1. S&I Framework Doug Fridsma, MD, PhD Director, Office of Standards and Interoperability, ONC Fall 2011 Face-to-Face

2. Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Enforce compliance with validated information exchange standards, services and policies to assure interoperability between validated systems How do we achieve interoperable healthcare information systems? 1

3. Separate tasks but one harmonious effort Assemble Team to Solve Problem Solutions & Usability Accuracy & Compliance 2

4. Why the S&I Framework? For many problem domains, there are multiple or ambiguous standards HITSC has recommended that a parsimonious set of standards be chosen to enable the exchange of health information with consistency and accuracy S&I Framework enables a broad, open, transparent community* of stakeholders to help guide the development of realistic, implementable solutions that will fulfill these recommendations 3 S&I Framework supports the HITSC to accelerate the identification, piloting and use of standards for MU * As of 14 Oct 2011, ~400 people representing ~300 organizations had committed to the S&I Framework

5. S&I Framework Complements Other Standards Initiatives Transport & Security Content Structure Vocabulary & Code Sets INTEROPERABILITY STACK STANDARDS & SPECIFICATIONS NwHIN Power Team 4 Access Services PD – Query for Elec. Info. LRI ToC Clinical Quality WG & Vocab Task Force ePrescri- bing of Discharge Meds Power Team CI Metadata Analysis Power Team Surveillance IG Power Team Patient Matching Power Team PD – Cert. Disc. for Direct esMD – Digital Signature & Submission Content Query Health esMD – Directory Query (proposed) Data Seg.

6. Transitions of Care (ToC) Initiative Activities: Consensus on Implementation Guide for ConsolidatedCDA Templates Clinical Information Model (CIM) to provide the clinical perspective for care transitions, mapped to HL7 CDA Release 2 Pilots, Testing, RI, and Tooling to demonstrate and improve implementation 5

7. Templated CDA: The Next Step in the Evolution 6 Extensibility / Flexibility Ease of Implementation / Degree of Interoperability LowModHigh Low Mod High CDA CCR CCD C32 Templated CDA MU1

8. Lab Results Interface (LRI) Initiative Activities: Consensus on new HL7 2.5.1 LRI IG Consensus on use of LOINC for observation identifiers and SNOMED CT for reporting of appropriate lab results. Agreement on need for piloting of SNOMED (specimen info), UCUM, OIDs Piloting, testing, tooling and HL7 ballot reconciliation to enable implementation 7

9. LRI IG: Best of Both Worlds 8 LRI IG Standard: HL7 2.5.1 Extensible base with required profiles to enable constraints Constrained vocabularies ELINCS IG Standard: HL7 2.5.1 Designed for narrow use case HITSP IG Standard: HL7 2.5.1 Designed for broad set of use cases Flexibility Interoperability (esp. message structure) Flexibility Interoperability

10. Provider Directories (PD) Initiative – Certificate Discovery for Direct Activities: Agreement that DNS CERT for certificate distribution is working for Direct Project implementations today Consensus that a hybrid solution (DNS SRV  LDAP query) should be supported as the fail-over mechanism to broaden Direct Project compatibility Currently: –Writing the specification –Updating the Direct Project Reference Implementation –Preparing pilots 9

11. Provider Directories (PD) Initiative – Query for Electronic Services Activities: Agreement that standards to support queries to provider directories have limited deployment. Broader implementation experience is needed to allow an evidence-based approach to standards selection Identified the minimum data set for query (and response) for electronic service information from provider directories Mapping this data set to existing standards (e.g., IHE HPD and X12N 274) for which there is advocacy within the community 10

12. Certificate Interoperability (CI) Initiative Status: Current objectives completed Key Findings: There is a gap in Federal PKI policy to address identity validation for organizations requesting server certificates ONC is working with GSA and with community interest groups to ensure that an appropriate policy is developed The initiative also outlined options for ONC to provide support to the industry 11

13. Query Health Initiative Activities: Launched on September 6, 2011 Workgroups underway, focusing on: –Clinical: Use case / user stories –Technical: Abstract Model, Technical Approaches, applicable standards –Operations: Operations Requirements / Best Practices Policy Sandbox – Tiger Team recommendations review by HIT Policy Committee 12

14. Data Segmentation Initiative Activities: Launched on October 5, 2011 –Today is first full Data Segmentation meeting Problem Definition – Scope, Challenges, Constraints Use case and user story development 13

15. Electronic Submission of Medical Documentation (esMD) Initiative Activities: Launching today! Problem definition and scope selection centered on 3 priority issues: –Digital Signature to demonstrate that the Provider validated that content within the document is accurate (“wet signature”) –Provider Directory query, given CMS is required by law to use NPI number to identify providers –Standards for the relevant structured content 14

16. Goals for the S&I F2F Build trust by collaborating on tangible outcomes: –Focus conversations to address real issues –Tackle the most ambiguous/challenging issues –Accelerate artifact development –Establish cross-initiative collaborations –Learn from each other! Set the course: –Review outcomes against timelines: where are we, where are we headed? –Look to the future: what are our next steps, what should we work on, what shouldn’t we work on? 15

17. TO ALL S&I VOLUNTEERS: THANK YOU!!! 16