1. HIT Standards Committee Clinical Operations Workgroup Report on Gaps and Next Steps Jamie Ferguson Kaiser Permanente John Halamka Harvard Medical School October 14, 2009

2. 2 Scope Of Gaps For Discussion Criteria for certification Gaps for Health Information Exchange (HIE) –Standards for inter-HIE communications –Coordination of EHRs with HIEs and clinical ancillaries “coordination of all systems that must communicate with HIEs” Clarification of 2011 measures Gaps in specific domains, e.g., administrative vs. labs

3. 3 Gaps: Clarification Of 2011 MU Measures High cost imaging with structured indications –Needs definitions Patient access to EHR –Minimum content requirements –Direct access vs. PHR copies Patient-specific educational materials –Needs clarification

4. 4 Gaps: Vocabulary National SNOMED CT maps to ICD9 and ICD10 RxNorm –Cross-maps to existing codes –Complete federal medication terminology set w/ NDF-RT, SPL LOINC –Complete set of order codes including panels and profiles –Identify comparable test results e.g. for trending –LOINC/SNOMED boundary and relationship UCUM guidance and testing Standards to distribute code sets and updates Maintenance and management processes for subsets

5. 5 Gaps: Other Gaps Administrative –Operating rules for 5010 –Updates to electronic claim attachments –Explore how all documents in the CDA family can be used Clinical Lab Order Messaging Quality Reporting Architecture –Implementation guidance for architectural alternatives –QRDA and e-Measure guidance

6. 6 Next Steps Resolve identified gaps Launch Vocabulary Sub-Workgroup Develop additional and/or revised recommendations for 2013 to support 2013 policy objectives and measures Integrate with and support testing efforts