What’s On the Horizon?A National Perspective

Chris MuirActing DirectorState Health Information Exchange ProgramONC

2E-Patient Dave Cancer Survivor and Proud Father

It is About Life!

1. Adapted from Dr. Jonathan B Perlin, Healthcare 2015 & beyond: Some Thoughts on Planning Ahead, p. 95

HIT is the Foundation

• Intervene during sickness or injury

• Manage health and conditions

• Predict and prevent future problems

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National Quality Strategy

• 2nd Annual Report

• Developed with significant stakeholder input

• Process managed by AHRQ

• Goals:

– Improve the delivery of health care services, patient health outcomes, and population health

– Build a consensus on how to measure quality so that stakeholders can align their efforts for maximum results

– Serves as a framework for quality measurement, measure development, and analysis of where everyone can do more, including across HHS agencies and programs as well as in the private sector

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National Quality Strategy

Three aims for the health care system:1. Better Care: Improve the overall quality of care,

by making health care more patient-centered, reliable, accessible, and safe

2. Healthy People and Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants

3. Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government

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National Quality Strategy

Six priorities:1. Making care safer by reducing harm caused in the delivery of

care

2. Ensuring that each person and family are engaged as partners in their care

3. Promoting effective communication and coordination of care

4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease

5. Working with communities to promote wide use of best practices to enable healthy living

6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models

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National Quality Strategy

HHS Actions since the original report:1. Nationwide Initiatives to Advance Quality

Improvement

2. Alignment of Measurements

3. Key Measures to Track National Progress

4. State Adoption of the National Quality Strategy

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National Quality Strategy

HIT is a necessary part of the infrastructure to support NQS:

• Population Health• Quality Measures• Care Coordination• Consumer Engagement• Improving Quality and Efficiency

Major ONC Activities

• Privacy and Security

• Meaningful Use

• Consumer Engagement

• Interoperability

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Privacy and Security

• Privacy and Security associated with Meaningful Use phase I, II and III

• EHRs– Server based v. Cloud based EHR models

• Health Information Exchange – Provider-to-provider

– Decentralized with a record locator service

– Centralized data bases

Different models raise different privacy concerns

• Developing trust across the HIT spectrum

“Adoption at the Speed of Trust”

Meaningful Use

• ONC’s Major policy imperative for the foreseeable future

• Stage 2 – requirements recently released

• Hospitals can qualify October 2013

• Eligible Providers can qualify January 2014

• Additional requirements for exchange , such as:

– Summary of Care

– Lab Results

– Immunizations

– Reportable Lab Conditions

– Cancer Registries

• Stage 3 – currently under development 12

Engaging Consumers

10% to 20% of outcomes are determined by health care.

90% of care needed to manage a chronic disease must come directly from the patient (CGCF)

Three A’s for Consumer Engagement

•Give consumers secure, timely electronic access to their health information.

Access

•Support the development of tools that help consumers to take action using information.

Action

•Help expectations about consumer (and provider) roles to evolve.

Attitude

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Consumer Outreach

Major accomplishments:• Meaningful Use Stage 2 requirements for

providers and hospitals advances patient access to data through view, download & transmit.

• The ONC Pledge Program has grown more than 10 fold -- to 400 participating organizations.

• The Blue Button has evolved beyond its roots at the VA to reach 1 million members and is poised to go much bigger--management of it has now transferred over to HHS

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ONC’s Health Information Exchange StrategyHealth Affairs - March 5th, 2012

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Information Securely Follows Patients Whenever and Wherever They Seek Care

DIRECTED

QUERY-BASED EXCHANGE

CONSUMER-MEDIATED EXCHANGE

MULTIPLE MODELS

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HIE Market Reality

• HIE facilitated by a variety of organizations including:– HIOs– EHR vendors– National services providers– Hospitals – ACOs– Others

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ONC’s Approach

• Interoperability is a journey, not a destination

• Leverage government as a platform for innovation to create conditions of interoperability

• Health information exchange is not one-size-fits-all

• Multiple approaches will exist side-by-side

• Build in incremental steps – “don’t let the perfect be the enemy of the good”

ONC’s Role

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VALUE• Payment reforms• Meaningful Use• Interoperability and

wide-scale adoption

TRUST• Identify and urge

adoption of policies needed for trusted information exchange

COSTStandards: identify and urge adoption of scalable, highly adoptable standards that solve core interoperability issues for full portfolio of exchange optionsMarket: Encourage business practices and policies that allow information to follow patients to support patient careHIE Program: Jump start needed services and policies

