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Debate continues over health IT standards, meaningful use definitions

Mandates in the interim final rule for standards and certification went into effect even as policymakers and industry representatives continued to discuss their recommendations.

Policymakers have wrapped up a week of listening to stakeholders and making recommendations for health IT standards and requirements. And the debate continues about the definition of meaningful use and about ways to help providers adopt health IT.

Mandates in the interim final rule for standards and certification went into effect Feb. 13, even as policymakers and industry representatives on the federal Health IT Standards Committee were discussing the recommendations they will make before the final rule is released. The requirements in the IFR explain the technology that providers must implement to comply with the criteria for meaningful use.

The standards committee accepted recommendations from its clinical operations, clinical quality, and privacy and security workgroups during its meeting on Feb. 24. Those recommendations included expanding the health IT standards that vendors can embed in their products for some processes, while making other requirements more specific.

In some instances within the IFR, the technology standards required for specific or individual functions might be defined too narrowly, according to John Halamka, a physician who is chief information officer of Boston’s Beth Israel Deaconess Medical Center and chairman of the Healthcare Information Technology Standards Panel. Instead of being that specific or narrow, the standards panel’s recommendations call for broadening implementation guidelines to include families of health IT standards.

The goal is to set a floor, or a minimum requirement, while allowing flexibility for innovation and new standards as they’re developed, Halamka said during his presentation to the full standards committee. “We don’t want to say, it must be this one implementation guide.”

The standards committee agreed that required standards must be set at a level that to ensures that technology meets federal mandates and is being used meaningfully, but that flexibility will help providers as new health IT comes into play. “I just don’t think we’ve invented all the health IT we’re going to need,” said committee member Christopher Ross, CIO of Minneapolis-based MinuteClinic LLC, a provider of retail health care services.

Still, allowing some flexibility does not help in all situations. Among pharmacists and providers, electronic prescribing requires that more standards be spelled out, said John Klimek, a standards committee member and senior vice president of industry IT for the National Council for Prescription Drug Programs.

Interoperability -- the ability for physicians and pharmacists to share information -- is crucial, and that communication piece hasn’t been defined yet. “Our struggle with e-prescribing has been getting physicians to sign up,” Klimek said in an interview before the standards committee meeting.

Making technology work with clinical workflow

That contentiousness between physician adoption and how easily IT fits into a clinical workflow played out during a separate meeting on Feb. 25 of the adoption/certification workgroup of the federal Health IT Policy Committee (which is separate from the Health IT Standards Committee).

As the standards committee addressed implementation, the policy committee workgroup heard from doctors and stakeholders about the safety of IT and electronic health record (EHR) systems, as well as whether using IT might have unintended consequences.

When systems are poorly designed and difficult for doctors to use, there will be problems, said Ross Koppel, a professor and researcher at the University of Pennsylvania. Providers are reluctant to adopt IT when data is presented in unhelpful ways or causes the clinical workflow to slow down. Technology should be the core of a well-running clinical operation, he said. “Vendors must listen and respond to clinicians.”

I just don’t think we’ve invented all the health IT we’re going to need.

Christopher Ross, CIO, MinuteClinic LLC

And technology by itself is not the answer, said David Classen, a partner and chief medical officer of Computer Sciences Corp.’s Health Services division, in Berwyn, Penn., and professor of medicine at the University of Utah. Although studies show the number of adverse medical events decreases, and patient safety increases, after the implementation of a complex EHR system and a well-planned clinical decision support system, “just putting those systems in place does not guarantee that level of safety,” he said. Providers and vendors should continue to evaluate EHR and other IT systems after they have been implemented and used.

The adoption/certification workgroup will deliberate about the presentations before bringing recommendations to the full policy committee during its March 17 meeting.

Let us know what you think about the story; email Jean DerGurahian, News Writer.

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