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The Office of the National Coordinator for Health Information Technology should more clearly define pieces of its plan for governing the Nationwide Health Information Network by clarifying its terminology and separating policy-level requirements and technical, implementation-level requirements, according to comments from the HIT Standards Committee's workgroups.
For example, ONC needs to clarify that “validation” of the NwHIN network validated entities (NVEs) encompasses both accreditation and certification, and should define the terms accordingly, Dixie Baker, chair of the NwHIN power team and senior vice president and technical fellow at Science Applications International Corp., told members of the committee May 24.
The NwHIN power team and the privacy and security workgroup presented recommendations at the Standards Committee meeting on ONC's May 15 request for information on the best governance practices to enable a competitive and open market for electronic health information exchange (see previous article).
ONC proposed a voluntary validation process for entities to demonstrate compliance with its conditions of trusted exchange, which will be used to validate their participation in the NwHIN. Conditions of trusted exchange would include standards for interoperability, data safeguards, and business practices.
According to the power team's recommendations, some conditions of trusted exchange are too specific, such as the transport standards and certificate discovery standards.
Additionally, the power team recommended that validation of exchange technology under defined governance policies should be separated from certification of exchange systems' conformance to technical specifications, though both processes may be considered parts of an overall governance model, Baker said.
The key factor in governing health information exchange is building a “trust fabric” to support data exchange practices, according to recommendations from the ONC privacy and security workgroup.
According to the workgroup, people in the marketplace do not know about or understand yet what NwHIN or NVE mean, and ONC should make clear how NVE validation will facilitate broader exchange of health data.
The workgroup recommended that ONC's federal partners play a key role in communication and outreach on NwHIN governance. For example, the Centers for Medicare & Medicaid Services could require that health information be electronically exchanged with the agency only through an NVE.
“The integrity of the validation process, and ongoing oversight and policy enforcement, are critical to the success of the voluntary approach,” the workgroup said.
ONC officials also provided an update to the HIT Standards Committee on the agency's Query Health Initiative, part of its Standards & Interoperability Framework.
The initiative has launched pilots with the New York City and New York State Departments of Health to support electronic queries for data on diabetes and hypertension. A pilot has also been launched at the Massachusetts Department of Health for diabetes queries.
The Food and Drug Administration and the Centers for Disease Control and Prevention are participating in query health pilots on the use of clinical data sources for FDA questions and CDC national and regional disease syndromes, Richard Elmore, ONC coordinator for query health, told the committee.
The overall goal of the query health initiative is to enable a learning health system to understand population measures of health, performance, disease and quality, while respecting patient privacy, Elmore said.
Materials and presentations from the meeting are available at http://healthit.hhs.gov/FACAs by clicking on the April 18 HIT Standards Committee meeting entry on the ONC federal advisory committee calendar and clicking on the meetings link.
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