Efforts to Strengthen Healthcare Communities Dr. Lauren Thompson, Director December 13, 2012 The Federal Health Architecture

Federal Health Architecture: Background Federal Health Architecture (FHA) program was established as an OMB E-Gov Line of Business (LoB) To support federal activities related to the development and adoption of health IT standards To ensure that agencies seamlessly and securely exchange health data with other agencies, other government entities, and with other public and private organizations Over time, FHA’s focus and scope has expanded To emphasize federal advancement of the national agenda for health IT To provide enterprise architecture, standards adoption, tools and communication support

Federal Health Architecture: Participation FHA ensures federal participation in initiatives such as the Nationwide Health Information Network, the Direct Project, EHR adoption and CONNECT E-gov initiative managed by ONC within HHS Many federal agencies participate

Federal Health Architecture: Key Initiatives Nationwide Health Information Network (NwHIN) Exchange is now eHealth Exchange Transitioned from ONC federal program to a public/private collaboration HealtheWay, a non-profit, is supporting eHealth Exchange operations Testing and onboarding Maintaining DURSA, and operating policies and procedures Service registry and digital certificates 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 Incorporation into VLER Health for DoD and VA HIE activities

Federal Health Architecture: Key Initiatives RESTful Health Exchange (RHEx) An open source project, sponsored by FHA Demonstrated simple, secure, standards-based Web technologies for health information exchange Two Pilots Telemedicine & Advanced Technology Research Center (TATRC) Use Case: Consult/Referral Secure Person to Person exchange OpenID Connect for distributed user authentication HealthInfoNet Use Case: Populate clinical data repository with patient data from EHR at small health care provider in medically underserved area to Maine HIE Secure Machine to Machine exchange OAuth2 for service to service authentication

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 Federal Health Architecture: Key Initiatives

A federal health information technology environment that is interoperable with the private sector and supports the President’s health information technology plan enabling better care, increased efficiency, and improved population health Federal Health Architecture: FHA Strategic Plan – ( )

Federal Health Architecture: FHA Strategic Goals Improve exchange of health data among the federal government and private sector healthcare providers by establishing a unified federal voice on health data exchange interoperability Encourage adoption of interoperability specifications resulting in active data exchange in the federal health community Align federal policies in health data exchange to use the federal government’s combined influence as a payer, provider, and public health guardian to improve the healthcare system

Federal Health Architecture: Federal Interoperability Landscape Enterprise architecture is about understanding all of the different elements that make up the enterprise and how those elements interrelate. Nationwide Health Information Network Standards & Specs Exchanges (eHealth Exchange, etc.) CMS exchange Non-federal exchanges DoD exchange SSA exchange CDC exchangeVA exchange

CONNECT: The Platform for Secure Health Information Exchange

CONNECT CONNECT is an open-source solution to support health information exchange (HIE) CONNECT uses NwHIN standards both Exchange and Direct to ensure doctors, community hospitals and hospital systems, and Regional Health Information Organizations and HIEs can exchange health information securely and easily CONNECT can be used to: Set up a HIE within an organization Exchange data with other HIEs Set up a Direct Health Information Service Provider

About CONNECT Open source license Open release planning, sprint review and planning sessions Community contributions Bug reports + fixes Feature requests + implementations Documentation Custom or specialized components FHA-sponsored product management, curation, support, development

What CONNECT Does Provides the connection between existing health information systems to health data exchanges Supports multiple usage environments Delivers foundational functionality necessary for supporting interoperability Secure messaging services The framework for request justification of electronic health information for a patient Registry services to discover exchange participant existence and connection information Patient preferences about sharing their electronic health information

CONNECT Enables Interoperability Find a patient based on demographic information Locate a patient’s electronic health information Retrieve specific electronic health information associated with a subject or patient

CONNECT Enables Interoperability Submit patient-specific information without the need for a request or query Submit non-patient-specific documents Provide a publish/subscribe capability for ongoing feeds Exchange of health based SMTP messages per Direct specs Fully functional out of the box but flexible for customization for environmental and use case needs

Do you have information on Jane Doe? NwHIN/Direct specifications NwHIN Technical Specifications: Finding, acquiring, + sharing health information

I’m sending you info on Jane Doe Direct specifications Direct Project Specifications: Simple health information transport

Why a Platform? Flexible architecture Allows CONNECT to build out, and make available, the health information exchange methods and use cases we’ve discussed at this meeting NwHIN Exchange specifications Direct (secure ) transport Whatever’s next: – Benefits discovery? Pre-approval? Quality? Etc. Single product Do you really want to install and maintain separate products for your distinct exchange needs? Pooled efforts Open source license and development allows community engagement, collaboration, contribution Needs are better met through openness, participation, + interaction

Who Uses CONNECT? Anyone who wants to exchange health data A sampling of the CONNECT community.

