ONC ponders voluntary, certified health information exchange

A new trusted health information exchange certification program is underway in ONC advisory committees. Here's what you need to know.

The Office of the National Coordinator for Health IT (ONC) is contemplating a certification for trusted health information exchange that would function something akin to the Energy Star seal used to validate an electronic device's energy-saving attributes, in this case to validate data standards and business practices related to patient data exchange.

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At the HIT Policy Committee (HITPC) meeting held in early June, ONC head Farzad Mostashari, M.D. and his colleagues received input on 66 questions about how certification would work. The ONC conducted a "governance request for information (RFI)," basically a feasibility study with input supplied from its various advisory committees, to put together its report to the HITPC.

Like the trusted Energy Star program to label energy-saving products so consumers can easily discern which appliances and devices meet stringent requirements , the HIE certification would  validate a health care entity's ability to adhere to Nationwide Health Information Network (NHIN) privacy, security, interoperability and business practices required for standardized HIE. Organizations could easily discern which other health care facilities they’d like to conduct information exchange with, ONC's Federal Policy Division Director Steven Posnack in the meeting.

The governance ideas discussed at the HIT Policy Committee meeting included matters such as who should accredit entities, how they might go about attesting and auditing them, how state laws might interact with the process, interoperability issues and processes for revoking trusted status once an entity failed to live up to its attestation. Also on the agenda: Estimating the potential economic impact of certification and its costs to U.S. health care, down to the patients.

Mostashari said this certification process, on a micro level, would simplify HIE between two parties that otherwise didn't know each other. On the macro level, it's a push to facilitate HIE during later stages of meaningful use adoption, the same way stage 1 pushed EHR systems into physician offices and hospitals.

"What this is all about is that -- at the end of the day -- electronic health information exchange just works," Mostashari said. "It shouldn't require long negotiations, it shouldn't require an army of lawyers…to be able to have health care providers exchange information with each other. They shouldn't have to think about it."

What this is all about is that -- at the end of the day -- electronic health information exchange just works.

Farzad Mostashari, M.D., National Health IT Coordinator

If the ONC moves forward after the governance RFI process makes it appear workable, then pilot projects could potentially follow. After that comes the typical proposed rulemaking processes the HIT world knows from watching HIPAA and meaningful use work their way through the regulatory pipeline.

In the discussions of the new trusted HIE certification, several members of the HITPC wanted to make clear that HIE certification would not be an additional layer of regulation for health care providers, but rather a voluntary program for whom it made sense.

Doug Fridsma, M.D., director of the ONC's Office of Standards and Interoperability, told SearchHealthIT that the ONC hopes to create a program flexible enough to quickly facilitate nationwide HIE, yet also will be able to accommodate new technologies and evolving health care approaches. Without, he stressed, adding more compliance.

"There's no need to create a lot of additional infrastructure if HIPAA provides the protections we need," Fridsma said. "We need to recognize that and make sure we leverage the existing structures that are out there that protect patients' privacy and security… and at the same time, reduce barriers to information exchange."

Editor's Note: This story was updated to correct the lead, which initially mischaracterized the nature of the ONC's proposed HIE certification program.

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