Uphill climb at HHS
Policymakers struggle with how to meet recommendations for IT program
Federal policymakers directing the government’s multibillion-dollar health information technology incentive program were in a quandary again last week—as they have been for a couple of months—over how to deal with recommendations from a council of presidential advisers.
The President’s Council of Advisors on Science and Technology, or PCAST, has called for IT program leaders at HHS to shift into a higher gear and at least partly drive in a different technological direction.
Planning for those changes were key HHS advisory groups, the Health IT Policy Committee and its sister Health IT Standards Committee, plus a work group of both, which met in a daylong, joint hearing last week in Washington. Twenty witnesses testified.
The following day, members of the PCAST workgroup met for four hours to try and digest the testimony they had just heard and to begin drafting policy recommendations that will be presented to the workgroup’s two parent committees. From there, the recommendations will flow to the Office of the National Coordinator for Health Information Technology, where they could inform or even drive policy changes affecting the government’s national incentive programs for electronic health-record system adoption. Both meetings were devoted to addressing PCAST’s 108-page report, Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans, released in December.
The report encouraged the ONC to “move more boldly” to ensure the nation has EHR systems “that are able to exchange health data in a universal manner based on metadata-tagged data elements.” Metadata are data that describe or categorize other data.
“I think you’re telling us to go boldly where nobody has ever gone before,” said PCAST workgroup member Carl Gunter, an engineer from the University of Illinois. Gunter’s remarks came near the end of the longer Feb. 15 meeting and were directed at Microsoft executive Craig Mundie, a PCAST member.
PCAST recommended HHS push harder toward achieving advanced interoperability of EHRs by asking that HHS include mandating use of its proposed web-based architecture in the government’s Stage 2 meaningful-use criteria, which become effective in 2013. To accelerate interoperability, PCAST recommended the government oversee the creation of a universal computer language for information sharing based on extensible mark-up language, or XML—a language common to the Web. The proposed new XML-based language would enable medical records and even “granular” elements of a record, such as a single diagnostic code, to be affixed with metadata tags.
Providers who testified at the hearing complained of PCAST additions to their already full IT plates, including a switch this year to the Version 5010 data transmission standard and conversion by Oct. 1, 2013, to ICD-10 diagnostic and procedural codes.
Dr. Theresa Cullen, chief information officer for the Indian Health Service, sees the PCAST recommendations as a mixed bag.
“Interoperability is critical, but I don’t think we’re there yet, so I think a focus on that in 2013 and 2015 is good,” she said. Cullen said she shares the concerns expressed by fellow panelists, that the real issue is, “what’s doable?”
“There are a zillion things coming at us,” Cullen said. “The 5010 and ICD-10 are going to require a substantial change in the systems, including recoding, that I think are