S&I FRAMEWORK PROPOSED INITIATIVE SUMMARIES Dr. Douglas Fridsma Office of Interoperability and Standards December 10, 2010

Bottom Up Use Case Development Within a Top-down Coordination Framework Target Problems + Interoperability Framework = Focused Collaboration 2 CORE PRINCIPLES Prioritization Transparency Engagement Rapid Results Focused Collaboration A Thousand Flowers Bloom Command and Control Low High Participation Classic Trade-Off Low High Focus

Approach to S&I Framework NATIONAL GOALS: QUALITY, COST, ACCESS, PUBLIC HEALTH (HITECH, ACA, etc.) Robust Interoperability Across Settings of Care, Increased "Systemness" of Care Delivery “ultra-large scale systems” Robust Interoperability Across Settings of Care, Increased "Systemness" of Care Delivery “ultra-large scale systems” Tools and Services (Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc) (Stanley) Tools and Services (Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc) (Stanley) Use Case Development and Functional Requirements (Accenture) Use Case Development and Functional Requirements (Accenture) Certification and Testing (Stanley/Deloitte) Certification and Testing (Stanley/Deloitte) Harmonization of Core Concepts (Deloitte) Harmonization of Core Concepts (Deloitte) Implementation Specifications (Deloitte) Implementation Specifications (Deloitte) Reference Implementation (Lockheed Martin) Reference Implementation (Lockheed Martin) PRIORITY 1 PRIORITY 2PRIORITY 3 PRIORITY 4 Value and Outcome Focused Projects to Address Key Obstacles, Prioritized by Value, MU, Leverage 2 Months 3

Standards and Interoperability as a “Platform” for Interoperability Initiatives Initiatives Tools and Services (Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc) Use Case Development and Functional Requirements Certification and Testing Harmonization of Core Concepts Implementation Specifications Reference Implementation Initiative 1 Initiative 2 Initiative 3 Initiative…N Standards Support Pilot Demonstration Projects 4

Contract Team Initiative Steering Committee Another view… Use Case (Accenture) Use Case (Accenture) Harmonization (Deloitte) Harmonization (Deloitte) Implementation Specifications (Deloitte) Implementation Specifications (Deloitte) Reference Implementation (Lockheed Martin) Reference Implementation (Lockheed Martin) Certification/Testing (Stanley/Deloitte) Certification/Testing (Stanley/Deloitte) Strategic Steering Committees Pilot Demonstrations (Lockheed Martin) LAB PROVIDER DIRECTORY CLINICAL CARE SUMMARY (C32) Stakeholders PRIORITY 4 VALUE/OUPUTS 5

S&I Initiative Prioritization Framework (Short Term) Aligns priorities with other immediate initiatives of ONC’s S&I Framework InitiativeImmediate Need Meaningful Use Conform to US healthcare reform legislation Support existing standards Provide tools to bridge gap to achieve Stage 1 Measures Provide foundation to support Stage 2 and 3 Measures Nationwide Health Information Network Build upon existing NW-HIN framework Address critical interoperability needs of stakeholder initiatives such as VLER Proposed Short Term Priority Initiatives: Clinical SummaryQuality Measures Templated Clinical DocumentsPopulation Health Query Lab Interface ImprovementClinical Decision Support Medication Reconciliation ImprovementBlue Button Provider DirectoriesGreen Button Syndromic SurveillanceValue Set Development 6

S&I Initiative Prioritization Framework (Long Term - Criteria Category 1 of 4) Focuses on broader requirements, challenges, and long-term goals of the US Health Care system and its communities CategoriesCriteria Importance /Relevance Meaningful Use (Stages 2 and 3 requirements): Addresses "Improve care coordination“ Criteria Addresses "Engage patients and families in their health care“ Criteria Addresses "Improve population and public health" Criteria Addresses "Improving quality, safety, efficiency, and reducing health disparities" Criteria Addresses "Ensure adequate privacy and security protections for personal health information" Criteria Build upon the existing NHIN framework while addressing critical interoperability needs of stakeholder initiatives Health Care Delivery Model Support: Supports Accountable Care Organizations' infrastructure Supports Patient Centered Medical Homes Activities Supports Bundled Payments Model Stakeholders impacted by Initiative; Level of impact Potential to drive sustainability of S&I Framework 7

S&I Initiative Prioritization Framework (Long Term - Criteria Categories 2, 3 and 4 of 4) Focuses on broader requirements, challenges, and long-term goals of the US Health Care system and its communities CategoriesCriteria Feasibility Requires/Supports Information Exchange Leverage of Existing Interoperability Specification(s) Utilizes Standards Developed By Existing SDOs Supports Data Flow Which Can Be Tested Feasible Timeline Driving Initiative Requires ONC to Address Policy Issues Requires Policy/Regulatory/Legislative Issues To Be Addressed Contribution to Cost Savings within Health System Usability Aligns with Stakeholders' Readiness Level for Use Improves General Health IT Usability Has Outcome or Performance Measures Evidence- Based Medicine & Research Support Supports ONC SHARP Program Support of Evidence-Based Medicine practice Support for Comparative Effectiveness Research Supports Other High Priority Research 8

ONC perspective on near-term priorities »Continuation of HITSP work The S&I framework is intended to support the continued maintenance and support of HITSP standards, particularly those that have been adopted to support Stage 1 meaningful use –Clinical Care Summary (C32, CCR) »Responding to key HITPC recommendation and needs of the grantee communities States and RECs are moving quickly to resolve provider identity assurance through certificates. There is a need to establish certificate interoperability to reduce future complexity. Need has also been identified as part of the Direct project. –Certificate Interoperability –Certificate Discovery (ie, provider directories) »Laboratory information Support for low-cost provider to lab interfaces »Need to pilot the S&I framework as we work out remaining priorities and coordination processes Need to pick a limited set of activities to test and develop our coordination processes through real world experience 9

Comments on S&I Initiatives posted on FACA Blog »7 comments so far, anticipate many more »Topics include Suggestions for potential new initiatives Feedback on currently proposed initiatives Options to improve the Prioritization Framework Other comments: timing and interdependencies of initiatives, opportunities for broad public input, etc »Commenting period is open until December 23,