Why IT Standards are critical to improving Quality?

Keith Boone

Since this is my first post, I thought I’d make it clear that when I talk about standards, I mean standards for interoperability between Healthcare IT systems, not standards for providing care.  I am very involved in Health IT Standards development in Health Level Seven International (HL7), and in Integrating the Healthcare Enterprise (IHE) and keep track of what is going on in at least four other similar organizations.  At the National level, I follow the activities of the HIT Standards Federal Advisory Committee, and to some extent, those of the HIT Policy Committee.

I thought it might be helpful to orient you to the lay of the land with respect to healthcare IT standards impacting quality and safety.  I’m certain that most of you are already familiar with CMS and the Meaningful Use regulations, and the quality measures included therein.  CMS may be in charge of Meaningful Use, but the Office of the National Coordinator for Health IT selects the IT standards used by those regulations, and determines how Health IT products using them are to be certified.  The current National Coordinator, Dr. Farzad Mostashari, not only heads up that office, but is also designated by the HITECH Act to be a leading member of both the HIT Standards and HIT Policy advisory committees.  His office also sponsors several IT standards development initiatives through their Standards and Interoperability Framework program.

The focus of ONC is to improve the quality and reduce the costs of care.  Many of the ONC initiatives focus on quality measurement and clinical decision support.  These two fields have a common requirement: Health IT systems supporting them must be able to compute with clinical data.  Existing Health IT standards and new ones are being developed to enable just that.

The CDC’s Public Health Informatics Conference that I just returned from highlighted several implementation guides using one standard at a panel session.  The HL7 Clinical Document Architecture standard is being used for voluntary reporting of Healthcare Associated Infections to the National Healthcare Safety Network and to support public health reporting.  The National Quality Forum sponsored the development of the Health Quality Measures Format (HQMF) standard recently published by HL7.  Defining a quality measure in a  standard format to makes it possible for systems to compute it automatically.

There are so many Federal projects around CDS that ONC has created a Collaborative space for participants to exchange information.  The Agency for Healthcare Research and Quality (AHRQ) has sponsored development of a number of projects supporting CDS.  A couple involve implementations, and at least one will use the HL7 Continuity of Care Document (CCD).  CCD is a standard based on CDA and also specified for meaningful use. ONC is also sponsoring the Advancing Clinical Decision Support project to distill best practices and demonstrate CDS implementations.  Some participants in this project overlap with other CDS grants from ARHQ.

IT Standards the ones I just mentioned are essential tools you can use to eliminate costly manual processes for managing, measuring and delivering high quality care.

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