A Health & Human Services Department advisory group endorsed changes in the regulation governing standards for certified electronic health records that bridges the gap between flexibility and technical specificity in the hope that it will help drive adoption of EHRs.
The Health IT Standards Committee, which met Feb. 24, believes the new version of the Interim Final Rule (IFR) will allow industry to move health IT functionality forward without having to wait for a complete overhaul of the regulations.
It should also make it easier for physicians and hospitals to purchase and use certified EHRs since their capabilities can evolve over time.
The IFR lays out requirements for certified EHRs that physicians and hospitals must use to qualify for health IT incentives. The rule took effect Feb. 12, but HHS is accepting comments until March 15. The standards committee plans to submit its recommendations for changes around March 1.
In crafting the rule, the Office of the National Coordinator for Health IT did not want to lock in specific standards for certification that would become outdated, said Jodi Daniel, ONC's director of policy and research.
"It is a snapshot, and we're trying to make sure we don't lock that it in," she said. "There may be some creative solutions with certification or implementation guidance."
The IFR incorporates standards that providers must meet in 2011 for sharing clinical information, such as patient summaries and prescriptions, as well as the vocabulary to communicate clinical problems and medications between systems.
Regulations are hard to change, said John Halamka, co-chairman of the standards committee and chief information officer of Harvard Medical School.
"We want to set a floor that would provide us the capacity to evolve rapidly," he said. "(Otherwise) you run a risk by providing very specific standards in the regulation that it's cast in concrete and industry can't move."
For example, the IFR as currently written has declared a specific version from Health Level 7-- HL7 version 2.5.1 for lab reports " and no industry guidance for how to put it into practice.
"Yet the specific HL7 version 2 continues to change," Halamka said.
The committee recommended that a new version of the rule require a family of standards, including the HL7 version 2 group, but not a particular release. ONC would also find a mechanism to immediately provide the technical guidance that can evolve outside of the regulation, "as often as the industry can tolerate," Halamka said.
More advanced releases of the standards family could be provided through the guidance mechanisms, he said.
ONC also expects to provide more details about how certification will be conducted in the future, said David Blumenthal, national coordinator for health IT. It will release a proposed rule for a certification process soon, he said.
