Health IT Policy Committee and Health IT Standards Committee Work Product Collaboration of the Health IT Policy and Standards Committees Policy and Standards Federal Advisory Committees on Health Information Technology to the National Coordinator Interoperability Experience Task Force Jitin Asnaani, co-chair Anjum Khurshid, co-chair June 1, 2016

Health IT Policy Committee and Health IT Standards Committee Work Product Membership 2 MemberOrganizationRole Jitin AsnaaniCommonWell Health AllianceCo-Chair Anjum KhurshidLouisiana Public Health InstituteCo-Chair Shaun GrannisRegenstrief InstituteMember Ty FaulknerLawrence Technological UniversityMember Janet CampbellEpicMember Larry WolfStrategic Health NetworkMember Phil PosnerPatient AdvocateMember A. John Blair, IIIMedAllies, Inc.Member Jane PerlmutterGemini GroupMember Lawrence GarberReliant Medical GroupMember Christopher RossMayo ClinicMember Kelly AldrichCenter for Medical InteroperabilityMember George ColeAllscriptsMember Jorge FerrerVeterans Health AdministrationFederal Ex Officio Anastasia PerchemONCONC Lead

Health IT Policy Committee and Health IT Standards Committee Work Product Agenda I.Opening Remarks II.Review IXTF Charge III.Review “Vote” Outcomes (Top 3 Priority Needs & Components ) IV.Discuss Recommendations for Top 3 Priority Needs V.Recap & Next Steps VI.Adjourn 3

Health IT Policy Committee and Health IT Standards 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 Policy Committee and Health IT Standards Committee Work Product Top 3 Priorities to improve the interoperability experience for providers and patients nationwide (1 of 2) Given our Charter, it makes sense where this group landed. All 8 categories of challenges received at least one vote in the feedback. Not surprising as all are fundamental to a “User’s Experience” as it relates to interoperability. However, there was relatively clear consensus in 3 categories: »Ability to meaningfully utilize the data (impact on cognitive burden) »Ability to exchange data »Ability to encode data that is syntactically and semantically interoperable 5

Health IT Policy Committee and Health IT Standards Committee Work Product Top 3 Priorities to improve the interoperability experience for providers and patients nationwide (2 of 2) Summary of the feedback as it relates to Experience for these top 3 categories: »Aligning policy, business, technical and clinical workflow needs to allow providers to meaningfully use data (including aggregating data for population health and quality reporting) »By fostering open API’s, accepting direct communication from patients and utilizing OAuth for data validation, the ability to interoperate data is greatly enhanced. »By creating standardized data coding, automation and prior clinical review before data is imported, the cognitive burden on physicians to decipher relevant information is greatly reduced. 6

Health IT Policy Committee and Health IT Standards Committee Work Product Components of Top 3 Priorities Ability to meaningfully utilize the data (at the least, reduce cognitive burden) »Seamlessly reconciling data »Surfacing clinical insights from data »Usability/Visualization »Usability/Workflow design Ability to exchange data »Querying & retrieving data from EHRs/HIT »Pushing to & receiving from from EHRs/HIT »Submitting device data to EHRs/HIT »Accept data push directly from patients Ability to encode data that is syntactically and semantically interoperable »Standardized encoding for computable data (esp. orderable tests and procedures) »Standardized formatting of (or access to) discrete data »Standardized formatting of (or access to) free-text descriptions/explanations »Standardized formatting of (or access to) non-clinical data (e.g., social, behavioral, etc.) »Ability to determine provenance of the data 7

Health IT Policy Committee and Health IT Standards Committee Work Product Recommendations for Top 3 Priority Needs to Improve User Experience (#1 of 3) Ability to meaningfully utilize the data (at the least, reduce cognitive burden) Recommendations: »Adopt automation & structured formatting to remove cognitive burden from provider »Utilize Open APIs »Adopt policy solutions that use consistent outcome-based metrics to fully align incentives for providers and engage them to act on the data in a way that is truly transformative 8

Health IT Policy Committee and Health IT Standards Committee Work Product Virtual Hearing Feedback for Top 3 Priority Needs (#1 of 3) Ability to meaningfully utilize the data Consumer Focus: “We must create an ecosystem or marketplace where a consumer can easily find all of his or her information using the tools of his or her choice and establish connections to automate the flow of data from the clinical system to those applications.” Christina Caraballo, MBA Get Real Health Simply Routing Data Not Enough: If we were to simply route ADT messages into systems and pass it through to existing Direct messaging…we could say we’ve achieved system interoperability. But I would argue that this comes at a cost….True interoperability entails more than the ability to just share the data, the real value comes in actually using that exchanged data to drive better patient outcomes. “ Lara Sinicropi-Yao, PatientPing 9

Health IT Policy Committee and Health IT Standards Committee Work Product Recommendations for Top 3 Priority Needs to Improve User Experience (#2 of 3) Ability to exchange data Recommendations: »Utilize Open APIs »Utilize a protocol such as OAuth to support authorization workflows and ensure a specific user has permissions to do something (e.g., Facebook, Twitter utilize OAuth) »Accept Direct communication from patients (patient-generated data which may have costs associated with it) »Normalize variability of state to state HIE requirements and costs 10

