Billions for health records rest on NIST standards

Health care information professionals say the success of the economic stimulus package's $19 billion investment in electronic health records rides on the development of technology standards.

The 2009 American Recovery and Reinvestment Act gives that job to the National Institute of Standards and Technology. NIST will receive $20 million to develop standards for electronic health records so that doctors and hospitals nationwide can share patients' files over what will eventually become the Nationwide Health Information Network.

Health IT researchers said those standards are the linchpin in making the system work. Dr. Bart Harmon, chief medical officer for systems integrator Harris Healthcare Solutions, called the standards critical to exchanging health data nationwide. Dr. Stephen Jones, principal deputy assistant secretary of Defense for health affairs, said "in order to have interoperability you must have standards . . . just like railroads need to have standard gauges of track."

The economic stimulus bill requires NIST to create a committee to recommend to the Office of the National Coordinator for Health Information Technology standards and certification criteria for individual health records systems.

President Bush established the national coordinator's office in 2004 and the stimulus act enshrines it in law. The bill also provides the office, currently headed by Robert Kolodner, broad authority to develop a standards-based, nationwide health IT infrastructure. The stimulus package gives $2 billion to the office to carry out the mandate and allocates $5 million for administrative overhead.

The systems that the national health network will tie together include personal health records, those used by doctors and hospitals, and larger regional systems that exchange aggregated health care information. The standards committee will include members representing health care providers; consumers; insurance plans; IT vendors; federal agencies; and individuals with technical expertise in health care quality, privacy and security, as well as the electronic exchange of information. The bill did not specify how many members should be on the committee.

The stimulus act also requires the national coordinator, which resides in the Health and Human Services Department, to "keep or recognize a program or program for the voluntary certification of health information technology." The nonprofit Certification Commission for Healthcare Information Technology, which is based in Chicago, currently certifies health technology for the national coordinator's office. Dr. Mark Leavitt, chairman of commission, said he interprets this section of the law to imply that his organization will continue its certification role because it is the only recognized health IT certification body in existence.

Leavitt said the act's language requiring certification using the commission's testing, supported by NIST, will ensure interoperability among health records systems nationwide. Vendors might be tempted to affix a standards label on an electronic health record system, but the commission's testing process ensures that all vendors' health IT systems will be able to share information. Leavitt said the commission has certified 160 health IT systems since 2006, including electronic health record systems used by doctors, hospital inpatient systems and emergency room systems. He expects the commission to certify personal health record systems this year.

Certification also is the key element in the Centers for Medicare and Medicaid Services' program to provide grants to doctors and hospitals to purchase the computer hardware and software for electronic health records systems. The stimulus law requires the agency to fund only those systems that have been certified.

CMS will receive $17 billion to give to doctors and hospitals to purchase systems and software through pay-for-performance grants. Doctors can receive grants worth up to $63,000 and hospitals could receive grants as high as $11 million for installation of health IT systems, said Chanley Howell, a partner in the Washington law office of Foley & Lardner, which specializes in IT.

Jones said the CMS grants to doctors will benefit the Defense Department's Military Health System because they will provide funding to civilian clinicians, some of whom care for military personnel, retirees and their families under the Tricare insurance program. If these clinicians purchase systems, they can exchange electronic medical data with Defense's electronic health record system known as AHLTA.