Q&A: Information Age must get beyond Industrial Age data mgt

The Health IT Standards Committee is charged with identifying and mapping the standards that will enable a functional Nationwide Health Information Network (NHIN). This is a challenging mission, but it’s a crucial piece of a 21st century approach to medicine, Jonathan B. Perlin, MD, PhD, chairman of the ONC’s Health IT Standards Committee and president of clinical services and chief medical officer of Hospital Corporation of America (HCA), based in Nashville, Tenn., recently told CMIO.

CMIO: What goals for HIE were specified in the HITECH Act for the Health IT Standards Committee to consider?
Perlin: There are eight goals for electronic health information exchange, five of which relate to private and secure transmission:

1. Protect privacy of health information;
2. Support national health IT infrastructure--the context for the health internet;
3. Support use of certified EHRs for everyone by 2014;
4. Support accounting of patient information disclosures;
5. Support quality measurement and reporting;
6. Assure identifiable health information be rendered unusable or unreadable in appropriate context (i.e., encryption);
7. Support collection of demographic data; and
8. Address the needs of children and other vulnerable populations.

CMIO: How will these goals be mapped and achieved?
Perlin: The HIT Standards Committee work is done through four workgroups, and through public meetings. The Clinical Operations Workgroup makes recommendations on specific criteria and standards to support data exchange. The Clinical Quality Workgroup makes recommendations on standards in support of quality metrics proposed by the HIT Policy Committee. The Privacy and Security Workgroup supports requirements in ARRA to create and assure trust in the process, so there’s confidence in using electronic technologies for secure, private, appropriate, authenticated interchange of personal health information. The fourth group is the Implementation Workgroup, which provides advice for implementation of standards for meaningful use.

CMIO: Where does the NHIN fit into this picture?
Perlin: The NHIN is meant to be a vehicle through which different entities will ultimately securely exchange information. To use the PC-Mac analogy, if you play by a certain set of rules on the Internet, you can use a Mac, I can use a PC and both of us can exchange information. We need to create that degree of interoperability for health information. To build that support requires 1) A set of standards that are solid, specific, usable and understood; and 2) An environment of trust.

To assure that effective, secure interchange of information requires fairly explicit specifications of standards. The process recommends standards in six areas of data exchange in support of the 2011 meaningful use requirements:

• E-prescribing;
• Patient engagement/communication;
• Checking insurance eligibility and submitting claims;
• Ability to exchange key clinical info among providers, patients and patient-authorized entities;
• Ability to submit data to immunization registries and provide syndromic surveillance and lab data to public health agencies; and
• Quality measurement and reporting.

CMIO: What is the National eHealth Collaborative’s role?
Perlin: NeHC is helping to build the environment of trust so collaboration can occur. It provides the logistics and support for NHIN and support for the coordinating and technical committees. Its purpose is to convene as broad an array of stakeholders as possible.

There are needs that each stakeholder group can articulate that can be understood in the context of other stakeholders. Providers have certain functional requirements, vendors have certain technical requirements and patients have both informational and clinical requirements, but also certain privacy requirements. That conversation can help to define the specifications of standards that would support the mutual needs, but in the process create a frame of reference for functional and non-functional requirements for those who are working in government and on committees such as HIT Standards Committee to consider.

As with the Health IT Standards Committee, the stakeholders are brought together in an open manner, and in open environment. This helps all build cultural literacy around the expectations of meaningful use, and ultimately, understanding of the opportunities NHIN will create. There are a lot of moving pieces and the timeline is ambitious.

CMIO: The federal time frames for EHR adoption and HIE have been called challenging, if not impossible. Why is this so urgent?
Perlin: Electronic health information exchange is the backbone of higher quality and higher value healthcare. It’s necessary to support transparency and necessary to support reform. It is necessary to reduce breaches of safety in delivery of care, and it is necessary to support the coordination of health information between patients and authorized care providers.

Healthcare is very sophisticated in the use of technologies—ironically, the IT  that should tie all the data that those technologies produce together is in its infancy. So we have an Information Age set of activities in healthcare tied to an Industrial Age way of managing the data that should, in fact, connect together into a coherent story about health status and needs, and support data-based and evidence-based decision-making.

Thus, there’s an urgency based on the need to improve the quality and the value of healthcare that compels rapid adoption of much more reliable health records. I subscribe to the adage, based on data and experience with a system that became completely electronic at VA and is in rapid evolution at HCA, that paper kills, and those injuries can be avoided through more reliable information systems.

HITECH and the concept of meaningful use is not just a statement that ‘thou shalt have certain standards,’ but really a requirement that we adopt electronic health records and interoperable health information for safer, more effective, more efficient and more compassionate healthcare.