US health IT leaders to rule on key standards

Last week, the healthcare informatics committee of standards-setting organisation ASTM International approved a minimum set of patient data to ensure continuity when patients move between care settings.

Meanwhile, balloting closes this Friday on a proposed voluntary standard from Health Level Seven that would create a first-ever industry-consensus definition of standards for the exchange, management and integration of data for an electronic health record.

Titled the Electronic Health Record-System Functional Model Draft Standard for Trial Use (EHR-S DSTU) the voluntary draft standard contains about 130 functions.  According to the HL7 organisation the HL7 EHR-S Model "can be used to enable consistent expression of system functionality".

Members of ASTM Committee 31 on Healthcare Informatics on 6 April overwhelmingly adopted the Continuity of Care Record (CCR), following a month-long balloting process. This standard defines a data set for practitioners to give patients so future providers will have ready access to basic health information.

ASTM will not issue the final, official text of the standard until it finishes a routine formal review of the balloting process in the next several weeks, but based on an earlier draft, the CCR should include a summary of the patient’s health status, including information about allergies, medications, vital signs, diagnoses and recent care provided.

It also should contain basic information about practitioners who have treated the patient, insurance coverage, advance directives, care documentation and recommended care plans, according to ASTM and the Massachusetts Medical Association.

"It’s really needed anywhere in any country," committee Chairman C. Peter Waegemann says of the CCR. “The data should be following you.”

Waegemann also is executive director of the Medical Records Institute, which, along with the Massachusetts Medical Association, helped launch the CCR project a year ago. Other sponsoring groups include the Healthcare Information and Management Systems Society, the American Medical Association, the American Academy of Family Physicians, the American Academy of Paediatrics and the Patient Safety Institute, which represents safety advocates from the public and private sectors.

According to Waegemann, last week’s vote concludes the first of four to five stages of CCR development. “We are now working on a core data set demonstration,” in an attempt to show that the concept really can be implemented, he says.

The ASTM committee settled on XML as the preferred format for CCR data so records are universally compatible with clinical IT systems, Waegemann says. Healthcare facilities and providers ought to be able to give patients their basic continuity information either as a printout or stored on portable media.

Waegemann says that at least a half-dozen companies are preparing to put CCRs on USB drives for the demonstration phase.

While the CCR project effectively started at the grass-roots level, the impetus for the proposed EHR standard that HL7 members are voting on through 17 April actually came from the US Department of Health and Human Services (HHS). Last year, HHS Secretary Tommy Thompson called on the healthcare community to develop a model EHR standard that organisations could adopt voluntarily.

The current balloting actually is the second round; HL7 members soundly defeated the first proposal last August after the document became bloated with specifications more suited for a technical standard than a functional one, according to HL7 officials.

“The majority of the effort (in the second balloting process) has been taking something that is way too specific and making it more general,” explains Linda Fischetti, co-chair of the HL7 special-interest group on EHR.

“The previous proposal did not ‘fail’ in the general sense of the word. It succeeded in effectively activating the standardisation process,” says David Markwell, chair of HL7 UK, based in Reading, Berkshire.

"The original draft document was certainly not ready for adoption as real standard," Markwell adds. “However, it is the normal process of standardisation to bring material forward for ballot when its authors feel this is the best approach to generate the discussion that leads to an eventual consensus.”

HL7 will announce the results of the voting early next month. Should the plan pass, HL7 will publish the so-called draft standard for trial use so healthcare IT professionals can test the standard for up to 24 months. Following the trial period, HL7 would solicit comments, update the document and put it to a final vote for adoption as industry standard.

In the US, HHS has said it will make the HL7 EHR standard freely available and may require its use in government-run health programs for the elderly and disabled, as well as for military personnel.

The British NHS has not publicly committed to using the HL7 recommendation, though Markwell says members of HL7 UK “have been actively monitoring the development” of the standard.