HIT Policy Committee Information Exchange Workgroup Micky Tripathi, Massachusetts eHealth Collaborative, Chair David Lansky, Pacific Business Group on Health, Co-Chair September 14, 2010

Information Exchange Workgroup Chair: Micky Tripathi, MA eHealth Collaborative Co-Chair: David Lansky, Pacific Business Group on Health Members: Judy FaulknerEpic Connie W. DelaneyUniversity of Minnesota, Nursing Gayle Harrell Michael KlagJohns Hopkins School of Public Health Deven McGrawCenter for Democracy & Technology Latanya SweeneyCarnegie Mellon University Charles KennedyWellPoint, Inc. Paul Egerman James GoldenMinnesota Department of Health Dave GoetzDept. of Finance and Administration, TN Jonah FrohlichCalifornia Health & Human Services Steven StackAMA George HripcsakColumbia University Seth FoldyDHS, Wisconsin Jim BuehlCDC Jessica KahnCMS Walter SuarezKaiser Permanente David A. RossPHII Hunt BlairVermont Medicaid George OestreichMissouri Medicaid Dianne HasselmanCenter for Health Care Strategies Donna FrescatoreNY State Health

Charge to the IE Workgroup Breakthrough areas where policy barriers prevent providers and/or states from being effective enablers of broader and deeper health exchange –Specific clinical transactions already identified as important to meaningful use –Critical issues that get unearthed by the over $1.5 billion programs in state- level HIE, RECs, Beacons, and NHIN Direct IE WG will also act as conduit for state-level policy issues that need HITPC attention –For issues in IE WG charter, Identify and recommend solutions to such issues to HITPC –For issues outside of IE WG charter, navigate to most appropriate HITPC WG(s) and facilitate/coordinate as necessary

4 Provider Directory Taskforce Co-Chair: Jonah Frohlich, California Health and Human Service Agency Co-Chair: Walter Suarez, Kaiser Permanente Members: Judy FaulknerEpic Paul Egerman James GoldenMinnesota Department of Health Dave GoetzDept. of Finance and Administration, TN Steven StackAMA Seth FoldyDHS, Wisconsin Hunt BlairVermont Medicaid George OestreichMissouri Medicaid Sorin DavisCAQH Sid ThorntonIntermountain Healthcare Keith HeppHealthBridge Lisa RobinFederation of State Medical Boards Jessica KahnCMS JP Little Surescripts

What problem are we trying to solve? State HIE Cooperative Agreements and MU Stage 1 focus on “directed exchange” types of transactions, specifically lab results delivery and patient care summary exchange While there are multiple ways that these functions will be performed in the market (for example, through EHR-based hubs or state-level HIE activities) all of these approaches will need to have a way to handle provider identity and addressing –While directed exchange transactions are the most immediate need, there are many other potential users such as public health, health plans, etc that also spend considerable effort on provider identity The lack of a universal approach to provider directories will be a barrier to progress in “directed exchange” and a missed opportunity to combine multiple streams of funding to yield a lower cost, higher quality service for all What, if anything, can federal and state governments do to catalyze and guide the creation of market-enabling provider directory approaches to serve the immediate needs of “directed exchange” transactions and also serve as a platform for broader needs in the future?

6 Provider Directory Requirements Dimensions Coverage – What groups of individuals should the directory approach cover? What jurisdiction/geography is covered by the provider directory? What level/type of information is needed to support providers who practice at multiple unaffiliated sites (e.g. ability to distinguish provider between different practice locations)? Content – What type of information is needed for each individual and entity? (may need different information for a provider vs. a practice) Standards – What standards are needed on the data elements? Architecture – How should the directory approach be architected? What are the different models (federated vs. repository vs. other approaches)? What level/type of information is needed to support providers who practice at multiple unaffiliated sites? Data validity – What level of assurance is needed to assure high use, and how will that assurance be provided? Data accuracy – What level of accuracy is needed? What is user tolerance for errors? Distribution channels – How will users of the directories access the information? Maintenance – What level of effort will be required to maintain the directories, who will pay for it, and who will manage and execute it? Funding – How much will be required to create such directories, and how will they be funded (up- front and ongoing)? Business terms and policies – What trust framework is required for information sharing between provider directories (how should governance operate, what qualifies an entity to be listed, do listing requirements need to be nationally uniform or, if not, ‘posted’ by each directory, what are violations and mechanism for de-listing, relisting, etc.)? What uses are permitted?

7 Provider Directories Timeline DateMeeting/ CommitteeDeliverables Sep 30Public Hearing Oct 20HITPC MeetingRecommendations: Key Principles and Outline of State Implementation Issues Nov 19HITPC MeetingRecommendations: Guidance to Support Provider Directory Implementation

8 Public Health Taskforce Membership Co-Chairs Co-Chair: Jim BuehlerCDC Co-Chair : David A. RossPublic Health Informatics Institute Current Membership Deven McGrawCenter for Democracy & Technology Jonah FrohlichCalifornia Health & Human Services Steven StackAMA George HripcsakColumbia University Seth FoldyDHS, Wisconsin (soon to be with CDC) Walter SuarezKaiser Permanente

9 What problem are we trying to solve? Enabling Stage 1 population and public health objectives –Wide variation in public health department capabilities to meet EP and hospital needs for Stage 1 MU: Immunization reporting Reportable conditions Syndromic surveillance –What policy actions might be taken to facilitate state public health agencies’ abilities to meet expected MU-driven demand for public health electronic capabilities?

10 Public Health Taskforce Focus Areas Meaningful Use Opportunities for rapid progress to enable MU reporting and data exchange requirements – public health departments, HIEs, providers –Electronic reporting to immunization registries –Notifiable disease reporting –Electronic syndromic surveillance Standards Harmonization/Adoption Key steps to harmonize standards and drive adoption (MU, CDC, NHIN Direct, state systems, PHIN) Are translation services one viable pathway? Public Health Capacity, Platform Universal migration path for public health so every state and local agency does not have to reinvent the wheel? Opportunities to increase uniformity in public health data platforms (health care providers have EHR certification, what can be done for public health)? How to promote economies in public health interoperability development across states/regions? Leveraging Provider Directories How to best leverage provider directories for public health communications and alerts? How leverage public health provider directories for HIE?

11 Public Health Task Force Timeline DateMeeting/ CommitteeDeliverables Oct 20HITPC MeetingIssues in public health capacity to support Stage 1 MU transactions Nov 19HITPC MeetingPerspectives on public health capacity landscape and discussion of Key Principles