In 2011 IHE published the Reconciliation of Diagnoses, Allergies and Medications (RECON) profile which described the interoperability requirements for reconciling these items from multiple sources. Remarkably, without even trying, this profile was very well aligned with ONC's Meaningful Use Stage 2 requirements which were published later in 2012, as I described here.
The profile has received little uptake, in part due to attention to Meaningful Use in the US, and perhaps because of some unnecessary complexity. Many EHR vendors implement the basic Reconciliation capability described in the profile. However, none implemented the recording functions around the reconciliation specified in the profile, and that may have been one of the reasons.
This year, IHE re-factored this profile to incorporate reconciliation of other data elements needed for care management, and made it simpler and easier to implement.
The Reconciliation Agent is the principle actor in this profile, and it supports the basic operation of reconciling data from multiple lists in an appropriate user interface. This is the same capability that I've seen most EHR vendors demonstrate, so they can have it basically by declaring it (and ensuring that they support the required functionality in the profile, which most likely do).
We split off the requirement that subsequent content be created with an annotation of the reconciliation act having been performed, and simplified the requirements for that act. In the original profile, this was required. Now it is described as a named option. Finally, the structure of the Reconciliation act has been simplified. When present, it simply declares that all the things of the type indicated in that section (be they problems, medications, allergies, et cetera) have been reconciled, who did the reconciliation and when, and what the sources of information were. It no longer has to wrap the reconciled content, and because of that, we don't need a different one for each kind of item to reconcile.
So now it is easier to implement, and so I hope to see many more systems using it and testing it at connectathon next year.
Keith, though this comment is several months after the fact, I hope you still see it.
ReplyDeleteI'm glad to see there was a refresh of RECON, and that it addresses the recording of the reconciliation act (which some clinicians clamored for, but didn't get, in CCDA for MU2). I hope that FACAs/ONC/S&I will give more attention to the need for guidance re reconciliation, since everyone seems to be complaining of difficulties in data consumption in CCDA, of which reconciliation is one aspect.
Do you know if there are any other fledgling standards, other that RECON, providing guidance for reconciliation? And is FHIR addressing reconciliation in any way?