Whats New in ONC? The Office of the National Coordinator for Health Information Technology Panel: Insight into Emerging Policy Copyright 2009. All Rights.

What’s New in ONC?

The Office of the National Coordinator for Health Information Technology Panel:

Insight into Emerging Policy

Copyright 2009. All Rights Reserved.

Agenda

Vision for Meaningful Use John Glaser

Standards and Certification Carol Bean

Policy Activities Jodi Daniel

Nationwide Health Information Network – Future Direction John Glaser

State Grants Kelly Cronin

Health IT Extension Program Rachel Nelson

Nationwide Health Information Network Ginger Price

2Copyright 2009. All Rights Reserved.

John Glaser, PhDSenior Advisor to the National Coordinator

Copyright 2009. All Rights Reserved.3

Vision for Meaningful Use

Slides that follow are from a draft set of recommendations made by a Work Group of the HIT Policy Committee on June 16, 2009


OFFICE OF THE NATIONAL

COORDINATOR

Achievable Vision for 2015

• Prevention, and management, of chronic diseases

– A million heart attacks and strokes prevented

– Heart disease no longer the leading cause of death in the US

• Medical errors

– 50% fewer preventable medication errors

• Health disparities

– The racial/ ethnic gap in diabetes control halved

• Care coordination

– Preventable hospitalizations and re-admissions cut by 50%

• Patients and families

– All patients have access to their own health information

– Patient preferences for end of life care are followed more often

• Public health

– All health departments have real-time situational awareness of outbreaks


2009 2011 2013 2015

HIT-Enabled Health ReformHIT-Enabled Health Reform

HITECH Policies 2011 Meaningful

Use Criteria (Capture/share

data)2013 Meaningful

Use Criteria(Advanced care processes with

decision support) 2015 Meaningful Use Criteria (Improved Outcomes)

HIT-Enabled Health ReformAchieving Meaningful Use


Improve Quality, Safety, Efficiency2011 Objectives

• Capture data in coded format

– Maintain current problem list

– Maintain active medication list

– Maintain active medication allergy list

– Record vital signs (height, weight, blood pressure)

– Incorporate lab/test results into EHR

– Document key patient characteristics (race, ethnicity, gender, insurance type, primary language)

• Document progress note for each encounter (outpatient only)

• Use CPOE for all order types

– Use electronic prescribing for permissible Rx

– Implement drug-drug, drug-allergy, drug-formulary checks

• Manage populations

– Generate list of patients by specific conditions (outpatient only)

– Send patient reminders per patient preference


Improve Care Coordination2011 Objectives

Exchange key clinical information among providers of care

Perform medication reconciliation at relevant encounters


Summary

• Journey to a transformed health system requires meaningful use of transformation-capable HIT

• Migration of HIT readiness from current situation to fully HIT-enabled ecosystem will evolve over time

• Proposed MU criteria for 2011 and beyond provides escalating capabilities, balancing urgent need for reform and feasibility of what is achievable


Carol Bean, PhD, MLS, MPH Acting Director, Office of Interoperability and Standards


Standards and Certification



COORDINATOR

HHS Interoperability Standards

“Recognized” in 2007-2008

• EHR Laboratory Results Reporting (IS01)

• Biosurveillance (IS02)

• Consumer Empowerment (and Access to Clinical Information via Network, IS03)

• Emergency Responder EHR (IS04)

• Consumer Empowerment and Access to Clinical Information via Network (IS05)

• Quality (IS06)

“Accepted” in January 2009

• Medication Management (IS07)

• Personalized Healthcare (IS08)

• Consultations and Transfers of Care (IS09)

• Immunizations and Response Management (IS10)

• Public Health Case Reporting (IS11)

• Patient-Provider Secure Messaging (IS12)

• Remote Monitoring (IS77)

• Updates to IS02, IS03, IS04, IS05


Eight Technology Priority Areas for HIT in ARRA

1. Privacy and Security

2. HIT Infrastructure

3. Certified Health Record

4. Disclosure Audit

5. Improve Quality

6. Individually Identifiable Health Information (IIHI) Unusable

7. Demographic Data

8. Needs of Vulnerable

Source: John Halamka11Copyright 2009. All Rights Reserved.

