Officials from two federally funded healthcare information technology support organizations are themselves supportive of the private-sector effort by the Continua Health Alliance, even though that industry-supported consortium is plowing similar ground in the field of healthcare IT standards harmonization, product testing and certification.
David Whitlinger, president and board chairman of Continua, announced last week that the consortium would by early next year complete and publish its first version of standards guidelines against which it will test and certify home-healthcare devices for data interoperability with personal health records and electronic health-record systems. Those home-care devices include blood pressure cuffs, glucose meters, bathroom weight scales and electronic medication-management cabinets.
As such, Continua is running on a parallel track to the federally overseen American Health Information Community, and the federally supported Healthcare Information Technology Standards Panel and the Certification Commission for Healthcare Information Technology.
AHIC was formed in 2005 by HHS Secretary Mike Leavitt to advise the federal government on healthcare IT policies. Half of its members are government healthcare IT leaders with Leavitt serving as its chairman.
Physician informaticist John Halamka, chief information officer for the Harvard Medical School and CareGroup Health System in Boston, serves as chairman of HITSP. The panel was created in late 2005 by the American National Standards Institute, which was awarded a $3.3 million contract by HHS to identify the most appropriate data transmission standards to carry out a series of "use cases" selected by AHIC.
Halamka said in an e-mail in response to a request for comment about Continua that its efforts should not cause a conflict with work of HITSP.
"In 2008, HITSP (will have) six new use cases from AHIC, including remote monitoring, specifically vital signs and labs such as glucose, Halamka said. Continua is doing important foundational work on these items, and I think their effort is very complementary to HITSP. I know that ONC (the Office of the National Coordinator for Health Information Technology at HHS) has had recent conversations with Continua, and I'm confident our efforts will align in 2008.
The national coordinator, physician Robert Kolodner, said staff at his office and at Continua "have had conversations," and they are "continuing to explore the best options for ensuring that our activities are complementary and even synergistic with one another."
Mark Leavitt, a physician, serves as CCHITs chairman, which was formed in 2004 to promote adoption of healthcare IT systems by testing and certifying them for functionality against a set of criteria developed by its own panels of IT industry experts. CCHIT has tested and certified more than 80 EHRs used in the ambulatory-care environment and is expanding its operations to include testing and certification of hospital-based clinical IT systems.
In part because of their different startup dates, HITSP and CCHIT last year had to work through a bit of a standards clash over which to use for clinical laboratory messaging. The dust-up was settled with a compromise to phase in adoption of the more futuristic HITSP-selected standard over time. The flap resulted in preparation last month of a formal memorandum of understanding spelling out a plan to coordinate future activities between HITSP and CCHIT to avoid a reccurrence of similar problems.
Leavitt said that he has had a number of telephone conversations with Whitlinger, who also serves as director of healthcare device interoperability for the giant computer-chip maker Intel Corp., and has met with him several times in person. While he acknowledges there is a potential for conflict, I think the chances are much higher that this will be complementary, Leavitt said. Weve discussed whether we should create a document of agreement or a memorandum of understanding, but we didnt think there was a need to do that.
As best that I can tell, theyre not interested in certifying health records and were not interested in testing personal health devices and certifying them, he said.
Leavitt said he believes the two organizations will find the formats for transferring information from devices to EHRs will be similar to those used for sending from devices to personal health records. He noted that because Continua has committed to using the Continuity of Care Document format and HL7 Version 2.5 data standards, both developed by the Ann Arbor, Mich.-based standards development organization Health Level 7 and both used by CCHIT, it shows theyre not trying to reinvent the wheel, Leavitt said.
In fact, because CCHIT and Mitre Corp., McLean, Va., are developing an open-source software tool to test EHRs for interoperability, some synergy between the two testing and certification programs could develop.
I think there is potential that that testing tool could test the EHR side of the interface with those (home) medical devices, he said. I think its a way to get the big job done faster with different people working in this area.
Whitlinger said Joseph Ternullo, who serves as vice president of Continua and is the associate director of the Center for Connected Health at Partners HealthCare, Boston, sits on the AHIC chronic-care work group and expects coordination between AHIC and the alliance to go smoothly. Continua, which was founded in June of last year by 22 organizations, now claims 133 members.
Essentially, our position is, we as an industry organization have all the right stakeholders in the organization, we have momentum and that whole package (of chosen standards) up and rolling, so lets not have AHIC re-create that, he said. That would be tragic. So, were working with them.
The idea, he said, is for AHIC, HITSP and CCHIT to leverage what were doing, not re-create what were doing. Were focused on personal telehealth, everything outside the clinic, outside the doctors office. Continua will be very successful outside of the (healthcare) enterprise; that leaves AHIC and CCHIT a lot of room to focus inside the enterprise.
Whitlinger said that the meeting with the national coordinators office was the first formal discussion with that government organization. Hed prefer, as AHIC transitions to a private-sector organization, that some agreement between Continua and the new AHIC be put in writing.
That would be our hope that there would be a formal arrangement and a formal memorandum of understanding between us on how we do business, he said. Maybe the seeds of that are planted this fall and as AHIC 2.0 begins, we might move toward that.
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