Friday, April 17, 2009

Of Moon Shots and Progress

I've previously described George Bush's executive order 13335 issued in early 2004 as the initial step in moon-shot for healthcare. In announcing this order, he called for most Americans to have secure, interoperable electronic health records by 2014. I'm not sure his announcement was as stirring and Kennedy's in 1961, but it's still been a tumultuous and exiting time for those of us involved in healthcare.

If you've been tracking what's been going on at the national level for the past five or six years, you are fairly aware of many of the things that have occured since that order, including the creation of ANSI/HITSP as a body selecting standards, CCHIT certifying EHR products, multiple NHIN projects demonstrating the ability of those standards to connect the nation together, HISPC activities to rationalize policy, recognition of selected standards, testing of those implementations, and their actual use in real world projects. The incorporation of much of what was championed by that executive order, and executive order 13410 which followed it into the HITECH legislation enacted under the America Reinvestment and Recover Act of 2009 is yet another significant step forward for all of us.

As we move forward, I've heard several complaints about the "lack of progress", the gist of which are that "we aren't there yet". We still have a ways to go before we are done, as was anticipated when this was originally outlined as a 10-year goal. We are at the mid-point of that goal, and I ask you to look at the successes we've already seen. Many of the HITSP specifications not just prototyped, tested, or piloted, but put into real production and use, and available in real-world products. We'll be hearing later this year from some of those HIEs in the real world who have already implemented HITSP specifications. This year, the CCHIT certification criteria includes several HITSP specifications for the first time. I fully expect to see numerous systems that have already demonstrated their ablilty to implement HITSP specifications become certified for the first time.

NASA took six and a half years from Kennedy's commitment to land men on the moon before the first unmanned launch of the Saturn V rocket into low earth orbit. HITSP's managed to accomplish a similar feat in only 4 years since it's inception.

So in response to "Are we there yet?" I answer "No, we are about halfway, but be patient. We will arrive in due time."

Tuesday, April 14, 2009

What is HITSP Doing?

The American Recovery and Reinvestment Act (ARRA) has a number of provisions and deadlines which need to be completed by the end of this year. One of these is the publication of a proposed regulation by December 31st of this year. The Office of the National Coordinator (ONC) realized that many of the requirements of ARRA are already supported by publications from ANSI/HITSP, but that these need to be restructured to support the ARRA requirements.

HITSP has been asked by ONC to produce an interoperability specification to support the needs of that office in obeyance of the ARRA law. The accepted publications produced by HITSP to date (those referenced by IS01 through IS12 and IS77) are expected to be used within this specification. The end result is intended to be a simpler publication that addresses the interoperability requirements needed for meaningful use of EHR systems.

As a result, HITSP has formed five tiger teams to quickly produce this information for the HITSP Panel approval by July 15th. The tiger team leadership was selected from existing HITSP Co-chairs and Staff, and approved by John Halamka, chair of ANSI/HITSP. We recieved notification today of who was selected to co-chair the teams.

The five tiger teams are:

Tiger TeamCochairs
EHR-Context ISManick Rajendran, Eze Care LLC
Corey Spears, McKesson
Mike Nusbaum, HITSP
Data ArchitectureDon Bechtel, Siemens
Keith W. Boone, GE Healthcare
Don Van Syckle, HITSP
Exchange Architecture and Harmonization FrameworkSteve Hufnagel, DOD
Mike Lincoln, VA
Ed Larsen, HITSP
Security and PrivacyJohn Moehrke, GE Healthcare
Glen Marshall, Grok-a-lot
Jonathon Coleman, HITSP
Quality MeasuresFloyd Eisenberg, NCQA
Lori Fourqet, HITSP

The EHR-Context IS team will be developing a new implementation specification, focused on the EHR.

The data architecture team will be focusing on describing the information requirements of interoperable exchanges used by the new IS.

The Exchange Architecture and Harmonization Framework team will be addressing the exchange services and underlying base standards used by the new IS.

The Security and Privacy team will be addressing the Security and Privacy services needed in interoperable exchanges used by the new IS.

The Quality Measures team will be addressing how to exchange quality measures in the new IS.

This is all happening rather rapidly, and new information is coming to light daily. Calls will be held tommorrow and Thursday to kick off the new work for each team. If you are interested in participating in any of these teams and are already a HITSP member, I urge you to contact the leaders of the technical committees that you are a member of to see where you might best assist. If you aren't a HITSP member but want to contribute, please see, as we would welcome your assistance in this new work.

I'm especially urging those with experise in data elements used in HL7 Version 2, CDA Release 2, NCPDP and X12 standards, as well as those with expertise in vocabulary, including SNOMED, LOINC, RxNORM, et cetera to participate in the Data Architecture tiger team.