host of online tools, resources and educational opportunities to help members navigate and analyze the nearly 700 pages of regulatory change. HIMSS is looking for members from the HIE community to participate in the Society’s efforts within the public comment process. To join this effort and be included in upcoming calls, please contact Andrew Piersol, coordinator, Business & Financial Information Systems.
HIMSS Call for Committee Volunteers Now Open
HIMSS is seeking volunteers interested in applying for a Committee appointment for fiscal year 2011. Committee participation is open to all members who have at least one year of consecutive membership (12 continuous months) and are not currently serving in a HIMSS leadership position. Committee appointments are assigned by the HIMSS Chair-Elect with input from existing committee leadership. Committee terms are for two years (June 2010 through July 2012). Accepted applicants will be notified of their appointments via e-mail on or before April 30. For more information and to complete the online application form, visit HIMSS’ Committee page online. Members with questions regarding serving on a committee or the application process should contact Member Services Coordinator Megan McGuirk.
Legal Corner
As Procurements Approach, Attention Shifts to Effective Process
By Allen Briskin and Gerry Hinkley, Pillsbury Winthrop Shaw Pittman LLP
Gerry Hinkley
Allen Briskin
As the States’ HIE plans coalesce, attention will be shifting to the health IT procurement process for each initiative. Those charged with procuring health IT systems, as well as the vendors who wish to provide those systems, stand to benefit by understanding the procurement process and how that process can work effectively.
The procuring agency should assemble a project team in which the essential disciplines are represented: process administration, finance, IT expertise, risk management, legal and so on. The agency should establish a procurement timeline that starts at the end, with the date by which it needs the procurement contract to be executed, and then works backward to accommodate all the procurement process’s phases.
Procurement phases typically include: developing the request for proposals (“RFP”), identifying prospective bidders; soliciting and addressing bidders’ questions (through a bidder’s conference and/or through a written question and answer process); modifying the RFP if appropriate to address issues identified by bidders; a due date for proposals; a process for evaluating the proposals received; notifications to finalists and site visits and/or demonstrations by those finalists; contract negotiations with the finalists; selection of the winning bidder; and completion of the contract. When planning the procurement process, extra time should always be included to allow for a certain measure of unavoidable delays. Holidays, summer vacations and the like should be remembered and taken into account.
The development of the RFP should be focused upon making it understandable to bidders and likely to develop responses that will be helpful to the agency’s decision-making. The RFP should help bidders focus their resources upon providing the information that the agency needs to distinguish among bidders. Of course, the RFP should also describe the agency’s organizational, financial, technical and legal requirements, in order to fully inform bidders of both the evaluation criteria as well as the substantive requirements for the completed contract.
When developing the RFP, the agency should also develop the scoring criteria it will apply to rank bidders and select finalists. The scoring and evaluation process should be focused upon selecting a limited number of finalists for closer examination. Having more than one finalist helps assure that the process remains competitive through the final selection. Site visits and demonstrations should be required of each finalist. Also, as an essential element of the selection process, the agency should negotiate the terms of the contract with each of the finalists, and then include the results of that negotiation in the final evaluation and selection of the winning bidder. The procuring agency typically has greater bargaining power in negotiating licensing and service agreements when the bidders remain in competition with each other.
Thoroughly preparing for the procurement process, giving bidders the information they need to prepare the best and most responsive proposals, maintaining the competitive dynamic of the process, and remaining on schedule can help bidders make their best presentations and help the agency achieve its objectives on time.
Calendar of Events
Upcoming HIE Events
HIMSS Chapter HIE Roundtable Call
Thursday, Feb. 18, 12 pm Eastern
Topic: SAFEHealth – A Sustainable HIE with a Novel Patient Consent Architecture
Guest Speaker: Larry Garber, MD, Medical Director for Informatics, Fallon Clinic/SAFEHealth
This call is open to ALL interested HIMSS Members!
Register here for this free event!
HIMSS10 HIE Symposium—"Meaningful HIE"
Feb. 28, 2010
Held in conjunction with the 2010 Annual HIMSS Conference and Exhibition in Atlanta, the full-day HIMSS10 HIE Symposium—Meaningful HIE explores issues and challenges facing today's HIEs and shares success stories. Topics include:
- The national landscape of HIEs.
- Grants and programs available through the American Recovery and Reinvestment Act.
- Plans for achieving meaningful use across states.
- Success stories from HIEs in rural and underserved communities.
The symposium wraps up with a networking reception.
Registration
Save $100 when you register for the full conference and a pre-conference symposium. This special discount applies to full paid conference registration (Sunday-Thursday) only and is not available for students. The discount will be applied automatically during the registration process. Visit the HIMSS10 Web Site for more information.
ARRA Webinar Series on Meaningful Use and Certification Criteria
Workforce Development: An Industry Update
Feb. 10
12 – 1 pm CT
2010 Annual HIMSS Conference & Exhibition
March 1-4, 2010
Atlanta, Ga.
2010 World of Health IT Conference & Exhibition
March 15-18, 2010
Barcelona, Spain
HIMSS AsiaPac10 Exposition
May 26-28, 2010
Beijing, China
HIMSS Virtual Conference & Expo
June 9-10
6th Annual Government Health IT Conference & Exhibition
June 15-16
Washington, D.C.
HIMSS 9th Annual Policy Summit
June 16-17
Washington, DC