The July HIT Standards Committee

The July HIT Standards Committee included a robust discussion of Benefits and Formulary standards, a brief overview of our work on image exchange thus far, preparations for the July 23 HITSC Implementation Workgroup and HITPC Meaningful Use and Certification and Adoption Workgroup joint hearing on Implementation and Usability, an overview of ONC S&I Framework activities, and a discussion of the CMS electronic submission of medical documentation planning.

We started the meeting with a presentation from Kim Nolen and John Klimek reviewing the final recommendations for enhanced formulary and benefit standards.   While short term incremental improvements are important, the committee was more focused on the Stage 3 trajectory for formulary and benefits transactions.   Ultimately, the committee made 5 recommendations

1. We endorse the adoption of RxNorm as the preferred medication substance vocabulary in formulary and benefits transactions
2. We support standardizing content on NCPDP Formulary and Benefits version 3.0 to simplify current batch formulary import implementations in the short term but prefer the certification criteria for stage 3 focus on the real time transactions described in recommendation #5
3. We recommend that batch formulary transport standards move from FTP to Direct/XDR to align better with existing Meaningful Use transport standards
4. We recommend that patient matching to pharmacy benefits utilize PCN/BIN/Group Number to more accurately reflect the benefits of the patient's plan.
5. ONC should facilitate development of national standards for real time lookup of patient specific drug/dose benefits by prescribers at the point of care including estimated patient out of pocket cost at the time of the prescription order.

Also, I provided this image exchange update.  We will continue our hearings with more expert testimony this Friday.

Next we heard from Liz Johnson and Cris Ross about their planned July 23 implementation and usability hearing.   Their group has prepared great questions for its four panels - Eligible Professionals, Eligible Hospitals, Health Information Exchange/Interoperability, and Usability

Doug Fridsma provided a comprehensive update about the S&I framework activities, identifying all the current and planned deliverables for the many groups working on these important future looking projects.   Especially interesting was the data accress framework project which incorporates many of the previous point solution projects like QueryHealth and targeted query ("pull" of medical records from multiple sources).

Jodi Daniel offered this ONC Policy and Program Update focusing on the Health IT Patient Safety Action & 
Surveillance Plan.

Finally Melanie Combs-Dyer from CMS and Bob Dieterle presented the roadmap for fully electronic closed loop CMS medical documentation submission to support medical review by Medicare Administrative Contractors (MACs), Medical Review (MR) Departments,
Comprehensive Error Rate Testing Contractor (CERT), Payment Error Rate Measurement Contractor (PERM), and Medicare Recovery Auditors (formerly called RACs).   The digital signature provisions which provide provenance and integrity protections generated the most discussions and these will be reviewed by the HITSC Privacy and Security Workgroup and Clinical Operations Workgroup.

In my introductory remarks to the meeting, I stressed the importance of focusing our standards work on those items which will support the hard work of hospitals and professionals to achieve all phases of meaningful use, ICD-10, Accountable Care, and compliance/regulatory mandates.   Formulary support, image sharing, "pull" based health information exchange,  ensuring are EHRs are safe, and supporting Medicare review workflows definite fall into that category.

As the meeting closed, we thanked MacKenzie Robertson for her work as our FACA facilitator.   She will be replaced by Michelle Consolazio.

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