The Stage 2 Standards and Certification NPRM

On Friday, ONC released the Standards and Certification NPRM, the companion to the the CMS Meaningful Use Stage 2 NPRM.

Here's a bookmarked PDF  - thanks to Tony Panjamapirom of the Advisory Board.

In my view, the NPRM is a work of art, reflecting the work of the HIT Standards Committee, the S&I Framework, and  the multi-stakeholder consensus that fewer, more complete standards with less optionality will lead to greater interoperability.

I've always thought of healthcare standards as having three components -  content, vocabulary, and transport.

For content, the NPRM specifies HL7 2.51 for lab results, syndromic surveillance, reportable lab, and immunizations (HL7 2.31 is not longer an option).   For summary transactions, the Consolidated CDA is the only recommended standard.   (CCR and CCD/C32 are no longer specified).    NCPDP is specified as standard for the exchange of prescription information between entities, including for discharge medications.

For vocabularies, the NPRM specifies a single vocabulary per domain, just as HITSC recommended
Lab - LOINC
Medications - RXnorm
Problem Lists - SNOMED-CT
Discharge Diagnosis - ICD10-CM
Immunizations - CVX
Demographics preferred language - ISO 639-1
Demographics preliminary cause of death ICD10-CM

For transport, two standards are available, consistent with the Direct Project - SMTP/SMIME and SOAP.   A RESTful option is not specified, but ONC recognizes that a RESTful implementation guide may be available in the future.

The 2014 edition of the Standards and Certification NPRM eliminates the "OR", since this standard OR that standard implies that vendors need to support both, creating an "AND" for implementers.  

The ONC NPRM is clear, unambiguous, forward looking and reasonable.   Congrats to the team who wrote it.