U.S. Department of Health and Human Services

1. U.S. Department of Health and Human Services Presentation for the ArchitecturePlus Seminar March 18, 2008

2. Health Care Challenges for the Federal Government The backlog of Social Security disability claims have climbed to 755,000 this year from 311,000 in 2000(New York Times, December 10, 2007) Some 14,000 U.S. military service personnel have been wounded in action in Iraq and Afghanistan and have not immediately returned to duty (Defense Department) Hundreds of thousands of people lost their medical records in Hurricane Katrina. Health and Human Services Secretary Leavitt said the chaos wreaked "powerfully demonstrated the need for electronic health records"(New York Times, September 19, 2005) A growing federal government share of healthcare costs; currently, 45%; projected to 50% In the next 10 years(Washington Post, February 21, 2007)

3. The secure exchange of interoperable health information within the federal government, and with the public and private sectors can support agency priorities such as: Wounded Warrior Disability and Long Term Care Continuity of care across federal, tribal and community-based health providers Pandemic/Disaster Situational Awareness Post-Market Surveillance of drugs and durable medical goods Bio-surveillance Submission of evidence for disability and claims processing Anonymized clinical data to support research Quality metrics for determining value in health care Emergency response Real World Business Priorities for Federal Agencies 3

4. Presidential Executive Orders Executive Order 13335 – April 27, 2004 • Announces commitment to the promotion of health IT • President Bush calls for widespread adoption of interoperable EHRs within 10 years • Establishes the Office of the National Coordinator (ONC) Executive Order 13410 – August 22, 2006 • Requires federal agencies to perform the following: 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.

5. Today’s Health IT Environment:What are the Federal Agencies doing? Implement HITSP harmonized standards Adopt use of CCHIT Certified Products Employ NHIN Compliant Services to exchange health information

6. Identify Needs Plan Investments Architect Solutions Implement Solutions Measure Progress Today’s Health IT Environment:What steps are required for Agencies to implement solutions How does an agency implements acquire, or upgrade health information technology systems used for the direct exchange of health information?

7. The National Products, Agency Architecture, and Investment Decisions

8. Federal Agencies with a Healthcare Activity and Participating in FHA 8

9. FHA Program Tools and Services Secure Exchange of Interoperable Health Information Federal Implementation Tools and Services * Available for use bystate, tribal, local governments & others Investment Planning and Progress Reporting Health InformationExchanges Standards Adoption InteroperabilityArchitecture HIT Education • NHIN-Connect (C) Gateway* • NHIN-C Software Development Kit for agency connectivity to NHIN-C* • NHIN-C Community Portal* • HITSP Engagement Plan • SDO Engagement Plan • Standards Catalogue • Terminology Distribution Specification • Health Information Interoperability Architecture Framework (HIIAF)* • Federal Transition Framework (FTF) • AHIC Use Cases Business Process Models (BPM)* • Investment Planning and Information Reporting Guide* • Health Information (HI) Survey - Systems Inventory - Implementation Planning - Standards Compliance Methodology • Instructor-led Training Courses • Computer Based Training Courses • Interoperability Specifications • Health info exchange • Architecture • Investment planning • Implementation TOOLS • Agency Health Information Exchanges Requirements Definition • NHIN Implementation Support • Agency Participation Planning Support - HITSP - SDO - Terminology Distribution • Agency Transition Planning Support • Agency Investment Planning Support • ImplementationPlanning Support • Webinars • Briefings • On-site Presentations SERVICES

10. Nationwide Health Information Network (NHIN) FROM THE NATIONAL HIT AGENDA: …foster widely available services that facilitate the accurate, appropriate, timely, and secure exchange of health information …information that: - follows the consumer - supports clinical decision - integrates public health needs

11. Federal Strategy for Connecting to the NHIN Establish the Federal NHIN Consortium A cross agency FHA collaboration to create solutions for health exchanges in and out of government Develop a NHIN Gateway Solution Providing architecture and strategies for a Federal NHIN-C Gateway Solution Participate in the Trial Implementations Articulating Federal NHIN-C Consortium role in the NHIN Trial Implementations Cooperative

12. NHIN-C Federal Gateway Overview Agency NHIN Core Services • Agency-Specific Adapter • Data (e.g. CCD conformant to HITSP C.32) N H I N • Existing Agency Health IT System(s) Other NHIN Participant • HIEs • Federal • States • Local • IDNs • Data Banks • PHRs etc… • Adapter Software Development Kit

13. Why is this important? The secure exchange of interoperable health information serves the needs of the: Wounded Warrior Applicants for Disability Benefits Emergency response to Pandemic/Natural Disaster victims The Patient is Waiting