The United States Health Information System (USHIK) - Then, Now and for the Future

Yesterday I attended two meetings: HIT Policy and Medication Terminology.I plan to attend the the HITSP Harmonization Subcommittee meeting tomorrow and the Health IT Standards Committee meeting on Friday. After the Policy meeting, I emailed two comments that I would like to explain in more detail.

But first, by way of background, I live in McFarland, Wisconsin, just outside of Madison. Epic Systems is located in Verona, Wisconsin, about twenty miles from where I live. My physician is associated with a University of Wisconsin Health Clinic located in McFarland. My hospital of choice is Meriter Hospital located in Madison. Both UW Health and Meriter Hospital have installed Epic's system.

My first comment was that "meaningful use" should include patient education/training on how to use Health Information Technology(HIT). Considerable discussion was held during the meeting concerning workforce education on how to use HIT but I don't believe anyone mentioned patient education. During a visit a month or so ago, accompanying my wife, to another UW Health Center, there was a small sign by the reception desk saying that staff were learning a new system. From the standpoint of patients, a brochure explaining the new system and its benefits would have been welcome and helpful.

My second comment was that from a patient's point of view the definition of "meaningful use" should be "crisp, clear and understandable". My comment paralleled Judith Faulkner's comment that "meaningful use" requirements should be "crisp, clear and doable".

The proposed requirements should be stated in unambiguous terms so that judgments can be made before adoption, not only whether they are desirable, but also whether they are programmable. From a patient’s point of view, I want to be able to understand the security that is actually built into the system in response to understandable requirements.

Ten years ago, in preparation for the Wisconsin Department of Health and Family Services (DHFS) to implement HIPAA, I participated in the HIPAA Metadata Registry Coalition sponsored by the (then) Health Care Financing Administration (HCFA) and the Environmental Protection Agency (EPA). I was a beta tester/registrar for a distributable metadata registry based on ANSI X3.285-1998 Metamodel for the Management of Shareable Data and ISO/IEC 11179 Specification and Standardization of Data Elements.

DHFS’ effort in establishing a metadata registry paralleled the national effort of the United States Health Information Knowledgebase (USHIK) and was intended to facilitate data exchange relationships and agreements between DHFS and many federal agencies. USHIK at that point was located on a military Web site that after 9/11 was closed to other than federally authorized users. USHIK over the years was moved from site to site and finally found a home with AHRQ.