Health IT Standards Committee A Public Advisory Body on Health Information Technology to the National Coordinator for Health IT 2017 Interoperability Standards Advisory Task Force Kim Nolen, co-chair Richard Elmore, co-chair April 15, 2016

Health IT Standards Committee Work Product Agenda 2 Welcome and Introductions ISA Background and Overview Review Workplan and Discuss Next Steps

Health IT Standards Committee Work Product Membership 3

Health IT Standards Committee Work Product Task Force Charge 4 By the July 2016 HITSC meeting, submit recommendations to the Health IT Standards Committee regarding revisions and enhancements ONC should consider as it creates the Draft 2017 Interoperability Standards Advisory (ISA), taking into account feedback from the public comment process.

ISA BACKGROUND AND OVERVIEW 5

Health IT Standards Committee Work Product Interoperability Standards Advisory ONC’s first deliverable in support of the Nationwide Interoperability Roadmap towards a Learning Health System. Provides the industry with a single, public list of the standards and implementation specifications necessary to fulfill specific clinical health information technology interoperability needs. Documents known limitations, preconditions, and dependencies as well as known security patterns among referenced standards and implementation specifications when they are used to fulfill a specific clinical health IT interoperability need Non-regulatory “advisory” document, using straight-forward approach with an interactive and predictable process for updates. Prompts dialogue, debate, and consensus among industry stakeholders when more than one standard or implementation specification could be listed as the best available. Initially published in January, 2015, with major growth as a result of recommendations from ISA Task Force and from comments from stakeholders. Further refinement and expansion occurred through final 2016 ISA published in December

Health IT Standards Committee Work Product Interoperability Standards Advisory 7 Listed standards and implementation specifications may be adopted in regulation, required as part of a testing and certification program, or included as procurement conditions. Provide stakeholders who administer programs, procurements, and testing or certification programs with an advisory to help achieve their interoperability goals. Serves to provide clarity, consistency, and predictability for the public. Does not yet represent the full breadth and depth necessary for all purposes for which stakeholders may seek to interoperate but will continue incremental expansion.

Health IT Standards Committee Work Product ISA Organization 8 Executive Summary Scope & Purpose & Structure “Best Available” Characteristics Section I: Best Available Vocabulary/Code Set/Terminology Standards AllergiesImmunizationsProcedures Health Care ProviderIndustry and OccupationImaging (Diagnostics, interventions, procedures) Encounter DiagnosisLab TestsTobacco Use (Smoking Status) Race and EthnicityMedicationsUnique Device Identification Family Health HistoryNumerical References & Values Vital Signs Functional Status/DisabilityPatient Clinical “Problems” (i.e., conditions) Gender Identity, Sex, and Sexual Orientation Preferred Language

Health IT Standards Committee Work Product ISA Organization (Continued) 9 Section II: Best Available Content/Structure Standards and Implementation Specifications Admission, Discharge, and Transfer Family Health History (clinical genomics) Public Health Reporting Care PlanImagesQuality Reporting Clinical Decision SupportLaboratoryRepresenting clinical health information as a “resource” Drug Formulary & BenefitsPatient Education MaterialsSegmentation of sensitive information Electronic PrescribingPatient Preference/ConsentSummary Care Record Section III: Best Available Standards and Implementation Specification for Services “Push” ExchangeProvider DirectoryResource Location Clinical Decision Support ServicesPublish and Subscribe Image ExchangeQuery

Health IT Standards Committee Work Product ISA Organization (Continued) 10 Section IV: Projected Additions to the ISA Section V: Questions and Requests for Stakeholder Feedback Appendix I: Annual Process to Update the ISA Appendix II: Sources of Security Standards Appendix III: Revision History Appendix IV: Responses to Comments Requiring Additional Consideration

Health IT Standards Committee Work Product Section I-D: Race & Ethnicity 11

Health IT Standards Committee Work Product Section II-H: Laboratory 12

Health IT Standards Committee Work Product Section III - C: Image Exchange 13

Health IT Standards Committee Work Product Specific Questions for Task Force to Address – Slide 1 14 With respect to 2017, does the ISA contain information and criteria that makes it a useful tool for the industry? What additional content or criteria could be added to improve its utility? What gaps exist in the ISA that this task force should address? Example list: population queries for population management, distributed queries for risk adjudication, research-related, value set harmonization for quality measures (emerging work relative to QDM and FHIR) representation of other standards that exist to offer context, e.g., EHR System Functional Model from HL7 relationship of LOINC/SNOMED for questions/observations?

Health IT Standards Committee Work Product Specific Questions for Task Force to Address – Slide 2 15 How can the ISA better show relationships across various programs/initiatives? (e.g. MACRA, meaningful use, precision medicine, etc.) What standards become more or less relevant in an open API world? Examples: Are there patterns of exchange that we should be pointing practitioners towards? Importance of SMART/EDMP/EDI triggered decision support? What is the evolution of SOAP based web services vs FHIR – what gets done where? Is there a more precise method for measuring adoption level? How can the ISA better show "trajectory" (i.e., is adoption increasing rapidly or waning?) What are the overlaps with the Interoperability Experience Task Force?

Health IT Standards Committee Work Product DRAFT Workplan 16 Meeting DatesTask  Fri, Apr 15, :00pm ETTask Force Kickoff Fri, May 6, :00pm ETISA Characteristics, Structure, etc. Tue, May 10, :00pm ETSection I Mon, May 23, :00pm ETSection II Thu, Jun 2, :00pm ETSection III Wed, Jun 8, :30am ETDraft Findings / Recommendations to HITSC Tue, Jun 14, :00pm ET Tue, Jun 28, :00pm ET Wed, Jul 13, :30amRecommendations to HITSC Tue, Jul 26, :00pm ET

Health IT Standards Committee Work Product Next Steps Review ISA for accuracy and begin thinking on questions for task force to address. Prioritize top 3 areas of focus from within Appendix IV and submit via by April 22 nd. ONC will provide summary level information on public comments received in advance of May 6 th meeting. Be prepared to discuss. 17

Health IT Standards Committee Work Product Next Meeting May 6, :00pm – 3:30pm ET 18

Health IT Standards Committee A Public Advisory Body on Health Information Technology to the National Coordinator for Health IT