HIMSS Interoperability Showcase Orlando, Florida February, 2008

1. HIMSS Interoperability Showcase Orlando, Florida February, 2008

2. For Immediate ReleaseOffice of the Press SecretaryAugust 22, 2006 Executive Order: Promote Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs Sec. 3. Agencies shall perform the following functions: Health Information Technology - For Federal Agencies. As each agency implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards.

3. Standards Harmonization

4. The Certification Commission for Healthcare Information Technology (CCHIT) Healthcare Information Technology Standards Panel (HITSP) American Health Information Community The Health Information Security and Privacy Collaboration (HISPC) Nationwide Health Information Network Architecture Projects(NHIN) A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability HITSP includes a 398 member organizations and is administered by a Board of Directors 23 SDOs (6%) 313 Non-SDOs (79%) 34 Govt. bodies (8%) 16 Consumer groups (4%) 12 Project Teams (3%) The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way.

5. What is the Healthcare Information Technology Standards Panel? • The Healthcare Information Technology Standards Panel (HITSP) is a volunteer, consensus-driven organization • The Panel brings together experts from across the healthcare community – from consumers to doctors, nurses, and hospitals; from those who develop healthcare IT products to those who use them; and from thegovernment agencies who monitor the U.S. healthcare system to those organizations who are actually writing the standards More info at: www.hitsp.org

6. HITSP formed Technical Committees to focus on AHIC breakthrough areasOverview/Structure and Current Use Cases • Care Delivery Technical Committee: • EHR - Lab Reporting-- Deploy standardized, widely available, secure solutions for accessing laboratory results and interpretations in a patient-centric manner for clinical care by authorized parties. • Emergency Responder – EHR-- Covers the use of the ER-EHR from the perspective of on-site care providers and emergency care clinicians. Definitive care clinicians involved in the care and treatment of emergency incident victims, medical examiner/fatality managers investigating cause of death, and public health practitioners using information contained in the ER-EHR, are included because of their interactions with the other portions of this use case. • Medication Management– Focuses on patient medication and allergies information exchange, and the sharing of that information between consumers, clinicians (in multiple sites and settings of care), pharmacists, and organizations that provide health insurance and pharmacy benefits.

7. HITSP formed Technical Committees to focus on AHIC breakthrough areas Overview/Structure and Current Use Cases • Consumer Empowerment Technical Committee: • Consumer Empowerment-- Deploy to targeted populations a pre-populated, consumer-directed and secure electronic registration summary. Deploy a widely available pre-populated medication history linked to the registration summary. • Consumer Access to Clinical Information– Includes three scenarios which describe highlights of the processes, roles and information exchanges which could enable a consumer’s access to clinical information via a personal health record (PHR). The three scenarios are: Consumers receive and access clinical information; Consumers create provider lists and establish provider access permissions; and Consumers transfer PHR information.

8. HITSP formed Technical Committees to focus on AHIC breakthrough areasOverview/Structure and Current Use Cases • Population Health Technical Committee: • Biosurveillance -- Transmit essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems in standardized and anonymized format to authorized public health agencies with less than one day lag time. • Quality – This use case depicts two scenarios related to quality measurement, feedback and reporting with respect to a patient’s encounter with the healthcare delivery system: quality measurement of hospital-based care and of care provided by clinicians.

9. Identify a pool of standards for a general breakthrough area Identify gaps and overlaps for a specific context Make recommendations to the HITSP for resolution of gaps and overlaps Develop interoperability specifications for using the selected standard for a specific context Test the instruction for using the standard HITSP Standards Harmonization Process Mission: To harmonize relevant standards in the health care industry to enable and advance interoperability The standards harmonization process is an open, inclusive, collaborative, use case driven process www.hitsp.org

10. Interoperability Specification Process • The specifications are intended to be used by architects and system designers as a way to guide future implementation efforts based on health IT • The specifications represent an ongoing effort to create a framework/template that represents a solution set for solving the known problems related to a Use Case

11. What is a Standard? • A standard specifies a well defined approach that supports a business process and . . . • has been agreed upon by a group of experts • has been publicly vetted • provides rules, guidelines, or characteristics • helps to ensure that materials, products, processes and services are fit for their intended purpose • is available in an accessible format • is subject to ongoing review and revision process • Harmonization is required when a proliferation of standards prevents progress rather than enables it HITSP Definition

12. Harmonization Process Steps ReceiveRequest IX Program Management BeginSupport

13. Tier 1 Standards Readiness Criteria • The standards required to support each major Use Case event were organized within an agreed upon standards taxonomy • The standards selected for inclusion in the pool were examined using ‘HITSP approved’ Tier 1 and Tier 2 Harmonization Readiness Criteria

14. Tier 2 Standards Readiness Criteria • Suitability • The standard is named at a proper level of specificity and meets technical and business criteria of use case • Compatibility • The standard shares common context, information exchange structures, content or data elements, security and processes with other HITSP harmonized standards or adopted frameworks as appropriate • Preferred Standards Characteristics • Approved standards, widely used, readily available, technology neutral, supporting uniformity, demonstrating flexibility and international usage are preferred • Standards Development Organization and Process • Meet selected criteria including balance, transparency, developer due process, stewardship and others. • Total Costs and Ease of Implementation • Deferred to future work

15. A Journey through the Patient Care Delivery Process A Private Matter Accenx Acuo Agfa Healthcare Alert Allscripts Blueware Capmed Carestream Careev Dejarnette Digichart Epic GE GMT Interoperability Showcase Scenarios Starring

16. Interoperability Showcase Scenarios Starring • A Journey through the Patient Care Delivery Process • A Private Matter HXTI • IBM, • Initiate • Intersystems • McKesson • MedNet • Microsoft • MIE • Misys • NDOrange • NextGen • NMC • NUVON • Quovodz • Sage • SAIC • SWPartners • University of Washington

