Federal health IT policymakers said yesterday they crafted a set of more flexible standards for electronic health records systems to make it easier for providers to qualify for meaningful use when the first phase of the health IT incentive program starts next year.
After 2011, as providers face more challenging requirements for meaningful use of EHRs they purchase under the plan, these standards could tighten, members of the Health IT Standards Committee said in their Jan. 21 meeting.
Policymakers discussed setting a path for introducing EHR technical standards over the course of the 2011-2016 incentive plan. The standards are part of the Interim Final Rule (IFR) that lays out requirements for certified EHRs physicians and hospitals must use to qualify for health IT incentives.
In tuning the standards, ONC tried to strike a balance between using regulation and market forces, officials said, with enough specificity to allow for innovation on one hand and a stiff arm for rulemaking on the other.
It is unclear how specific standards for 2013 and 2015 will be, "but that tension between market and regulation will continue into the future," said Dr. Doug Fridsma, an ONC senior adviser who is an associate professor in biomedical informatics at University of Arizona.
ONC's interim final rule, which will take effect Feb. 12, encompasses 2011 standards for sharing clinical information, such as patient summaries and prescriptions as well as to describe clinical problems and medications and to communicate between systems.
"We did not include all the possible functionalities that an electronic health record could provide but just those that could support meaningful use and be tested objectively," Fridsma said.
For example, the ONC rule allows for either a continuity of care document (CCD) or continuity of care record (CCR), widely used clinical documentation standards for patient summaries developed by two different organizations.
"We may see tools that may come on board that makes one process easier than the other," Fridsma said. "We may see difference in adoption rates of one over the other."
ONC also tried to be more prescriptive about standards specific to healthcare, such as lab data reporting to public health agencies. For standards that applied more broadly, such as identity authentication of those involved in a health information transaction, ONC described only the function.
"We wanted to make sure that if there were a new method for encryption, for example, we could set a floor and [still allow for] innovative versions," Fridsma said.
Finding the sweet spot in such trade-offs "going to take using all the different levers and the motivators that we have, market forces and regulation forces, certification criteria and federal and local policy," he added.
Dr. David Blumenthal, the national health IT coordinator, said the incentives under the stimulus would also act as a lever for standards adoption. When the incentives become available, the market will move forward "doing the things that are necessary to get those monies, and do it without our help" he told the committee.
In addition to the discussion on standards, Blumenthal also reported on recent developments in the Health IT Policy Committee, including efforts underway to expand the nationwide health information network (NHIN).
"As we get more advice about the various mechanisms of exchange that will make sense for meaningful use, we are thinking about if there are complementary consistent alternatives to the full NHIN as ways of undertaking exchange," he said.
The committee is "developing a set of possible programs to accelerate the use of NHIN mechanisms that might be simpler and less robust perhaps, but easier for small providers to access the NHIN in the short term," he said.
