Office of Science & Technology Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Teams convened to solve problems Solutions & Usability Coordinate Federal Partners R&D I like to describe OST’s work as four-fold. OST ENABLES stakeholders to come up with simple, shared solutions to common info exchange challenges through the S&I Framework. Rather than prescribing standards and specifications to the health IT community, ONC is asking the health IT community WHAT challenges need to be addressed, and then provides stakeholders with the administration and support they need in order to develop and harmonize standards and specifications. As an open government initiative, any interested stakeholder is welcome to participate and help create solutions. Secondly, OST curates a portfolio of standards, services and policies that accelerate interoperability and health information exchange. These “building blocks” can be utilized to enable a wide range of uses and use cases for health information exchange. Third, OST supports Innovation through its Innovation Challenge Grants program and the Strategic Health IT Advanced Research Projects (SHARP) program. OST is also responsible for interfacing with the international health IT community to share and leverage best practices from all around the world. Finally, OST manages the Federal Health Architecture (FHA) program, an e-gov initiative designed to help federal agencies coordinate federal health IT priorities. Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community

ONC’s Interoperability Strategy Leverage government as a platform for innovation to create conditions of interoperability Health information exchange is not one-size-fits-all; create a portfolio of solutions that support all uses and users Build in incremental steps – “don’t let the perfect be the enemy of the good” ONC’s strategy for standards development and interoperability is three-fold: Do what government does best – use our powers of convening to help bring together members of the health IT community to prioritize and develop solutions to common health IT challenges. Rather than doing what we THINK is right – gather the community and have them TELL us what is right. We need to make sure we are creating a portfolio of solutions, because different health IT users will have different uses and needs for interoperable health information exchange. Make sure that all interests are considered. Finally, don’t let the perfect be the enemy of the good…we have to build incrementally or we will never get anywhere!

What is the S&I Framework? The Standards and Interoperability (S&I) Framework represents one investment and approach adopted by the Office of Science & Technology (OST) to fulfill its charge of prescribing health IT standards and specifications to support national health outcomes and healthcare priorities The S&I Framework is an example of “government as a platform”– enabled by integrated functions, processes, and tools – for the open community* of implementers and experts to work together to standardize * As of April 2012, 1100+ people had registered on the S&I Framework wiki, and 450+ people representing 300+ organizations had committed to the S&I Framework

Why the S&I Framework Approach? Create a collaborative, coordinated incremental standards process, Guided by ONC, with input from Federal Advisory Committees, Enabled and led by the an open community of industry participants who are interested in solving real world problems Value created through this approach: Solve real-world issues to enable health information exchange Harness the expertise and passion of the community to solve problems Empower the community to create the best solutions for interoperability and standards adoption

ONC’s Interoperability Portfolio Vocabulary & Code Sets How should well-defined values be coded so that they are universally understood? Content Structure How should the message be formatted so that it is computable? Transport How does the message move from A to B? Security How do we ensure that messages are secure and private? Services How do health information exchange participants find each other?

S&I Initiative Portfolio Snapshot Pre-Discovery Use Case Harmonization RI, Test & Pilot Evaluation Direct Project (S&I Archetype) Transitions of Care Balloted Lab Results Interface Balloted Query Health Provider Directories Data Segmentation for Privacy Public Health Reporting This snapshot describes the various initiatives that are currently in process as part of the S&I Framework and details their progress. esMD Longitudinal Coordination of Care Laboratory Orders Interface Health eDecisions Automate Blue Button (ABBI)

S&I Framework Updates SDO Activities IG’s for LRI and ToC successfully balloted HQMF V2 under ballot Initiatives in Progress esMD LOI/eDOS Query Health (Pilots) Longitudinal Care Coordination PHRI Initiatives Completed ToC LRI Provider Directory Support Activities: Test data generation activities for MU2 CCDA Guide for BEACONS 7

Office of Science & Technology Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Teams convened to solve problems Solutions & Usability Coordinate Federal Partners R&D Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community

Nationwide Health Information Network A portfolio of services, standards and policies that enable secure health information exchange over the Internet.

