1. Impact of Federal Health IT Priorities on FHA Strategic Plan
Gretchen Wyatt, ONC
Dr. Lauren Thompson, Director, FHA

2. Agenda Federal Health IT Priorities
Impact of Federal Health IT Priorities on FHA’s Strategic Plan

3. Gretchen Wyatt Office of the National Coordinator for Health IT FEDERAL HEALTH IT PRIORITIES

4. FHA Strategic Plan – Vision
A Federal health information technology environment that is interoperable with the private sector and supports the President’s health information technology plan enabling better care, increased efficiency, and improved population health

5. Federal Health Architecture: Advancing National Health IT
FHA Guiding Principles
Stakeholder Engagement
Demonstrate through Pilots
Open Communication and Transparency
Commitment to Action
Focus on Specifications
FHA Moving Forward: 2014
STRATEGIC GOALS
Establish a unified federal voice on health data exchange and interoperability
Establish FHA as a “convener of stature”, and broaden participation
Institutionalize governance decision-making processes
Expand outreach and access to tools
Achieve adoption of interoperability specifications, leading to active data exchange in the Federal health community
Support S&I Framework by providing federal use cases and pilots
Enable FHA partners to move from legacy to new solutions in effective, coordinated manner
Align federal policies in healthcare data exchange
Provide a forum of cataloging and aligning federal policies and practices

6. Impact of Federal Health IT Priorities
FHA Strategic Plan grows and evolves to support federal health IT priorities
FHA federal partners contribute to development of priorities, ensure addition of federal requirements
FHA encourages federal agencies to adopt priorities to their unique health IT requirements

7. Current FHA Health IT Priorities
Healthcare Directory
Patient Consent & Authorization
Directed Exchange
CONNECT
Federal Health Information Model (FHIM)
Integrating with the Standards and Interoperability Framework
Patient Identification
This is an ONC priority that FHA supports.

8. CONNECT Open Source Community Development
CONNECT is moving to the open source community for management
FHA will remain engaged to ensure developments include federal requirements
Join the CONNECT Open Community Collaboration today:

9. Engagement in the Standards & Interoperability (S&I) Framework
FHIM
S&I
Requirements
Scope
Modeling
Data Collection
Publish
Discovery
Pre-Discovery
Pilot
Implementation
Evaluation
Support for Federal partner priorities such as Meaningful Use
Direct support of Federal partner use cases
FHIM provides semantic and syntactic modeling constructs to support the definition of information
FHIM, combined with MDHT*, can be used to generate implementation standards using an MDA* approach
*MDHT - Model Driven Health Tools
*MDA - Model Driven Architecture

10. Core workgroups that support federal health IT priorities:
FHA Workgroups
Core workgroups that support federal health IT priorities:
Architecture & Modeling
Data Exchange & Interoperability
Communications & Coordination
Directed Exchange

11. Stay connected, communicate and collaborate
Find out more about FHA on the ONC website:
Contact us at:
Subscribe, watch, and share:
@ONC_FHA,
@CONNECT_Project

12. Applying RESTful Health Exchange, FHIR, and Direct ONC Annual Meeting Ollie Gray (TATRC) January 2014

13. Outline RESTful Health Exchange RESTful Health Exchange Addresses Gaps
Research, Development, Testing and Evaluation (RDT&E) with REST and Direct
RDT&E Outcomes
Summary

14. RESTful Health Exchange
Open source project to apply Web technologies to demonstrate a simple, secure, standards-based health information exchange
Builds the foundation for patient access to data via the Web and mobile devices, facilitating broad electronic health data exchange
Offers a new approach to health data exchange:
Replaces moving documents to linking to needed information
Sponsored by the Federal Health Architecture (FHA) program in FY12, TATRC in FY13 and FY14, VHA in FY14
Addresses NwHIN Power Team recommendation to develop a specification for RESTful exchange of health data
Applies RESTful health data exchange to key capability gaps
VHA=Veterans Health Administration
NwHIN=Nationwide Health Information Network
REST technology enables secure, Web-based health data exchange

15. RESTful Health Exchange Addresses Gaps
SMTP (Direct) does not scale to allow sharing of very large files, such as diagnostic images
Lightweight exchange is needed to allow health information sharing with out-of-network providers
Standing up CONNECT can be a challenge for small, independent providers and providers in rural areas
CONNECT capabilities not needed for stateless transactions

16. Research, Development, Testing and Evaluation (RDT&E) with REST and Direct
Improved Coordination of Care ~ Timely Remote Record Access ~ Low barrier of entry

