Meeting Report: National Committee on Vital and Health Statistics Subcommittee on Standards and Security, August 17-19, 2004.

The National Committee on Vital and Health Statistics Subcommittee on Standards and Security (NCVHS) met on August 17-19, 2004 to hear testimony related to e-prescribing and the Medicare Modernization Act (MMA). The alphabet soup discussion clearly reinforced the complexity of the today's US healthcare delivery system related to pharmaceuticals and durable medical equipment, insurance claims and reimbursement mechanisms. Although the primary focus was related to electronic prescribing for Medicare Part D benefits, the implications for the industry are far reaching beyond ambulatory care and will affect long term and acute care settings as well. The evolution from paper-based prescriptions to totally electronic transactions involves significant numbers of information transfers, including eligibility checks and drug utilization reviews (DURs).

Health Level Seven (HL7) and National Council for Prescription Drug Programs (NCPDP) described the formation of their Electronic Prescribing Coordination Project to map relevant portions of the NCPDP SCRIPT version 4.2 and HL7 version 2.3 standards and to create associated documentation to facilitate electronic prescribing messaging between HL7-centric and NCPDP-centric pharmacy and prescribing systems. ASTM testimony addressed the e-prescribing and medication management content component associated with the Continuity of Care Record (CCR). RxHub identified which existing standards were available and could be part of the upcoming Department of Health and Human Services electronic prescribing demonstration project initiative. X-12 and MediMedia representatives provided testimony. The Veterans Affairs, Food and Drug Administration, and National Library of Medicine representatives provided updates on the terminologies standards. NCPDP representatives described how HCIdea was developed when the National Provider Identifier (NPI) did not materialize as mandated in Public Law 104-191 (HIPAA 1996). HCIdea is a database that houses a unique enumerator for all healthcare professionals qualified to write prescriptions.

The subcommittee members spent their meeting time on August 18 and 19 discussing and clarifying the resultant matrix compilation of observations and recommended actions. This working document will assist the subcommittee in development of the draft letter of initial recommendations that will be presented to the full NCVHS at the September 1 meeting.

Of significant concern is the subcommittee's support for proposed e-prescribing standards that promote continuation of such convoluted business practices. Although the opportunity to streamline and create more efficient business processes exists, the automation of the current healthcare mess and perpetuity of existing practices will not garner the best outcomes for patient safety, quality of care, and reductions in cost.

To retrieve the transcript and to actually hear the testimony from this meeting, go to this Internet address: http://www.ncvhs.hhs.gov/

Editor's Note: The following report was originally posted on the CARING list serve. It is printed here with permission of the author.

By Carol J. Bickford, PhD, RN, BC

Carol J. Bickford, PhD, RN, BC Senior Policy Fellow, Department of Nursing Practice and Policy American Nurses Association * 600 Maryland Avenue, SW, Suite 100 West * Washington, DC 20024-2571