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FAQ: NHIN Direct v. Meaningful Use Certification Requirements

by Wes Rishel  |  June 25, 2010  |  1 Comment

Dear Abby,

The question is how SMTP as the preferred transport mechanism reconciles with the EHR certification criterion (in the IFR) that requires certified EHRs to use either SOAP or REST for HIE (i.e., §170.202 Transport standards for exchanging electronic health information).

Just sign me “Puzzled in Peoria”

Dear P in P,

First, let’s be clear. I speak for no-one. What I am saying hear does not cite an official position of the ONC, it is not a consensus position of the NHINDirect org, and so on. I speak as an individual who is a self-avowed cheerleader for NHIN Direct.

The certification requirements do not limit healthcare organizations to using the standards on which software is certified. They really only say that if a healthcare delivery org buys or builds software and wants to get incentive money for meaningful use the software has to be capable of using the standard (i.e., pass certification tests).

For example, MU requires a provider to get 50% of the lab results in structured form. An HDO could meet the requirement by sending CDs by courier and still qualify for the MU incentive money, as long as they uses software that could have accepted data according to the certification requirements were it asked. Certainly all the people that currently receive data through sources that do customized links to their EHRs are not going to have to re-implement their interfaces in order to get MU incentive money.

Part of the positioning of NHIN Direct is that it is metaphorically a “try before you buy” opportunity. ONC is facilitating activities that produce specifications  they might choose later. The “buy” would happen, for example, if a stage 2 certification rule were to incorporate the actual specs developed by NHIN Direct. The “try” is what happens when NHINDirect participants put the interfaces in place and actually begin to use it. If the “try” shows rapid uptake, the “buy” is more likely to happen.

It is also important to keep in mind that NHIN Direct is not directly comparable to existing standards that are certified. It is designed to encompass cases of “clinician to clinician” (rather than “clinician’s EHR to clinician’s EHR” over email and “physician to patient” (via PHR). It is also designed to require less elaborate governance and less complex technology because it sidesteps many of the consent issues that encumber HIEs.

(signed) Abigail van Bureaucrat

Dear Abby,

The convergence proposal accepts SOAP and REST at the edge as inputs from the EHR, so the convergence proposal is completely consistent with the IFR as written.

(signed) Halamka from the Hub

Dear H from H,

OMG! How cool. Wish I’d thought of that.

BFF Ab van B’rat

Revised 26 June 2010

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Category: healthcare-providers  interoperability  vertical-industries  

Tags: arra  ehr  healthcare-interoperability  healthcare-providers  meaningful-use  nhin-direct  

Wes Rishel
VP Distinguished Analyst
12 years at Gartner
45 years IT industry

Wes Rishel is a vice president and distinguished analyst in Gartner's healthcare provider research practice. He covers electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards. Read Full Bio

Thoughts on FAQ: NHIN Direct v. Meaningful Use Certification Requirements

  1. VIshal says:

    Nice post. Seem tree on most accounts but I also think that
    today medical practitioners are looking to avail of this federal incentive by trying to comply with the definition of meaningful use but at the same time EHR providers are looking at their own set of profits.
    This misunderstanding is mostly I believe as a result of wrong interpretation of the federal guidelines. The EHR providers need to look at these guidelines from the prospective of the practitioners who deal with different specialties.
    Each specialty EHR has its own set of challenges or requirements which I believe is overlooked by in most EHR vendors in a effort to merely follows federal guidelines. This is resulting in low usability to the practitioners, thus less ROI, finally redundancy of the EHR solution in place.
    I think ROI is very important factor that should be duly considered when look achieve a ‘meaning use’ out of a EHR solution. Though one may get vendors providing ‘meaning use’ at a lower cost, their ROI / savings through the use of their EHR might be pretty low when compared to costlier initial investment. Found a pretty useful ROI tool that is pretty customizable and easy to use. It also accounts for the different specialty EHR’s too.

    Some of the other useful resources on this topic:
    REC’s putting EHR’s to meaningful use
    Certification criteria for EHR

    Also the introduction of REC’s through the HITECH act. is a great way to avail of quality EHR solutions at competitive prices. The stiff competition among not only these REC’s but also among EHR vendors ( to become a preferred vendor of a given REC) will result in lot of positives to medical practioners.
    Looking the funding provided to the REC’s, the staggered grant allocation system also promises to be an unbiased way of allocating funds. It will also help in the concept of REC’s helping out each with their own unique business models. It can be one of the possible answers to the
    ’safe vendor challenge’ as discussed by many critics.

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