17. REST with Direct for Sharing Diagnostic Images
Demonstrated in a RDT&E environment that MHS and third-party providers can access diagnostic images and associated records securely over the Web
MHS = Military Health System
PCM = Primary Care Manager
Improved Coordination of Care ~ Timely Remote Record Access

18. RDT&E Outcomes RDT&E initiatives successfully demonstrated that:
Physicians can securely share health data over the Web
Diagnostic images can be shared using REST with Direct
High volumes of data can be moved over the Web securely in support of HIE patient data integration
RESTful capability is being implemented across Maine to support small, independent providers and FQHCs in medically underserved areas
New Pilot with TATRC in FY14
REST and FHIR technology being explored as possible solutions for government HIE exchanges
New pilot with VHA Office of Rural Health (ORH)
REST, FHIR, and Direct technology will support secure sharing of information between VHA and third-party providers in support of home healthcare for Veterans in rural Utah
FQHC = Federally Qualified Health Center
iEHR = integrated Electronic Health Record

19. Summary
RDT&E initiatives with REST and Direct have addressed gaps in capability
Out-of-network providers can share information securely over the Web using REST
Direct + REST can be used to share diagnostic images in a scalable fashion
REST can be used to allow small, independent providers and providers in rural areas to exchange health information
RDT&E initiatives contributed to the goals of:
Improved care coordination
Equal healthcare for all
Timely remote record access
Low barrier-of-entry for small practices
Applicability of FHIR is being explored
Goals map to :

20. Federal PKI Cross-Certifictation Overview
24 January 2014 Deb Gallagher, GSA FPKIPA Chair ONC Annual Meeting Federal Priorities for Health IT Training Session

21. Work Groups and Tiger Teams
Agenda
FPKI Overview
FPKI Cross-Certification Process
Cross-Certified Affiliates
PIV-I Providers
EGCA Overview and Purpose
Work Groups and Tiger Teams

22. Criticality of PKI
Consumer Online
Shopping and Banking
CAC Card Access to
Systems and Facilities
Trusted B2B, G2B, C2B, C2G Communications
PIV Card Access to
Trusted Network
Devices and VPN
Signed Code for Trusted Execution
Public Key Infrastructure
Government Trusted by Commercial Organizations
Commercial Organizations Trusted by Government
Policies and Governance
Trusted Issuers
Trusted Algorithms
Revocation and Validation
PKI Enables
PKI Trust
Components
PKI provides identity authentication, integrity, confidentiality
Formal controls for certificate issuance and management enable trust in these services

23. FPKI Purpose The FPKI facilitates federated identity
Throughout the Federal Government; and
Between the Federal Government and external partners
Includes the FPKI Trust Infrastructure
Federal Bridge Certificate Authority (FBCA)
Cross-certification assures comparability of certificate issuance policies
Incorporates multiple assurance levels
Federal Common Policy CA (FCPCA)
Trust Anchor for the U.S. Federal Government
E-Governance CAs (EGCA)
Supports various ICAM Programs
The FPKI Policy Authority (FPKIPA) governs policies for operation of the FBCA, FCPCA, and EGCA
Operates under the authority of the Federal CIO Council

24. Cross-Certification Process Overview

25. Currently Cross-Certified Affiliates
Federal Agencies
Department of Defense (DoD);
Department of State (DoS);
Drug Enforcement Administration (DEA CSOS);
Government Printing Office (GPO);
Department of Treasury;
United States Postal Service (USPS); and
United States Patent and Trademark Office (USPTO)
Two PKI Bridges
CertiPath:* Aerospace and Defense
Eid Passport*
Cassidian*
Carillion*
Non-Federal PKIs
State of Illinois
Entrust*
Verizon Business*
Symantec*
ACES – ORC & Identrust
DoD ECAs
DigiCert*
ORC*
Identrust
Exostar
SAFE-BioPharma: Pharmaceutical and healthcare industries
= PIV-I Provider

26. EGCA – Supports ICAM The EGCA supports the ICAM mission by:
Enabling governance – control which endpoints participate and can be trusted for technical interoperability or information sharing.
Conveying trust between endpoints in a transaction – allow endpoints to determine trust at run time.
Facilitating secure communications between endpoints in a transaction – once endpoints have established trust, the ensuing communication between endpoints is secure.
The EGCA supports ICAM Assertion-based Initiatives
Issues certificates to devices and applications.
Issues different types of certificates to different types of endpoints.
Enables trusted access to government services for more participants and communities of interest (e.g., commercial and financial communities).

27. Questions?
Q&A ???
Deb Gallagher General Services Administration Office of Governmentwide Policy Director, Identity Assurance and Trusted Access Division (desk) (mobile)