1. 1 State Alliance for e-Health National Credentialing Forum 2008 February 7 & 8, 2008 Betsy Ranslow Senior Policy Analyst Office of Policy and Research Office of the National Coordinator for Health Information Technology

2. 2 Office of the National Coordinator (ONC) Overview Executive Order, April 2004: The President created the position of National Coordinator To advance the vision of developing a nationwide interoperable health information technology infrastructure To achieve the President’s goal of widespread adoption of interoperable electronic health records (EHR) by 2014

3. 3 Established: By the National Governors Association Center for Best Practices under contract with US Department of Health and Human Services Charge: Identify, assess, and, through consensus solutions, map ways to resolve state health IT issues that affect multiple states and pose challenges to interoperable electronic health information exchange State Alliance for e-Health

4. 4 Co-chairs Gov. Phil Bredesen (TN)Gov. Jim Douglas (VT) 9 Voting Members8 Advisory Members 3 State Legislators3 State Government Health Policy/Planning Office reps. 2 Former Governors4 Private Sector Health Care reps. 2 State Insurance Commissioners 1 Health Policy Academician 2 State Attorneys General

5. 5 State Alliance for e-Health Structure State Alliance for e-Health Health Information Protection Taskforce Health Care Practice Taskforce Health Information Communication and Data Exchange Taskforce Advisory Committee (non-voting members) Input

6. 6 Health Care Practice (HCP) Taskforce Charge: Develop recommendations on issues regarding the regulatory, legal, and professional standards that have an impact on the practice of medicine and create barriers to the interoperable exchange of electronic health information.

7. 7 HCP Taskforce Recommendations Recommendations Adopted by the State Alliance The State Alliance for e-Health should recommend:

8. 8 HCP Taskforce Recommendations 1.1: That state medical, nursing, and pharmacy boards work to implement online licensure applications. (adopted 8/15/2007) 1.2: That all state nursing and pharmacy boards develop common core licensure application forms, and state medical boards adopt the FSMB’s Common Licensure Application Form (CLAF). Individual states may include state specific requirements. (adopted 8/15/2007)

9. 9 HCP Taskforce Recommendations 1.3: That each health care professional board (e.g., nursing, medicine, pharmacy) develop, with its counterparts in other states, a nationwide core set of credentialing requirements that their respective health professionals would have to meet in order to obtain a license. Individual states may include state specific requirements in addition to the core requirements. (adopted 10/3/2007)

10. 10 HCP Taskforce Recommendations 1.4: In order to reduce and/or eliminate the need for repeated primary source verification, states should require their medical, pharmacy, and nursing regulatory boards utilize a single centrally coordinated credentials verification organization (CVO) for each profession to conduct the primary source one-time only verification of license applicants’ static credentials (e.g. professional school graduation) and update and maintain the verification of dynamic credentials (e.g. licensure status).

11. 11 HCP Taskforce Recommendations These centrally coordinated CVOs should collect and verify a core set of credentials established by each profession (see recommendation 1.3). They should have a means of identifying practitioners with a high degree of confidence such as requiring the use of the national provider identification number or using such functionality as a master provider index algorithm. (adopted 10/3/2007)

12. 12 HCP Taskforce Recommendations The Federation’s Credentials Verification Service (FCVS) and its trusted agent platform, operated by the Federation of State Medical Boards (FSMB), is an example of a service that could assume this role for the boards of medicine. The pharmacy and nursing boards should work with their professional organizations, certification organizations, or other similar organizations with a mission to facilitate public protection to develop and implement centrally coordinated CVOs for their professions. (adopted 10/3/2007)

13. 13 HCP Taskforce Recommendations 1.5: That all state boards require that applicants for initial professional state licensure must undergo state and federal criminal background checks prior to obtaining a license. These background checks may be conducted periodically thereafter. (adopted 10/3/2007)

14. 14 HCP Taskforce Recommendations 1.6: That all Health Care Practice Taskforce recommendations, as applicable, be used as a model for other licensed healthcare professionals, (e.g. physical therapists) contingent upon verification that there are no unique requirements applicable to those professions. (adopted 10/3/2007)

15. 15 HCP Taskforce Recommendations Recommendations that will be presented to the State Alliance on February 22, 2008 Regarding physician licensure: That to facilitate e-health (which includes telemedicine), states and territories must move towards requiring at least one state/territory license that is recognized by other states/ territories in order to enable a physician to practice across state/territory lines. (to be presented)

16. 16 HCP Taskforce Recommendations States and territories must create a licensure system that, in a uniform manner, permits open doctor to doctor consultation and doctor to patient interaction across jurisdictional boundaries. (to be presented) State/territory boards must be empowered, through the statutory authority, to discipline physicians practicing in their respective states/territories, regardless of the state/ territory of licensure. (to be presented)

17. 17 HCP Taskforce Recommendations This model should be based upon agreements and information sharing among the states/territories to facilitate a licensure process that enables coordinated action among the states/territories and should not be considered national licensure. (to be presented) This model should be used for the purposes of promoting e-health (which includes telemedicine), but may serve as a model for other forms of medical practice. (to be presented)

