Meaningful use still remains a mystery after Tuesday's Health IT Policy Committee meeting and standards for electronic laboratory orders have been pushed off until next month. 

David Blumenthal, MD, the national coordinator for health IT, asked the advisory Health IT Policy Committee to defer until January a decision on whether to allow temporary variations in those standards to be used.

The policy committee had recommended providers start using in 2011 a single set of national standards for communicating electronically with labs, one of the tenets of the administration’s meaningful use policy to encourage the use of health IT.

But at its meeting, the panel wrestled with and stopped short of stripping a phrase that would have allowed providers to depart from those standards until 2013.

That exception had been introduced in September by HHS’ Health IT Standards Committee, which had recommended specific messaging and vocabulary standards for 2011 but allowed for temporary variations for local codes and existing lab interfaces in 2011 and 2012.

“The practical effect is that there would be a standard, but non-standard transmissions would not disqualify someone from being a meaningful user until 2013,” Blumenthal said.

Officials originally said meaningful use would be defined by mid-December, but the deadline has been pushed  back to the end of the month.

The standards set are Health Level 7, version 2.5.1, for lab content exchange, and Logical Observation Identifiers Names and Codes (LOINC), Unified Code for Units of Measure (UCUM) and Systematized Nomenclature of Medicine--Clinical Terms (SNOMED CT) for clinical lab vocabularies.

A workgroup of the Policy Committee urged that there be no variations to the standards in 2011; instead it recommended instituting a glide path or roadmap to enforcement by 2013.

Blumenthal said both the policy and standards committee should work to craft an agreement on whether to prohibit variations to the standards requirement.

Allowing variations even of a single standards set will continue to keep provider costs high to install those options in their electronic health record systems, said Micky Tripathi, co-chair of the policy committee’s information exchange work group, and also president and chief executive of the Massachusetts eHealth Collaborative.

“Labs are the Achilles heel of meaningful use,” he said, adding that most lab results are still delivered through letter and fax.

Neil Calman, a committee member and president and chief executive officer of New York’s Institute for Family Health, described how the current approach to multiple standards and lab interfaces was eating up resources.

“We have five lab interfaces, and it’s an expanding nightmare. We use up days just setting them up,” he said. It’s also a huge quality issue when the lab reports don’t come back in the right presentation to the right record.

“If we can smooth this over, people will be able to put systems in place and become meaningful user much easier,” Calman said.

In addition to setting national lab standards, the policy committee also recommended that ONC create implementation guides for providers to establish the standards in their systems and for vendors to incorporate them in new EHRs for certification.

To assert some oversight of the standard, the committee also recommended that the Centers for Medicare and Medicaid Services develop a survey and certification letter for labs that would explain how lab information should be presented in EHRs and health information exchanges using the standards. CMS would describe how the standards would meet the Clinical Laboratory Improvement Act (CLIA), which governs labs.