Dec 222012

There are a num­ber of organ­iz­a­tions in the US try­ing to encour­age the use of vari­ous stand­ards in health­care, but­tressed by US Fed­er­al funds. Here’s a brief sum­mary of some of them, which glosses over many details. All of this is sub­ject to change at any time depend­ing on both fed­er­al and state polit­ics (in the US, some parts of the health­care sys­tem are fun­ded and man­aged fed­er­ally, oth­ers at a state level). I wro­te this for a friend in Ger­many, and then thought oth­ers might also find it use­ful.

Office of the Nation­al Coordin­at­or for Health Inform­a­tion Tech­no­logy (ONC; part of the US Depart­ment of Health and Human Ser­vices, the Nation­al Coordin­at­or has the job of encour­aging the adop­tion of health­care IT and appro­pri­ate stand­ards. It’s a rel­at­ively new depart­ment, foun­ded in 2004. It cer­ti­fies health IT products accord­ing to the stand­ards it adopts, and provides fund­ing for vari­ous aspects of health­care IT, for example as part of Mean­ing­ful Use.

Cen­ters for Medi­care and Medi­caid Ser­vices (CMS; runs Medi­care (health insur­ance for the eld­erly as well as young­er people with dis­ab­il­it­ies), Medi­caid (means-tested health insur­ance for those on low incomes), and the Children’s Health Insur­ance Pro­gram. CMS doesn’t set the stand­ards for the clin­ic­al care itself, but they do set stand­ards for report­ing the qual­ity met­rics for clin­ic­al care, as well as deal­ing with pay­ment for their pro­grams.

Mean­ing­ful Use ( the US ver­sion of Mean­ing­ful Use is a health IT pro­gram that’s meant to pro­mote the spread of elec­tron­ic health records to improve health care in the United States. There are a num­ber of aspects to this pro­gram. CMS provides fin­an­cial incent­ives to phys­i­cians and oth­er eli­gible pro­fes­sion­als, as well as hos­pit­als, to use cer­ti­fied elec­tron­ic health record (EHR) sys­tems, for example. The oth­er part of the pro­gram is decid­ing which stand­ards are the appro­pri­ate ones for the EHR sys­tems to use. This is where ONC plays a role. The pro­ject is being rolled out in stages across a num­ber of years. Stage 1 is also called the 2011 edi­tion. Stage 2 was just released; the Stage 2 Mean­ing­ful Use set of stand­ards is also known as the 2014 Edi­tion S&CC final rule and com­ple­ments the CMS Stage 2 of the Medi­care and Medi­caid Elec­tron­ic Health Record (EHR) Incent­ive Pro­grams. There are con­crete plans up to Stage 3; any fur­ther stages depend on polit­ics and per­ceived needs.

Health Level 7 Inter­na­tion­al (HL7; an ANSI-accredited stand­ards devel­op­ing organ­iz­a­tion that has mem­bers and affil­i­ates in many coun­tries. HL7 cre­ates health­care IT stand­ards based on an over­all archi­tec­ture. Stand­ards can be norm­at­ive or inform­a­tion, and go through a peri­od of tri­al use (Draft Stand­ard for Tri­al Use; DSTU) before becom­ing full stand­ards. The list of stand­ards in the DSTU phase is at The list of ANSI-approved HL7 stand­ards is at, and the list of ISO-approved HL7 stand­ards is at People who are not mem­bers of HL7 do have to pay for the stand­ards, but HL7 has com­mit­ted to mak­ing them free of charge in early 2013. Sev­er­al HL7 stand­ards are quoted in the mean­ing­ful use reg­u­la­tions that have been pub­lished so far, both Stage 1 and Stage 2.

Integ­rat­ing the Health­care Enter­prise (IHE; is an ini­ti­at­ive to cre­ate pro­files of vari­ous stand­ards to improve the way health­care IT sys­tems share inform­a­tion. They are an inter­na­tion­al organ­iz­a­tion with many mem­bers and run con­necta­thons to test inter­op­er­ab­il­ity of health­care IT sys­tems both in the US and in Europe. Many IHE pro­files and tech­nic­al frame­works are cited for Mean­ing­ful Use. There is sig­ni­fic­ant cross-membership between HL7 and IHE.

Thanks to Bob Yen­cha for review and sug­ges­tions for improve­ments. Any errors, of course, are mine. After writ­ing this, I do find myself won­der­ing wheth­er there is some rule about three-letter acronyms in health­care IT. And no, there is no mean­ing to the order­ing of the descrip­tions.

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