eHealth Exchange Strategic Road Map Initial Rollout (2009 – 2011) Mature, Grow, Scale 2012-2013 Sustainability 2014 Phase 1 Phase 2 Phase 3 Early adopters Federal business cases Shared infrastructure Early lessons learned Success / viability ONC program pilot concludes Production ramps up Transition to public-private model Grow participation and transactions Refine and scale Expand value cases Align with NwHIN governance Implement sustainability model Continued growth in participant and transactions Revenue model sustains operations Nationwide deployment Interoperable exchange among private entities

Office of Science & Technology Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Teams convened to solve problems Solutions & Usability Coordinate Federal Partners R&D OST ENABLES stakeholders to come up with simple, shared solutions to common info exchange challenges through the S&I Framework. Rather than prescribing standards and specifications to the health IT community, ONC is asking the health IT community WHAT challenges need to be addressed, and then provides stakeholders with the administration and support they need in order to develop and harmonize standards and specifications. As an open government initiative, any interested stakeholder is welcome to participate and help create solutions. Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture

Investing in Innovation (i2) ONC’s Challenges and Prizes program spurring private-sector innovation and engaging developers to address health problems that touch every person in America: Care Transitions Cancer Research Heart Disease Population Health Sexual Abuse Disabilities Over 100 new applications developed Winners have received $195,000 in prizes Over 25 new challenges planned

SHARP – Strategic Health IT Advanced Research Projects Automated complex decisions around health record exchange, assuring regulation compliance Security of Health IT - Innovations in security and privacy required to build public trust in health IT systems Developed techniques to analyze health records access logs to catch policy violations Patient-Centered Cognitive Support – Innovations in health IT usability and clinical decision support Piloted Rapid Usability Assessment Protocol for EHRs Comparing usability across EHR systems via Usability Lab 13

SHARP – Strategic Health IT Advanced Research Projects Healthcare Applications – New health IT architectures enabling substitutable applications Created SMART platform – a test-bed for the substitutable app development SMART-enabled i2b2, a data analytics platform, and Indivo, a PHR Secondary Use of EHR Data – Enabling exchange through creating tools, services for large-scale data sharing Conversion and normalization of lab messages & medication orders Extraction of medication from narrative clinical documents

Office of Science & Technology Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Teams convened to solve problems Solutions & Usability Coordinate Federal Partners R&D Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture

Federal Health Architecture: Advancing National Health IT FHA in 2012: Strategy and Architecture New Governance More strategic alignment within and across Federal partner agencies Greater transparency and enhanced communications Commitment to fulfilling original intent of FHA as E-Gov Line of Business Strategy Planning FHA Strategic Plan nearing completion FHA Line of business (LoB) Service Plan delivered to OMB Interoperability Architecture Identify current and planned data exchanges among Federal agencies and partners Develop FHA public-facing portal Align with standards harmonization efforts (e.g. Standards and Interoperability Framework) Demonstrate exchange methods beyond Direct and SOA – RHEx pilots 16

Federal Health Architecture: Advancing National Health IT FHA in 2012: Innovations CONNECT Open Source CONNECT code on GitHub, sprint sessions open Engaging open source community through code-a-thons, encouraging code contributions Developing CONNECT 4.0, incorporating Direct specifications RESTful Health Exchange (RHEx) Two pilots TATRC HealthInfoNet 17

The CONNECT Gateway Project The CONNECT gateway project was later established as a separate OMB E-Gov LoB To form a federal health IT consortium to jointly govern and develop CONNECT as a shared investment toward a common solution that would be deployed and operated separately utilizing existing standards and terminologies/value sets Provides transport gateway and adapter services for participants CONNECT v4.0 just launched and is being demonstrated in the Interoperability Showcase!

Key Takeaways Although not perfect, does it represent the best we have so far? Is it the next step in an incremental approach to refining the standards and implementation guides? Does it support our policy objectives? Interoperability is not “one size fits all”: Create modular standards and specifications that allow for innovation i.e. Internet: we’re not building AOL; we’re creating the building blocks to make it possible for Facebook, Twitter, etc. to flourish We are on a journey together!

Questions/Discussion Learn more at: ONC website: www.healthit.gov/ S&I Framework Wiki: http://wiki.siframework.org/ 20