Health IT Joint Committee Work Product Health IT Joint Committee Collaboration A Joint Policy and Standards Public Advisory Body on Health Information Technology to the National Coordinator for Health IT Interoperability Experience Task Force (IXTF) Jitin Asnaani, co-chair Anjum Khurshid, co-chair April 26, 2016

Health IT Joint Committee Work Product Agenda I.Opening Remarks II.Review virtual hearing framework III.Review and Finalize Use Case Needs Framework IV.Begin articulating Use Case Solutions to meet Needs V.Recap & Next Steps VI.Adjourn 2

Health IT Joint Committee Work Product Membership 3

Health IT Joint Committee Work Product IX TF Charge Provide recommendations on the most impactful policy, technical, and public-private approaches that could be implemented to improve the interoperability experience for providers and patients. »Assume that the stakeholder has access to a system(s) that can interoperate with at least one other system from outside »Identify the top 3 to 5 most important needs for these stakeholders » Narrow the scope of work to where the most (doable) impact can be made » Make specific/actionable recommendations for ONC, in collaboration with others (e.g., standards bodies, commercial parties and other Federal entities) 4

Health IT Joint Committee Work Product Virtual Hearing – May 6, Panel 1: Healthcare Stakeholders Panel 2: Health IT Stakeholders Panel 3: Federal & State Stakeholders Physicians Community Based HIE Programs Federal Partners (DoD, VA, CDC) Health SystemsPharmacyState HIEs PayersNetwork ProvidersResearch Networks Patients *IT Systems Providers (Advisory Board/Crimson) *Care Managers/Social Workers *ACO Organizations

Health IT Joint Committee Work Product Virtual Hearing Question for all Panels  What are the top interoperability challenges that you have faced and how have you overcome them in order to share clinical information with other organizations/physicians in a timely fashion? 6

Health IT Joint Committee Work Product Use Case Summaries 7

Health IT Joint Committee Work Product Use Case #1 Transitions of care: A. John Blair, Kelly Aldrich, and Larry Garber 8 Summary: Automated query of Massachusetts PCP’s patient summary when HIV+ patient visits ER in Florida Stakeholders: Patient, PCP, Emergency Room Physician Key Data Exchange Issues: data query (pull), consent management, incorporation of structured data into EHR, out of-state exchange Description: In order to effectively treat a patient at the time of an Emergency Room visit, the ER physician should have the ability to obtain the patient summary from the PCP’s EHR record where the patient is regularly seen. The appropriate patient’s consent needs to be accessible and interpretable. The patient’s information should be imported directly into the ER physician’s EHR.

Health IT Joint Committee Work Product 9 Summary: Oncologist orders a blood draw. Home health nurse sharing care for the patient collects the specimen. The specimen is resulted by the lab and results are communicated to appropriate stakeholders. Stakeholders: Patient, Oncologist, Home Health Agencies, Lab Key Data Exchange Issues: business process integration, communication of computable and discrete lab result data, communication of orders, different Description: TBD Context: Patient Identity across the providers has been established (algorithmic, shared IDs, cross-linked IDs, single ID, etc). The various providers already have established electronic connections (to include resolving addressing, provider ID's, technology for exchange, use intermediaries, etc). A home health episode had been established. The CMS 485 or equivalent information has been exchanged. A shared care plan has been signed by the attending. Use Case #2 Shared care plans Shaun Grannis, Janet Campbell, and Larry Wolf

Health IT Joint Committee Work Product 10 Summary: Diabetic patient’s caregiver gathers notes and lab results from her PCP and Endocrinologist, graphs the Hemoglobin A1c results from both, and submits the patient’s glucometer readings to both doctors Stakeholders: Patient, Caregiver, Specialist, Primary Care Key Data Exchange Issues: patient/caregiver query (pull), patient- generated data, patient/caregiver data submission (push) Description: As long as a patient has given appropriate consent, caregivers should have the ability to access, monitor and submit electronic clinical information on the patient’s behalf to their treating physicians. The caregiver should have the ability to submit data back. Data should automatically route to all appropriate physicians and be automatically populated into the patient’s record. Use Case #3 Patient-initiated data Cris Ross, Ty Faulkner, and Jane Perlmutter

