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Overview of National HIT Standards: A Presentation to the Seminar Series on Integrated Surveillance

This presentation by Steven J. Steindel, Ph.D. from the National Center for Public Health Informatics provides an overview of national HIT standards, including voluntary standards, consensus standards, industry standards, and regulatory standards. It also discusses the flow, format, and content of data in public health and clinical settings. Relevant initiatives and organizations such as AHIC, HITSP, and CCHIT are highlighted.

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Overview of National HIT Standards: A Presentation to the Seminar Series on Integrated Surveillance

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  1. Overview of National HIT Standardsa presentation to the Seminar Series on Integrated Surveillance Presented bySteven J Steindel, Ph.D. National Center for Public Health Informatics (NCPHI), CDC

  2. Non-Government Government LAWS MARKET NEEDS Voluntary standards Consensus standards Industry standards Consortia Standards Etc. Regulatory standards: Levels of Protection Health, Safety Environment When applicable and appropriate, voluntary standards may be referenced in mandatory regulations.

  3. Regulations Based on Health & Welfare (Legitimate Objectives) Development Process (openness, public comment, transparency, timely notification) Mandatory Voluntary Standards Based on Market and Business Relevance (Demands or Needs) Development Process (much the same as regulatory; regulators are among the participants in standards development bodies) Voluntary

  4. Consideration for Standards • Flow - where, when, and how data move • Format - mechanics of data transfer • Content - which data elements

  5. “Public Health World” Clinical Data Users Network Users Public Health System NHIN/RHIO Public Health Surveillance Pathology Laboratory SNOMED, Numbers, Dates, Text 92 Disease specific HL Messages Reportable Cases Schematic Public Health Data Flow Example: Laboratory Reporting Standards Standard CodesH7 Messages Architecture Systematic Report TextReport Encoding

  6. Acronym Soup! • AHIC • American Health Information Community • ONC • Office of the National Coordinator for Health Information Technology (IT) • HL7 • Health Level 7 • CCHIT • Certification Commission for Health IT • HITSP • Health IT Standards Panel • NHIN • Nationwide Health Information Exchange Network

  7. American Health Information Community Standards Harmonization Process Certification of HIT Privacy and Security Solutions Nationwide Health Information Systems Prototypes Health Information Technology and Health-care Anti-fraud Health IT Adoption Initiative Gulf Coast Task Force State RHIO Best Practices ONC Major Initiatives In 2004, President Bush called for the widespread use of electronic health records (EHRS) within 10 years. ONC has set the foundation for interoperable EHRs though the following initiatives: For more information: http://www.hhs.gov/healthit/

  8. AHIC – a Public and Private Sector Collaborative AHIC is the public-private collaborative that sets priorities and oversees and/or endorses HIT Standards, certification, the NHIN, and polices on a national level. • AHIC: American Health Information Community • HITSP: Health Information Standards Panel • CCHIT: Certification Commission for Health IT • NHIN: Nationwide Health Information Community • HISPC: Health Information Security and Privacy Collaboration • State-Level HIE Initiatives: State-level Health Information Exchange Initiatives For More information: http://www.hhs.gov/healthit/community/background/

  9. AHIC Workgroups (1/07) • Population Health and Clinical Care • Subsumes work of the Biosurveillance WG • Includes Data Content Steering Group • Consumer Empowerment • Chronic Care • Electronic Health Records • Laboratory Reporting • Emergency Preparedness • Privacy and Security • Quality • Personalized Healthcare For more information: http://www.hhs.gov/healthit/ahic/index.html

  10. Health Information Technology Deployment Coordination

  11. Standards Harmonization Process • Health Information Standards Panel (HITSP) • Business driven standards harmonization process • Coordinated with AHIC Use Cases • Funded for 3 years by ONC; self-sustaining thereafter • Published Implementation Guidance 10/06 • Consumer Empowerment • Biosurveillance • EHR: Laboratory Reporting For more information: http://www.ansi.org/standards_activities/standards_boards_panels/hisb/hitsp.aspx?menuid=3

  12. HITSP Technical Committees • Cross-Technical Committee Coordination • Care Delivery • Consumer Empowerment • Population Health • Security and Privacy • Emergency Responder-EHR

  13. HITSP Harmonization Process Harmonization Process Steps ReceiveRequest I Harmonization Request II RequirementsAnalysis III Identificationof CandidateStandards IV Gaps,Duplicationsand Overlaps Resolution V Standards Selection VI ConstructionofInteroperabilitySpecification VII InspectionTest VIIIInteroperabilitySpecificationReleaseandDissemination IXProgram Management BeginSupport

