ONC interoperability leader discusses EHR meaningful use certification

At the HIMSS 2010 annual conference in February, the Office of the National Coordinator for Health Information Technology announced a long-awaited process for EHR meaningful use certification. We sat down with Dr. Doug Fridsma, acting director of ONC's Office of Interoperability and Standards, to talk about the significance of this announcement.

In our conversation, Fridsma also explains what the Nationwide Health Information Network is, and provides a glimpse into NHIN Direct. This new initiative will help determine the essential services, standards and protocols required for providers to begin the secure exchange of health information.

Check out this video to hear the doctor's advice for providers who are venturing into the world of electronic health information.

Let us know what you think about the story; email editor@searchhealthit.com.

Read the full transcript from this video below:  

ONC interoperability leader discusses EHR meaningful use certification

Don Fluckinger: Here we are at the SearchHealthIT.com booth with Doug
Fridsma, with the Office for the National Coordinator for Health
Information Technology. He is the acting director of the
Office of Interoperability and Standards. Thank you for joining
us today.

Doug Fridsma: Thank you. Thank you for having me.

Don Fluckinger: There was a big announcement about an hour ago. Tell us
all about it.

Doug Fridsma: One of the questions that a lot of the EHR vendors have been asking
is: when is the ONC going to come out with the certification
process? At the recent ONC Town Hall, we have now posted on the
HealthIT.gov website the regulations, or at least the proposed
regulations around the certification processes. I had an
opportunity to get feedback from the people here at HIMSS, and
we are now entering the comment period. As soon as that gets
posted, we will have 30 days for the temporary rule and 60 days
for the permanent certification process to get feedback from
folks. We are hopeful that people will go to Regulations.gov and
provide us feedback after they have had an opportunity to read

Don Fluckinger: I know you are not allowed to talk about the content or
the making-of or anything like that, but what is the
significance of this announcement?

Doug Fridsma: This is the third in a trifecta of rules that have come out of the
ONC. The first was a rule from CMS that defined meaningful use,
and we worked very closely with CMS in developing that rule. The
second was the IFR, the Interim Final Rule on standards, and
that set up the criteria, the standards and criteria in which
EHR vendors will be evaluated against. The third is the one
that was announced just an hour ago, and that one has to do with
how that process of certification will occur. Those three rules
together work very, very closely; one defines what meaningful
use is, the second defines what is the criteria that the
electronic health records need to satisfy to be considered
certified and the third is the process by which that
certification will occur.

Don Fluckinger: I know you are doing more than just that here at HIMSS.
Tell me about some of the other presentations, and some of the
things you are doing at the Interoperability Showcase.

Doug Fridsma: The Interoperability Showcase really highlights a lot of the
activities that have gone on with people that are trying to
exchange information using some of the standards, policies, and
the protocols, the services that we have that define the
Nationwide Health Information Network, or the NHIN. There is a
lot of demonstrations that are going on, where people are really
actively exchanging information, using that infrastructure, and
those services and policies to help provide that. I think one of
the things that is going to be exciting is that we have other
announcements that are pending in the next day or so.

Tomorrow we will be talking about a new initiative that is being
launched here at HIMSS as well, around expanding the number of
people that are participating in the Nationwide Health
Information Network. Currently, that is composed of a lot of the
folks that are using the policies, services and the standards
that define the Nationwide Health Information Network. We have
been working very closely with the Federal Advisory Committees,
and there is one on the Nationwide Health Information Network,
the working group on that. They have asked us to explore what
the minimum sets of all of those components that will allow us
to exchange health information. This new initiative called NHIN
Direct is something that will actually help us define what that
should look like, what the services are, what the standards that
are required, what protocols that we need. Also, what are the
important privacy and security protections that are going to be
needed to help support that kind of exchange?

Don Fluckinger: I have heard over the last month, both people inside the
ONC, and outside in the private sector
presenters, have to explain a 101 what NHIN is. First
of all, sort of define it. A lot of people might think it is a
server plugged in, in some obscure government building, but it
is not that.

Doug Fridsma: Sure. The Nationwide Health Information Network--  and I described it in
the words that I have used so far -- is the standards, services,
and the protocols that we need to securely exchange information
across the internet, using the internet. All of those things
become pieces of software. They might become trust relationships
or agreements between parties that are exchanging information,
but all of those things work together to enable that kind of
exchange to occur.

One of the prime examples of those three components is the FHA
Connect and the NHIN exchange that has a bunch of people
exchanging information in a limited production pilot. Connect,
the software, takes those specifications and creates a software
program that can then exchange that information, but it is an
instantiation, or an instance, of one of those services in a set
of those standards that are all packaged together. We anticipate
that by defining those three components, we hope that lots of
other people will use those specifications, if you will, and
those standards to come up with new and innovative solutions
that will help patients in the exchange of information.

Don Fluckinger: There has been a lot of talk about the Healthcare Reform
Bill. Does that affect any of your initiatives whether it passes
or not, or not really?

Doug Fridsma: No. In fact, the work that we do has been ongoing for a number of
years, and with the HITECH Act that was passed as part of the
ARRA Stimulus Bill, we were charged with developing technology
solutions that would help support information exchange. It is
entirely separate from healthcare reform, and in fact, we will
continue to proceed, given the charge that Congress gave us back
in February, to establish a way for this exchange to occur.

Don Fluckinger: What advice, or what would you have to say to physicians
and other healthcare providers who are still out there on paper
and who are really anxious about this whole movement to go to
electronic health records? They are worried about how they are
going to pay for it, and they are worried about just wrapping
their heads around the whole transformation.

Doug Fridsma: Sure. I think there is a few things. The motivation we have for the
work that is going on within the ONC is technology as an
enabler and meaningful use as an enabler that links the technology
to the outcomes and the quality improvements that we would like
to see. That linkage is really meaningful use, and that is the
vehicle by which we can use that technology in a meaningful way
to improve patient outcomes. At the end of the day, that is the
thing that drives and motivates us.

For an individual provider, that can be a daunting task to look
at all this technology out there and how do I navigate through
that. Within the ONC, we've got a variety of programs that we have
established that will help support physicians in getting to
that point. There are regional extension centers that have been
established, that will provide guidance to physicians - boots on
the ground if you will - that will help be a resource to
physicians that are trying to figure out what is the right EHR
to choose, how they implement it, what are the choices they can
have between alternative vendors, and provide
a neutral platform for people to have that conversation.

That, coupled with some of the state health information exchange
grants that are going on, as well as work that we got on cutting
edge research and beacon communities that are meant to be the
leaders in this. We hope that within the ONC, it is not just
about developing that technology for exchange, but supporting
the entire ecosystem from an education and support of the
providers so that we can get to the point where people can have
meaningful use.

Don Fluckinger: I think that covers pretty much everything I wanted to ask

Doug Fridsma: Good.

Don Fluckinger: Is there anything else you would like to add or say?

Doug Fridsma: No. I am just delighted to have this opportunity to talk. Thank you
so much.

Don Fluckinger: Thank you.

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