The Office of the National Coordinator has just released:

Voluntary 2015 Edition Electronic Health Record (EHR) Certification Criteria; Interoperability Updates and Regulatory Improvements

Which requires the use of the HL7 Pedigree standard, eliminating the option to use SNOMED-CT for family history.  The full text of this portion of the document is below.

It is critical that, in the genomics era, EHRs and useful HIT software need to have Clinical Decision Support (CDS) capability, in order to help clinicians manage patients properly.  As of now, family history is a critical part of decision making, having been called “the first genetic test” by Marc Williams, MD of Geisinger Genomic Institute.

The HL7 pedigree model allows complete transmission of critical family relationships to n-generations, an dis in use by Hughes RiskApps, MyFamilyHealthPortrait, the BayesMendel Risk Service, PenRad and other software packages.

If EHR would institute the core data set needed for genomics (as published by Feero), and become compliant with the HL7 Pedigree Standard, we would move a significant step closer to using evidence based genomic medicine in Healthcare, and markedly improve the quality of care.

Page 49 of Voluntary 2015 Edition Electronic Health Record (EHR) Certification Criteria; Interoperability Updates and Regulatory Improvements

We propose to adopt a 2015 Edition certification criterion that revises the 2014 Edition version. The 2014 Edition “family health history” certification criterion requires EHR technology to  demonstrate that it is capable of enabling a user to electronically record, change, and access a patient’s family health history according to certain standards. In support of the MU Stage 2 requirement that family health history be captured in structured data, we adopted two standards for recording family health history: Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT ®) terms for familial conditions and the HL7 Pedigree standard. In adopting SNOMED CT ®, we acknowledged that HL7 Pedigree was a relatively new standard and that an implementation guide had not yet been published.  As such, we stated that the use of SNOMED CT was perhaps the best intermediate step for coding family health history in structured data if one was not to use the HL7 Pedigree standard. 

In April 2013, an HL7 Pedigree IG, HL7 Version 3 Implementation Guide: Family History/Pedigree Interoperability, Release 1, was published. With the publication of this IG, we propose to adopt a 2015 Edition “family health history” certification criterion that requires solely the recording of family health history according to the HL7 Pedigree standard and the HL7 Version 3 implementation Guide: Family History/Pedigree Interoperability, Release 1 (i.e., it omits SNOMED CT ® as an option). We believe that convergence to this single standard and IG will ensure more precise electronic recording of family health history data and, more importantly, improve the  interoperability of family health history information. As part of the 2014 Edition Final Rule, we incorrectly assigned the HL7 Pedigree standard to § 170.207 where we adopt “vocabulary” standards. Accordingly, for the 2015 Edition proposal we have placed the HL7 Pedigree standard and its IG.

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