The heads of the federal Health IT Standards Committee, Jonathan Perlin and John Halamka, moved the panel at its meeting this morning to the next phase of work – guidance for implementation.

In a nod to the work the panel had already accomplished, Perlin, of the Hospital Corporation of America, thanked those who had felt a "heavy lift." But, he warned, the work done so far is merely "the end of the beginning."

The committee will now move to the next – and more difficult – phase.

Perlin called it "a change in tenor."

The work will change, he said, from refining what has already been done to probing and understanding the ways the committee could be most effective in providing guidance for implementation. That phase, he said, would have to be based around "experience in what has worked."

Halamka, the CIO of Harvard Medical School, picked up the implementation theme.

"You need to have the guidance to say 'how,'" he said. "We don't want something that moves too fast, otherwise people will fall off."

The Health IT Standards Committee is charged with making recommendations to the National Coordinator for Health Information Technology on standards, implementation specifications and certification criteria for the electronic exchange and use of health information.

To be eligible for incentive reimbursement under the federal stimulus package, providers must report quality measures by 2011 – to show "meaningful use" of healthcare IT. One example is the ability to exchange lab results.

After Perlin and Halamka offered the rallying cry around implementation, the panel wasted no time getting down to the nitty-gritty. As Halamka put it: "What are the 'ands' and what are the 'ors' ? We need to think through all the complexities."

The complexities emerged quickly:

• How will the quality measures flow from the electronic health record to the collecting entity – the Centers for Medicare and Medicaid?
• The electronic health record should show real-time performance, rather than have a system that enters information at the end of the year.
• How can the panel take into account the differences between a rural hospital in Wyoming reporting data and the University of Pittsburgh Medical Center reporting, for example?
• Can an entity qualify on its own for meaningful use, or will it depend on whether another entity in the community has done its part – a composite function, asked committee member Wes Rishel of Gartner, Inc. "I can argue both ways, but I think we need to know the answer," he said.
• What are the holes in the Swiss cheese of the data? Asked member Marc Overhage of the Regenstrief Institute: "You can't assume you have all the data in the EHR."

Workgroup meetings will now be scheduled to discuss implementation guidelines.