Health data standard could be key to better informed patients

An emerging technical standard could improve the delivery of health information to patients -- and help electronic health records comply with "meaningful use" requirements under Human Services Department rules, according to a new white paper from health executives.

The Health Level 7 “Infobutton” global decision-support standard has been circulating in draft form since 2007 and is currently under consideration by the American National Standards Institute. The health executives who wrote the Jan. 25 white paper would like to see the standard broadly adopted. 

"Now there is an easier way to help doctors keep their patients fully informed and engaged,” wrote co-author Don Kemper, chief executive of Healthwise, a nonprofit organization that promotes patient engagement. The other authors are Dr. Guilherme Del Fiol, assistant professor of clinical informations at Duke University; Leslie Kelly Hall, Healthwise senior vice president; and Shawn Myers, Healthwise senior product manager.

There is also a lot of money at stake.

HHS recently released a Notice of Proposed Rulemaking that describes how doctors and hospitals can become meaningful users of digital records. Providers who meet the requirements can qualify for a share of $17 billion in economic stimulus law payments.

Among the requirements are benchmarks for patient engagement. For example, doctors must provide an electronic copy of a patient’s medical record from a visit within 48 hours, if requested. Hospitals must provide an electronic copy of the patient discharge summary.

The Health Level 7 standard, also referred to as the Context-Aware Knowledge Retrieval Standard and the Infobutton standard, was initially developed to assist in delivering decision-support clinical information to doctors when they need it. It is still used in that manner.

At the same time, the standard also may be applied to improve patient engagement to fulfill the meaningful use requirements under HHS’ proposed rule, the authors wrote. The standard automates the process by which patients receive care and diagnoses information, and tailors the information to their needs based the diagnoses and time of request, among other factors.

A patient who was just diagnosed with high blood pressure, for example, may be given Web-based information on the disease, on treatments, and on additional sources of help, and a schedule for medications. The doctor can request the information from the computer, or it can be automatically triggered. Triggers also can be activated over time, such as when the patient is advised to come back for a followup visit.

The need for prescribed information is complicated because it must be tailored to the patient’s situation and must not cause too much interfence with the workflow in the doctor’s office, the white paper states.

“Patients need information that is specific to who they are, where they are, and what treatment and self-management choices they face at a specific clinical moment. If the information isn’t relevant and doesn’t help them make a better decision or improve the self-management of their specific health problem, then it just doesn’t help. For the expanded vision of meaningful use to succeed, developers and implementers of Health IT need a way to integrate the complex needs of patients and families into the Health IT infrastructure without fundamentally changing design or hindering use,” the paper states.

The white paper characterizes the Health Level 7 standard as a feature of information therapy, a relatively new discipline. Several information therapy standards are included in the HHS’s recent proposed rulemaking on meaningful use.