17. HITSP 2008 Work Plan – TC IS Development 2/11/08 HITSP Board WE ARE HERE 6/16/08 HITSP Board 9/29/08 HITSP Board 12/2/08 HITSP Board 12/13/07 HITSP Panel 2/20/08 HITSP Panel 3/27/08 HITSP Panel 6/23/08 HITSP Panel 10/6/08 HITSP Panel 12/8/08 HITSP Panel APR FEB NOV DEC JAN MAR APR MAY JUNE JULY AUG SEPT OCT NOV DEC 1/23 – 1/25 TC F2F Chicago 3/24 – 3/26 TC F2F DC Area 5/12 – 5/14 TC F2F TBD 6/11 – 6/13 TC F2F DC Area 9/8 – 9/10 TC F2F TBD 10/28 – 10/30 TC F2F Chicago Phase I Use Cases EHR and BIO v 3.0 S&P v 1.0 Update constructs with S&P Phase 2 Use Cases ER-EHR v 1.1, CA Media and Quality v 1.0 and CA Network v 3.0 Potential Phase 3 timeline based on receipt of final use cases in mid-March 2008 and based on “standard” 9 to 10 month delivery cycle. Subject to change based on TC analysis of use cases ? Medications Management v 1.0 Comment Construct Dev Comment Resolution 2008 Use Cases v 1.0 Phase 3 Use Cases Plan Comment Comment RDSS IS Development Comment Res

18. Impact of 2006 HITSP Interoperability Specifications HHS Secretary Michael Leavitt.. - “Accepted” all three HITSP Interoperability Specifications – December 2006 - “Recognized” them and announced that recognition in the Federal Register and at the AHIC meeting on January 22, 2008 - “Recognition” triggers Executive Order expectations for federal agencies to implement the interoperability specifications in all new and upgraded systems

19. Other CollaborationsCertification Commission on Healthcare Information Technology (CCHIT) & HITSP JOINT WORKING GROUP: • Between the federal implications and the certification efforts of CCHIT, stakeholders will be motivated to adopt a standard way of sharing data throughout the Nationwide Health Information Network, leading to better healthcare for us all.”

20. Nationwide Health Information Network (NHIN): • HHS has awarded $22.5 million in contracts to nine HIEs to begin trial implementations of the Nationwide Health Information Network (NHIN). • HITSP/NHIN Education and Communications

21. New 2008 AHIC Use Cases • Consultations and Transfers of Care • Personalized Healthcare • Immunizations and Response Management • Public Health Case Reporting • Remote Monitoring • Patient - Provider Secure Messaging (formally called Remote Consultations)

22. New Technical Committee Structure • 3 Perspective Committees, aligned with AHIC perspectives • Provider • Population • Consumer • 3 Domain Committees focused on healthcare domains • Care Management and Health Records • Security, Privacy and Infrastructure • Administrative and Financial

23. Provider Perspective Care Management and Health RecordsDomain Committee Technical Committees – A Matrix Organization Population Perspective Consumer Perspective Security, Privacy and Infrastructure Domain Committee Administrative and Financial Domain Committee

24. Transitioning Existing TCs to new TCs PLANNED TC STRUCTURE CURRENT TC STRUCTURE HITSP Panel Board of Directors HITSP Panel Board of Directors Technical Committee Technical Committee Care Delivery Provider Perspective Committees Population Population Health Consumer Security, Privacy and Infrastructure Consumer Empowerment Domain Committees Care Management and Health Records New Security and Privacy Administrative and Financial New Foundations Committee Foundations Committee

25. HITSP Perspective Technical Committees Terms of Reference • Review each new Use Case or Interoperability Request, provide feedback to requestor, evaluate scope of effort and develop statements of work for completion • Perform high level design of Interoperability Specifications and lower level constructs including requirements analysis, standards selection and minimum data set identification • Submit recommendations to Panel for review, approval and resolution • Identify Domain Committee(s) and provide high level design and statements of work to guide construct development • Develop, review and evaluate Interoperability Specifications for the selected standards, integrating relevant constructs • Manage overall execution plan/schedule in collaboration with Domain Committees • Ensure timely response and disposition of public comments • Ensure on-going process for addressing corrections/change requests and resolutions

26. HITSP Domain Technical Committees Terms of Reference • Identify and analyze gaps and duplications within the standards industry as they relate to domain constructs • Describe gaps, including missing or incomplete standards • Describe duplications, overlaps, or competition among standards • List all standards that satisfy requirements imposed by the relevant Use Case or Interoperability Request and apply readiness criteria • Interact with Standards Organizations to coordinate communication regarding standards gaps, overlaps, and identification of standards • Evaluate, select and constrain recommended standards • Receive and prioritize statements of work and collaborate with Perspective Committees to refine scope and develop work plan • Develop and/or revise domain constructs to meet requirements, high level design and statements of work • Maximize reuse w/ consideration for backwards compatibility • Ensure domain constructs adequately support all Interoperability Specifications referencing those constructs • Work in collaboration with Perspective Committees to meet project schedule and timelines

27. The ANSI Public Document Library is used for publicly posting completed works and related materials. It can be found on the “Document Library” links from the main HITSP site: www.hitsp.org HITSP Interoperability Specifications (ISs) and Executive Summary can also found at www.hitsp.org which links to them directly. The Use Cases are located in the Public Document Library in the following link: AHIC Harmonized Use Cases How to get involved? HITSP Panel and Coordinating Committees Michelle Deane, ANSI at: mmaasdeane@ansi.org HITSP Technical Committees Jessica Kant, HIMSS at: jkant@himss.org or Theresa Wisdom, at: twisdom@himss.org HITSP Resources