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Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co- chair

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Page 1: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Interoperability and Health Information Exchange

Workgroup

October 9, 2014

Micky Tripathi, chairChris Lehmann, co-chair

Page 2: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Agenda

• Review Charge and Workplan• Governance Subgroup Recommendation

Page 3: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Advanced Health Models and Meaningful Use Chair: Paul Tang

Co-chair: Joe Kimura

HITPC Workgroups and Chairs

3

Interoperability & Health Information ExchangeChair: Micky Tripathi

Co-chair: Chris Lehmann

HIT Implementation, Usability & SafetyChair: David Bates

Co-chair: Larry Wolf

HIT Strategy and InnovationChair: David Lansky

Co-chair: Jennifer Covich

Privacy and SecurityChair: Deven McGraw

Co-chair: Stanley Crosley

Health Information Technology Policy Committee

Chair: Karen DeSalvoVice Chair: Paul Tang

ConsumerChair: Christine BechtelCo-chair: Neil Calman

Page 4: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Charge

• The Interoperability and HIE Workgroup will recommend policy and promote opportunities to reduce barriers and to increase electronic sharing of health information among providers, organizations, and patients/caregivers.

• The workgroup will use implementation lessons learned • The work group will align efforts with the Privacy and Security Workgroup and

the Health IT Standards Committee. • The workgroup will make recommendations that focus on policies that can help

address implementation challenges.• The workgroup will promote a business and regulatory environment supportive

of widespread information exchange. • Examples of issues the workgroup may consider include, but are not limited to:

– health information exchange– Governance– technology policy (such as patient matching)

Page 5: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Member Responsibilities

• Workgroup members are expected to be actively engaged in their workgroup– Membership of the workgroups will be reviewed on a quarterly basis to

ensure active participation– Members missing more than 5 meetings will be removed from

membership (unless extenuating circumstances)– Differing opinions are welcome and encouraged but should be done in a

respectful manner– Participants should be prompt and do their best to minimize personal

interruptions (e.g., mute phones)

• All meeting materials are due at least 24 hours in advance of workgroup meetings– Members are expected to review materials in advance of the meeting

and be actively engaged in the discussion

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Page 6: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Membership

First Last Name Organization

Micky Tripathi Massachusetts eHealth Collaborative

Christoph Lehmann Vanderbilt

Brian Ahier Medicity

Beth Morrow The Children's Partnership

Arien Malec RelayHealth

Larry Garber Atrius

Ray Scott Arkansas Office of Health Information Technology

Jitin Asnanni athenahealth

Tony Gilman Texas Health Services Authority

Landen Bain CDISC

Shelly Sprio Pharmacy HIT Collaborative

Troy Seagondollar Kaiser / United Nurses Association of California

Melissa Goldstein The George Washington University

Carl Dvorak Epic

Marc Probst Intermountain

Wes Rishel Consultant

Dave Whitlinger NYeC

Page 7: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

2014 Q3 2014 Q4 2015 Q1 2015 Q2

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

(estimates)

FACA Milestones

Interoperability Governance Subgroup

JASON Task Force

Kick-off Federal Milestone

Joint HITPC/HITSC Meeting JASON/Governance Recs

Federal HIT Strategic Plan Posted for Comment

Interoperability and HIEFinal Interoperability Roadmap Recs

FACA Final HIT Strategic Plan Comments

Interoperability Roadmap Posted for Comment

HITPC comments on MU3 NPRMHITSC comments on Certification NPRM

Interoperability and HIE Workgroup

FACA Milestone7

Page 8: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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High-level Workplan

Tasks Start Date Due Date 14-Jun

14-Jul

14-Aug

14-Sep

14-Oct

14-Nov

14-Dec

15-Jan

15-Feb

15-Mar

15-Apr

15-May

15-Jun

Interoperability and HIE Workgroup JASON TF charged by HITPC/HITSC 6/10/2014 6/10/2014

Governance Subgroup charged by HITPC

7/8/2014 7/8/2014

Governance strawman – Draft presented to HITPC

7/8/2014 9/3/2014

JASON TF recommendations – Draft presented to HITPC

6/10/2014 9/3/2014

Final Governance recommendations 9/3/2014 10/15/2014

Final JASON TF recommendations 9/3/2014 10/15/2014

Workgroup Kick-off 10/3/2014 10/3/2014

Charged with informing the Interoperability Roadmap

10/15/2014 10/15/2014

Draft roadmap recommendations 10/15/2015 11/4/2014

Final roadmap recommendations 11/4/2014 12/2/2014

Comment on published version of Interoperability Roadmap - Lead WG

TBD - Q1 TBD - Q1

Page 9: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Meeting Schedule

Meetings TaskOctober 9, 2014, 12:00-1:30 PM ET • Review charge and workplan

• Review Governance recommendations

October 21, 2014, 2:30-4:00 PM ET • Review JASON TF recommendations• Feedback from HITPC/HITSC• Prepare to inform Interoperability Roadmap

