1. Health IT Standards Committee A Public Advisory Body on Health Information Technology to the National Coordinator for Health IT 2017 Interoperability Standards Advisory Task Force Kim Nolen, co-chair Richard Elmore, co-chair June 02, 2016

2. Agenda Health IT Standards Committee Work Product Welcome and Opening Remarks Recap Previous Discussions “Best Available” Discussion Review Workplan and Discuss Next Steps 2

3. Membership MemberOrganizationRole Kim NolenPfizer, Inc.Co-Chair Richard ElmoreAllscriptsCo-Chair Mark RocheAvanti iHealthMember David McCallie, Jr.Cerner CorporationMember Dan VreemanRegenstrief InstituteMember Christina CaraballoGet Real HealthMember Michael IbaraMichael Ibara, LLCMember Russ LeftwichInterSystemsMember Dale NordenbergNovasano Health and ScienceMember Michael BuckNew York City Department of Health and Mental Hygiene Member Eric HeflinThe Sequoia Project/HIETexasMember Tone SoutherlandReady ComputingMember Susan MatneyIntermountain HealthcareMember Robert IrwinRobert Wood Johnson University HospitalMember Clem McDonaldNational Library of MedicineFederal Ex Officio Health IT Standards Committee Work Product 3

4. Membership MemberOrganizationRole Kin Wah FungNational Library of MedicineFederal Ex Officio Christopher HillsDoD/VA Interagency Program OfficeFederal Ex Officio Brett AndriesenOffice of the National Coordinator-Health and Human Services ONC Lead Chris Muir Stacey Perchem Nona Hall Office of the National Coordinator-Health and Human Services ONC Project Team / Analysts Health IT Standards Committee Work Product 4

5. Task Force Charge 5 Over the course of two phases, the 2017 ISA Taskforce is charged to develop recommendations for the HITSC on the following: Phase 1 (Now ->July) Updates to the ISA based on an analysis of public comments; Structural and framing improvements to the ISA, including elements that could provide additional clarity and context for stakeholders that would use and consult the ISA; Limited set of new “interoperability needs” that should be included in the ISA along with attributed standards and implementation specifications; The explicit “best available” designation to a standard or implementation specification, where appropriate (and in consideration of available implementation experience). Phase 2 (July ->Nov 1) Discussion and recommendations around the TF’s priority list for inclusion in the 2017 ISA’s “Projected Additions” section.

6. General ISA Discussion - Proposed Recommendations Health IT Standards Committee Work Product ISA TF agrees that patient matching is a critical factor in achieving interoperability, but patient matching is not achieved by a specific standard today and should be discussed from a policy perspective. 6

7. ISA Scope – Proposed Recommendations Health IT Standards Committee Work Product ISA document should focus on data, standards and interoperability needs for Certified Health IT and will, when appropriate, include an appendix which references authoritative sources for other standards in healthcare including security, administrative, research/clinical trial etc. Secondary data used for ISA purposes will be defined as the reuse of the same data that is collected for clinical care. ISA should include standards for interoperability which connect technologies outside the EHR creating a path where data can be put in once (primary use) but used many time (secondary use). 7

8. ISA Structure – Proposed Recommendations Health IT Standards Committee Work Product The ISA document should continue to evolve creating a more dynamic document which links to websites like the Interoperability Proving Ground demonstrating interoperability use cases along with linking to known profiling entities which coordinate standards listed in ISA to address specific clinical needs and use cases. Interoperability Proving Ground ISA TF recommends adding a category under Standards Process Maturity of 'ballot in development’, but not include speculative standards in discussion. 8

9. ISA “Characteristics” – Proposed Recommendations Health IT Standards Committee Work Product The Adoption Level bubbles need to be more incrementally defined so the reader can quantify how much adoption difference has occurred between each bubble representation (ie one bubble is ≤ 10; 2 bubbles is 10 - 20 implementations, etc). One consideration could be to have a descriptive field of what is known about Adoption Level. The ISA TF recommends linking the maturity assessments to known published criteria about the standards either from the SDO itself to other known evaluation entities (like IHE) From public comments: Include in the descriptive text of each standard the year the standard was released and the depth of changes that occurred between this version and the last version similar to a citation (eg. CDISC ODM v.1.3.2; released: 2013-12-01 (minor update); (previous version 1.3.1; released 2010-02-11); standard inception year: 1997) 9

10. New Interoperability Needs – Proposed Recommendations Health IT Standards Committee Work Product Recommendation for ISA to include a section on how to approach an API based standards, as they are needed for interoperability but not sufficient alone, to help the industry understand constraints with optionality's, profiling, laying out a blueprint to be successful in API use in interoperability. »Potential sub-group to address/refine Work on gaps in coded values; value pairs: spirometry; ekg; Healthcare provider, Race & Ethnicity; Family Health History; functional status disability; gender identity, sex, & sexual orientation; lab test; tobacco use ; provider directories »Potential sub-group to address/refine 10

11. Health IT Standards Committee Work Product Public Comments - “Best Available” Concept 11 Add a definition of what an emerging standard is to distinguish between the terms final, balloted draft, production and pilot. Need to better distinguish between pilots and emerging standards. Important to clarify “the best standard for what?” This issue remains a challenge with this version of the Advisory. The new organization and section titles are a step in the right direction, but it remains a challenge to understand the specific use cases for standards listed. Each “interoperability need” should be better described to prevent unintended consequence of developers investing in the wrong solutions or hampering innovation by focusing on the wrong problems. Make more explicit that developers should consider the ISA and its standards to be a starting point, while assessing the level of maturity and whether the needs of their clients dictate that they adopt early in the lifecycle and help mature the standard, or wait until standards have matured and/or are included in regulatory programs.

12. Workplan Meeting DatesTask Apr 15, 2016 11:00amISA Task Force Kickoff Meeting May 6, 2016 2:00pmReview Purpose and Assign Task Force Workgroups May 23, 2016 2:00pmISA Framing & Structural Improvements  Jun 2, 2016 2:00pmBest Available Standards Jun 14, 2016 2:00pmDiscuss Section II Comments Jun 20, 2016 2:00pmDiscuss Section II & Section III Comments Jun 23, 2016 9:30am - Joint Committee Present Draft Recommendations Jun 28, 2016 2:00pmDiscuss Section I Comments Jul 26, 2016 2:00pmRefine Recommendations Jul 27, 2016 9:30am - Joint CommitteePresent Findings / Recommendations to HITSC Health IT Standards Committee Work Product 12

13. Next Meeting Tuesday, June 14 2:00pm-3:30pm ET Health IT Standards Committee Work Product 13

14. Health IT Standards Committee A Public Advisory Body on Health Information Technology to the National Coordinator for Health IT