EHRs and Meaningful Use: The Case for Semantics

Ram D. Sriram

Chief, Software and Systems Division

Information Technology Laboratory

E-mail: sriram@nist.gov

2010-11-12

Meaningful use for EHRs• Stage 1

– Focus will be on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information. (http://www.cms.gov)

• Stage 2– Expand upon the Stage 1 criteria in the areas of disease management, clinical

decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. (http://www.cms.gov)

• Stage 3– Focus on achieving improvements in quality, safety and efficiency, focusing on

decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes. ((http://www.cms.gov)

Challenges for meaningful use

– Multiple perspectives • Physicians, EHR vendors

– How to test/measure • Syntax vs semantics• Quality of rules• Module-module interactions

Current state on testing

• Current state– Directed towards syntax checking– Some vocabularies included– http://healthcare.nist.gov/use_testing/index.html

• Example criterion– Automatically and electronically generate and indicate in

real-time, notifications at the point of care for drug-drug and drug-allergy contraindications based on medication list, medication allergy list, and computerized provider order entry

Future needs from our perspective

• Formal techniques to test criteria (and rules) • Testing methods for

vocabularies/ontologies