Listening to the Community What do you need? Why are you here? What is your mission? What are your challenges?

How to use CONNECT: A solution to support meeting MU requirements The exchange of health data and interoperability is a key theme and requirement of meaningful use ONC National Coordinator Dr. Farzad Mostashari states “…as we look toward meaningful use Stage 3, we will monitor the ease with which EPs [eligible professionals], eligible hospitals, and CAHs [critical access hospitals] engage in electronic exchange, especially across different vendors…” Goal of a national health IT system is to make sure "information follows the patient regardless of geographic, organizational, or vendor boundaries” ONC remains dedicated to the idea of health information exchange without borders, across different ….areas of care, but also across different technologies

How to use CONNECT: A solution to support meeting MU requirements CONNECT provides the functionality to meet exchange requirements for meaningful use for example Providing a summary of care record to another care setting for a referred patient with suggest standard of Direct Project protocols Receiving clinical lab-test results for incorporation into an EHR as structured data Provide patients with ability to download and transmit their health information Capability to submit electronic data to immunization registries Capability to submit electronic surveillance and reportable laboratory results data to public health agencies Electronic submission of clinical quality measures reporting requirements CONNECT is fully functional out of the box but flexible for customization for environmental and use case needs

How to use CONNECT Health Information Exchange Infrastructure Low cost solution that is open source and maintained by fellow adopters CONNECT provides multiple migration paths for exchange adoption and abilities to meet interoperability requirements Direct transport, Exchange transport or both One implementation allows for exchange with two different transport protocols increasing exchange opportunities CONNECT is a platform that can be easily extended to support the new underlying specifications CONNECT is a health exchange platform that is flexible to support an evolving exchange environment A solution that complies with requirements and specifications associated with MU and established Exchanges Flexible for implementing into an adopters established infrastructure and environment

Master Patient Index System (MPI) Document Registry Document Repository Policy Engine EHR/HIE System System that wishes to CONNECT with other health information sources CONNECT Any Health Organization / Provider Regional Health Information Organizations Government sponsored facilities Disease-oriented care networks Federation of enterprises (hospitals and care providers) Other Communities of Care EHR/HIE Implementation Adapter Service Creates/sends messages to CONNECT and receives/processes and responds to messages from CONNECT CONNECT Building Blocks How CONNECT enables exchange

CONNECT Building Blocks: Tailoring your implementation CONNECT provides the health information exchange (HIE) key building blocks: Provides an integrated implementation which provides functionality and access to interoperate with other partners CONNECT sits between the HIE infrastructure systems Exchanges for example the eHealth Exchange or Direct participating partners CONNECT sends messages to the exchange and receives messages from the network on behalf of the HIE CONNECT provides reference adapters for guidance but allows for the customization of the adapters to tailor processing messages to and from CONNECT and the HIE systems To further build only what is needed CONNECT allows for the deployment of only the services needed to support desired use cases

Next CONNECT Events December 31, 2012 (11am) Next sprint review + planning meeting January 2, 2013 CONNECT 4.0 Beta Release February 11, 2012 CONNECT 4.0 Release Mid-February, 2013 CONNECT User Group Meeting

WIKI/Release In+Progress WIKI/Requirements+Artifacts WIKI/CONNECT+4.0+Design+Approaches resources/forums/developer-forum Release info: Requirements artifacts: Design approach documents: JIRA: Forums: More Details on CONNECT 4.0

Federal Health Architecture: Stay connected, communicate and collaborate Browse the ONC website at: healthIT.gov click the Facebook “Like” button to add us to your networkhealthIT.gov Contact us at: Subscribe, watch, @CONNECT_Project Health IT and Electronic Health Records – Health IT Buzz Blog

Federal Health Architecture: More about Federal Health IT Initiatives ONC website: Direct Project website: S&I Framework wiki: CONNECT website: eHealth Exchange:

Thank you!