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Wednesday, April 11, 2012

SIFramework Face to Face

The rest of this week is the S&I Framework Face to Face meeting.  This morning's session is for project leads.  Since I happened to be here, I attended.  The project leads did go through some updates on their status, and I thought I'd share some of the more significant (at least to me) details:

First of all, Doug Fridsma introduced two new coordinators for the S&I Framework project.  Now, as some of you know, many of the the current contracts supporting the S&I initiative expire this Federal fiscal year (ending September 30th).  So, I observed the elephant in the room and asked the obvious question about how the initiative would be maintained given that it would be losing its funding.  Doug pointed out to me that ONC has regulatory authority, and so the S&I program could move forward using ONC budget allocations to move forward the agencies regulatory requirements to promote standards and certification.  Phew.  That's a relief.  I think.  At least we won't be left with a set of specifications that there is nobody to support, although I still wonder about the long term plan to make the initiative sustainable.  I've heard little about that since it's inception.

Hans Buitendijk reported on the Laboratory Reporting Interface initiative.  Basicially, the material is now being balloted in HL7, so that workgroup is on R&R.  However, there is also a Laboratory Orders Initiative starting (big surprise there).  While Hans referenced the LRI and eLincs work that has been done in that space, he is also aware of several other activities that have already taken place (having been involved in several of them):
My hope is that the great work that Clem McDonald (of NLM and LOINC fame) did on the Common Lab Observations for HITSP is finally put to use.

The Public Health Reporting Initiative reported on its work to reduce the variability in data standards across the various jurisdictions.  They have some 30 use cases that they are trying to harmonize data elements for.  They have been doing some mapping to the Data dictionary work coming out of Transfers of Care and Query Health.  My hope, consistent with some of the work that has been done for Cancer Registries, is that eventually we can move to a model of using CDA for much of this content.

Three of the current S&I Projects are funded outside of ONC sources, including esMD (electronic submission of medical documents), LCC (long-term care), and public health reporting.

LCC is working on a longitudinal care plan.  LCC is presently working on supporting exchange of assessment data, currently being piloted by one of the Beacon Communities (Geisinger).  Consolidated CDA is going to be updated to provide some NEW templates to support better representation of assessments, and it will hopefully also support the needs of the CMS CARE program to harmonize assessments across long-term care agencies.

The CIC (Cross Initiative) workgroup reported out on their accomplishments.  One of them is that the initial work on the CEDD (Clinical Element Data Dictionary) is now available in USHIK.  CEDD isn't a TLA, so they are thinking about a name change to HDD (Healthcare Data Dictionary).

Several times today I heard the phrase "S&I Framework 2.0".  Given the outcomes on AHIC 2.0 and HITSP 2.0, I hope they decide to come up with a different way to talk about restructuring S&I.  Maybe they should just move directly to V3 ;-)


1 comment:

  1. Despite Dr. Fridsma's assurances, government funding and sponsorship is a political process that offers more risk than rewards. I would like to see a clear plan to put the S&I work into a less risky position.

    One way to reduce risk is to have sound metrics that show benefits from the work being done. They cannot be theoretical or estimated benefits, but actual recurring ones. It needs to prove that the work is worthy of being perpetuated. I wonder where the metrics are and who is responsible for publishing them.

    Another way to reduce risk is to focus on actual known and measured risks. For example... Significant risk in health care IT comes from clinical data unavailability, tardiness, disuse, and error. It is risky because it actually harms patients. Interoperability is presumptively a key to this, but how do we measure its effectiveness as a means for risk reduction?

    Without a plan, with such metrics-based business rationale, to perpetuate the S&I framework it will rightfully become dust-gathering shelfware.