S&I Framework Transitions of Care Initiative All Hands Meeting

1. S&I FrameworkTransitions of CareInitiative All Hands Meeting June 18, 2012

2. Agenda • Welcome & Announcements – John Feikema & Russ Ott • Pilot Achievement & Next Steps – John Feikema • State HIE Closed Loop Referral Project – Guest: Richard Eshbach • Implementation Guidance Update – Harmonization Team

3. Welcome & Announcements

4. Transitions of Care Initiative Timeline

5. Pilot Achievement & Next Steps

6. Pilot Achievements • Volunteer Lead: Mark Bamberg • Influenced the contents for proposed 2014 Edition Meaningful Use • Developed open-source tooling that can accelerate progress towards demonstrating meaningful use objectives

7. Pilot Logistical Updates • For now, no further Pilot Work Group calls are scheduled • In the future, the Transitions of Care Initiative will likely reach out to the Pilots via the mailing list • What’s next?

8. State HIE ProgramClosed Loop Referral Project

9. Sponsorship • The Closed Loop Referral (CLR) project is an ONC sponsored initiative (not S&I). • Promote the accelerated development and pilot-to-production of proposed MU/S2 functionality for CLR. • The big focus will be on ubiquitous interoperability between players (different EHR, HISPs)….. • And Direct workflow integrationwithin the EHRs.

10. Mission As quickly as possible using proposed MU Stage 2 standards, enable providers to exchange patient information for referrals from their EHR workflow, regardless of the EHR systems and/or HISP services used (i.e., allowing information to move point-to-point between unaffiliated organizations, differing EHRs, and differing HISPs) and with at least the same quality of workflow integration providers currently experience when referring between homogeneous EHR systems.

11. Key observations • What we know… • CLR is technically possible today • Happens in homogenous EHR environments (Vendor A  Vendor A) • To what degree is a little unclear… • Doesn’t happen (much) in heterogeneous HIT environments (Vendor A  Vendor B) • Requires intermediaries and/or one-off implementations • What we believe… • Standards exist to facilitate these exchanges • Examples: Direct, consolidated CDA, etc. • End-to-end implementation guidance and ‘gap-filling’ does not exist • Workflow of clinicians must be central concern • Common cross-vendor, industry-wide approach best path to widespread adoption

12. Potential issues/gaps to explore • Some initial examples: • Patient matching • Referral matching/linking • SMTP vs. XD* • Provider directories • Management of multi-format documents • Direct integration to EHR • Direct (HISP) interoperability / trust framework(s)

13. How we (plan to) roll… • Operating model is a mash-up • Direct Project / S&I Framework + “Labs over Direct” Pilot Program • Approach • Group modeled on the Direct Project’s community-style forum and operating practices • Engage vendors at the national level, seeking to define a minimum set of common implementation guidance that may be widely deployed • Remain Agile throughout project • Have diverse group of stakeholders participate • Instantiate a series of pilot-to-production projects • Cross-community exchange will be a required success factor

14. Timeline • Broad email communication announcing launch to be disseminated this week • Kick-off: first workgroup meetings in early July • Target: real-world implementations by HIMSS 2013 • Timeline estimates (phased-approach) • 1-2 months of requirements definition and gap analysis • 1-2 months of writing implementation guidance • 1-x months of implementation • Vendor dependent on starting point • Identify pilot-to-production sites during guidance development phase

15. First steps… • Identify workgroup leaders from the community • Define scope, use case, requirements • What does “success” look like? • Inventory and assess existing capabilities • Perform gap analysis

16. Who’s in? • Confirmed participants: • Allscripts • Athena • GE • McKesson • MedAllies • NextGen • Siemens • We’re recruiting more… • Would appreciate your involvement…

17. Want more info or to join? • Contact: • Paul Tuten (paul.tuten@hhs.gov) • Richard Eshbach (reshbach@deloitte.com) • Megan McMenamin (mmcmenamin@deloitte.com) • Wiki and project e-mail address forthcoming • Likely a subdomain of the existing State HIE Resources site.

18. Recent Progress

19. Implementation Guidance Sub-Workgroup Activities • Volunteer Leads: David Tao, Dr. Holly Miller & Dr. Russell Leftwich • Completing work of Transitions of Care Initiative efforts through the development of a Companion Guide • Establishes clear guidance on the usage of the core clinical elements in common care transition scenarios • Provides supplemental guidance as part of the tools and resources to lower the barrier to implementation • Purpose is to develop clear guidance for the implementation of regulatory requirements on care transition exchange packages to meet clinician needsandMeaningful Use requirements.

20. IG SWG Timeline

21. Initiative Companion Guide • The ToC Companion Guide acts as a supplementto the Initiative’s recommended standard: HL7 CDA Consolidation Implementation Guide • Contains supplemental guidance that is traditionally outside the scope of HL7balloted standards • Uses clinical scenarios to provide contextual information for business analysts and references for Physician Champions • Contains XML examples based on the clinical examples for real-world care transition implementation guidance • Describes HL7 CDA concepts which implementers may not have extensive knowledge of • Provides specific implementation specificationsfor stakeholders to meet regulatory requirements

22. ToC IG SWG Meetings • Implementation Guidance SWG meeting schedule • Mondays 5:30PM – 7:00PM EST • Wednesdays2:00PM – 3:00PM EST **New** • Current Activities: • Refining data elements for inclusion in the clinical scenarios– “Key Information Exchanges” • Completed Closed-Loop Referral: PCP to Specialist & Specialist to PCP • Finishing Discharging Physician in Hospital Setting to PCPtoday • To be completed: PCP to Patient, Discharging Physician in Hospital Setting to Patient • Analysis on current C-CDA documents to determine “best fit” document recommendation for each clinical scenario • Completed mapping of ToC CEDD data elements to Consolidated CDA • To be completed: analysis of C-CDA document requirements to accommodate MU2 requirements and ToC recommendations

23. Virtual Round – Questions, Comments, concerns?