转发博客文章：美国国家HIT组织的职责和分工

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The National HIT organizations - How it all works从 Life as a Healthcare CIO 作者：John Halamka
Severalblog readers have asked me to take a fresh look at all theorganizations related to ARRA and explain how it all works. Here's myunderstanding:

Office of the National Coordinator
TheObama administration's ONC is different from the Bush administration'sONC in several ways. It's now funded with $2 billion to acceleratehealthcare IT adoption. Its new leader, Dr. David Blumenthal has apolicy focus, so we'll see broad policy guidance and specifichealthcare outcome goals rather than technology for technology's sake.It has regulation - ARRA is law and there are several new privacy,standards, and implementation requirements that were only voluntary ormarket-driven previously. You can expect that ONC will have a majorrole in coordinating federal agencies' use of healthcare IT as well asadoption in the private sector. By controlling the definition ofmeaningful use of healthcare IT as the gatekeeping function for payingstimulus dollars to clinicians, ONC has real power.

HIT Standards Committee
TheHealth IT Standards Committee is charged with making recommendations tothe National Coordinator on standards, implementation specifications,and certification criteria for the electronic exchange and use ofhealth information. Initially, the HIT Standards Committee will focuson the policies developed by the Health IT Policy Committee’s initialeight areas (listed below). The HIT Standards Committee will alsoprovide for the testing of standards by the National Institute forStandards and Technology (NIST). In its first meeting, the HIT Standards Committee created three workgroups.   Below are their Broad and Specific charges:

Clinical Operations Workgroup:
Broad Charge –
Makerecommendations to the HIT Standards Committee on requirements forstandards, implementation specifications, and certification criteriarelated to EHRs and clinical operations.

Specific Charge –
Makerecommendations to the HIT Standards Committee on the role of EHRs ande-prescribing, clinical summaries, laboratory and radiology reportfunctionality within two (2) months of the workgroup’s first meeting.The workgroup will also take into consideration the eight (8) areaslisted in Section 3002(b)(2)(B) when developing recommendations for thecommittee.

Clinical Quality Workgroup:
Broad Charge –
Makerecommendations to the HIT Standards Committee on quality measures thatshould be included in the Meaningful Use definition and for future EHRrequirements. Make recommendations to the HIT Standards Committee onrequirements for standards, implementation specifications, andcertification related to EHRs and clinical quality.

Specific Charge –
Makerecommendations to the HIT Standards Committee on specific qualitymeasures that should be included in the definition of Meaningful Usefor 2011 within two (2) months of the workgroup’s first meeting. Theworkgroup will also take into consideration the eight (8) areas listedin Section 3002(b)(2)(B) when developing recommendations for thecommittee.

Privacy and Security Workgroup:
Broad Charge –
Makerecommendations to the HIT Standards Committee on privacy and securityrequirements for standards, implementation specifications, andcertification criteria.

Specific Charge –
Makerecommendations to the HIT Standards Committee on specific privacy andsecurity safeguards that should be included in the definition ofMeaningful Use, with a specific focus on the eight (8) areas listed inSection 3002(b)(2)(B), within two (2) months of the workgroup’s firstmeeting.


HIT Policy Committee
TheHealth IT Policy Committee will make recommendations to the NationalCoordinator on a policy framework for the development and adoption of anationwide health information infrastructure, including standards forthe exchange of patient medical information. The American Recovery andReinvestment Act of 2009 (ARRA) provides that the HIT Policy Committeeshall at least make recommendations on standards, implementationspecifications, and certifications criteria in eight specific areas:
-Technologies that protect the privacy of health information
-A nationwide health information technology infrastructure
-The utilization of a certified electronic record for each person in the US by 2014
-Technologies that support accounting of disclosures made by a covered entity
-The use of electronic records to improve quality
-Technologies that enable identifiable health information to be rendered unusable/unreadable
-Demographic data collection including race, ethnicity, primary language, and gender
-Technologies that address the needs of children and other vulnerable populations

At it's first meeting, The HIT Policy Committee created three workgroups - Meaningful Use, Information Exchange, and Certification.

Here'sthe broad and specific charge for the Information Exchange workgroup.I'll add the details for the others as soon as I receive it.

Information Exchange Workgroup:
Broad Charge-
Makerecommendations to the HIT Policy Committee on policies, guidancegovernance, sustainability, and architectural, and implementationapproaches to enable the exchange of health information and increasecapacity for health information exchange over time.

Specific Charge-
Makerecommendations to the HIT Policy Committee within six (6) monthsregarding priority policy areas and other issues that are necessary inthe short term to advance the exchange of health information throughimplementation of HITECH. Make recommendations to the HIT PolicyCommittee to inform and provide guidance on the implementation of theNationwide Health Information Network (NHIN)


Health Information Technology Standards Panel
HITSPprovides an important consultative role to the HIT Standards Committee.As the HIT Standards Committee and its workgroups prioritize thetransactions needed to support meaningful use, they will consultstandards harmonization organizations (HITSP), Standards DevelopmentOrganizations, and Implementation Guide writers. HITSP volunteers andstaff have been placed on each of the HIT Standards Committeeworkgroups to provide technical assistance.

National eHealth Collaborative
NeHC, based on their recent meeting,will focus on implementation topics such as regional healthcare ITextension centers and the reality of increasing EHR adoption in thecountry.

Certification Commission for Health Information Technology
I'mconfident that CCHIT will continue to be the leading HIT certificationorganization in the US, but its certification criteria will evolve. TheHIT Policy Committee's workgroup on certification is likely to providevaluable input about certification by the Fall.

I hope thishelps clarify how all these organizations relate to one another as theyall work together to support ARRA, improve healthcare quality, andenhance efficiency, all through the implementation of interoperablehealthcare IT.