HHS adopts new rules to coordinate health care technology

The Health and Human Services Department on Wednesday announced several new interoperability standards for health care information technology, paving the way for nationwide adoption of electronic health records.

Three new sets of IT standards aimed at enabling diverse systems to talk to one another took effect on Jan. 16, according to a notice in the Jan. 21 Federal Register. The standards are mandatory for all federal agencies implementing any type of health care information technology system.

"We recognize that if we want interoperable health care and want [President] Obama's vision of e-health records by 2015, we don't need islands of hardware and software; we need a coordinated health care system," said Dr. John Halamka, chief information officer for Harvard University's Medical School and chairman of the Healthcare Information Technology Standards Panel, which established the standards. Halamka said Wednesday's announcement means that a lack of uniformity among IT standards is no longer a barrier to the creation of national e-health care records.

Obama has said establishing e-health records is a priority for his administration.

The three groups of standards use XML tags to define data elements common to all medical records. Those elements are searchable by any network user seeking a particular piece of information. A spokesperson for HITSP said the new standards use existing technology available on the market.

"The notion that there will be a single medical record system for the country won't work," said Halamka. "But we want a network of networks, where single hospitals and doctors can communicate with each other and send stuff back and forth over the wire. That's really what a nationwide health care network is all about."

The notice in the Federal Registeroutlines interoperability standards for electronic health records used by emergency first responders, consumers seeking to download their own medical records, and organizations examining the quality of medical care provided by hospitals, providers and other groups.

Halamka said there are about 60,000 data elements in the average medical record, but not all of them are necessary for every search. The panel examined the possible uses for electronic health care data and determined which elements would be most helpful to providers, researchers and public health organizations. Then each "use case" was assigned interoperability standards to ensure the data contained in the records is available to all stakeholders while taking appropriate privacy and security concerns into consideration.

The first set of new standards address how emergency responders access the electronic health records of patients involved in a mass incident such as a terrorist attack or natural disaster. It describes how to obtain a person's lifetime medical records, including a list of medical problems and history, and transmit that information to emergency responders without compromising security or privacy.

The second set of standards relates to how individuals access their own electronic health records and transmit them using a storage device such as a thumb drive or DVD. It establishes a standard level of encryption and requires password protection to call up the records. In addition, it develops an audit trail so users can track how many times a particular record has been downloaded.

The third group of standards is aimed at researchers and public health organizations seeking to use medical records to track patient care and make sure health care providers are using best practices. Halamka said the panel worked closely with the National Quality Forum, a nonprofit organization dedicated to developing a strategy for measuring health care quality to ensure that the metrics being used are relevant and that the data being accessed does not compromise patient privacy.

Last year HHS recognized interoperability standards for personal health records as well as for biometric surveillance data. The Jan. 21 notice also contained some updates to those standards in keeping with the latest technological developments.