HIT Standards Committee shines spotlight on information exchange

Health information exchange is a critical part of meaningful use stage 2, but it's not yet fully automated. Nor is it easy enough for providers to scale up the sharing of patient data to improve care, according to Farzad Mostashari, MD, the national health IT coordinator.

Mostashari shared those comments during a meeting of the advisory Health IT Standards Committee on May 24 in Washington.

Some steps for preparing data for exchange are still often almost hand-coded, such as vocabulary mapping, value sets and quality measures, he said.

The development of "rules of the road" to govern the nationwide health information network (NwHIN) could promote that automation by detailing the policies and technical standards that organizations intending to perform exchange activities would meet to foster trust in their services.

“This is what we’re expecting people to be able to use for meaningful use," said Mostashari. "This is what needs to be [done] to enable meaningful use stage 2 pretty quickly.”

He added, “Whether it’s moving from the information exchange trust that is based on first-name basis and resulting in point-to-point sharing to a more scalable approach where, once conditions for trusted exchange are met, there can be assurance that it just works."

Middleware might also be developed to support policies and evolving technical implementation guidance as governance and exchange matures.

The Office of the National Coordinator for Health IT (ONC) seeks feedback on rules of the road and conditions for trusted exchange that can help it develop a notice of proposed rulemaking. ONC published a request for comments May 15 and has reached out to its advisory health IT committees for the expertise of their members. Public comments are due June 14.

The NwHIN standards, services and policies enable secure health information exchange over the Internet, until now typically among large providers and federal agencies. NwHIN participants can share complex health queries with multiple participating organizations at the same time instead of just one-to-one exchange.

ONC wants to open NwHIN to many more participants. Current participants enter into data-use agreements, which can be expensive and time-consuming for legal departments to complete.

John Halamka, MD, committee co-chair and CIO of Beth Israel Deaconess Medical Center, said, “We have the technical ability to do exchange, but our legal teams are very backed up.” Instead, government and stakeholders need to work together to come up with a straightforward trust fabric concept, he explained.

He compared it to the way electronic health records are certified. An organization could be certified as an NwHIN-validated entity (NVE) to be a trusted steward of data and an exchange member, according to the ONC request for comments.

“At that point, it is no longer the responsibility of state governments or local entities to do these binary, bi-directional point-to-point, one-off type of agreements before hospitals can trust each other to share data about patients they share in common,” Halamka said.

He envisions the result being some kind of certification program with clear standards and criteria by which an individual organization can join local, regional and national networks.

ONC has acted now because there has not been national guidance. States and other large groups have begun to develop potentially conflicting governance approaches to health information exchange and a need has arisen for a consistent trust baseline.

Mostashari described the goal as “if I’m working with a nationally validated NVE and I want to communicate with another provider who also is working with an NVE. I have confidence that there would be no need for negotiations between those two around the conditions for interoperability or for conditions for trust or around business practices.”

ONC has assembled a list of 16 conditions for trusted exchange that collectively serve as a starting point for discussion for rules of the road. They include:

  • Safeguards to protect confidentiality, availability and prevent disclosure and unauthorized access.
  • Interoperability that focuses on the technical standards and implementation specifications needed for exchanging electronic health information.
  • Business practices in operations and finance to which NVEs would need to adhere in order to support trusted exchange.