Excerpts of an article from Modern Healthcare authored by Joseph Conn.
According to the author, the federally chartered Health Information Technology Policy Committee took the time Tuesday to parse some recommendations from one of its work groups on what to do about standards for electronic laboratory orders. The policy committee then hustled up a vote to accept the eleventh-hour recommendations so they still could be considered by rulemakers before the first round of meaningful-use criteria are published.
The American Recovery and Reinvestment Act of 2009 called for creation of the HIT Policy Committee to advise HHS' Office of the National Coordinator for Health Information Technology on a host of subjects. Committee members have spent a significant portion of their time since the group was launched in May dealing with meaningful-use recommendations. Earlier this year, the HIT Policy Committee made several suggestions to the ONC on the meaning of "meaningful use."
It recommended three tiers of increasingly more stringent criteria lasting for periods of two years each. The years 2011, 2013 and 2015 were chosen as the starting and ratcheting up dates to coincide with break points in the subsidy payment regime. The recommendations the HIT Policy Committee voted on Tuesday came from its information exchange work group and specified standards for use by providers when electronically ordering laboratory tests for a patient.
Work group Co-chairman Micky Tripathi of the Massachusetts eHealth Collaborative said 70% to 80% of lab transactions are not performed using EHR systems. The failure of the healthcare industry to come together on a common set of messaging standards and their implementation guides for labs is "in many ways, the Achilles' heel of meaningful use," he said.
"There are a lot of standards out there that are not used, and many standards that are used in various ways," Tripathi said. In addition to 5,200 commercial labs, there are 8,500 hospital laboratories, 400 public health laboratories and 115,000 small laboratories in physician offices and clinics, Tripathi said.
A lack of consensus on laboratory standards has remained an intractable barrier to interoperability for multiple reasons, Tripathi said. Large national reference laboratories control 25% of the market, he said, but are only part of a contingent of commercial laboratories, all of which are ineligible for EHR subsidy payments under the stimulus law. Thus, they won't receive direct incentives to respond if laboratory standards are included in the meaningful use criteria.
Commercial labs are covered under the federal Clinical Laboratory Improvements Amendments of 1988 or CLIA, but the law permits variance in regulation by the states. Many states require that lab results only be transmitted to the providers who ordered the tests, which precludes direct transmission to a patient through his or her personal health record, for example.