0 enabling healthcare interoperability Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Standardizing How We Share Information in Healthcare An Introduction to HITSP Webinar 1 June 5, 2008 | 2:00 – 3:30 pm (Eastern) Presenter: Dr. John Halamka, chair of the HITSP

Slide 1 HITSP – enabling healthcare interoperability Learning Objectives  During this 90-minute webinar, participants will gain a basic knowledge of: — the need for standards in healthcare information sharing and how standards can help enhance patient care and contain costs. — the importance of healthcare information sharing and what healthcare interoperability really means. — how HITSP fits in with the Nationwide Health Information Network (NHIN), the Certification Commission for Healthcare Information Technology (CCHIT), other HIT organizations, and standards bodies. — work underway within HITSP — projects that have already been developed, accepted by Secretary Leavitt and implemented; new work and what may be coming next. — why members of the HIT community should care about HITSP’s work and how any interested stakeholder can become engaged. a webinar series on U.S. healthcare interoperability

Slide 2 HITSP – enabling healthcare interoperability Agenda  Introduction: Steve’s story  Standards to promote healthcare information sharing and interoperability  Overview of HITSP — How HITSP fits into the NHIN and how it works with other HIT organizations — HITSP deliverables  How and why HIT stakeholders should become engaged with HITSP  Questions and Answers / Open Dialogue a webinar series on U.S. healthcare interoperability

Slide 3 HITSP – enabling healthcare interoperability Introduction: Steve’s story  Patient is a 26-year-old male who had a brain tumor removed as a child and is now suffering from frequent headaches  Referrals to many different doctors and healthcare facilities for treatment — required to repeat registration information, medical history, allergies, medications, etc. — required to repeat tests and procedures due to a lack of comparison test results and scans  Contracted infection during recent hospital visit  Concerned about ongoing and emergency care  Increasing levels of fear and frustration

Slide 4 HITSP – enabling healthcare interoperability Introduction: Steve’s story (continued)  The Future: Healthcare in an interoperable world — with patient’s consent, healthcare information will be seamlessly and securely exchanged between and among diverse systems across the United States — care providers will have instant access to key data from providers and care settings, including  active and past medication lists  allergies  current and previous problems and diagnoses  discharge and visit summaries  lab results and other test results, including images  registration and insurance information — personal health records will also allow the patient to record his/her own findings and to collect clinical information from healthcare providers

Slide 5 HITSP – enabling healthcare interoperability The Problem  Current lack of interoperable healthcare information Interoperable: the ability to share and make use of electronic healthcare information between and among systems  Barriers — Different data definitions — Different data formats — Different communication protocols

Slide 6 HITSP – enabling healthcare interoperability The Solution Standards: a well-defined approach that supports a business process and... — have been agreed upon by a group of experts; — have been publicly vetted; — provide rules, guidelines, or characteristics; — help to ensure that materials, products, processes and services are fit for their intended purpose; — are available in an accessible format; — are subject to an ongoing review and revision process. Examples of standards currently in use within the healthcare community — XML — IHE-XDS — HL7-CCD — DICOM — LOINC — SNOMED-CT — NCPDP-Script — etc.

Slide 7 HITSP – enabling healthcare interoperability The Solution (continued)  Standards Harmonization: addressing issues such as.... — More than one standard exists for a given purpose — Multiple standards are required to solve a problem — A standard does not exist or there are gaps in existing standards — Other...

Slide 8 HITSP – enabling healthcare interoperability The Benefits of Harmonized Standards  Consumer-centered care — Clinicians can spend more time on patient care — Health information moves with consumers — Care is delivered electronically as well as in person  Fewer medical errors — Less variation in care  Medical records are protected from unauthorized access

Slide 9 HITSP – enabling healthcare interoperability Impetus for Change “Within ten years, every American must have a personal electronic medical record...” ­ President George W. Bush April 26, 2004 President Bush has called on U.S. healthcare institutions to adopt electronic systems for a majority of patients by 2014 as a way to make healthcare delivery more efficient and more effective.

Slide 10 HITSP – enabling healthcare interoperability For Immediate Release Office of the Press Secretary August 22, 2006 Executive Order: Promote Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs Sec. 3. Agencies shall perform the following functions: Health Information Technology - For Federal Agencies. As each agency implements, acquires, or upgrades health information technology systems used for the direct exchange of health information between agencies and with non-Federal entities, it shall utilize, where available, health information technology systems and products that meet recognized interoperability standards.

