1. 1 Collaboration and Concept Exploration Nationwide Health Information Organization (NHIO) Gateway March 28, 2007

2. 2 Purpose Demonstrate a secure, structured health information exchange to improve coordination of care, thereby promoting quality of care, patient safety, and efficiency between two major nationwide health information organizations (NHIOs): KP and VA.

3. 3 Project Leads Kaiser Permanente –Jamie Ferguson Veterans Health Administration –Tim Cromwell

4. Proposed High-Level Timeline As of January 2007 Aug 2006 Dec 2006Jan 2007Jun 2007Dec 2007Jun 2008Dec 2008 Kick Off Meeting Aug 06 Phase I – T&E Demo Milestone Approval Design Phase I – Develop Physical Gateway Connectivity and Pt Demo Concept Exploration Phase III – Lab results Operational Milestone Approval Initiate Design /Development Milestone Approval Phase II – Medications / Allergies Phase II – T&E Demo Milestone Approval Architecture Solution Design

5. 5 Current Activity 3 workgroups are meeting: Core: –Draft charter for proposed Content Group Completed –VA has not assigned a Content Lead yet Privacy and Security –Deliverable status Technical Architecture –Deliverable status: Architecture Document v January 2007 submitted

6. 6 Related Developments Discussions in ONC and FHA about state level RHIOs as the next iteration of NHIN projects. –How will this affect our project? VA/DoD Joint Inpatient EHR –Feasibility study –Project will monitor

7. 7 Performance Outcomes Identify NHIO functional requirements, processes, and architecture solutions for health information exchanges Apply and implement health information technology and data standards Establish of common business rules and policies for interoperability Identify and raise the legal and regulatory issues around federal and non-federal health information exchanges Provide a management and organizational governance framework and related considerations for federal and non-federal health information sharing

8. 8 Challenges and Opportunities Testing out NHIN functional requirements and implementation phasing of accepted standards - “Production prototype demonstration” Privacy / protection of health information Patient consent and authorization to share health information Common terminology of health data required to enable semantic interoperability Authorization and access controls for health information exchanged across organizational boundaries Provide greater visibility into patients’ multiple benefits eligibility status Scope control versus related other use cases (e.g. Emergency Responder EHR) Other priorities for VA DoD sharing projects may take precedence and force this project to compete for limited resources

9. 9 Cost Estimate Prepared for leadership, December 13, 2006 Revised 3/28/2007 DoDVAKPTotal Total Cost $4.6M$1M +/- 50% $5.6M

10. 10 Cost Estimates Prepared for leadership, December 13, 2006 Last Update:

11. 11 Closing Leadership Commitment Go/No-go review Other Questions Next Steps

12. 12 Background slides Previously reviewed

13. 13 Background April 2004, Executive Order 13335, entitled “Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator,” –VA and DoD were directed to engage in more activity with the private sector to make agency health information available. May 2005, the Health IT Leadership Panel, comprising nine industry chief executive officers, articulated an imperative for the federal government to act as leader, catalyst, and convener of the nation’s health information technology efforts. –Federal leadership is the key component for enabling the NHIN. Hence, DoD and VA have agreed to initiate that dialog and concept exploration with one of the largest health non-federal, nationwide entities. August 2006, Executive Order 13410, entitled “Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs,” –Federal agencies to use recognized health interoperability standards to promote the direct exchange of health information between agencies and with non-federal entities in supporting quality and efficient health care.

14. 14 Architecture Approach (based on NCVHS proposed NHIN architecture)