ONC

Reduce Cost and Increase Trust and Value To Mobilize Exchange

We Made Big Strides to Enable Exchange in Stage 1

The first challenge was to make sure that information produced by every EHR was understandable by another clinician and could be incorporated into his EHR

With the vocabularies, code sets and content structure standards in Stage 1 meaningful use every certified EHR can produce the standardized content needed:

– Produce and consume a standardized care summary

– Maintain standardized medication lists

– Consistently report quality measures and public health results

– Consume structured lab results21

Next we needed a common approach to transport, allowing information to move from one point to another

– We now have two easily adopted standards for transporting information – NwHIN Direct and the transport protocol used in NwHIN Exchange

And it was clear that we needed more highly specified standards to support care transitions and lab results delivery

– For the first time in our country’s history there is a single, broadly-supported electronic data standard for patient care transitions

Additional Critical Pieces Are Now In Place

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• Directories – standards and policies to make them consistent, reliable, findable and open to be queried

• Certificate management and discovery - common guidelines for establishing and managing digital certificates and making the public keys “findable”

• Creating Trust - baseline set of standards and policies that will accelerate exchange by assuring trust and reducing the cost and burden of negotiations among exchange participants

This Year We Are Addressing Components to Support Scalable Exchange

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Building Blocks for Exchange

How should well-defined values be coded so that they are universally understood?

How should the message be formatted so that it is computable?

How does the message move from A to B?

How do health information exchange participants find each other?

Transport

Content Structure

What are the policies needed to assure trust and protect information?

Services

Vocabulary & Code Sets

Policies

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Standards, Services and Policy Building Blocks

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Consolidated CDA

(Sum. Record)

Direct Specifications

SOAP – Secure Transport

(NwHIN Exchange Spec)

SNOMED CT(Problems)

ICD-9-PCS/ HCPCS & CPT-4

(Procedures)

ICD-9-CM(Prelim Cause of Death &

Encounter Diagnoses)LOINCRxNorm

(Medications)

MPIProvider Directory

Queryable Data

Repository

Consumer Controlled

Data Platform

HIPAA Provider authentication

Certificate Management and Discovery

Meaningful Patient Choice

Populating RLS, MPI

Data platform policies

Consumer authentication

/matching

Electronic patient access

Audit and correction

Governance

HL7 2.5.1 IG – Lab Result

Interface

Transport

Content Structure

Services

Vocabulary & Code Sets

Policies

RLS

FOCUS Give providers viable options to meet MU exchange requirements

• E-prescribing• Care summary exchange• Lab results exchange• Public health reporting• Patient engagement

APPROACH • Make rapid progress• Build on existing assets and private sector

investments• Every state different, cannot take a cookie cutter

approach• Leverage full portfolio of national standards

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State HIE Program

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Making Progress: Directed Exchange Implementation Status as of June 30, 2012

04/19/2023 Office of the National Coordinator for Health Information Technology

Summary Stats Number of Grantees

States/territories with directed exchange options broadly available 36

States/territories piloting directed exchange solutions 10

States/territories with directed exchange options unavailable 10

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Making Progress: Organizations and Staff Enabled for Query-based Exchange as of June 30, 2012

Summary Stats Number

Total number of organizations enabled for query-based exchange nationally 3,554

Total number of individuals enabled for query-based exchange nationally 56,496

04/19/2023 Office of the National Coordinator for Health Information Technology

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Near Term Challenges

• Taking standards from the S&I Framework and support community-driven implementation initiatives to advance adoption of standards

• ONC striving to provide:– Identify workable approaches– Implementation guidelines – Provide outreach and dissemination

Key Takeaways for HIE

1. Although not perfect, does it represent the best we have so far?

2. Does it support our policy objectives?

3. Interoperability is not “one size fits all”:

• Create modular standards and specifications that allow for innovation

• Internet Metaphore: we’re not building AOL; we’re creating the building blocks to make it possible for Facebook and Twitter to flourish

5. We are on a journey together!

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Some Ideas about the future

• Supporting ACO and other payment reform models to improve efficiencies

• Enable patients to make better health decisions through access and tools:– Predict and prevent medical conditions– Manage chronic conditions– Identify impacts of lifestyle choices

• Enable better tools for providers to help patients manage chronic conditions, acute injuries and illnesses – Better support transitions of care– Automatically populating personal health records– Enable home health care

• Enable population health studies for predicting and preventing medical conditions – Aggregating and analyzing data

Donna Cryer Liver Transplant Survivor and Style Maven