Engineering HIE Standards

Much important work is currently underway to develop vocabulary, packaging, and transport standards for health information exchange (HIE), according to last week’s National eHealth Collaborative ONC Anniversary Event, which highlighted the  collaborative work of the Beacon Communities and seven EHR companies (NextGen, Greenway, GE, Allscripts, Vitera, Cerner and SuccessEHS) that are working together to accelerate interoperability and exchange.This affinity group began in November 2011 as a part of the Beacon Communities Quality Measurement conference in Salt Lake City, which was followed by some more planning at an ONC All Grantee meeting later that month where a draft charter was developed. Some of the main problems this group seeks to solve are the difficulty of obtaining a consistently formatted CCD to complement existing practice workflows, and the lack of clear documentation/toolsets from EHR vendors to assist practices to extract quality measures data and to achieve meaningful use.The affinity group is comprised of all 17 Beacons and all EHR vendors that are interested in joining. It is governed by an executive steering committee with five Beacon and five vendor representatives, as well as an ONC representative who meet monthly to review and provide feedback to workgroups. Instead of giving workgroups a prescriptive roadmap on what standards to use, the steering committee asked them to simply come to an agreement on a set of guidelines to work with.“The technical workgroup of the EHR affinity group endeavored to really focus on this CCD issue and to focus on the use cases that were most common within the 17 Beacons and to develop the requirements around two or three specific use cases,” said David Groves, vice president of grants and programs, HealthBridge and executive director of the Tri-State Regional Extension Center. “We decided to focus on transitions of care and disease registries.”What Groves’ found in his community was that vendors weren’t all ready to meet the requirements of first generation C32 documents, and the data they could in fact send were not structured or machine-readable.Groves said, therefore, the focus of the affinity group has been on defining the package the data are sent in and how they are expressed. He said the group first created a technical discovery guide that explored what data format Beacon Communities could accept, and what formats vendors could support, to move forward. “One of the challenges of effective exchange over the past couple of years, and probably for a short time to come, is we don’t necessarily start with well-structured data that’s encoded with right medical terminology code sets,” he added.Marilee Benson, vice president of sales, Mirth Corporation and group member, said she has seen a lot of variability of standards in the industry, and the affinity group’s goal is to take out the heavy lifting for providers, especially single- physician practices, to send health information.To move forward, the group decided to pick a standard that was currently in production like the CCDA (Consolidated Clinical Document Architecture), and agreed to move away from using just one document type to using the HITSP C83 clinical data templates, said Tone Southerland, senior developer, Greenway, and technical workgroup co-chair. Southerland said the group has been focusing on the content of the clinical data templates, and answering questions about how to import and map pieces of discreet data.Vendors in the group agreed to use open source where it made sense, said Charlie Jarvis, vice president of health reform, NextGen Healthcare. “It’s important to note that the vendor community embraces open source, as well as proprietary based on what the needs are,” he said. “Our goal really is to focus on what’s going to be the quickest, easiest, and most effective way to get providers live and interoperable. So the use of open source capabilities is built into some of our programming as well as proprietary. That really isn’t the important factor, the important factor is can we get agreement around a set of connectivity standards.”“Really all three of these things are required—the vocabulary standards, the packaging standards, and the transport standards,” concluded Judy Murphy, deputy national coordinator for programs & policy, Office of the National Coordinator for Health IT. “They all need to be taken into account to be successful in this space.”