1. Beyond the EMR – Exchanging Health Information Outside of Your Organization John W. Loonsk, MD, FACMI Office of the National Coordinator for Health Information Technology

2. Some Critical Health Needs Avoidance of medical errors –Up to 98,000 avoidable annual deaths due to medical errors Improvement of resource utilization –Up to $300B spent annually on treatments with no health yield Acceleration of knowledge diffusion –17 years for evidence to be integrated into practice Reduction of variability in healthcare delivery and access –Access to specialty care highly dependent on geography Empowerment of the consumer –Capitalize on growing consumer trend of active health management Strengthening of data privacy and protection –HIPAA becomes reality Promotion of public health and preparedness –Surveillance is fragmented, and importance to homeland security brings heightened awareness

3. Information Exchange Needs During Anthrax Attacks

4. 25 20 15 10 5 0 4.4% 20.8% Size of Practice Physicians* Percentage 11 or more in practice 1 or 2 in practice Current State EHR Adoption: US Physicians (2005) 25 20 15 10 5 0 25% 10% Level of Function Physicians* Percentage Using some functions With (1) electronic note keeping, (2) lab order, (3) med orders, & (4) ability to obtain lab results *3 times more prevalent in metropolitan areas

5. The National Health IT Agenda Priorities American Health Information Community Business needs and priorities Use Cases Priorities American Health Information Community Business needs and priorities Use Cases Standards Healthcare Information Technology Standards Panel Recognized standards Standards Healthcare Information Technology Standards Panel Recognized standards Networking NHIN - network of networks Architecture specifications Networking NHIN - network of networks Architecture specifications Policies State laws and regulations – State Alliance Health Information Security and Policy Collaboration Policies State laws and regulations – State Alliance Health Information Security and Policy Collaboration Certification Certification Commission For Healthcare Information Technology Criteria development Testing Certification Certification Commission For Healthcare Information Technology Criteria development Testing Business Deployment Sustainable business models Software State / regional partnerships Evaluation Business Deployment Sustainable business models Software State / regional partnerships Evaluation Agenda

6. AHIC Priorities and Use Case Roadmap

7. Standards in the National HIT Agenda American Health Information Community Priorities (AHIC) Healthcare Information Technology Standards Panel (HITSP) Nationwide Health Information Network (NHIN) Certification Commission for Healthcare Information Technology (CCHIT) Stark and Anti-kickback Use Cases Interoperability Specifications Federal Systems and Healthcare Contracts (Executive Order 13410) Secretary and recognition January, 2008 - 52 standards January 2009 - 60 standards

8. The Nationwide Health Information Network Labs Pharmacies Community Health Centers State and Local Gov Health Bank CDC Geo HIE RHIO DoDSSACMSVA PCHR Support Organization Common “dial tone” and “chain of trust” PHR HIE Fed HIE IDS HIE FDA

9. 1.Provider has a patient but not their record 2.Updating health data where it is needed 3.Patient wants / doesn’t want information to be electronically released 4.Providing the best care and protecting the population Common Network “Dial Tone” Functions and specifications: 1.Patient look-up and information retrieval 2.Information routing and delivery 3.The exchange of consumer preferences 4.Support for population data uses

10. Enabling Information Exchange Trust Issues –Tacit “ownership” –HIPAA and other legal angst –Propriety business needs –Patient confidentiality issues Enablers –Value of exchanging data –Patient choice x 2 –Support trusted users –High level access controls –Minimize identifying information

11. The Nationwide Health Information Network Labs Pharmacies Community Health Centers State and Local Gov Health Bank CDC Geo HIE RHIO DoDSSACMSVA PCHR Support Organization Common “dial tone” and “chain of trust” PHR HIE Fed HIE IDS HIE FDA