HITSP – enabling healthcare interoperability

Tiger Teams Focus Areas:Business Cases vs Use Cases

• A new EHR Centric Interoperability Specification to meetARRA requirements

• Security, Privacy & Infrastructure

• Quality Measures

• Data Architecture (Element, Template, and Value Set)

• Exchange Architecture and Harmonization Framework

• Clinical Research


Source: John Halamka

Tiger Team membership

232 technical experts

New Paths to Certification: In Brief (CCHIT Concept)

• Certified EHR Comprehensive [EHR-C]

– Rigorous certification of comprehensive EHR systems that significantly exceed minimum Federal standards requirements

– For providers who seek maximal assurance of EHR compliance and capabilities

• Certified EHR Module [EHR-M]

– Flexible certification of Federal standards compliance for EHR, HIE, eRx, PHR, Registry and other EHR-related technologies

– For providers who prefer to integrate technologies from multiple certified sources

• Certified EHR Site [EHR-S]

– Simplified, low cost certification of EHR technologies in use at a specific site

– For providers who self-develop or assemble EHRs from noncertified sources

Copyright 2009. All Rights Reserved.13 Source: “Town Call: New Paths to Certification ©CCHIT

Mapping Current CCHIT Programs to the New Paths (CCHIT Concept)

• EHR-C– Ambulatory and Inpatient EHRs

– Child Health, Cardiovascular, Enterprise add-on

• EHR-M– Emergency Department, other specialties and settings under

development

– Stand-alone ePrescribing

– PHRs

– Health Information Exchanges

• EHR-S– Ambulatory or Inpatient internally developed EHRs

Copyright 2009. All Rights Reserved.14 Source: “Town Call: New Paths to Certification ©CCHIT

Jodi Daniel, JD, MPHDirector, Office of Policy & Research


Policy Activities



COORDINATOR

Policy Activities

American Recovery and Reinvestment Act of 2009 (ARRA)

– Established two Federal Advisory Committees

– Requires the Secretary to promulgate regulations related to the electronic exchange of health information.

– Provides incentives to eligible providers who are meaningful users of certified EHRs.

• Two step process

– Added Privacy Protections

Copyright 2009. All Rights Reserved.1616Copyright 2009. All Rights Reserved.

Policy Activities

The Nationwide Privacy & Security Framework for Electronic Exchange of Individually Identifiable Health Information

• Draft Model Personal HealthRecord (PHR) Privacy Notice & Facts-At-A-Glance

• Reassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care Practices

• HIPAA Privacy Rule Guidance Related to the Privacy and Security Framework and Health IT

Copyright 2009. All Rights Reserved.1717Copyright 2009. All Rights Reserved.

Policy Activities

Other Policy Areas– NHIN

• DURSA development

• Consumer preferences

• Privacy and Security

– 501(c)(3) status for Health Information Organizations

– Anti-Fraud and health IT

– CLIA and the electronic exchange of laboratory data


John Glaser, PhDSenior Advisor to the National Coordinator


Nationwide Health Information Network

Future Direction



COORDINATOR

Nationwide Health Information NetworkFuture Direction

• The NHIN is a set of conventions that provide the foundation to the exchange of health information that supports meaningful use. The foundation includes technical, policy, data use and service level agreements and other requirements that enable data exchange, whether between two different organizations across the street or across the country.

• The NHIN foundation supports both the local and nationwide exchange of health information. The foundation does not distinguish between the two.

• Health information exchanged should be enabled for all clinical information systems including at the edge systems (EHRs, PHRs, etc.) (not quite sure of the definition of an edge system).


Nationwide Health Information NetworkFuture Direction

• ONC will maintain overall responsibility for the governance of the NHIN, the development and management of the foundation and the demonstration of new components of the foundation.

• ONC will identify an organization to assume operational responsibility for CONNECT and the core set of NHIN-wide infrastructure.


Kelly CroninDirector, Office of Programs and Coordination


State Grants



COORDINATOR

Section 3013: State Grants to Promote HIT

• A program to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards.

• Information exchange to improve the quality of health care is a requirement for the meaningful EHR use incentives.

• Depending on maturity of efforts re: health information exchange, a state or state designated entity will be eligible for either a Planning grant or an Implementation grant.

