1. Sensmeier, Joyce MS, RN-BC, CPHIMS, FHIMSS
  2. Alexander, Gregory L. PhD, RN

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As nurse informaticists work toward the adoption of electronic health record (EHR) systems, they understand the important role that standards play in enabling health information exchange. The Healthcare Information Technology Standards Panel (HITSP) is a public-private volunteer-driven community that was established in 2005 as part of a government contract between the American National Standards Institute (ANSI) and the Office of the National Coordinator for Health Information Technology (ONCHIT) of the Department of Health and Human Services (DHHS). The HITSP serves within the federally chartered American Health Information Community (AHIC), which was chaired by former DHHS Secretary Mike Leavitt, to provide input and recommendations to DHHS on how to make health records digital, interoperable, private, and secure. The HITSP is the national harmonization body responsible for collaborating with the public and private sector to achieve a widely accepted and useful set of standards to enable the widespread interoperability among healthcare software applications. Other chartered members reporting within this community include the Certification Commission for Healthcare Information Technology (CCHIT), the Health Information Security and Privacy Collaboration (HISPC), and the Nationwide Health Information Network Architecture Projects (NHIN).


The HITSP is charged with several different tasks, including selecting and harmonizing standards for use cases prioritized by the AHIC and developing, evaluating, and testing interoperability specifications. These efforts are being accomplished through technical committee (TC) work, which is focused on AHIC breakthrough areas. Technical committee structures currently in place are addressing standards from several perspectives, including the population (ie, biosurveillance, quality, and public health case reporting), consumer (ie, consumer empowerment, access to clinical information, and remote monitoring), provider (ie, emergency responder, medication management, and transfers of care), care management and health records (ie, family and social histories, genetics, and pedigree development), security and privacy, financial and administrative, domains, and foundational components.


Nurses are positioned to play a vital role through their participation on the HITSP panel or within TCs. Nursing participation in these groups ensures that recommended standards are inspected with a nursing lens, with a constant focus on how standards can support care of patients, improve nursing practice and quality of care, and make patient care safer. Responsibilities of participants are to review definitions and rules of existing or new use cases or harmonization requests; conduct requirement analysis on the requests; identify and select standards to be considered within EHR systems; identify and resolve gaps, duplications, or overlaps in existing standards; and develop and recommend interoperability specifications.


The primary goal of the HITSP is to harmonize and integrate diverse standards that will meet clinical and business needs for sharing information among organizations and systems. To achieve this goal, it is critical that key stakeholders contribute to this effort on behalf of the broader healthcare IT community. Currently, more than 500 organizations, including the Alliance for Nursing Informatics, are HITSP members, representing clinicians, general practitioners, specialists, payers, suppliers, providers, consumers, government agencies, standards development bodies, and healthcare IT organizations. These individuals and groups work together to


* establish HITSP Interoperability Specifications and promote their acceptance


* support the deployment and implementation of HITSP Interoperability Specifications across the healthcare enterprise


* facilitate the efforts of standard-developing organizations to maintain, revise, or develop new standards as required to support the HITSP Interoperability Specifications



Members of the HITSP contribute as volunteer, subject matter experts who may participate as TC members or panel members; members are responsible for reviewing and approving HITSP work products, which, after a public vetting process, take the form of Interoperability Specifications. The HITSP process is consensus based, which requires that members come to agreement prior to making recommendations. This process can be quite challenging when different perspectives or agenda are at play. As chairman of the panel, John Halamka, MD, facilitates these consensus discussions, ensuring that stakeholder representation is addressed and individual or organizational bias is minimized. When consensus cannot be achieved, a vote is taken, and each member organization has one vote.


It is the intent of this effort to harmonize standards that promote interoperability to enhance healthcare quality and contain costs. The use case road map in Figure 1 demonstrates current progress toward this goal, which is achieved by building on foundational elements such as EHR (laboratory) results to lay the groundwork for future work on General Laboratory Results Reporting. As these building blocks for health information exchange get implemented in healthcare IT systems, clinicians and consumers will be able to access health information wherever and whenever needed, thus improving the efficiency and quality of care and enhancing public health and reporting.

Figure 1 - Click to enlarge in new windowFIGURE 1. AHIC priorities and use case road map.

Beginning in 2005 with the establishment of AHIC and the awarding of contracts by the DHHS to implement a standards harmonization capability and an EHR product certification capability, the joint government and private sector efforts have identified 29 interoperability priorities for standards harmonization and eventual product certification. Once HITSP Interoperability Specifications are recognized by the DHHS secretary, they are used to inform the CCHIT product certification criteria.


In addition, federal agencies must adopt them according to an August 22, 2006, Executive Order. Specifically, each agency that implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities shall use, where available, health information technology systems and products that meet recognized interoperability standards, for example, HITSP Interoperability Specifications. The HITSP is also playing an integral role in the development of a Nationwide Healthcare Information Network (NHIN) for the United States by providing components of health information exchange for the NHIN specification process.


As we embark on a transition of the new administration, there are many questions ahead. However, if healthcare reform is at the forefront of our national conversation, it is likely that the work of these national initiatives will provide a foundation for an EHR system. While standards-based health information exchange is not the sole solution for broadscale healthcare reform, it does provide a mechanism to achieve many of healthcare reform's largely accepted goals, such as improving access, cost, and quality of healthcare, while empowering consumers in their healthcare decisions and ensuring the privacy and security of personal health information.