1. HIT Standards Committee NwHIN Power Team Dixie Baker, Chair July 20, 2011 1

2. Dixie Baker (SAIC) Tim Cromwell (VA) John Feikema (Ability) Ollie Gray (DOD) Kevin Hutchinson (Prematics) David McCallie (Cerner) Nancy Orvis (DOD) Wes Rishel (Gartner) Cris Ross (SureScripts) Ken Tarkoff (Relay Health) NwHIN Power Team 2

3. Using the NwHIN Exchange and Direct Project as primary inputs, recommend a modular set of transport, security, and content components (“building blocks”) that can be selectively combined and integrated to enable the trusted exchange of documents in support of the meaningful use of electronic health record (EHR) technology In defining these components, emphasis should be on: –Simplicity –Ease of implementation –Cross-modularity among components Present recommendations at September 2011 HITSC Meeting Review of NwHIN Power Team Charge 3

4. Avinash Shanbhag briefed team on ONC efforts to evaluate the specifications (and underlying standards) used by NwHIN Exchange and the Direct Project to determine which are suitable for consideration as candidate NwHIN “building blocks” –Draft Evaluation Process Inputs from user community (e.g., NwHIN Exchange Coordinating Committee) Inputs from NIST Inputs from Power Team –Draft Evaluation Criteria Specification Maturity Implementability Level of Market Adoption Priority –Subjective evaluation of NwHIN Exchange specifications Power Team provided feedback Activity Since June HITSC Meeting 4

5. EXAMPLE Evaluation of NwHIN Exchange Specifications SpecificationSpec Maturity Industry Adoption Implementable / Priority Description RetrieveHigh Federal Agency priorityDefines service which allows an initiating Node to retrieve one or more documents for a specific patient from a responding Node Access Consent PolicyLow SSA priorityProvides a standard language for expressing restrictions on access to health information. Document submissionModerateLowCMS priorityUnlike Query/Retrieve and Pub/Sub, does not require a prior request to retrieve a document or to subscribe to content and is categorized as a “push” transaction. Health Information Event Management (HIEM) ModerateLowCDC priorityDefines an information exchange service which allows node to request to subscribe or unsubscribe to various classes of content and events, and to notify nodes when content or events matching a subscription have been created or modified. 5

6. EXAMPLE Mapping Specification Grid to Levels 6 Maturity Adoption Authorization Framework Retrieve Direct Transport Direct Security Authorization Framework Retrieve Direct Transport Direct Security Access Consent Policy esMD Access Consent Policy esMD LowModHigh Low Mod High Messaging Query Messaging Query Patient Discovery Web service registry HIEM Document Submission Administrative Distribution Web service registry HIEM Document Submission Administrative Distribution

7. Agreement that process and approach proposed by the ONC are good for the purpose intended Suggested modifications to evaluation criteria: –Add whether an alternative standard exists –Add need –Add technology maturity within the life cycle –Replace “Industry Adoption” with “Market Adoption” – considering broad market, not just health care ONC will make these criteria adjustments and update the grid Ken Tarkoff to lead small group that will identify mechanisms other than Exchange and Direct that are being widely used for healthcare exchange – such as those used for ePrescribing, administrative transactions, and lab reporting Power Team Feedback 7

8. Next meeting scheduled for July 26 Agenda –Ken Tarkoff team to report back on other widely used exchange mechanisms –Avinash Shanbhag to present evaluation updated evaluation grid Next Steps 8