Healthcare Standards: ARRA: Short Term Tactics or Long Term Strategic Plan

Monday, July 20, 2009

ARRA: Short Term Tactics or Long Term Strategic Plan

Today I gave a brief presentation to a class covering "Key Standards in Health Informatics" at Northeastern University. While the capstone of my presentation was meant to be the HITSP Capabilities of IS 107, I spent far too much time on my "Brief History" slide to do the HITSP capabilities justice. However, I found that I really enjoyed putting the History slide together and presenting on it. The slide covers some key events over the past 10 years that help to formulate where we are today. My timeline is not complete, I'm missing key dates (e.g., the ONCHIT-1 through 4 RFP dates), and there are significant gaps in other areas, and I could go back even further if I hadn't placed a self imposed 1-decade limit on it. However, it's enough to fill a Slide at 12 point type, which argues that it is already too much. I reproduce the content of that slide below:

Nov 1999: IOM: To Err is Human: Building a Safer Health System
Nov 15, 2001: NCVHS: Information for Health: A Strategy for Building the National Health Information Infrastructure
Jul 18, 2003: HL7 EHR System Functional Model Draft Standard for Trial Use Begins
Jul 31, 2003: IOM: Key Capabilities of an Electronic Health Record System
Apr 27, 2004: EO 13335: Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator
Jul 2004: HL7 EHR System Functional Model Draft Standard for Trial Use Published
Jul 2004: CCHIT Formed by AHIMA, HIMSS and NAHIT (The Alliance)
Jul 21, 2004: The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care
Nov 9, 2004: ONCHIT RFI: Development and Adoption of a National Health Information Network
Jan 17, 2005: 13 Member Collaborative Response (AHIMA, AMIA, ANSI/HISB, CITL, CfH, eHealth, HIMSS, HL7, EHR(V)A, IHE, Internet2, Liberty Alliance, NAHIT)
Sep 13, 2005: American Health Information Community formed as Federal Advisory Committee
Sep 2005: ONCHIT-1 – ONCHIT-4 Awarded
Oct 2005: ANSI/HITSP Founded by ANSI, HIMSS, Booz Allen Hamilton, and the Advanced Technology Institute

EO 13410: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs
Oct 26, 2006: CCHIT Recognized as a Certifying Body
Jan 2008: HITSP Specifications Recognized; HITSP Specifications Recognized
Feb 17, 2009: ARRA Passes

HITSP IS 107 EHR-Centric Release for Implementation
Jul 17, 2009: Meaningful Use Defined
Jul 21, 2009: Standards Committee Meets to Identify Standards for Meaningful Use

I spent a good 20 minutes on this slide showing how we got to meaningful use today. Going through this history you can see how

The IOM 8 functional areas are tied to the HL7 EHR Functional Model, CCHIT Certification Critiera, and the ARRA 8.

The National Health Information Infrastructure became the National Health Information Network

Programs such as CHI and HISB were rolled into ANSI/HITSP.

Executive Order 13335 and 13410 become keys points in ARRA and HITECH, to the point of using almost the same language.

You might find it instructive to go back through some of this historical material for yourself and see where we've been and how it's influenced (or failed to influence) where we are today, and more importantly, where we will be tomorrow. I reread various pieces of these documents today, and found the review to be very illuminating.

Keith

P.S. One of the students remarked during her presentation on ICD-10 that followed mine that "... the costs exceed $1B dollars, but that doesn't sound like so much after hearing Keith speak." I'm not sure what she meant, but I thought it significant enough editorially to include the comment here.