Halamka's Report on the June 2015 HIT Standards Committee

John D. HalamkaThe June 2015 HIT Standards Committee focused on celebrating the accomplishments of those individuals who have reached their federal advisory committee term limits.  Most served 6 years:

• Dixie Baker
• Anne Castro
• Marty Harris
• David McCallie
• Stan Huff
• Liz Johnson
• John Derr
• Sharon Terry
• Jon Perlin
• Jeremy Delinsky

Karen DeSalvo thanked each one and I offered comments about their unique contributions, changing the fundamental trajectory of standards in the US from a 1990’s “EDI” payload model to a 2015 “Facebook” Application Program Interface model.   Their leadership has brought modern, open web standards to the healthcare domain, specified controlled vocabularies, and established appropriate security. They will be missed.

Next, John Feikema and Dragon Bashyam presented a summary of the Data Access Framework project.  We thanked them for the foundational work that has been incorporated into the private sector Argonaut project.

Chris Muir provided an Interoperability Standards Advisory Update and described the process by which a task force will refine the FY16 sub regulatory guidance.   While regulation generally includes only mature standards, sub regulatory guidance can enumerate emerging standards that are likely to become mature.

The next portion of the meeting focused on the  final recommendations of the committee for the standards to include in regulation and those to specifically exclude from regulation.

We highlighted the measures of maturity that Dixie Baker outlined in her paper about standards readiness.

We emphasized that standards require a business case, policy enablers, and supporting infrastructure.  As David McCallie wrote, Standards Alone are not the Answer for Interoperability.

In that spirit, Rich Elmore presented the recommendations from the Content Standards Workgroup.

Mitra Rocca presented the recommendations of the Semantic Standards Workgroup.
   
David McCallie and Arien Malec presented the recommendations of the Architecture, Services, and APIs Workgroup.

Liz Johnson and Cris Ross presented the recommendations of the Implementation, Certification, and Testing Workgroup

The themes included:

• CCDA is mature but needs to significantly constrained
• FHIR is nearly ready for widespread use and should be highlighted as directional
• Quality standards such as HQMF and QRDA will be refined in their next version
• Many standards are just not ready for regulatory or sub regulatory recommendation including HPD+ (provider directory), eSMD (electronic submission of medical documentation), DS4P (data segmentation for privacy), and HeD (Healthy Decisions)
• Providing a laundry list of immature standards is not going to accelerate interoperability

After the meeting I spoke with several members about writing a journal article that will summarize the lessons we’ve learned providing standards advice for the Obama administration.  The most significant point is that interoperability doesn’t happen when standards are named.   Interoperability happens when there is a business case, trust between two parties, and governance over the process.    It generally takes a few years to achieve all the enablers  and there is no magic standard that will make the cultural and policy changes needed to accelerate information flow.