1. S&I Framework Transitions of Care Initiative All Hands Meeting June 18, 2012

2. Agenda Welcome & Announcements – John Feikema & Russ Ott Pilot Achievement & Next Steps – John Feikema State HIE Closed Loop Referral Project – Guest: Richard Eshbach Implementation Guidance Update – Harmonization Team 2

3. Welcome & Announcements 3

4. Transitions of Care Initiative Timeline

5. Pilot Achievement & Next Steps 5

6. Pilot Achievements Volunteer Lead: Mark Bamberg Influenced the contents for proposed 2014 Edition Meaningful Use Developed open-source tooling that can accelerate progress towards demonstrating meaningful use objectives 6

7. Pilot Logistical Updates For now, no further Pilot Work Group calls are scheduled In the future, the Transitions of Care Initiative will likely reach out to the Pilots via the mailing list What’s next? 7

8. State HIE Program Closed Loop Referral Project 8

9. The Closed Loop Referral (CLR) project is an ONC sponsored initiative (not S&I). Promote the accelerated development and pilot-to- production of proposed MU/S2 functionality for CLR. The big focus will be on ubiquitous interoperability between players (different EHR, HISPs)….. And Direct workflow integration within the EHRs. 9 Sponsorship

10. As quickly as possible using proposed MU Stage 2 standards, enable providers to exchange patient information for referrals from their EHR workflow, regardless of the EHR systems and/or HISP services used (i.e., allowing information to move point-to-point between unaffiliated organizations, differing EHRs, and differing HISPs) and with at least the same quality of workflow integration providers currently experience when referring between homogeneous EHR systems. 10 Mission

11. What we know… – CLR is technically possible today – Happens in homogenous EHR environments (Vendor A  Vendor A) To what degree is a little unclear… – Doesn’t happen (much) in heterogeneous HIT environments (Vendor A  Vendor B) Requires intermediaries and/or one-off implementations What we believe… – Standards exist to facilitate these exchanges Examples: Direct, consolidated CDA, etc. – End-to-end implementation guidance and ‘gap-filling’ does not exist – Workflow of clinicians must be central concern – Common cross-vendor, industry-wide approach best path to widespread adoption 11 Key observations

12. Some initial examples: – Patient matching – Referral matching/linking – SMTP vs. XD* – Provider directories – Management of multi-format documents – Direct integration to EHR – Direct (HISP) interoperability / trust framework(s) 12 Potential issues/gaps to explore

13. Operating model is a mash-up – Direct Project / S&I Framework + “Labs over Direct” Pilot Program Approach – Group modeled on the Direct Project’s community-style forum and operating practices – Engage vendors at the national level, seeking to define a minimum set of common implementation guidance that may be widely deployed – Remain Agile throughout project – Have diverse group of stakeholders participate – Instantiate a series of pilot-to-production projects – Cross-community exchange will be a required success factor 13 How we (plan to) roll…

14. Broad email communication announcing launch to be disseminated this week Kick-off: first workgroup meetings in early July Target: real-world implementations by HIMSS 2013 Timeline estimates (phased-approach) – 1-2 months of requirements definition and gap analysis – 1-2 months of writing implementation guidance – 1-x months of implementation Vendor dependent on starting point – Identify pilot-to-production sites during guidance development phase 14 Timeline

15. Identify workgroup leaders from the community Define scope, use case, requirements – What does “success” look like? Inventory and assess existing capabilities Perform gap analysis 15 First steps…

16. Confirmed participants: – Allscripts – Athena – GE – McKesson – MedAllies – NextGen – Siemens We’re recruiting more… Would appreciate your involvement… 16 Who’s in?

17. Contact: – Paul Tuten (paul.tuten@hhs.gov)paul.tuten@hhs.gov – Richard Eshbach (reshbach@deloitte.com) – Megan McMenamin (mmcmenamin@deloitte.com) – Wiki and project e-mail address forthcoming Likely a subdomain of the existing State HIE Resources site. 17 Want more info or to join?

18. Recent Progress 18

19. Implementation Guidance Sub-Workgroup Activities Volunteer Leads: David Tao, Dr. Holly Miller & Dr. Russell Leftwich Completing work of Transitions of Care Initiative efforts through the development of a Companion Guide – Establishes clear guidance on the usage of the core clinical elements in common care transition scenarios – Provides supplemental guidance as part of the tools and resources to lower the barrier to implementation Purpose is to develop clear guidance for the implementation of regulatory requirements on care transition exchange packages to meet clinician needs and Meaningful Use requirements. 19

20. IG SWG Timeline

21. Initiative Companion Guide The ToC Companion Guide acts as a supplement to the Initiative’s recommended standard: HL7 CDA Consolidation Implementation Guide – Contains supplemental guidance that is traditionally outside the scope of HL7 balloted standards – Uses clinical scenarios to provide contextual information for business analysts and references for Physician Champions – Contains XML examples based on the clinical examples for real-world care transition implementation guidance – Describes HL7 CDA concepts which implementers may not have extensive knowledge of – Provides specific implementation specifications for stakeholders to meet regulatory requirements 21

22. ToC IG SWG Meetings Implementation Guidance SWG meeting schedule – Mondays 5:30PM – 7:00PM EST – Wednesdays 2:00PM – 3:00PM EST **New** Current Activities: – Refining data elements for inclusion in the clinical scenarios– “Key Information Exchanges” Completed Closed-Loop Referral: PCP to Specialist & Specialist to PCP Finishing Discharging Physician in Hospital Setting to PCP today To be completed: PCP to Patient, Discharging Physician in Hospital Setting to Patient – Analysis on current C-CDA documents to determine “best fit” document recommendation for each clinical scenario Completed mapping of ToC CEDD data elements to Consolidated CDA To be completed: analysis of C-CDA document requirements to accommodate MU2 requirements and ToC recommendations 22

23. VIRTUAL ROUND – QUESTIONS, COMMENTS, CONCERNS? 23