Health IT Policy Committee and Health IT Standards Committee Work Product Virtual Hearing Feedback for Top 3 Priority Needs (#2 of 3) Ability to exchange data Open APIs: “I think anybody who has data that is relevant to what's happening in the clinical setting or the patient setting needs to be required to have an open API and to make that data available. “ Anna McCollister-Slipp, Galileo Analytics Codifying Prior Auth: “The other thing that we’ve started to discuss as we [PCORnet] try to expand our partnerships more with payers is getting a sense of whether or not some of the prior authorization information for care plans can be codified in a way that’s interoperable with the data that's coming into our data warehouses and being returned to docs in a timely manner so that they would be able to build out their decision-making process.“ Daniella Meeker, PhD – Keck School of Medicine VDT+Receive: And we enable our users to generate CDA documents that can be viewed, downloaded or transmitted [VDT] in both human readable and machine readable formats... EMR technology should be able to accept direct communications from patients and VDT should truly become view, download transmit and receive.” Christina Caraballo, MBA Get Real Health 11

Health IT Policy Committee and Health IT Standards Committee Work Product Recommendations for Top 3 Priority Needs to Improve User Experience (#3 of 3) Ability to encode data that is syntactically and semantically interoperable Recommendations: »Engage EHR Vendors to prepare/standardize formats for data used nationally »Normalize semantic data into standard and commonly used terminologies to enhance the ability for data exchange and care coordination »Improve data structure/standardization to allow multiple sources (lab, eRX) the ability to effectively and accurately transmit information to EHRs »Standardizing formatting of nonclinical data (behavioral, social) 12

Health IT Policy Committee and Health IT Standards Committee Work Product Virtual Hearing Feedback for Top 3 Priority Needs (#3 of 3) Ability to encode data that is syntactically and semantically interoperable Data Reconciliation: “There needs to be clinical review of the data before it's brought into the local curated medical record. Just posting the data is not enough, we need to combine like things and have some intelligence in the machine to prepare the data... Today the burden of reconciling outside data is so grand that most providers just don't do it.” Steven Lane, M.D., Sutter Health Moving Discrete Data: “I think the Carequality Framework provides a tremendous opportunity for all of us to start moving data at a much lower cost than the old big iron HIE models that we’ve utilized. And I think that once that really starts moving, we are going to see a lot of data moving much more quickly at a much lower cost. ” Steven Lane, M.D., Sutter Health Normalize Semantic Coding: You can move data around and get a document from one doctor to another without normalized semantic coding, but the value of what you can do with health information exchange and with interoperability is much, much greater if you can get to the point that semantic coding is normalized between sharing partners. John Kansky, Indiana Health Information Exchange 13

Health IT Policy Committee and Health IT Standards Committee Work Product Next Steps/Homework (Please respond by before June 3 rd ): 14 #1) Ability to meaningfully utilize the data (at the least, reduce cognitive burden) Comments (Please specify if impactful and/or feasible) Timeframe for Solution (6M, 1Y, Longer) Stakeholders Required for Addressing the Need Any Examples of Working Solutions Adopt automation & structured formatting to remove cognitive burden from provider Utilize Open APIs Adopt policy solutions that use consistent outcome-based metrics to fully align incentives for providers and engage them to act on the data in a way that is truly transformative Please review the following Three Recommendations charts for each of the Top 3 Priority Needs and fill out the request accordingly, making sure to ask yourself -- Are these the right approaches for improving the interoperability experience for providers & patients?

Health IT Policy Committee and Health IT Standards Committee Work Product Next Steps/Homework (Please respond by before June 3 rd ): 15 #2) Ability to exchange data Comments (Please specify if impactful and/or feasible) Timeframe (6M, 1Y, Longer) Stakeholders (Required) Examples of working solutions Utilize Open APIs Utilize a protocol such as OAuth to support authorization workflows and ensure a specific user has permissions to do something (e.g., Facebook, Twitter utilize OAuth) Normalize variability of state to state HIE requirements and costs Accept Direct communication from patients (patient-generated data which may have costs associated with it

Health IT Policy Committee and Health IT Standards Committee Work Product Next Steps/Homework (Please respond by before June 3 rd ): 16 #3) Ability to encode data that is syntactically and semantically interoperable Comments (Please specify if impactful and/or feasible) Timeframe (6M, 1Y, Longer) Stakeholders (Required) Examples of working solutions Engage EHR Vendors to prepare/standardize formats for data used nationally Normalize semantic data into standard and commonly used terminologies to enhance the ability for data exchange and care coordination Improve data structure/standardization to allow multiple sources (lab, eRX) the ability to effectively and accurately transmit information to EHRs Standardizing formatting of nonclinical data (behavioral, social)

Health IT Policy Committee and Health IT Standards Committee Work Product Workplan 17 Meeting DatesTask Tue, Mar 8, :00pm ET Task 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 ET Administrative planning call for hearing (not public) Tue, Apr 26, 2016 – 1:00pm ET Refine the use case framework Fri, May 6, :30am ET Virtual Hearing Wed, May 11, :30am ET Summarize hearing outcomes Wed, Jun 1, :00pm ETReview Top 3 Priority Needs & Components Begin to Draft recommendations Tue, June 14, 2016 – 10:30am ETDraft recommendations Tue, June 21, 2016 – 1:00pm ETRefine recommendations June 23, Joint HITSC/HITPC MeetingDraft Recommendations presented to HITSC/HITPC Tue, July 5, 2016 – 1:00pm ETRevise and edit recommendations July 27, Joint HITSC/HITPC MeetingFinal Recommendations presented to HITSC/HITPC