October 29, 2014, 2:00-3:30 PM ET • Inform Interoperability Roadmap

HITPC Meeting November 4, 2014 • Draft recommendations to HITPC

November 5, 2014, 10:00-11:30 AM ET • HITPC feedback integrated into recommendations

November 19, 2014, 9:00-10:30 AM ET • Refine recommendations

December 1, 2014, 1:00-2:30 PM ET • Refine recommendations

HITPC Meeting December 2 • Final recommendations to HITPC

December 16, 2014, 10:00 PM-11:30 AM ET • Interoperability Measurement (tentative)

Page 10: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Interoperability Workgroup Governance Subgroup

Christoph Lehmann, co-chairCarol Robinson, co-chair

Page 11: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Membership

Member Organization

Christoph Lehmann, co-chair Vanderbilt School of Medicine

Carol Robinson, co-chair Robinson & Associates Consulting

Jitin Asnaani athenahealth

John Blair Taconic IPA

Anne Castro BlueCross BlueShield of South Carolina

Tony Gilman Texas Health Services Authority

Melissa Goldstein George Washington University

Anil Jain Explorys, Inc.

Anjum Khurshid Louisiana Public Health Institute

John Lumpkin Robert Wood Johnson Foundation

Beth Morrow The Children’s Partnership

Tim Pletcher Michigan Health Information Network Shared Services (MiHIN)

David Sharp Maryland Health Care Commission

Deanna Wise Dignity Health

Mariann Yeager Healtheway, Inc.

Barclay Butler, Ex Officio Defense Health Agency

Elaine Hunolt, Ex Officio The Department of Veterans Affairs 11

Page 12: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Subgroup Charge

• Identify the substance, scope, and process ONC should use to implement an approach to establish the “rules of the road” necessary for information to flow efficiently across networks

• This approach should address the key problems that slow trust and exchange across diverse entities and networks that provide exchange services including:– misaligned/inconsistent security policies and practices– privacy policies and practices and operational/business– inconsistent policies and technical agendas of governance bodies

at the local, state and regional levels

Page 13: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Revised Ask

• Due to the short timeline given to the Subgroup to tackle a difficult issue ONC revised its ask to the following questions:– Will continuing with the current governance approach ONC

has taken ensure the community can fully achieve the three year goal of providers and patients being able to send, find, receive and use a basic set of essential health information across the health care continuum?

– Which governance-focused actions should the government take in order to best protect the public interest, including improving health care, improving the health of the public, and reducing costs in immediate future?

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Page 14: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

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Draft Workplan Governance Subgroup

Meetings Task

Wednesday, July 23rd 2:00-4:00 pm ET • Review charge• Governance history• Action steps

Friday, August 15th 10:00am-12:00 pm ET • Listening session 1

Friday, August 22nd 10:00am-12:00 pm ET • Listening session 2

Tuesday, August 26th 10:30-12:00 ET • Summarize listening sessions• Finalize problem list, update strawman and discuss

governance goal statement• Prep for HITPC presentation

Wednesday, September 3rd - HITPC Meeting • Progress toward creation of a recommendation governance framework presented to HITPC

Friday, September 12th 10:30-12:30 pm ET • Review HITPC discussion and update documents/plans based on feedback

• Deep dive on deeming program

Friday, September 19th 10:30-12:30 pm ET • Review ONC questions• Discussion

Friday, October 3rd 12:00-2:00 pm ET • Continue discussion of responses to ONC questions• Finalize responses

Thursday, October 9th Interoperability and Health Information Exchange WG

• Review recommendations with Workgroup

Wednesday, October 15th – Joint HITPC/HITSC Meeting • Final recommendations

Page 15: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 1

• Will continuing with the current governance approach ONC has taken enable the community to reach the three year goal of providers and patients being able to send, find, receive and use a basic set of essential health information across the health care continuum?

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Page 16: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 1 Response

• Subgroup members felt ONC’s current approach to governance has been helpful in advancing progress, citing successes borne from the Exemplar HIE Governance grants, the State Health Policy Consortium program, and other examples.

• The Subgroup feels additional work by ONC is required to enable all communities to reach the three year goal. However, Subgroup members had differing perspectives on the types and amount of additional interventions required to reach the three year goal. Some felt ONC needs to take a more active role in governance to achieve the goal. Others felt ONC could reach the goal by continuing its current approach to governance with a few additional targeted initiatives.

– Supporters of a more active role for ONC felt the velocity of change is not sufficient and that without additional government action the industry is highly unlikely solve the key governance problems needed to achieve the three year goal. Industry is currently implementing standards in a variety of ways and taking varying policy approaches to key governance questions. These divergent approaches are not likely be solved without additional government involvement to drive consensus.

