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Interoperability Workgroup Governance Subgroup July 23, 2014 Christoph Lehmann, co-chair Carol Robinson, co-chair.

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Presentation on theme: "Interoperability Workgroup Governance Subgroup July 23, 2014 Christoph Lehmann, co-chair Carol Robinson, co-chair."— Presentation transcript:

1 Interoperability Workgroup Governance Subgroup July 23, 2014 Christoph Lehmann, co-chair Carol Robinson, co-chair

2 Agenda Overview of Subgroup activities ONC Governance Overview Next Steps 2

3 Membership MemberOrganization Christoph Lehmann, co-chairVanderbilt School of Medicine Carol Robinson, co-chairRobinson & Associates Consulting Jitin AsnaaniAthenahealth John BlairTaconic IPA Anne CastroBlueCross BlueShield of South Carolina Tony GilmanTexas Health Services Authority Melissa GoldsteinGeorge Washington University Anil JainExplorys, Inc. Beth MorrowThe Children’s Partnership Tim Pletcher Michigan Health Information Network Shared Services (MiHIN) David SharpMaryland Health Care Commission Deanna WiseDignity Health Mariann YeagerHealtheway, Inc. FHARepresentative TBD 3

4 Subgroup Charge Identify the substance, scope, and process ONC should use to implement an approach to establish the “rules of the road” necessary for information to flow efficiently across networks This approach should address the key problems that slow trust and exchange across diverse entities and networks that provide exchange services including: – misaligned/inconsistent security policies and practices – privacy policies and practices and operational/business – inconsistent policies and technical agendas of governance bodies at the local, state and regional levels 4

5 Meeting Schedule MeetingsTask Wednesday, July 23 rd 2:00-4:00 pm ET Review charge Governance history Action steps Friday, August 15 th 10:00am-12:00 pm ET Listening session? Friday, August 22 nd 10:00am-12:00 pm ET Listening session? Wednesday, September 3 rd Draft framework recommendations to HITPC Friday, September 12 th 10:30-12:30 pm ET Friday, September 19 th 10:30-12:30 pm ET Friday, September 26 th 10:30-12:30 pm ET Friday, October 3 rd 10:30-12:30 pm ET Report to Interoperability WG Wednesday, October 15 th – Joint HITPC/HITSC meeting Final recommendations 5

6 Governance and ONC Jodi G. Daniel, JD, MPH Director, Office of Policy Office of the National Coordinator for Health IT (ONC)

7 Post HITECH Governance Activities 7

8 Background HIE Governance HITECH Act - Required ONC to establish a “governance mechanism for the nationwide health information network.” 8

9 Background HIE Governance Public Input – Health IT Policy Committee Recommendations – December 2010 – RFI - Nationwide Health Information Network: Conditions for Trusted Exchange - May 2012 Response – ONC announced decision not to continue with formal rulemaking process - September 2012 9

10 ONC’s HIE Governance Definition The establishment and oversight of a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants. 10

11 HIE Governance Focus Health information exchange at a national level, to address challenges to exchange between different exchange organizations and across state boundaries. 11

12 ONC Governance Activities Cooperative Agreements Framework of Principles HIE Governance Forum Monitor Exchange Progress 12

13 Exemplar HIE Governance Program RecipientAward DirectTrust.org, Inc.$280,205 New York eHealth Collaborative, Inc.$200,000 13 In late March 2013 ONC awarded two cooperative agreements to existing HIE governance entities to: – develop and adopt policies, interoperability requirements and business practices that align with national priorities – overcome interoperability challenges – reduce implementation costs, and – assure the privacy and security of health information

14 Governance Framework for Trusted Electronic Health Information Exchange Principles 14 OrganizationalTrustBusinessTechnical

15 National HIE Governance Forum Created under National eHealth Collaborative cooperative agreement with ONC Forum for HIE governing entities convened in 2013 to identify their common challenges and potential common solutions 15

16 National HIE Governance Forum Used the Governance Framework as a guide in prioritizing their areas of focus. Developed resources to advance trust in health information exchange for consideration by the wider community of exchange entities: – Identity and Access Management: Level of Assurance (LOA) Continuum: This educational resource helps organizations examine identity management and progress along the LOA continuum to support secure exchange with a wider group of entities while reducing risk. Identity and Access Management: Level of Assurance (LOA) Continuum – Trust Framework for Health Information Exchange: This whitepaper proposes a framework for exposing trust requirements between many stakeholders. Trust Framework for Health Information Exchange – HIE Certification and Accreditation Landscape: This presentation provides the results of a preliminary assessment of HIE certification and accreditation activities. HIE Certification and Accreditation Landscape 16

17 Moving Forward 17

18 10 Year Interoperability Vision Leverage health IT to increase health care quality, lower health care costs and increase population health Focus on supporting health broadly, including but not limited to health care delivery Build incrementally over time from current technology – multiple methods of exchange required Focus on establishing best minimum possible for all; this creates room for innovation Maintain focus on and empower individuals 18