Planning grants will assist states in developing a roadmap to implement statewide health information exchange consistent with the meaningful EHR use criteria.

Implementation grants will assist states with acting on approved roadmaps to build statewide health information exchange capacity consistent with meaningful EHR use criteria.

Planning and implementation should be done in coordination with Medicaid to ensure the direct relevance and support for meaningful use of EHRs.


Planning and Implementation Grants

• Planning and Implementation grants should be pursued in the public interest and be consistent with the National Coordinator’s plans.

– Federal – State partnership is key!

• Funds shall be used to facilitate and expand HIE according to nationally recognized standards and to:

– Enhance broad and varied participation.

– Assist in identifying state or local resources to support a nationwide effort.

– Complement other federal grants and programs.

– Provide technical assistance to overcome barriers to exchange.

– Promote effective strategies to support exchange in underserved communities.

– Assist patients in utilizing health information technology.

– Encourage clinicians to utilize Regional Extension Centers for technical assistance.

– Support public health agencies authorized use of and access to health information.

– Promote use for quality improvement, including reporting on quality measures.

• The Secretary shall ensure continuous improvement based on annual evaluation and implementation of lessons learned.

– Funding will be tied to approaches that lead towards the greatest improvement in quality of care, decrease in costs and the most effective authorized and secure HIE.


Qualified State Designated Entities (QSDE)

States may appoint a QSDE to carry out the work specified in Section 3013. A QSDE should meet the following criteria:

•Be designated by the state as eligible to receive awards.•Be a not-for profit entity with broad stakeholder representation on its governing board.•Demonstrate that one of its principal goals is to use information technology to improve health care quality and efficiency through the authorized and secure electronic exchange and use of health information.•Adopt non-discrimination and conflict of interest policies that demonstrate a commitment to open, fair and non-discriminatory participation by stakeholders.

A QSDE should consult with and consider the recommendations of:

• Health care providers

• Health plans

• Patient or consumer organizations

• HIT vendors

• Health care purchasers/employers

• Public health agencies

• Health professions schools

• Universities

• Clinical researchers

• Users such as clerical staff


Rachel Nelson, MHASpecial Assistant to the Deputy National Coordinator


Health Information Technology Extension Program



COORDINATOR

Health Information Technology Extension Program

National Health Information Technology Research Center (HITRC)

Regional Centers Offering Direct Technical Assistance to Providers


HITRC (National Research Center)

• Supports efforts to adopt, implement, and effectively use health IT:

– Offers Technical Assistance & Educational Resources

– Develops or recognizes best practices

• Incorporates input from Federal agencies, health IT users, others as appropriate

• Serves as resource and forum for knowledge and best-practices exchange


Regional Centers

Individualized technical assistance to providers seeking to adopt and effectively use health IT to exchange information within appropriate policy frameworks

Technical Assistance with product selection, workflow changes toward achieving meaningful use – including helping with provider in-house work to connect to health information exchange infrastructure, and in effectively leveraging electronic health information and health information technology to improve quality of cares


Ginger PriceProgram Director, Nationwide Health Information Network





COORDINATOR

NHIN Architectural Principles

• Highly distributed: Patient health information is retained at the local health information exchange level

• Local autonomy: Each HIE must make their own determinations with respect to the release of patient information

• Focus only on inter-organizational health exchange: The NHIN does not attempt to standardize implementations of the NHIN services and interfaces, only the communications between HIEs

• Use public internet: The NHIN is not a separate physical network, but a set of protocols and standards that run on the existing internet infrastructure

• Platform neutral: The NHIN has adopted a stack (web services) that can be implemented using many operating systems and programming languages




Nationwide Health Information Network Standards and Services

Profiles describe how to implement services for a specific domain like consumer preferences for information sharing or biosurveillance

Services describe specific interfaces (web services) used between HIEs to discover and exchange health-related information

Messaging, Security and Privacy Foundation describes the underlying protocols and capabilities necessary to send and secure messages between NHIE


Messaging, Security and Privacy Foundation Messaging, Security and Privacy Foundation