18. 18 HCP Taskforce Recommendations It is therefore a recommendation by the Taskforce that a convention of all the state/territorial medical boards should be held under the auspices of the National Governors Association to establish consensus on methods for achieving the recommendations outlined above. The meeting should have the support of all the state and territorial governors. (to be presented)

19. 19 HCP Taskforce Recommendations A physician licensed in a different state/territory from where he/she is seeking to practice must notify that state’s/territory’s medical board using a common electronic notification form. A direct output of this convention should be the creation of a common electronic form to be used by physicians who are licensed in one state/territory but are intending to practice in another. (to be presented) Considerations for the implementation of this recommendation are:

20. 20 HCP Taskforce Recommendations A physician practicing e-health (which includes telemedicine), must be subject to the jurisdiction of both the state/territory in which the patient is located at the time of the physician-patient interaction and the state/territory of licensure. (to be presented) State/territorial medical boards must cooperate with each other and actively enforce, in a uniform manner, applicable disciplinary rules and legal standards. (to be presented).

21. 21 HCP Taskforce Recommendations States/territories should provide financial support to the medical boards that ensures funding at levels required for continued and future operations necessary for public protection, including disciplinary investigations and actions, criminal background checks, development of secure infrastructure for credentials verification and interagency communication. (to be presented)

22. 22 HCP Taskforce Recommendations Regarding RN/LPN licensure: States/territories should participate, through the respective authorities (e.g. governors, state legislatures, and nursing boards), in the Nurse Licensure Compact (NLC), taking into consideration the importance of the NLC for e- health purposes (which includes telehealth). (to be presented) States/territories should provide financial support to the nursing boards for the initial implementation of the NLC and ensure that the boards are funded at levels required for continued and future operations necessary for public protection. (to be presented)

23. 23 HCP Taskforce Recommendations Regarding Advanced Practice Nurses: States/territories should pursue standardization of credentials, scope of practice, and regulatory framework for advanced practice nursing. (to be presented) States/territories that agree to the common standards should consider the mutual recognition model for advanced practice nurses to facilitate e-Health (which includes telehealth) while maintaining public protection. (to be presented)

24. 24 HCP Taskforce Recommendations Regarding pharmacist licensure: That to facilitate e-health (which includes telepharmacy), states/territories must move towards requiring at least one state/territory license that is recognized by other states/territories in order to enable a pharmacist to practice across state/territory lines. (to be presented) We must create a licensure system that, in a uniform manner, permits open pharmacist consultation and pharmacist to patient medication counseling across jurisdictional boundaries. (to be presented)

25. 25 HCP Taskforce Recommendations State/territorial boards must be empowered, through the statutory authority, to discipline pharmacists practicing in their respective states/territories, regardless of the state/territory of licensure. (to be presented) This model should be based upon agreements and information sharing among the states/territories to facilitate a licensure process that enables coordinated action among the states/territories and should not be considered national licensure. (to be presented)

26. 26 HCP Taskforce Recommendations This model shall be used for the purposes of promoting e-health (which includes telepharmacy), but may serve as a model for other forms of pharmacy practice. (to be presented) It is therefore a recommendation of the taskforce that the National Governors Association request that the National Association of Boards of Pharmacy (NABP) gain consensus on methods for achieving the recommendations outlined above. (to be presented)

27. 27 HCP Taskforce Recommendations A pharmacist licensed in a different state/territory from where he/she is seeking to practice must notify that state’s/territory’s pharmacy board using a common electronic notification form. A direct output of this consensus should be the creation of a common electronic form to be used by pharmacist who are licensed in one state/territory but are intending to practice in another. (to be presented) Considerations for the implementation of this recommendation are:

28. 28 HCP Taskforce Recommendations A pharmacist practicing e-health (which includes telepharmacy), must be subject to the jurisdiction of both the state/territory in which the patient is located at the time of the pharmacist to patient interaction and the state/territory of licensure. (to be presented) State/territory pharmacy boards must cooperate with each other and actively enforce, in a uniform manner, applicable disciplinary rules and legal standards. (to be presented)

29. 29 HCP Taskforce Recommendations States/territories should provide necessary funding resources to support the pharmacy boards in carrying out operations necessary for public protection, including disciplinary investigations and actions, criminal background checks, development of secure infrastructure for credentials verification and interagency communication. (to be presented)

30. State Alliance for e-Health Next Steps Recommendations will be presented to the State Alliance at its February 22, 2008 meeting. A State Leadership Guide will be developed and will include all the recommendations of the 3 Taskforces through the February 22, 2008 State Alliance meeting.

31. 31 Contact Information State Alliance for e-Health Web Site: http://www.nga.org/center/ehealth To subscribe to the State Alliance listserv send a blank e-mail to: subscribe-state-alliance@talk.nga.org ONC www.hhs.gov/healthit Betsy Ranslow (202) 205-4387 Betsy.Ranslow@hhs.gov