HIT Policy Committee Looks to Incremental Approach to Certification

Part of meaningful use is the exchange of data, said Gayle Harrell, a former Florida legislator who also manages her husband’s practice. “I know from personal experience that doesn’t happen easily,” she said. Much of the work on exchanging data must happen at the state level, she said, and “many of our states are not prepared to do this.” In discussing information sharing, Latanya Sweeney of Carnegie Mellon University said there must be discussion of what constitutes fair information practices. Those practices exist on an individual level, she said, but “there is a total void about what should be the practices when sharing data.” That void extends across all industries, not just health care, she said. Neil Calman of the Institute for Family Health said he’s concerned about jumping into the process of exchanging data without first considering the principle of patient ownership of their information. Moving forward could take the system in a direction from which it can’t return to consider the principle, he said.

Harrell suggested an incremental, “ladder” approach to certification, given the time frame the committee must meet. “I don’t believe we can do everything we want to do by 2011,” she said. Marc Probst of Intermountain Healthcare said he agrees with the ladder approach but the committee must ensure all the ladders are leading somewhere. Richard Chapman of Kindred Healthcare suggested an incremental approach could help the committee avoid the “marked failure” of past groups’ efforts, namely, “they're so comprehensive they're not implementable.” Judith Faulkner of Epic Systems said the committee should avoid the “deadly embrace” of requiring software to do things that aren’t yet doable. Privacy, for example, must be crisp and clear so companies or users aren’t left wondering if they'll be civilly or even criminally liable for not taking steps that aren’t possible, she said. David Lansky of the Pacific Business Group on Health suggested teasing apart certification into functional bundles, with separate certification in each of the areas the committee must consider. A product doesn’t have to have every functionality, he said, particularly as different practices have different needs.

After some discussion, the committee agreed to three work groups: meaningful use, certification and adoption, and information exchange. The certification work group will also consider infrastructure and workforce issues, and all the groups will work from a patient-centered perspective and consider privacy and security, Blumenthal said. The policy committee will tell the standards committee, which by statute begins meeting this week, to begin thinking of a process to get to standards and await more defined criteria from the policy committee, Blumenthal said. He said parts of health information exchange could fit under the infrastructure heading, as well. The department must spend at least $300 million on health information exchanges, he said, so quite apart from the theoretical discussion of how to define health information exchange, there is a question of how to get money out the door and what it should be spent on.

Blumenthal initially suggested a privacy and security workgroup. But Deven McGraw of the Center for Democracy & Technology objected. “I'm a little reluctant to have a workgroup set off to the side to do the privacy and security issues,” she said, noting that such a group wouldn’t be considering the issues in context. Sweeney said the answers that the committee gets about privacy and security will be tied to how it forms work groups. If there’s a separate privacy and security work group, it will get general principles, which can be good for guidance but miss some of the nuts and bolts, she said. If privacy and security is integrated into each work group, then the committee will get specific solutions for each work group’s focus, she said. The group agreed that, in Harrell’s words, privacy and security must be foundational.

The policy committee will take into consideration the work of the National Committee on Vital and Health Statistics, which recently held a public hearing on the term “meaningful use.” During the public comment period, Tom Leary of the Healthcare Information and Management Systems Society asked the committee to consider the work of the Certification Commission on Healthcare Information Technology and the Healthcare Information Technology Standards Panel, which he said represent thousands of hours of volunteer work.