Health IT Joint Committee Work Product 11 Summary: Hospital discharge of high-risk patient to post-acute care with appropriate involvement of PCP Stakeholders: PCP, Pharmacy, Payer, Home Health Agency (alternatively SNF) Key Data Exchange Issues: data send (push), transitions of care, follow-up appointment, medication management, pre-authorizations, payer costs, pharmacy costs Description: In order to effectively allow for data transparency for a patient, there needs to be optimal access and interoperability among the stakeholders involved with delivering the care. The patient should have the ability to access and review their healthcare information, view costs associated with medications and pharmacies; in addition to payer coverage. Data transparency should be easily accessed during the transition of care (e.g., a patient from the hospital to the post- acute caregiver) and have the ability to view, reconcile and transmit the appropriate data to the patient/caregiver as well as the PCP. Use Case #4 Data Transparency for Patients/PCP Phil Posner, Jorge Ferrer, and George Cole

Health IT Joint Committee Work Product Use Case Need #1 12 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 1 Ability to identify patients nationwide HIGH 1.1 Capture standardized demographics for patients HIGH 1.2 Patient matching algorithm(s) HIGH 1.3 Show how to communicate with patients LOWMEDHIGH 1.4 Show proxy relationships and how to communicate with them MED HIGH 1.5 Show authenticated devices and how to communicate with them HIGH MED

Health IT Joint Committee Work Product Use Case Need #2 13 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 2. Ability to locate relevant patient records HIGH 2.1 Show providers affiliated with patients HIGH MED 2.2 Show roles of affiliated providers MED LOW 2.3 Show patient authorizations for communication with specific providers LOWHIGH 2.4 Show provider subscriptions for specific types of information, including events HIGH 2.5 Show how to retrieve record (or alternatively, enable native access/connection to record) HIGH

Health IT Joint Committee Work Product Use Case Need #3 14 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 3. Ability to locate and identify providers HIGH 3.1 Show provider services offered MEDLOW 3.2 Show provider capabilities to communicate electronically, including necessary certificates/addresses (or alternatively, enable native access/connection to provider EHR/HIT) HIGH 3.3 Enable locations to be continuously and automatically updated by provider EHRs/HIT HIGH

Health IT Joint Committee Work Product Use Case Need #4 15 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 4. Ability to access and interpret consents/authorizationsHIGH 4.1 Detail types of data, uses of data, restrictions on redisclosure, timeframes, etc… HIGH 4.2 Show how to convey requirements and assert that they have been received from patient HIGH 4.3 Show how to convey authorization for proxy access (e.g. to parents of minors, or children of elderly parents) on behalf of patient HIGH

Health IT Joint Committee Work Product Use Case Need #5 16 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 5. Ability to encode data that is syntactically and semantically interoperable HIGH 5.1 Standardized encoding for computable data (esp. orderable tests and procedures) HIGH 5.2 Standardized formatting of (or access to) discrete data HIGH 5.3 Standardized formatting of (or access to) free-text descriptions/explanations HIGH

Health IT Joint Committee Work Product Use Case Need #6 17 USE CASES Use Cases Needs Use Case #1 - Transitions of Care Use Case #2 - Shared Care Plans Use Case # 3 - Patient Initiated Data Use Case #4 - Data Transparency for Patients/PCP 6. Ability to exchange data HIGH 6.1 Querying & retrieving data from EHRs/HIT HIGH 6.2 Pushing to & receiving from from EHRs/HIT HIGH 6.2 Submitting device data to EHRs/HIT HIGH

Health IT Joint Committee Work Product Workplan 18 Meeting DatesTask Tue, Mar 8, :00pm ETTask Force Kickoff Needs identified by Task Force Wed, Mar 23, :00pm ET Finalize the Use Case Framework Topics for the virtual hearing (time permitting) Wed, Apr 6, :00pm ET Review Use Case Homework Planning for Virtual Hearing #1 Wed, Apr 20, :00pm ETAdministrative planning call for hearing (not public)  Tue, Apr 26, 2016 – 1:00pm ETRefine the use case framework Fri, May 6, :30am ETVirtual Hearing Wed, May 11, :30am ETSummarize hearing outcomes Wed, Jun 1, :00pm ETRecommendations refinement June 7/8 HITPC/HITSC MeetingsDraft Recommendations presented to HITPC/HITSC Tue, June 21, 2016 – 1:00pm ETRevise and edit recommendations Tue, July 5, 2016 – 1:00pm ETRevise and edit recommendations July 12/13 HITSC/HITPC MeetingsRecommendations presented to HITSC/HITPC

Health IT Joint Committee Work Product Health IT Joint Committee Collaboration A Joint Policy and Standards Public Advisory Body on Health Information Technology to the National Coordinator for Health IT Interoperability Experience Task Force Jitin Asnaani, co-chair Anjum Khurshid, co-chair