Meaningful use seeks to strike a balance, says Mostashari


The Health and Human Services Department faces a major challenge as it aims to strike a balance between rapidly modernizing the healthcare system and changing at a pace that can be absorbed by healthcare professionals and IT vendors, said an HHS official during a Nov. 14 hearing before the House Science, Space and Technology subcommittee on technology and innovation.

"This is an escalator and we want people to get on the escalator and continue to advance through the different stages," said Farzad Mostashari, national coordinator for health information technology at HHS.

"How fast up that escalator can we push? What's the rise and the run so that people don't fall off the escalator?" he asked.

Under the HITECH Act (.pdf)--which became law under the American Recovery and Reinvestment Act in 2009--eligible doctors, healthcare professionals and hospitals can receive financial incentives if they meaningfully use certified electronic health record technology. Mostashari's office promotes an incremental approach to meaningful use criteria. It's in the process of executing stages 1 and 2 of its electronic health record meaningful use standards and preparing to release stage 3.

"Achieving meaningful use is meant to be hard, but achievable," said Mostashari.

Interoperability is crucial to health information sharing. The question is, should HHS push healthcare to invest in the use of common languages or the use of translators that can enable EHRs to better communicate?

"We need both," said Mostashari, who added that it's preferable if EHRs can communicate automatically, but the use of third-party translation services may be necessary.

"Each stage of meaningful use advances interoperability," said Charles Romine, director of the information technology laboratory at the National Institute of Standards and Technology.

To further that goal, NIST has developed a conformance test tool for the certification, testing program for the 2014 standards and certification criteria. The tool will also be used in a test bed that simulates exchange between a test EHR technology and a standards-compliant EHR technology, said Romine.

Beyond helping HHS and healthcare stakeholders solve interoperability problems, NIST has several efforts underway that could help tackle the challenge of patient access to EHRs. The agency is working on patient identification matching and NIST researchers have developed a tool that supports the testing on patient identifier cross reference and patient demographic query test cases, said Romine.

The agency is also houses the program office for the National Strategy for Trusted Identities in Cyberspace. The program will advance identity management broadly and have serious implications for health IT.

Finally, some of the first use cases to be tested by NIST's newly-launched National Cybersecurity Center for Excellence will be around health IT and patient records—"particularly focused on small providers' ability to transfer secure and private records," said Romine.

For more:
- go to the hearing page (includes archived webcast and prepared testimonies)

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