Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Federal Efforts at Defining Interoperability Standards

12/01/2011

The CHI Initiative was a federal effort with a goal of establishing messaging and vocabulary standards to allow federal agencies to exchange health information efficiently and effectively in order to provide better care and lower administrative costs.1 In 2006, the CHI Initiative was transferred to the FHA within the ONC, now an agency of the HHS. The FHA worked closely with the Health IT Policy Council (HITPC), which brought together entities within HHS and other federal agencies to advance short and long-term HIT policy.

In 2006, the CHI recommended for adoption, across the federal health enterprise, HIT standards defining requirements for exchanging and reusing standardized federally-required patient/client assessments for functioning and disability. The HIT standards approved were then presented to and approved by the NCVHS, and were subsequently approved by the Secretary of HHS, who forwarded them to the ONC.2

In late 2007, the adoption of the Disability and Assessments standards were one of three new domain areas and associated clinical standards announced in the Federal Register:

Disability and Assessments:

  • Regenstrief Institute, Inc LOINC© (Logical Observation Identifiers Names and Codes©)l representation and codes for questions and answers on federally-required assessment forms;
  • CHI-endorsed semantic vocabulary matches linked with the LOINC© assessment questions and answers; and
  • HL7© [Health Level Seven] v2.4 and higher messaging standard and the HL7© CDA (Clinical Document Architecture (CDA))m for exchanging standardized federally-required assessment content.3

In conjunction with other federal initiatives, the HITSP, convened by the American National Standards Institute (ANSI) in 2005 under contract to HHS, led efforts to identify and harmonize HIT standards, including those endorsed by the CHI Initiative. Despite the change in presidential administration in 2009, HITSP remained under contract to ONC through January 2010 and continued to play a role in addressing interoperability standards in alignment with the goals of the American Recovery and Reinvestment Act (ARRA) of 2009. ARRA established two new oversight bodies within the ONC, the HIT Policy Committee and the HIT Standards Committee. These committees report to the National Coordinator and are tasked with helping develop HIT data standards and implementation specifications, and with recommending the “meaningful use” criteria for EHR systems to be subsidized by CMS through incentive payments under ARRA.

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