The ONC Health Information Technology Policy and Standards Committees were hard at work at a meeting in Washington on Monday. The HHS website has posted the agenda and presentations from many of the Policy Committee workgroups, including the workgroups for:
- Meaningful use,
- Health exchange,
- NIHN, and
- Strategic planning.
However, after reviewing the workgroup presentations, the most content-rich and thought provoking presentation was from Aneesh Chopra, Workgroup Chair of the HIT Standards Committee.
This presentation offered the Top Ten Recommendations from the Implementation/Adoption Experience Hearing on 10/29/09. As stated directly from the presentation, the top 10 Implementation Recommendations included:
1. Keep it simple
- Think big but start small
- Recommend standards as minimal as required to support a necessary policy objective or business need, and then build as you go
2. Don’t let “perfect” be the enemy of “good enough.
- Go for the 80 percent that everyone can agree on.
- Get everyone to send the basics (meds, problems, allergies, labs) before focusing on the more obscure.
3. Keep the implementation cost as low as possible
- Minimize costs associated with implementation standards, including royalties, licensing fees and other expenses
- Open the NIST interoperability certification testing processes
4. Design for the little guys.
- Make sure the endorsed standards are as broadly implementable as possible, so diverse participants can adopt it, and not only the best resourced.
5. Do not try to create a one-size-fits-all standard
- Do not mandate or attempt to create a one-size-fits-all standard that adds burden or complexity to the simple use cases.
6. Separate content and transmission standards.
- Separate content standards from transmission standards; i.e. if CCD is the html, what is the https?
- Separate the network layer from the application layer.
- Avoid linking changes between senders and receivers.
7. Create publicly available vocabularies and code sets
- Ensure they are easily accessible and downloadable, with straightforward means to update or upgrade
8. Leverage the web for transport “health internet”
- Use what already works in transporting information securely on the Internet.
- Decrease complexity as much as possible to shorten the learning curve of implementers.
9. Position quality measure so they motivate standards adoption
- Strive for quality reporting to be an automated by-product of using certified technology and standards, lowering the administrative burden of reporting to the lowest extent possible.
10. Support Implementation
- Make Implementation Guides available that are human readable, with working examples and testing tools.
- Facilitate implementers’ use of Implementation Guides with effective national communication plans.
- Publish open source reference implementations.
This is encouraging, and it seems as if the Standards Committee is being led by a voice of reason. Perhaps it is the presentation’s concluding question that is most intriguing: Are complex solutions the best answer to complex problems?
Building a Health IT infrastructure for the nation is a complex problem, but I think this question is one that must be considered before the ONC releases the meaningful use and EHR certification standards. It is my opinion that complex solutions will only drive resistance to EHR adoption. Thinking simple, on the other hand, and developing simple solutions for widespread EHR adoption may be the key to success.