It was largely a happy Halloween for members of the
Health Information Technology Standards Panel, who, for
the most part, basked in praise as they delivered their
first three batches of harmonized healthcare
data-transmission standards and implementation guides
to the American Health Information Community on
But as with any good ghost or ghoul, the controversy
that churned and was laid to rest during the standards-selection process didn't really go away, but returned at
meeting's end as the leader of a key trade association
for lab operators arose to warn that his members will
be harmed by one of the HITSP standards recommended,
adding that the standards-selection process was
"fundamentally flawed" and the results will increase
costs and "create new roadblocks" to
HITSP was created by the American National Standards
Institute after it won a $3.3 million contract in October 2005
to develop a process to select and recommend
appropriate healthcare IT standards.On
Oct. 20, HITSP completed its first year of work by
approving for submission to AHIC some 22 standards
and eight implementation specifications to support
data transmissions in three areas selected by AHIC: to
move lab data into electronic health-records systems; to populate personal health records with a patient's
medication history and basic information to facilitate
registration; and to speed the transfer of healthcare
information from providers to public-health
authorities for biosurveillance.
HITSP Chairman John Halamka, the chief information
officer at Harvard Medical School and CareGroup Health
Systems, Boston, and John Loonsk, director of the
Office of Interoperability and Standards with the
Office of the National Coordinator for Health
Information Technology at HHS, made the presentation
of a work product, including 820 pages of
implementation guides, which, they said, is now ready
for field testing.
HHS Secretary Mike Leavitt, who created AHIC last year
to advise him on healthcare IT policy, lavished praise
on HITSP's work, noting that more than 260
healthcare organizations devoted more than 12,000
hours of volunteer labor to sift through more than 700
potential standards to come up with those in
the final report.
Leavitt thanked HITSP workers for their dedication. "I
don't have words to tell you how profoundly important
I feel this is in the process," he said.
Halamka noted that people working in the field of
standards development are commonly passionate about
and protective of their work.
By far the most difficult task was refereeing between the
two standards-development organizations Health Level 7 and ASTM, which offered competing versions of
standards that could have been used to move patient
summary data into a personal health record, according to Halamka.
"I received more than 1,700 e-mails on this particular
specification, compared to a few hundred on EMRs and a
few dozen on biosurveillance," Halamka said. HITSP
determined the best standard was a compromise being
developed jointly by HL7 and ASTM called the
Continuity of Care Document, which may be balloted by
HL7 as early as December or at least by February 2007, he
said. The CCD compromise was voted on at a HITSP
meeting Sept. 20, and "There was not a single
objection heard," Halamka said.
But that same day, although the standards to move laboratory
results into an EHR system also were voted on and
approved by the HITSP, the controversy surrounding
their selection survived.
Alan Mertz, president of the American Clinical
Laboratory Association, used the public-comment period
at the end of the AHIC meeting Tuesday to bring it back to life.
While noting that the ACLA is supportive of the HITSP
standards-harmonization effort, Mertz said, "It is our
belief that vendors have dominated this process." By
picking HL 7's version 2.5 for the lab
interoperability standard, "HITSP sacrifices
feasibility in the pursuit of technological
progress," he added.
Mertz said most healthcare providers and labs in the
U.S. use the much-earlier version 2.3 of the HL7
standard, while some use version 2.4, and only providers in
Europe use version 2.5.
"The cost and time required for providers to upgrade
their system to the HITSP standard would be
substantial," he said.
Mertz said ACLA supported as an alternative a lab
implementation specification called the EHR-Lab
Interoperability and Connectivity Standards, or
ELINCS, that was created last year by a consortium of
providers and labs under the auspices of the
California Healthcare Foundation. ELINCS is based on
HL7 version 2.4. He urged the AHIC to reject the HITSP
lab data scheme and support ELINCS instead.
David Brailer, vice chairman of the AHIC, asked for a
copy of Mertz's prepared statement, but the AHIC took
no action on Mertz's request.
Earlier in the meeting, Halamka noted that the HITSP
lab standard called for "leapfrogging" 2.4, which for
most hospitals would be a stretch, but the added
functionality of version 2.5 warranted its selection.
"We imagine there is going to be a gradual transition
to the 2.5 standard," Halamka said.
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