Up­hill climb at HHS

Pol­i­cy­mak­ers strug­gle with how to meet rec­om­men­da­tions for IT pro­gram

Modern Healthcare - - The Week In Healthcare - Joseph Conn

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

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