HIT Standards CommitteeHIT Standards Committee

Clinical Operations WorkgroupReport on Gaps and Next StepsReport on Gaps and Next Steps

Jamie FergusonKaiser Permanente

John HalamkaHarvard Medical School

October 14, 2009

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Scope Of Gaps For Discussion

• Criteria for certification

• Gaps for Health Information Exchange (HIE)– Standards for inter-HIE communications– Coordination of EHRs with HIEs and clinical ancillaries

“coordination of all systems that must communicate with HIEs”

• Clarification of 2011 measures

• Gaps in specific domains, e.g., administrative vs. labs

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Gaps: Clarification Of 2011 MU Measures

• High cost imaging with structured indications– Needs definitions

• Patient access to EHR– Minimum content requirements– Direct access vs. PHR copies

• Patient-specific educational materials– Needs clarification

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Gaps: Vocabulary

• National SNOMED CT maps to ICD9 and ICD10• RxNorm

– Cross-maps to existing codes– Complete federal medication terminology set w/ NDF-RT, SPL

• LOINC– Complete set of order codes including panels and profiles– Identify comparable test results e.g. for trending– LOINC/SNOMED boundary and relationship

• UCUM guidance and testing• Standards to distribute code sets and updates• Maintenance and management processes for subsets

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Gaps: Other Gaps

• Administrative– Operating rules for 5010– Updates to electronic claim attachments– Explore how all documents in the CDA family can be used

• Clinical Lab Order Messaging

• Quality Reporting Architecture– Implementation guidance for architectural alternatives– QRDA and e-Measure guidance

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Next Steps

• Resolve identified gaps

• Launch Vocabulary Sub-Workgroup

• Develop additional and/or revised recommendations for 2013 to support 2013 policy objectives and measures

• Integrate with and support testing efforts