  14. HITSPFramework

  15. Work Plan and Schedule Overview HITSP 2007 Timeline 10/09/07 HITSP Board 04/23/07 HITSP Board 07/09/07 HITSP Board 02/05/07 HITSP Board 09/07/07 HITSP Panel 02/12/07 HITSP Panel 03/19/07 HITSP Panel 07/16/07 HITSP Panel 10/15/07 HITSP Panel 05/11/07 HITSP Panel JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 6/18 – 6/20 TC Face to Face San Diego CA 5/08 – 5/10 TC Face to Face Arlington VA 09/04 – 09/06 TC Face to Face Arlington VA 03/06 – 03/08 TC Face to Face Chicago IL Activity 1 – Version 2.0 of Existing EHR, CE, BIO ISs EHR, CE and BIO v 2.0 On-going Support Implementation Support and Testing (includes minor document updates) Activity 2 – Security and Privacy for All Use Cases Activity 3 – New Emergency Responder EHR Use Case S&P and EHR-ER v 1.0 04/13 – 05/16 05/17 – 06/14 Implementation Support and Testing (with annual updates as required) Public Input on S&P Public Comment Inspect Test and Public Comment Comment Resolution and Panel Approval Requirements, Design, Standards Selection IS Construct Development 02/15 – 05/16 07/20 – 08/16 08/17 – 10/15 05/17 – 07/19 Activity 4 –New Use Cases from AHIC Detail Schedule to be Established Upon Review of the Use Cases

  16. Coordinated Timeline Two Years We are here

  17. Certification of EHRs • Certification Commission for Health IT (CCHIT) • Privately founded and funded 11/04 • ONC funding for three years • First certified Ambulatory EHRs 7/06 • 37 systems certified: 1/07 • Inpatient EHR Certification 6/07 • Network Certification 6/08 For more information: http://www.cchit.org/

  18. CCHIT History and Status • Goals of Product Certification • Reduce the risks of investing in HIT • Facilitate interoperability of HIT products • Enhance availability of adoption incentives • Ensure that the privacy of personal health information is protected • Sept 2004: AHIMA, HIMSS, and the Alliance partner to launch CCHIT • June 2005: Eight organizations add $325k funding support • Sept 2005: CCHIT awarded 3-year, $7.5M HHS contract to develop compliance criteria and inspection process • Ambulatory EHRs (2006) • Inpatient EHRs (2007) • Infrastructure and Networks through which EHRs interoperate (2008) • July 18, 2006: First batch of certified ambulatory EHRs announced

  19. CCHIT Development Process Develop Inspection Process Launch Certification Program Gather Data Develop Criteria Finalize Pilot Test • Methods • Self-attestation • Juror observation • Laboratory testing • Test scenarios • Step-by-step test scripts • Release for public comment • Respond to comments • Final adjustments • Commission review and approve • Publish final materials • Stakeholder priorities • Availability in vendor marketplace • Practicality of certification • Release for public comment • Criteria for next year • Functionality • Security/ reliability • Interoperability • Roadmap for • Next year + 1 • Next year + 2 • Release for public comment • Call for participants • Random selection for each market segment • Conduct pilot • Release for public comment • Results • Final criteria • Final test process and scripts • Certification handbook andagreement

  20. CCHIT Myths and Realities

  21. HL7 Groups of Importance • New • Public Health and Emergency Response • Patient Safety • Established • Vocabulary • Government Projects • Laboratory • Attachments • Structured Documents (CDA/Templates) For more information: http://www.hl7.org/

  22. Key Terminologies • LOINC • Lab Result Names • SNOMED • Clinical Terminology • Organisms • Both distributed free for use • http://www.regenstrief.org/medinformatics/loinc/ • http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html

  23. No restrictions – just join: HL7 HITSP Selected Membership CCHIT NCVHS Open Meetings AHIC NCVHS CCHIT Town Halls Registration LOINC SNOMED (IHTSDO) Get Involved!

  24. Contact Information Steven J Steindel, Ph.D. Director, Data Standards and Vocabulary Centers for Disease Control and Prevention National Center for Public Health Informatics U.S. Department of Health and Human Services 1600 Clifton Road, MS E-78 Atlanta, GA 30333 (tel) 404-498-2444 sns6@cdc.gov

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