1. Alexander, Gregory L. PhD, RN

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The Office of the National Coordinator (ONC) is inviting participation in the Standards and Interoperability (S&I) Framework Consolidation Project. The Framework is an initiative to facilitate greater harmonization of standards to achieve greater health information exchange. The current call for participation is for any member organization to participate that has a vested interest in achieving greater interoperability that will lead to improved exchange of healthcare information. Goals for this national initiative are to support the healthcare community by providing guidance for implementation of health information systems that meet the criteria for meaningful use (MU), the Nationwide Health Information Network and to accomplish ONC's ongoing mission. Initiatives that have been issued for the project include the following:


* transitions of care (ToC)


* laboratory (lab) interface


* clinical document architecture (CDA) consolidation



Each of these initiatives has specific purposes, goals, and outcome metrics. Links to each of these initiatives can be found at


The ToC initiative issues a charter challenging members to evaluate the exchange of clinical summary documents that are used to transmit information during ToC. MU requires ToC information to be incorporated into systems that are to be validated, which meet MU requirements. However, inconsistencies exist in current definitions of ToC data elements, how they are coded into information systems, and how these codes map to MU formats. These inconsistencies create barriers to implementation. An overall goal for ToC initiative members will be to recommend data element definitions that are more clearly stated and have improved usability and usefulness for the end-users trying to achieve MU requirements.


One stated health information exchange goal for ToC is that an organization with a validated health information technology (HIT) system has nearly a 100% chance of another organization with a validated HIT system being able to exchange core clinical information through clinical summary documents. In addition, the ToC initiative will focus on reducing unstructured and structured documents and template development time, which will be a time-saving initiative for facilities.


The lab interface initiative contains a charter that describes the current interoperability issues that challenge exchange through lab interfaces. Challenges include the use of multiple laboratory specifications for reporting in ambulatory settings, variable field details in implementation guides used by clinical laboratories, and variations in core code sets, which effect decision support and quality. A goal for this initiative is to reduce implementation time for laboratories by up to 20% by 2013. This initiative appears to be limited in its scope to specific primary care practices including internal medicine, family practice, and pediatrics.


Finally, the CDA consolidation initiative charter is designed to address feedback ONC has received from implementers, particularly related to the continuity-of-care document. Implementation guides that prescribe the CDA of an information system need to be harmonized to facilitate better health information exchange and MU. Some of the content contained in these CDAs include administrative (eg, registration, demographics, insurance, etc) and clinical (problem list, medication list, allergies, test results, etc) information. These content modules define content to promote interoperability between participating systems such as personal health record systems, electronic health record systems, practice management applications, and others. One expectation for this initiative is to create an implementation-ready program, which is user-friendly for implementers and contains textual and computable representations for health record content.


Each of these initiatives has an important component that will affect organization of nursing work and clinical documentation. For instance, because nurses are the main coordinators of care delivery, they are always involved in transitions of care from one setting to the next. Information that is exchanged between providers, facilities, and families is oftentimes a responsibility of nursing staff. Nurses are needed for these initiatives to ensure that meaningful data elements that are specifically for nursing, recommended by nurses, and defined by nurses are incorporated into clinical summaries along with other necessary provider data. Including nursing data such as plan of care in transition of care information is essential to maintain continuity of care as patients are transferred between care providers and facilities.


If you or your organization has an interest in participating in these initiatives, go to any of the links included in this overview. I would suggest reading over all the initiatives' charter information, purpose/goals, and scope to determine where you or your organization might contribute the most to the effort. Take time to review phases and outputs for the initiative you are interested in. Also, visit the guidelines for participation page, which will provide you with information about commitment options for being involved in the project. There is a site for instructions and rules for using the Wiki site, which contains important information about etiquette within the project working space. There is also a policy on Intellectual Property Rights for each project contributor to review, so that everyone understands how all the documents and content for the project are licensed. Once you have taken time to review this information, consider signing up by clicking on the link for Getting Started as a Volunteer: Once there, you'll be prompted to enter some personal information in an e-mail to the administrator for the S&I Wiki site, who will register you for access to the Web site. This response should take about 1 to 3 days.


Thanks for taking time to consider taking part in these important initiatives. It is vital that nurses maintain a voice in these types of national efforts to ensure that our profession is recognized as an important contributor to patient care, that nursing work is represented in the documentation systems being validated for MU, and that nursing care quality is included as a measurable goal for MU of information technology.