NHIN ServicesNHIN Services

NHIN ProfilesNHIN Profiles

Messaging• Message Transport• Services Definition

Messaging• Message Transport• Services Definition

Security• Public Key Infrastructure• Encryption• Digital Signature

Security• Public Key Infrastructure• Encryption• Digital Signature

Authorization Framework• Requestor Authentication• Requestor Authorization

Authorization Framework• Requestor Authentication• Requestor Authorization

Discovery Services• Subject Discovery• Authorized Case Follow-up • Query for Documents •NHIE Service Registry

Discovery Services• Subject Discovery• Authorized Case Follow-up • Query for Documents •NHIE Service Registry

Information Exchange Services• Retrieve Documents• Query Audit Log • Health Information Event Messaging

Information Exchange Services• Retrieve Documents• Query Audit Log • Health Information Event Messaging

Consumer Preferences Profile• Store and exchange consumer preferences for sharing of personal health information

Consumer Preferences Profile• Store and exchange consumer preferences for sharing of personal health information

Other Profiles in Development• GIPSE (Biosurveillance)

Other Profiles in Development• GIPSE (Biosurveillance)

NHIN 2008 Results


“ ”However beautiful the strategy,

you should occasionally look at the results..

Sir Winston Churchill

• Demonstrated Technical Capability

• Created a Set of Initial Interoperable Specifications

• 20+ disparate organizations participating in the NHIN Cooperative

• Laid foundation for data usage agreements

• Completed Trial Implementations

• Started limited production pilots in 2009

We have the building blocks…

NHIN Cooperative Participants


Private HIEs State-Level HIEsProvider Orgs

/ IDNsFederalEntities

CareSparkDelaware Health

Information Network Cleveland Clinic

CDC

Community Health Information Collaborative

New York eHealth Collaborative Kaiser CMS

HealthLINC (Bloomington) North Carolina Health Care Information and

Communications Alliance (NCHICA)

DoD

HealthBridge IHS

Indiana (Regenstrief Institute)

West Virginia Health Information Network (WVHIN)

NCI

Long Beach Network for Health NDMS

Lovelace Clinic Foundation (NMHIC)

SAMHSA

MedVirginia SSA

Wright State University VA

Lessons Learned from the NHIN Trial Implementations

– More directed activities with shorten cycles for work products

• Created processes and teams like the Specifications Factory

– The testing tools must be matured and processes automated.

• Providing Reference Implementation and automated test tools and scripts

– Baseline the foundational services of the NHIN

• Need a stable platform that will not require retooling for 18 – 24 months

– Large IDNs and federal data are significant attractor for private Health Information Exchange entities

• SSA, VA, Kaiser Permanente, DoD

– An executable DURSA is needed to avoid complexity of point to point.

• The Data Use and Reciprocal Support Agreement (DURSA) developed by the NHIN DURSA Team and the ONC Office of Policy and Research recently entered Federal clearance. The DURSA pragmatically addresses the agreements needed to exchange health information on the NHIN under conditions that exist today.

– Need a governance structure for real health information to flow

• Governance includes strategic direction, representational oversight, and operating policies and procedures, and enforcement mechanisms


• NHIN limited production pilots are critical to the success of demonstrating how standards and specifications are implemented as working operational solutions for health information exchange.

• MedVirginia and SSA entered into the first limited production pilot in February, 2009.

Demonstration Projects


weeks

SSA – MedVA Pilot Results

• Starting with one provider network (Bon Secours) in February

• Approximately 3200 SSA eligibility requests for Bon Secours last year

• In discussions with 4 more provider groups to come online in 2009


Demonstration Projects

Other organizations planning to demonstrate health information exchange later this year:

HealthBridge Indiana Health Information Exchange

Kaiser Permanente Department of Veterans Affairs

Department of Defense Centers for Disease and Prevention

The next NHIN pilot project demonstrations will include onboarding the pilot partners into the NHIN trusted community, performing conformance testing and interoperability testing, issuing a digital certificate, and adding them into the NHIN service registry.


NHIN and CONNECT


To learn more about the Nationwide Health Information Network:

Go to http://www.healthit.hhs.gov and look for:

Nationwide HealthInformation Network

Interested? We’d like to hear from you at [email protected]


CONNECT Seminar

Presentations are Available

for Download Online at

http://www.connectopensource.org


Whats New in ONC? The Office of the National Coordinator for Health Information Technology Panel: Insight into Emerging Policy Copyright 2009. All Rights.

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