19 10 Year Interoperability Vision 19

20 10 Year Interoperability Vision Increasingly diverse market of electronic exchange and network service providers Service providers have enabled exchange through local governance, data use agreements, and other contractual arrangements Scaling exchange is imperative and requires adherence to a minimum set of common privacy, security and business practices ONC considering a more active role in aligning efforts and initiatives across the nation in order to support our interoperability goals 20

21 Moving Forward Governance has a key role to play in enabling our national interoperability goals ONC is looking to re-visit our governance strategy and set a new direction to promote interoperability We have identified key governance problems impacting interoperability and HIE 21

22 Key Governance Problems Impending Interoperability and Information Sharing 1)Misaligned/inconsistent security policies and practices 1a) Encryption is not applied consistently to data at rest (data at the data source) 1b) Encryption is not applied consistently to data in motion (during data transmission) 1c) Data intermediaries do not use the same ID proofing practices/level of assurance (LOA) for data users – this relates to both individuals and care providers 1d) Data intermediaries do not use a shared set/minimum standard of authentication practices for users when they access electronic data (single factor v. 2 factor v. multifactor) 1e) Data intermediaries do not use a shared/common/minimum approach to authorization – 1f) Variation in the risk tolerance of data trading partners 2)Misaligned/inconsistent privacy policies and practices 2a) Inconsistent consent laws for sharing PHI 22

23 Key Governance Problems Impending Interoperability and Information Sharing 3) Misaligned/inconsistent operational/business practices 3a) Variation in fees that intermediaries charge each other to exchange/move information 3b) Variation in fees that intermediaries charge end users to exchange/move information 3c) The exchange ecosystem is complex and continually evolving making it difficult to identify questionable business practices or operational impediments that are inhibiting or slowing health information exchange. 3d) Varying policies on permitted data uses (i.e. treatment only vs. treatment and research etc) create a significant roadblock to exchange between HIEs. 4) There has been a proliferation of incompatible governance bodies at local, state and regional levels (setting policy and technical agendas that are inconsistent) 4a) The mechanisms to hold data intermediaries accountable under different governance structures varies 4b) Some players in the marketplace have been reluctant to commit to a specific governance approach or new technical standards because of uncertainty about the marketplace’s direction and ONC’s future intention. 23

24 Key Governance Problems Impending Interoperability and Information Sharing 5) Lack of clarity on liability when information moves from one system to another Notes: in which cases and under what circumstances is the data discloser/releaser liable? At what point does liability move from sender to receiver? 24 6) There is a lack of ability to deem, monitor, and govern existing standards in an ongoing way to enable an evolution and progression of a standards portfolio. How to know when standards are ready and should be included, and when to retire them, etc – what’s our role in this?

25 Key Governance Problems Impending Interoperability and Information Sharing 7) Direct Specific Problems 7a) HISPs need to exchange trust anchors in a one-off manner or participate in a common trust bundle for their participants to be able to exchange with one another. Multiple trust bundles exist today tied to differing trust/security policies. Notes: A common technical standard has been established and is widely adopted to enable the exchange of trust anchors among HISPs in addition the concept of trust bundles has been widely adopted by the HISP community. 7b) As Direct has developed in the marketplace it has become clear that a common way for individuals to discover providers’ addresses across HISPs is necessary to support providers achievement of the Meaningful Use Transition of Care requirements. HISPs generally have internal provider directories of their customers but no common approach for sharing this information and keeping it updated between HISPs has been established. 7c) DirectTrust accreditation is not uniformly approached, cost of accreditation and the potential for smaller players who could not afford to undergo the accreditation process to effectively be locked out of participating in the trusted Direct community. 25

26 Key Governance Problems Impending Interoperability and Information Sharing 8) Query Specific Problems 8a) Patients should have meaningful choice as to whether or not they are included in an aggregator service that permits queries from external providers. 8b) Data holders need the ability to affirm that the data requester has (or will have) a direct treatment relationship with the patient and has the legal authority and is otherwise authorized to obtain the data. 8c) The entities facilitating query based exchange need a way to log queries and/or disclosures of PHI to facilitate oversight and enforcement. 8d) Data intermediaries and providers have varying patient matching standards and methods. 8e) Data intermediaries have varying approaches to how data holders should respond to queries. For instance, if a HIO has data on a patient but the requester is not authorized to access it, even acknowledging the existence of a record would be disclosing PHI. 26

27 Potential Straw Man Governance Framework 27 Overarching Governance Principles Temporary Deeming Program Permanent Deeming Program Aimed at Governance Entities Temporary program sunsets upon completion of the Perm. Prog. Basic set of requirements built on top of base overarching governance principles Such a program would have to be established through rulemaking Aimed at entities doing exchange (HIE’s) Would create a core set of requirements Each module would be service level specific, and include technical and policy specifications Modules are meant to be quilted together to suit business model Establishes high level, rules of the road applicable to entire ecosystem Monitoring Program Governance Entities HIE Entities Core Implementation Guide Provider Directory Module Query Module Direct Module Patient Matching Module Alert Module

28 Next Steps Listening session planning call 28


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