Health IT panel aims for middle road

Members of the new federal Health Information Technology Standards Committee said today they aim to create new standards that are sufficient to improve quality of care and efficiency but not so demanding as to cause delays and discourage providers.

“If we set the bar too low, we will not see the quality improvements,” Committee Member James Ferguson, director of information technology strategy and policy for Kaiser Permanente, said at the committee's first meeting. “But there is potential danger in a high bar.”

The health IT standards committee was established by Congress as part of the economic stimulus law to recommend basic technical requirements for health IT and exchange of medical data, and a process for certifying products that meet the standards.

Under the law, the Health and Human Services Department (HHS) will distribute $17 billion in incentive payments to doctors’ offices and hospitals who purchase and meaningfully apply certified health IT systems. A separate advisory panel, the Health IT Policy Committee, met for the first time on May 11 to begin defining “meaningful use” and outlining certification.

Both committees must have health IT products in place by 2011 under the law. “We are goal oriented,” said Dr. David Blumenthal, HHS’ National Coordinator for Health IT, who sits on the standards committee and chairs the policy panel. “We do not have time to remake the world.”

The standards panel initially may focus on IT standards in four areas, said Dr. John Halamka, chief information officer for Harvard Medical School and vice chair of the committee. Those areas are transmission and exchange of e-prescribing, laboratory results and clinical summaries, along with and quality measurements, he said.

However, unlike past health IT standards-making efforts, which focused on business-use cases, the committee should look at data elements and a functional basis for each exchange of information, he said.

The preferred method may be to create a common index of medical terms and a process for exchange of the patient data, he said. For e-prescribing, for example, “there would be one way to name a medicine and one way to do a refill,” Halamka said.

Another possibility is to look at secure messaging as a basis for secure exchange of patient data, suggested Committee Member David McCallie, vice president for medical informatics at Cerner Corp.

“What is the most important and commonly used standard for data exchange now? The answer is the fax [machine],” McCallie said. The goal would be to replace the fax machine with a secure emailing system for patient data along with authentication and verification procedures for senders and recipients, he said.

A middle road might be to leave some things in text format that is transmitted like e-mail messages, but to move toward a common index of medical terms that would allow “semantic interoperability” of different health IT systems, Ferguson added.

The standards committee should account for innovation and future technologies, and plan for retrofits with current technologies and updates when IT systems are replaced, suggested Committee Member Wes Rishel, vice president of Gartner’s health care practice. The committee needs to realistically recognize the knowledge and behavior of physicians to avoid providers’ “health IT rage,” Rishel said.

Standards for digitized imaging data should be added to the list of the committee’s priorities, suggested Committee Member Anne Castro, chief design architect of Blue Cross Blue Shield of South Carolina, She also suggested developing a “practical fast path” to key information on a specific patient to avoid the confusion that results when huge amounts of patient medical records are exchanged.

As a longer term goal, the committee also should work toward incorporating patient-centric care, said Commitee Member Janet Corrigan, president of the National Quality Forum. That would include obtaining data on patient outcomes, using IT to engage patients in their care decisions, and involve home caregivers.

At the same time, the panel should be mindful of the myriad things that could go wrong with health IT implementation, said Committee Member Dr. James Walker, chief of medical informatics for Geisinger Health System.

“This is not just about physicians’ comfort. It also is about patient safety,” Walker said. “All kinds of things can go wrong. [Health IT] must be phased in so that providers are not overwhelmed.”