Health IT standards, value sets and terminology play a large role in meaningful use, and stakeholders are urging federal policymakers to establish an efficient, clearly defined practice for sharing them -- something that will not be easy to accomplish.
The Health IT Standards Committee, through its vocabulary task force, is considering the development of a "one-stop shop" where end users and electronic health record (EHR) vendors can find all the value sets and terminology they need to implement criteria for meaningful use. The task force, having asked for experts' input on how to structure such a central data repository, held a two-day hearing to listen to providers, insurers, vendors and standards development organizations.
Value sets describe all the possible values for a given purpose, such as creating a medication list from a patient's medical record or exchanging patient health information with another doctor. If providers wish to qualify for incentive payments through the use of EHR, they have to implement specific meaningful use criteria and ensure that they are following the standards mandated by the Office of the National Coordinator for Health Information Technology (ONC).
Harold Solbrigtechnical specialist, Mayo Clinic division of biomedical statistics and informatics
ONC's goal -- to collect all the required value sets from a range of health IT standards owners and put them into one spot -- is good but "daunting," said David Dobbs, director of medical informatics in the health solutions business of Science Applications International Corp. (SAIC). "Hundreds of value sets [are] required for meaningful use," he said during his testimony in the task force hearing. SAIC works with Health Level 7 International in the development of standards for health care, and has maintained value sets for the National Cancer Institute and the Centers for Disease Control and Prevention.
For a central repository to work, developers need to keep it simple, Dobbs said. They should group value sets around common objects, such as the specifications for certain quality measures, and create a Web-based interface that will let end users link to a full range of documentation regarding the value sets, along with the context for their purpose. "Implementation does no good if users don't understand the vocabulary," he said.
That richer context is key, especially in meaningful use, where the government hopes to create a more standardized approach to quality, said Harold Solbrig, technical specialist in the Mayo Clinic's division of biomedical statistics and informatics.
Value sets "are just the surface of structured technologies," Solbrig said in his testimony. "The value of these artifacts lies in their shared semantics -- the fact that different institutions separated by geography, culture and time can be reasonably certain that, when a code appears in a clinical document, it represents the same meaning as intended by the originator."
A central repository also would have to include software that makes it easy for providers and vendors to download value sets and receive alerts when the sets are updated, and that meets privacy and security requirements as well, Solbrig said. "We need tools that allow us to use this in our environments."
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