CHIME Members-Only StateNet Webinar June 28, 2012

1. CHIME Members-Only StateNet Webinar June 28, 2012

2. Meeting Overview • Welcome • Neal Ganguly, StateNet Vice Chair • EHR / HIE Interoperability • Dave Minch, President & COO HealthShareBay Area • StateNet Updates • Workforce Collaborations & Survey • CIO Coordinators

3. Implementing Standards – Interoperability for EHRs and HIEs: the States’ Vendors’ EHR/HIE Interoperability Workgroup David A. Minch President and Chief Operating Officer, HealthShare Bay Area; Chair, HIMSS National HIE Committee Page 3 of 16

4. Recognizing the Current Situation Limited Adoption of Existing Standards such as NHIN Direct Project, Connect, IHE and other national and state-wide standard protocols such as New York’s CHIxP protocols. Because of a lack of standards in developing HIEs, every new instance of an HIE launched presents a Custom Connection for EHR vendors that introduces unnecessary costs and delay – tens of millions at the state level Vendors are using their Limited Resources to ensure their products meet meaningful use capabilities. States are struggling to create the best strategy to promote uptake while minimizing costs. Potential to influence development of nationwide standards by creating a quorum of respected participants, that can leverage existing standards across multiple states/regions. Common Goal:Develop standards for “plug and play” connections between EHRs and HIEs by working in collaboration with Vendors and States Page 4 of 16

5. Terminology Page 5 of 16 • Standards – what we started with: HL7, HITSP, NwHIN • Implementation Specifications – what we leveraged: IHE, HITSP • Reference Implementations – what we developed: • Continuity of Care Document (HITSP C32) • NwHIN Direct with Provider Directory Specification • NwHIN Connect with ability to access a state-wide MPI, and to generate an aggregate CCD

6. Win-Win-Win Strategy for All Stakeholders Vendors • Differentiate product in highly fragmented market by developing a product that offers “plug and play” to HIE across multiple states (superior interoperability) • Build interface once, use for many different HIEs and EHRs • Better utilize limited resources to focus on product functionality improvements and customer adoption State and Regional HIE • Ability to rapidly deploy interconnection of systems by having standard interfaces and interface approaches • Minimize costs associated with connection fees by individual EHRseach time a new connection is made Providers • Increase value proposition of individual EHRs • Eliminate HIE connection cost as prohibitive barrier for adoption Page 6 of 16

7. Meetings • 1st Meeting: Feb 20, 2011 (States + Vendors) • 2nd Meeting: March 29 (States) • 3rd Meeting: April 13 at DIRECT Boot Camp (States) • 4th Meeting: April 20, 2011 (States + Vendors) • Created two workgroups, both met weekly, then biweekly on Tuesday mornings as milestones were set and achieved: • Clinical & Metadata Element Technical Subgroup • Direct Project Technical Subgroup • Target: September 30 to Complete Phase 1 Page 7 of 16

8. Founding Workgroup Members • 7 States represent ~ 30% of US Population • 11 Vendors are leading EHR and HIE vendors with significant market share Page 8 of 16

9. Current Workgroup Members Page 9 of 16

10. Terms of Participation Agreed to by All Stakeholders State Responsibilities • Actively participate and obtain buy-in with state policy groups • Agree to develop compliance process for interfaces within state • Ensure that specifications developed are utilized in their state (RECs & others). • Market to the healthcare provider community the value of using EHRs and HIEs that pass the “plug and play” compliance testing Vendor Responsibilities • Actively participate in workgroup • Work collaboratively with potential competitors • Utilize off the shelf standards • Commit that upon final approval of the specifications to develop product that meets such specifications within 1-2 major product releases Page 10 of 16

11. Workgroups Timeline Sep Feb Mar Feb Mar Apr Jun Jan May Jul Aug Oct Nov Dec WG Formed CCD (C32); Pull Functional and Technical Specifications Direct Functional and Technical Specifications Test Specifications & Compliance Strategy S&I Harmonization C32 & Direct Funcional Specs Ratified Pull Functional Specs Ratified Press Release Issued MOUs Signed Kick-off Meeting Page 11 of 16

12. Specifications Overview Statewide Consumable Continuity of Care Document Statewide Patient Data Inquiry Service (Pull) Send and Receive Patient Record Exchange (Push) • Provider Directories HPD, LDAP vs. HPD = HPD+ (supportive and adaptive) • NwHIN Direct • Main expansion beyond Direct is locating the provider through querying Provider Directory and finding digital cert per S&I. • CCD based on C32/C83 Tighter data element requirements based on C32 semantics and syntax. (Additional R/R2 items from C154 per states and Beacons as they relate to C32-based documents). • Register and Query patient Identity, Provide and Register/Query and Retrieve Patient Documents MPI search through PIX/PDQ and XCPD, Access management (XUA), provide and register document (XDS), and query and retrieve document (XCA/XDS); Consent management (ACP) discussed but not fully addressed. Page 12 of 16

13. Creating a Common C32Roadmap: Aligned the requirements from multiple programs with what was achievable by the vendor community • States established priorities based on provider input • Mapped C32 to Stage 1 Meaningful Use Priorities • Determined Vendor Capabilities – each vendor submitted what was in their EMR; data de-identified for confidentiality • Provenance and other Metadata - Separate “tiger team” developed a comprehensive approach to specify individual authors and sources; examined other data elements as needed (e.g. Dx Status) • Worked with Beacon Communities and ONC Transitions of Care to establish programmatic priorities (harmonization) • Decisions made taking into account each program’s requirements and what is achievable by vendors within 1 year Page 13 of 16

