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Overview of National HIT Standards a presentation to the Seminar Series on Integrated Surveillance. Presented by Steven J Steindel, Ph.D. National Center for Public Health Informatics (NCPHI), CDC. Non-Government. Government. LAWS. MARKET NEEDS. Voluntary standards Consensus standards

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overview of national hit standards a presentation to the seminar series on integrated surveillance

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

slide2

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.

slide3
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

slide4

Consideration for Standards

  • Flow - where, when, and how data move
  • Format - mechanics of data transfer
  • Content - which data elements
slide5

“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

acronym soup
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
onc major initiatives
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/

ahic a public and private sector collaborative
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/

ahic workgroups 1 07
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

standards harmonization process
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

hitsp technical committees
HITSP Technical Committees
  • Cross-Technical Committee Coordination
  • Care Delivery
  • Consumer Empowerment
  • Population Health
  • Security and Privacy
  • Emergency Responder-EHR
slide13

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

slide15

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

slide16

Coordinated Timeline

Two Years

We are here

certification of ehrs
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/

cchit history and status
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
cchit development process
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
hl7 groups of importance
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/

key terminologies
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
get involved
No restrictions – just join:

HL7

HITSP

Selected Membership

CCHIT

NCVHS

Open Meetings

AHIC

NCVHS

CCHIT Town Halls

Registration

LOINC

SNOMED (IHTSDO)

Get Involved!
contact information
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