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Joyce Sensmeier, HIMSS VP for informatics, told the congressional subcommittee on technology and innovation last week that data transport and basic security are focus areas where selected standards are missing. However, these standards are crucial as healthcare organizations prepare to exchange data between departments within a hospital and between hospital computers and systems residing at local, state, and federal organizations.
"We understand that Stage 1 is not intended to force interoperability on a healthcare community that is not technically ready to meet the requirement. However, identifying the accepted transportation method will have a dramatic impact on preparedness for Stage 2," Sensmeier said. "For example, it is important to designate standards for documenting the content of clinical summaries, but if we don't know how to transmit these summaries or acknowledge their receipt, we will have limited interoperability."
In her testimony to the committee, Sensmeier said that until the recommended transport standards are identified, EHR vendors will be forced to support all available transport methods, or risk developing software that may not meet future interoperability needs. She said the lack of guidance creates marketplace confusion, wastes existing resources, and could ultimately delay the progress of implementing EHR systems.
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, the Medicare and Medicaid EHR incentive programs was established to provide incentive payments for the "meaningful use" of certified EHR technology. The program provides incentive payments to eligible professionals and hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology.
According to Sensmeier, if vendors don't know what the selected standards are going to be, then they will guess what they might be and build those into their product development. Furthermore, there are currently two clinical summary content standards -- CCR and CCD -- and this creates further difficulties.
"When two standards are selected, vendors and providers have to choose to support one standard, or instead, support both, which is very costly, resource intensive, and minimizes interoperability capabilities across organizations. It is our recommendation that only one standard is selected for each criterion in future stages of meaningful use," Sensmeier told the committee.
Referring to Integrating the Healthcare Enterprise (IHE), which is a global initiative that drives the adoption of health IT standards for clinical needs as well as work done by the Healthcare Information Technology Standards Panel (HITSP) and other standards harmonization bodies, Sensmeier said there is already a body of work that has developed standards that can be incorporated by ONC as it guides the implementation of EHRs.
Sensmeier is also urging ONC to publish the selected standards for interoperability 18 months before Stage 2 of meaningful use commences. That, she said, will ensure optimal software development, testing, and safe implementation by providers.
Sensmeier told InformationWeek that, while the time to implement and publish selected standards for interoperability is short, there are standards available, and there's no need to reinvent the wheel.
"ONC needs to start working towards selecting transport standards which will take us further down the road to interoperability and they need to let us know in a timely way so that vendors can get it into their products earlier rather than having to rework them later," Sensmeier said.