– Supporters of the current approach felt the current velocity of change would allow the industry to reach the three year goal with some additional targeted initiatives. They see a variety of interoperable networks and approaches growing across the industry. Stakeholders are coming together via the current approach and solving some of the key problems. Government has an important role to play and has struck the right balance between action and inaction. Many of the current challenges in the field that need to be overcome are implementation issues that require a nimble and agile approach to address that is not conducive to a significantly larger government role. 16

Page 17: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 2

• Which governance-focused actions should the government take in order to best protect the public interest, including improving health care, improving the health of the public, and reducing costs in immediate future?

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Page 18: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 2 Response

• ONC should continue its current approaches to governance and expand and build upon them through potential mechanisms including, but not limited to:– Legal and business framework: Building on the Governance Framework

for Trusted Electronic Health Information Exchange ONC could develop a formal set of governance principles. To address implementation issues, ONC could issue guidance on important national interoperability issues to support alignment and convergence in the marketplace (e.g., Direct: Implementation Guidelines to Assure Security and Interoperability).

– Regulation, if utilized should be undertaken carefully and with a light touch to remove impediments, to create an environment for opportunity, and to provide for national goals.

– Align federal activities: ONC could align federal activities with guidance they issue to encourage consistent marketplace adoption and use.

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Page 19: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 2 Response continued

– Public-Private Collaborative Consortium: ONC could begin the process to establish or identify a public-private collaborative consortium with designated governance authorities (refined, for example, through by-laws and/or Rule). The consortium should:• Be modeled from a best practices review of other nonprofit, government-deemed organizations.* • The role of the consortium could include the evaluation of issues (technical, operational, financial and policy)

impeding interoperability and/or threatening the security of protected health information in electronic health information exchange, and apply governance levers where needed, coordinating across the multiple industry consortia, Standard Development Organizations (SDOs), and state, federal, and private sector initiatives.

• The appropriate structure, criteria and balance of members in the consortium needs to be carefully considered and curated to ensure the appropriate representation/balance of stakeholder interests including the perspective of patients, where possible.

• Striking the right balance of government involvement in the consortium will be important to its success and stakeholder buy-in.

ONC should consider these important design principles for the Consortium:• The Consortium’s work and priorities should consider market based use cases, which will evolve over time• The Consortium should consider partnering with relevant organizations to solve specific problems• ONC should review the experience of the National eHealth Collaborative and other governance initiatives to

draw lessons learned in designing the operating and governance principles for this Consortium

* Some examples for best practice review could include: ANSI (American National Standards Institute) ETSI (European Telecommunications Standards Institute), BSI (British Standards Institution), ITU (International Telecommunication Union), and AFNOR (Association Francaise de Normalisation).

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Page 20: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Question 2 Response continued

– Education: ONC could undertake an education campaign to encourage providers, vendors, payers and patients to adopt and use health information exchange for clinical and administrative use cases. As part of this campaign, ONC could publish studies regarding the benefits of health information exchange (e.g., case studies, ROI studies, etc.)

– Measure and Report HIE Progress - As part of the Interoperability Roadmap, ONC could develop and deploy a national measurement and reporting plan to track and measures progress in HIE (verb) adoption and use that:• Establishes and defines a core set of standardized national HIE measures for vendors,

payers and providers to track and report. • Articulate and prioritize use cases of high value and measure progress toward adoption• Establishes the current benchmark state of HIE between disparate EHRs, between

unaffiliated organizations across HIE networks, and with other geographic and organizational data, wherever possible

• Establishes a timeline with realistic milestones considering the maturity of implementation and use of health IT in various use cases and in different care settings

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Page 21: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair

Potential Levers To Be Used To Implement The Recommendation

• Are there other federal levers members would like to add to the list?:– Federal benefits purchaser requirements (FEHB)– Federal agency requirements / incentives / penalties

• As a provider (DoD, VA, HIS, etc.)• As a purchaser (DoD, VA CMS through state Medicaid programs: MU, 1115A waivers, 90/10 HIE funding, MMIS,

etc.)• As a purchaser (CMS through Medicare: MU, conditions of participation)• As a grantor (ONC, CDC, SAMHSA, CMMI, HRSA, AHRQ, NIH, etc.)• As a regulator (FTC, CMS, CLIA, FDA, CDC, SAMHSA)• As a researcher (NIH, AHRQ, HRSA, CDC, SAMHSA, ONC, DoD, etc.)

– Regulatory requirements through Federal Rule or Acts of Congress (e.g., payment reform)

– Federally-developed non-regulatory tools (FAQs, best practice toolkits, implementation

guides, testing suites, etc.)– Market convener (FACAs, S&I Framework, Exemplar HIE Governance grants, etc.)– Communications, outreach, education– Examine existing regulations and other levers in place today to see if they incentivize (or

disincentivize) desired exchange behaviors/approaches– Align incentives and levers with market based Use Cases 21

Page 22: Interoperability and Health Information Exchange Workgroup October 9, 2014 Micky Tripathi, chair Chris Lehmann, co-chair