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In recommendations on stage 3 meaningful use, the Office of the National Coordinator’s Health IT Standards Committee is urging ONC leaders to lean towards menu options and certification for use cases rather than core requirements, and to especially keep in mind that standards for a variety of clinical procedures are still evolving.
Standards committee vice chair and Beth Israel Deaconess Medical Center CIO John Halamka said their main concern was ensuring stage 3’s aspirations could be met practically, given current standard maturity and implementation trends.
Presenting the standards committee’s comments on several dozen meaningful use objectives to the Health IT Policy Committee, Halamka said that although the ONC is making progress in the Health eDecisions Initiative, there aren’t currently standards or technologies that “represent knowledge/rules and enable their automated incorporation into EHR workflows.” In other words, standards and interoperability for some functionalities and clinical procedures are still catching up to aspirations.
There’s currently no EHR vocabulary for describing adverse events or contraindications (factors, like allergies, for withholding a certain treatment), Halamka said. And there’s also no standardization for automation of multiple drug interactions and no way for automated broadcast of rules creating patient medication reconciliation and problem lists.
For the most part, Halamka said, the standards committee agrees with the stage 3 goals, and that meaningful use stage 2 “should be extended with higher thresholds which enable organizations and professionals to consolidate our gains.”
But, as Halamka wrote on his blog at 3:00 am Wednesday, “Given that the country is in the midst of ICD-10, Accountable Care/Healthcare Reform implementation, value-based purchasing, Meaningful Use stage 2, and HIPAA revisions, many clinicians, vendors, and IT professionals are feeling overwhelmed.”
A number of groups, including AMA, the AHA and the American Academy of Family Physicians, have called for delaying stage 3. Overall Halamka said he’s optimistic stage 3’s existing timelines will let providers “achieve a balance of benefit and burden” in key areas. But he thinks that the priority should be on “interoperability where standards are mature,” considering that some may not be forthcoming until 2016 and not implemented until thereafter.
The Health IT Standards Committee includes seven workgroups and has 25 members, including representatives from Kaiser Permanente, Cerner, Tenet Healthcare and the Genetic Alliance. Their comments cover a range of areas, sharing many of the ONC’s proposed stage 3 goals while trying to clarify certain provisions.
For a new meaningful use objective, computerized physician order entry referrals, the committee said it was unclear how the referral workflow would occur and if it would be a management process. “At this moment,” Halamka said, “there is not a product that we are aware of available in the marketplace that has this fully integrated CPOE referral closed loop capability.”
Atrius Health and Epic have developed the functionality for CPOE referrals in Boston pilot projects and it’s going to be tested with Boston Children’s Hospital via the state health information exchange, Halamka said, but the technology isn’t widely available now.
On a recommendation for incorporating smart medication reconciliation and problem lists into consolidated summary of care, the standards committee said the functionality “is not well enough characterized to be a certification criterion.” The functionality would be incredibly beneficial in helping diagnose conditions like hypertension and diabetes, Halamka said. “At the moment, there are no ways to represent rules, for example, to help us understand what a diabetic is that would be consumable from an EHR to an external source.”