Interoperability: Progress through Unprecedented Collaboration Charlene Underwood, MBA Director, Government and Industry Affairs, Siemens Chairperson, HIMSS Electronic Health Record Vendors Association HIMSS Annual Conference San Diego February 12, 2006

Agenda A Word About EHRVA Interoperability: A Brief History Progress Based on Collaboration A Suggested Roadmap What We’re Doing

HIMSS EHRVA Background Formed in 2004 All major EHR suppliers –Large and small companies serving ambulatory and acute care provider organizations of all types Key initiatives to support accelerated EHR adoption –Certification –Interoperability Membership is open to HIMSS corporate members who design, develop and market EHRs in the US HIMSS EHRVA collectively serves the majority of healthcare providers in the US

* * Acquired by Allscripts January 2006

1970’s 1980’s 1990’s Financially-driven HIT with basic clinical function. Increasingly complex clinical applications requiring more timely data sharing. HL7 emerges as Standard Development Organization. Evolving EHR functionality demands integration among disparate applications. DICOM sets precedent as single standard for diagnostic imaging in Radiology and Cardiology. 2000’s Growing public awareness of HIT importance increases pressure for seamless interoperability. Government drive to interoperable EHRs and IT based healthcare transformation. Interoperability: A brief history

Interoperability: A Definition Interoperability means the ability of health information systems to exchange and use healthcare information within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities. HIMSS 2006

Interoperability Goals Work together to agree on interoperability standards. Include our customers in the decision making process. Simplify access to EHR Vendors for government, standard development organizations and other associations. Move quickly using incremental approaches to improve product availability by using tight execution and reuse of existing standards. Promote industry collaboration, standards planning, and convergence.

Essential Factors to Achieving Goals Adoption of a single set of interoperability standards. Ability for standards to support multiple levels of sophistication, now and in the future. Ability to introduce advancements in standards incrementally, while assuring backward compatibility with current implementations. Processes for profiling and testing standards must be sustainable over time.

Interoperability Strategies Collaboration Leadership Commitment Community

Collaboration Interoperability Collaborative: HIMSS EHRVA, IHE and HL7 –Promote and demonstrate interoperability –Accelerate work towards a single set of standards –Communicate to all stakeholders Technical Non-technical Policymakers Vendors: Interoperability Roadmap –Built on available standards and / or promote the need for new / harmonized standards –Specify, test, and demonstrate interoperability in IHE

2006Interoperability Roadmap V2 Publication IHEConnectathon 2004 HHS/ ONC StrategicFramework 2005 AHIC Formation 2005HurricaneKatrina 2006EHRDemonstrationProjects 2005InteroperabilityCollaborationFormation 2014 Goal for National EHR Use Consumer & Population Connectivity RHIO Connectivity Inter Enterprise Connectivity Provider to Provider Connectivity Interoperability Roadmap Consensus Incorporates broader NHIN Initiatives Version 2 – Begin HL7 convergence of CCR into CDA Launch of HL7 Version 3 Single Standard Harmonization Interoperability Prototypes Gain Ground HHS Award of NHIN Demonstration Project contracts Gulf States RHIO Initiative Reprioritization of National HIT Goals: Interoperability a necessity for emergency response Interconnect Clinicians to Share Data Launch of Patient Care Coordination Domain Interoperability Roadmap Launch Incremental interoperability approach established Version

EHRVA Interoperability Roadmap Fully specified Interoperability Roadmap with Integration Profiles and Standards Internet HIT to HIT Systems Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIT Systems to NHIN Scanned Document Clinical Specialties EHRVA Roadmap HL7 Reference Information Model HL V2, V3 Patient Admin HL V2, V3 Pub. Health Rep. HL V3 Meds, Pt Care HL CDA CRS, CCD HL Consent Docs HL CDA Lab & Path HL CDA Rad Report HL CDA +PDF, TIFF HL CDA Anest., Pediat. HL V3 Meds, Orders, Lab IHE XDS IHE XDS-MS IHE Transact IHE CT, ATNA, XUA IHE PIX, PDQ IHE PIX, PDQ IHE XDS-I IHE XDS-Sc IHE XDS-zz IHE DynQ Med-All-Pb IHE DynQ Med-All-Pb IHE Lab RT WF ePrec. NPRM ePrec. NPRM CDC. Impl. Guide CDC. Impl. Guide IHE Axs Consent IHE Axs Consent IHE XDS-Lab EHRVA Interoperability Roadmap at :

Leadership Responded to NHIN RFI with EHRVA Interoperability Roadmap V1 Presented vendor consensus and commitment to achieve V1 roadmap to Dr. Brailer at HIMSS 2005 Included as part of response to ONC RFP for NHIN demo projects Used in EHRVA response to ONC after Katrina disaster Updated and expanded in January 2006 –Broadening collaborative input

Commitment Increased member leadership and involvement in standards processes –HL7 (EHR TC, Board, Advisory Groups) –ASTM, HL7 balloting –Health Information Technology Standard Panel (HITSP) Supported launch and leadership of IHE Patient Care Coordination Domain –ACP, AEP, AAFP, nursing, vendors –Planning and Technical Chairs –Close coordination with HL7 to develop Care Record Summary implementation guide –Member Education

Commitment Leadership and participation in HIMSS Interoperability Showcase –Planning Chairs –Nearly half EHRVA members implemented the IHE cross-enterprise sharing of medical summaries Structured data for meds, allergies and problems –Sponsorships and other support

Community Hurricane Katrina Response –Accelerated roadmap to support providers and evacuees –Offered free software and discounted support to affected practices –Ongoing evaluation of roadmap based on experience and NHIN input Support of AHIC and ONC initiatives –Through contribution to the success of HITSP, CCHIT and NHIN prototypes

2006 EHRVA EHRVA Interoperability Roadmap V.2 HIMSSHIMSS IHE RHIO Demo IHE RHIO Demo NHIN Demo NHIN Demo Projects Projects HHS/ ONC HHS/ ONCStrategicFramework AHIC AHIC Hurricane Katrina Hurricane Katrina Interoperability Interoperability Collaborative Collaborative 2014 Goal for National EHR Use Five Years from Now…Transformation! Personal Health Records Physician-to-Patient communications Peer-to-Peer interaction Quality measures & Pay-for-Performance Population health management Biosurveillance Two Years from Now… Interoperable EHRs: practices, hospitals, labs, imaging & pharmacies Interactive patient information exchange Now… EHR upswing Lack of connectivity: hospitals, labs & pharmacies Reliance on paper-based information

The Future: Delivering on the Value Promise Outreach and education –AHIC and legislators –Physician organizations –Provider IT executives Support national interoperability efforts –Community (AHIC) breakthrough areas –HITSP harmonization efforts and use cases –Global standards planning and harmonization efforts Deliver interoperable EHR components for the NHIN demo projects –Real-world implementation of interoperability –Work with RHIO projects to leverage EHRVA Interoperability Roadmap