14. Development of Functional & Technical Specifications Workgroup started with core requirements originating from ONC /NwHIN use cases for Direct and Connect Process was to define the general use cases that drove the specifications and then add to and constrain as needed to satisfy state requirements (functional specifications) For the technical specifications the starting point was the body of work from ONC / NwHIN (Direct and Connect). Technology choices were discussed and made Certain decisions used “tiger teams” to drill down – always included states and vendors. Monitored S&I Framework developments Specifications vetted by state policy groups and balloted by both states and vendors Page 14 of 16

15. Phase 2: Develop Mechanisms for Compliance Develop test specifications and test harness Leverage REC programs to drive compliance to specifications Develop compliance strategy (partner with NwHIN) Engage one or more certified testing body Engage broader vendor community for adoption of specifications Create mechanisms to promote use of IWG standards in connecting EHRs to HIEs Page 15 of 16

16. Phase 3: New work underway or scheduled • XUA (Cross-enterprise user assertion) • Leverage IHE variant of the OASIS XUA specification (work product of the SAML 2.0 task force) • Develop a constrained specification which is implementable within short timeframes • Develop a reference implementation • Develop a sample testing link which can be used to test user assertion packages • Next up: Workgroup will look at messaging that will be needed to support ACO / Health Home models Page 16 of 16

17. Other Current Opportunities for Collaboration • The Western States Consortium: Interstate exchange – policies, governance, directory svcs. • California: the “OK” (orderable kit) HL7 v2.x • ADT: ^A01, ^A03, ^A04, ^A08, ^A40, … • ORU^R01 Discrete lab (ELINCS with LOINC) • ORU^R01 for radiology & other reports • MDM: ^T02, ^T06, ^T08, ^T10, ^T11 (Text reports / transcription) • ORM^O01 orders (e.g. Lab ELINCS order) • Others http://taskgroups.caleconnect.org/Interface+MOU Page 17 of 16

18. HIMSS Interoperability Showcase Demonstration Interested in Learning More? For More information on the EHR/HIE Interoperability Work Group, to download specifications, and to become a member go to: www.interopwg.org 17 Vendors attempted to demonstrate specifications at IHE Connect-a-thon Meeting Demonstrators are featured in the Interoperability Showcase Page 18 of 16

19. Workforce & Training • In October 2010, CHIME released findings from a HIT Workforce Survey • IT staffing deficiencies will possibly (51 percent) or definitely (10 percent) affect their chances to implement an EHR and receive stimulus funding. • More than 70 percent of respondents reported that their organizations lack staff to implement clinical applications. • 2010 survey demonstrates an opportunity to increase knowledge and awareness • 4% of CIOs said they were looking to partner with community colleges as a staffing strategy

20. Workforce & Training

21. StateNet Platform StateNet Platform – http://ciostatenet.org • The StateNet Platform will serve as CHIME’s central line for Advocacy issues • State-based groups • New Issue-based groups • HIE • Workforce • Medicaid • Meaningful Use

22. CIO Coordinators Survey In May, CHIME circulated a survey to CIO Coordinators • Asking Coordinators of record to reaffirm their interest • Reorganize our communication channels to better understand what’s driving HIT in each state (what’s the rally cry, what get’s people excited, e.g.)

23. CIO Coordinators Survey What we Found… • 19 State Coordinators indicated they were willing to stay on board for a two-year term • Many CIOs with Republican governors are looking for guidance on how to implement HIT without state support. • Regional Extension Centers are providing support to many hospitals and providers to implement HIT. • Sustainability is a huge concern for CIOs.

24. CIO Coordinators Survey Next Steps… • We believe there are a handful of CIOs who did not take the survey, but may still be interested • CIOs can volunteer (alone or with a colleague) to represent their state and keep CHIME informed on the progress of HIT implementation in their state • CHIME plans to help CIOs network with others that have experience with similar issues Contact Angela Morris at amorris@cio-chime.org to sign up and take the survey.

25. Calendar Upcoming CHIME Advocacy Events: • Advocacy Community Webinar – July 19th@ 11am ET • StateNet Community Webinar & Meeting – July 26 @ 2pm ET • National Health IT Week – Week of Sept. 10

26. Calendar Upcoming CHIME Advocacy Events: • 20th Fall CIO Forum – Oct. 16 through 19, 2012 • Keynote by National HIT Coordinator Dr. Mostashari • Linking Stakeholders toward More Efficient Care • StateNet Roundtable: Progress & Challenges • Dialog with the CMS & ONC Regulators

27. Questions? Go to: http://ciostatenet.org to get started! CHIME StateNet Chair: Randy McCleese, St. Claire Regional CHIME StateNet Vice Chair: Neal Ganguly, CentraState CHIME Staff Sharon Canner, Senior Director of Advocacy Programs scanner@cio-chime.org Jeff Smith, Assistant Director of Advocacy Programs jsmith@cio-chime.org Angela Morris, Advocacy Coordinator & StateNet Community Manager amorris@cio-chime.org