meaningful use

So the Health and Human Services department released an interim final rule for certification of electronic health record (EHR) technology here in the States (http://healthit.hhs.gov/blog/onc/index.php/2009/12/30/a-defining-moment-for-meaningful-use/. The crux of this is that in the new recovery bills a lot of money is targeted at expanding the use of helath information technology (HIT). In order to get this money, you have to be an “eligible provider” with “meaningful use” of a “certified EHR”. When the legislation was written, the last two qualifications were pretty vague. Over the past few months, “meaningful use” has a set of criteria and a timeline (which includes point of care in 2013!). The final piece of the puzzle took shape today:

The certification criteria adopted in this initial set establish the capabilities and related standards that certified electronic health record (EHR) technology will need to include in order to, at a minimum, support the achievement of the proposed meaningful use Stage 1 (beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and Medicaid EHR Incentive Programs.

The document (PDF) is 136 pages, which is a bit overwhelming. However, there is a lot of extremely useful history and basis for the new rule that is included making it a useful read if you aren’t familiar with the plethora of acronyms that come with health information technology (e.g., HIPPA, HITECH, PHSA, CCHIT, AHIC, HITSP).

The rule is interesting to me on a number of levels, not the least of which is its relation to the National Data Standards work we did in Malawi. It is fascinating to see Malawi so far ahead on so many of the salient points. Additionally, the challenges from an IT perspective are strikingly similar (harmonizing code sets, agreeing on data transfer protocols, etc). I wonder if this is because the problems are germane to medical informatics or because we applied too much Western thought to the problem at hand.

Ultimately, to achieve semantic interoperability, we anticipate that multiple layers – network transportation protocols, data and services descriptions, information models, and vocabularies and code sets – will need to be standardized and/or harmonized to produce an inclusive, consistent representation of the interoperability requirements. We anticipate using a harmonization process that will integrate different representations of health care information into a consistent representation and maintain and update that consistent representation over time. For an information model, this process could include merging related concepts, adding new concepts, and mapping concepts from one representation of health care information to another. Similar processes to support standardization of data and services descriptions and vocabularies and codes sets may also be needed. (pg 31).

Still, I can’t help but think that we should admit defeat on shared code sets and start solving the problem of the comparability of heterogeneous, unstructured information.

Check out pages 51-61 for Table 1A (the main criteria) and Pages 79-81 for Table 2A (the content and vocabulary criteria standards) and Page 85 for Table 2B (the security criteria standards). Jumping through the tables you get the gist of what you need to know pretty quickly.

Simultaneously the Electronic Health Record Incentive Program for Medicare and Medicaid was released. I haven’t started on that one yet (it is 556 pages long).