Standards Committee Struggles with Structure

The HIT Standards Committee — a federal advisory body created to guide the Office of the National Coordinator (ONC) for Health Information Technology in its implementation of the HITECH Act — spent the initial part of its monthly meeting this week struggling with issues of communication, structure and capacity.

One reason for that struggle with capacity is the additional tasks being laid at the committee ‘s doorstep as a result of the recently passed healthcare reform legislation. Specifically the committee is being asked to oversee the enrollment transaction specifications which will be necessary for more people to buy health insurance at more locations.

Closer to its core work, but still a new request, the committee was recently asked by Arian Malec, Coordinator for the NHIN Direct project, to review RFPs it had received on how four Meaningful Use-related use cases could be handled.

NHIN Direct is defined as “a project to expand the standards and service definitions that, with a policy framework, constitute the NHIN. Those standards and services will allow organizations to deliver simple, direct, secure and scalable transport of health information over the Internet between known participants in support of Stage 1 Meaningful Use.”

“They ‘re all great approaches they ‘ve come up with,” said Malec, “(The Standards Committee) is a place we can wrestle with this and decide which is better. We ‘d love for you to give a focused evaluation of the draft approaches.”

The request seemed to throw a monkey wrench into the Standards Committee ‘s work for a few reasons. First, Malec wants the RFPs reviewed and evaluated by June 11, long before the committee will have another meeting. In addition to the time crunch, some committee members seemed concerned that their review of the RFPs would constitute an official imprimatur, which would not only make the guidance part of NHIN Direct, but the overall set of standards that will make up the NHIN.

John Halamka, vice chair of the committee and CIO at Harvard Medical School, said those concerns were misplaced. He said the committee ‘s review only constituted a “sanity check” on the RFPs and that the whole process should be seen as a “skunkworks” exercise rather than a formal process for deciding what becomes part of the final NHIN specifications.

The other major concern was that privacy and standards work had diffused through government agencies, their attendant advisory bodies and the workgroups created by those bodies.

ONC Chief Privacy Officer Joy Pritts, an assistant research professor at Georgetown University’s Health Policy Institute, said combining those bodies — which are now workgroups or components of the HIT Standards Committee, Policy Committee, NHIN Direct and NHIN — under one “Tiger ” team would be the best way to consolidate privacy and security efforts going forward.

According to Wikipedia, a Tiger team is defined as, “a specialized group that tests an organization’s ability to protect its assets by attempting to circumvent, defeat, or otherwise thwart that organization’s internal and external security.”

Explained Pritts: “It became apparent there were a number of privacy and security workgroups working on little pieces of this at the same time, and there are issues overlapping. We didn’t want to proceed in that fashion very much longer. Those groups may reach different conclusions because they are not integrated as a whole.”

Pritts said the Tiger team, which has funding available for full time staff, should contain a few members of the Standards Committee who could then report back to the full committee on the team’s progress.