Slide 11 HITSP – enabling healthcare interoperability Federal Agencies must use the Recognized Interoperability Standards that have been harmonized by the Healthcare Information Technology Standards Panel (HITSP) DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the National Coordinator for Health Information Technology (ONC), DHHS Notice of Availability: Secretarial Recognition of Certain Healthcare Information Technology Standards Panel (HITSP) Interoperability Specifications as Interoperability Standards for Health Information Technology Federal Register/Vol. 73, No. 15/Wednesday, January 23, 2008/Notices 3973

Slide 12 HITSP – enabling healthcare interoperability  Volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services  The Panel brings together experts from across the healthcare community... — from consumers to doctors, nurses, and hospitals; — from those who develop healthcare IT products to those who use them; and — from the government agencies who monitor the U.S. healthcare system to those organizations that are actually writing healthcare IT standards. Overview

Slide 13 HITSP – enabling healthcare interoperability  Patients  Consumers  Employers  General Practitioners  Review Boards  Practice Guidelines  Residential Care Providers  Specialists  Payers  Suppliers  Hospitals  Outpatient Healthcare Providers  Government Agencies HITSP Stakeholders

Slide 14 HITSP – enabling healthcare interoperability Roles and Responsibilities  To harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records — Create HITSP-recommended Interoperability Specifications (IS) that specify how and what standards should be used for a particular Use Case — Support deployment and implementation of these HITSP-recommended Interoperability Specifications — Help Standards Development Organizations (SDOs) maintain, revise or develop new standards as required to support the HITSP-recommended Interoperability Specifications

Slide 15 HITSP – enabling healthcare interoperability  Priorities — Established by the American Heath Information Community, an advisory body to the Secretary of Health and Human ServicesAmerican Heath Information Community  Relationships with other organizations — HITSP is playing an integral role in the development of a NHIN for the United States — Part of CCHIT certification requirements includes proof of compliance to HITSP specifications Priorities and Relationships

Slide 16 HITSP – enabling healthcare interoperability American Health Information Community (AHIC) Healthcare Information Technology Standards Panel (HITSP) Nationwide Healthcare Information Network (NHIN) Architecture Projects Health Information Security and Privacy Collaboration (HISPC) Certification Commission for Healthcare Information Technology (CCHIT) In 2005, HHS Secretary Michael Leavitt chartered a public-private “Community” to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability. Role of AHIC The Community provides input and recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market- led way. Plans are now underway to transition the AHIC to a public-private partnership based in the private sector.

Slide 17 HITSP – enabling healthcare interoperability

Slide 18 HITSP – enabling healthcare interoperability Joint Working Group Healthcare Information Technology Standards Panel (HITSP) and the Certification Commission for Healthcare Information Technology (CCHIT) Between the federal implications and the certification efforts of CCHIT, stakeholders will be motivated to adopt a standard way of sharing data throughout the NHIN, leading to better healthcare for everyone.CCHIT

Slide 19 HITSP – enabling healthcare interoperability HHS has awarded $22.5 million in contracts to nine Health Information Exchanges (HIEs) to begin trial implementations of the NHIN.  CareSpark Tricities region of Eastern Tennessee and Southwestern Virginia  Delaware Health Information Network Delaware  Indiana University Indianapolis metroplex  Long Beach Network for Health Long Beach and Los Angeles, California  Lovelace Clinic Foundation New Mexico  MedVirginia Central Virginia  New York eHealth Collaborative New York  North Carolina Healthcare Information and Communications Alliance, Inc. North Carolina  West Virginia Health Information Network West Virginia NHIN Trial Implementations

Slide 20 HITSP – enabling healthcare interoperability  HITSP Standards Harmonization Framework — Identify a pool of standards for an AHIC Use Case — Identify gaps and overlaps in the standards for this specific Use Case — Make recommendations for resolution of gaps and overlaps — Select standards using HITSP Approved Readiness Criteria — Develop Interoperability Specifications (IS) for using the selected standard(s) for the specific context — Test the IS Deliverables and Mode of Operation

Slide 21 HITSP – enabling healthcare interoperability HITSP Interoperability Specifications  Each HITSP Interoperability Specification defines a set of “constructs” that: — specify how to integrate and constrain selected standards to meet the business needs of a Use Case; and — define a Roadmap to use emerging standards and to harmonize overlapping standards when resolved.  In essence, a HITSP IS represents a suite of documents that integrate and constrain existing standards to satisfy a Use Case

Slide 22 HITSP – enabling healthcare interoperability HITSP Interoperability Specifications (continued)  HITSP construct types, in decreasing breadth of scope, include: — Interoperability Specifications Integration of all constructs used to meet the business needs of a Use Case Interoperability Specifications — Transaction Packages Logical grouping of transactions Transaction Packages — Transactions Logical grouping of actions that use components and/or composite standards to realize the actions Transactions — Components Logical grouping of base standards that work together, such as messaging and terminology Components

Slide 23 HITSP – enabling healthcare interoperability Steps in the HITSP Harmonization Process (continued)  IS Status = State in the acceptance process — Released Panel approved for submission to HHS — Accepted Secretary of HHS has accepted for a period of testing — Recognized Secretary of HHS has recognized the IS for immediate implementation  Revisions and updates may mean that multiple versions of some Interoperability Specifications exist with differing status levels

Slide 24 HITSP – enabling healthcare interoperability HITSP Program Management Summary Steps in the HITSP Harmonization Process Receive Request to Harmonize I Conduct Requirements Analysis II Identify Candidate Standards III Identify and Resolve Gaps, Duplications and Overlap IV Select Standards V Develop Interoperability Specification VI Begin Inspection Testing VII Release and Disseminate Interoperability Specification VIII Begin Support IX

