Broadly, the ONC’s Health IT Standards Committee charged the Clinical Quality Workgroup with “commenting on the appropriateness of certain standards and the alignment of standards” for Meaningful Use clinical quality measurement and clinical decision support, said workgroup co-chair Daniel Rosenthal, MD, director of healthcare intelligence at Inova Health System in Virginia.
Perhaps that’s too broad, Rosenthal said at a meeting of the clinical quality workgroup; indeed, he’s working to get “as explicit as possible clarity from chairs of HIT Standards Committee on questions they need answered.”
But the overarching goal remains to help streamline standards, and before the workgroup can align standards for clinical quality measurement and clinical decision support, they’re crafting a framework of principles.
“We can’t do either of those tasks unless we have some guiding principles,” said Keith Boone, GE Healthcare’s “standards geek,” a member of the workgroup who’s trying to lead the creation of those principles.
Guiding principles for standards — or standards for standards?
Boone acknowledged the pitfalls of over-complicating standards and pointed to a cartoon that aptly summarizes the dilemma.
Drawing on a number of standards frameworks from different industries and government agencies, Boone highlighted a few ideas that he thinks should guide the workgroup’s approach to clinical quality measures and clinical decision support — the first being to envision meaningful HIT use as an architecture.
“It’s important that your standard be able to work, not just with itself, but with other standards,” Boone said, estimating that an online web conference relies on about 20 different standards. “The idea is that there’s actually an architecture; there’s a plan for how all of these pieces will work together.”
Second, standards “should be aligned around a common data model” — ideally, that is. If systems have to go from one standard to the other, using SNOMED and ICD-10, the translation “should be obvious and non-ambiguous,” he said.
Another principle Boone and others discussed is understandability. “Is it something that I can explain to a developer who can implement it directly?” Boone asked, as a rough way to evaluate a standard.
Boone also queried members of the workgroup and leaders from health IT standards bodies HL7 and IHE, asking for their top concerns in aligning standards, and several common themes were cited:
•Ease of implementation •Ease of use and understandability •Explainable to MDs •Over the wire sparcity •Graceful extensibility •Use of existing technologies •Stop reinventing the wheel •Support reusability •Don’t adopt untested •Pilot tested in live environment
“One of things I heard quite a bit was the phrase ‘stop reinventing the wheel,’” Boone said. “This goes back to the concern that for many, the standards we have are good enough.”
Indeed, a large part of the challenge for the workgroup when they reconvene November 7 (and likely beyond) will be figuring out how to extract the best of the best while consolidating or aligning standards.
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