Slide 25 HITSP – enabling healthcare interoperability IS 01Electronic Health Record (EHR) Laboratory Results Reporting IS 02Biosurveillance IS 03Consumer Empowerment IS 04Emergency Responder Electronic Health Record (ER-EHR) IS 05Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management Current Interoperability Specifications

Slide 26 HITSP – enabling healthcare interoperability IS 01Electronic Health Record (EHR) Laboratory Results Reporting  This Interoperability Specification defines specific standards to support the interoperability between electronic health records and laboratory systems and secure access to laboratory results and interpretations in a patient-centric manner. — Version: 2.1 Recognized — Version: 3.0 Released (Panel Approved)

Slide 27 HITSP – enabling healthcare interoperability IS 02Biosurveillance  This Interoperability Specification defines specific standards that promote the exchange of biosurveillance information among healthcare providers and public health authorities. — Version: 2.1 Recognized — Version: 3.0 Released (Panel Approved)

Slide 28 HITSP – enabling healthcare interoperability IS 03Consumer Empowerment  This Interoperability Specification defines specific standards needed to enable the exchange of data between patients and their caregivers. — Version: 2.1 Recognized — Version: 3.0 Accepted

Slide 29 HITSP – enabling healthcare interoperability IS 04Emergency Responder Electronic Health Record (ER-EHR)  This Interoperability Specification defines specific standards required to track and provide on-site emergency care professionals, medical examiner/fatality managers and public health practitioners with needed information regarding care, treatment or investigation of emergency incident victims. — Version: 1.0 Accepted

Slide 30 HITSP – enabling healthcare interoperability IS 05Consumer Empowerment and Access to Clinical Information via Media  This Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). — Version: 1.0 Accepted

Slide 31 HITSP – enabling healthcare interoperability IS 06Quality  This Interoperability Specification defines specific standards needed to benefit providers by providing a collection of data for inpatient and ambulatory care and to benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients. — Version: 1.0 Accepted

Slide 32 HITSP – enabling healthcare interoperability IS 07Medication Management  This Interoperability Specification defines specific standards to facilitate access to necessary medication and allergy information for consumers, clinicians, pharmacists, health insurance agencies, inpatient and ambulatory care, etc. — Version: 1.0 Released (Panel Approved)

Slide 33 HITSP – enabling healthcare interoperability TN 900Security and Privacy  The HITSP Security and Privacy Technical Note addresses common data protection issues in a broad range of subject areas, including electronic delivery of lab results to a clinician, medication workflow for providers and patients, quality and consumer empowerment. — Version: 1.1 Released (Panel Approved)

Slide 34 HITSP – enabling healthcare interoperability View the Complete Set of HITSP Deliverables

Slide 35 HITSP – enabling healthcare interoperability AHIC-Defined Use Cases (2008) * formally called “Remote Consultations” Consultations and Transfers of Care Personalized Healthcare Immunizations and Response Management Public Health Case Reporting Remote Monitoring Patient – Provider Secure Messaging* Work Currently Underway

Slide 36 HITSP – enabling healthcare interoperability Summary AHIC Priorities Use Case Roadmap 36

Slide 37 HITSP – enabling healthcare interoperability Summary (continued) Use Case Roadmap 2009 and Beyond

Slide 38 HITSP – enabling healthcare interoperability  Use or specify HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs)  Ask for CCHIT certification  Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future  Ask... Is there a HITSP standard we could be using?  Get involved in HITSP... Help shape the standards How YOU can become involved

Slide 39 HITSP – enabling healthcare interoperability Webinar 1 Standardizing How We Share Information in Healthcare: An Introduction to HITSP Thursday, June 5, 2008 — 2:00-3:30 pm EDT Webinar 2HITSP Foundational Components Thursday, June 19, 2008 — 2:00-3:30 pm EDT Webinar 6Quality Thursday, August 7, 2008 — 2:00-3:30 pm EDT Webinar 3Consumer Access to Clinical Information Thursday, June 26, 2008 — 2:00-3:30 pm EDT Webinar 7Security, Privacy and Infrastructure Thursday, August 21, 2008 — 2:00-3:30 pm EDT Webinar 4Biosurveillance Thursday, July 10, 2008 — 2:00-3:30 pm EDT Webinar 8EHR and Emergency Response Thursday, September 4, 2008 — 2:00-3:30 pm EDT Webinar 5Electronic Health Record (EHR) and Lab Reporting Thursday, July 24, 2008 — 2:00-3:30 pm EDT Webinar 9Medication Management Thursday, September 18, 2008 — 2:00-3:30 pm EDT How YOU can become involved Learn more about specific HITSP activities during these upcoming webinars:

Slide 40 HITSP – enabling healthcare interoperability Jessica Kant, HIMSSTheresa Wisdom, HIMSS Re: HITSP Technical Committees Michelle Deane, ANSI Re: HITSP, its Board and Coordinating Committees Join HITSP in developing a safe and secure health information network for the United States. Visit or contact...

Slide 41 HITSP – enabling healthcare interoperability Sponsor Strategic Partners

42 enabling healthcare interoperability Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Standardizing How We Share Information in Healthcare An Introduction to HITSP