1. Hurdles and Solutions for the Interoperable EHR John W, Loonsk, MD FACMI Chief Medical Officer CGI

2. Issues with the availability of definitive and detailed standards – Standards are necessary, but not sufficient for interoperability – Best way to advance standards is to have many people using them Other challenges to interoperability: – Few incentives for exchanging information When “value” of exchanging is high it costs to not be interoperable – Many incentives for not exchanging information Propriety business needs Tacit “ownership” Integration services profits Existing non standards-based systems Patient confidentiality issues HIPAA and other legal angst Subpoena concerns Interoperability

3. Data standards – Text and viewing – Terminologies and value sets – Metadata and XML “bins” Technical standards – Queries, routing of information, security – Relationship to architecture Combinations of data, metadata and technical standards – Implementation guidance / specifications – Transactions Types of Standards

4. Dependencies - from Outcome to Initiation Testable interoperability – Identified data and technical standards – Detailed specifications – Testing infrastructure Identified standards and specifications – Valid process for identifying “named” standards – Well maintained, implementation level guidance Accepted process for identifying standards – Context for standards use – Multi-stakeholder process Value and context for standards use – Business value in information exchange – Alignment with broader agenda

5. Testing Challenges for testing – Need to test Terminology value sets Messages / documents Web services Transport Security – On-site implementation and testing – Multiple, connected business processes – Multiple participants and “one to many” interoperability – Errors and error handling – Technical tools to achieve

6. A Nationwide Health Information Network Labs Pharmacies Community Health Centers State and Local Gov Health Bank CDC Geo HIE RHIO DoD SSA CMS VA PCHR Support Organization Common “dial tone” and “chain of trust” PHR HIE Fed HIE IDS HIE FDA

7. Building Network Standards Patient lookup and Information retrieval Provision of electronic data for reporting and other uses Information routing and delivery (including summary patient records) Exchange of Consumer Preferences Common Access to Health Organizations Federated Information Management Transitions in Care Quality Reporting Results Delivery Personal Health Records ePrescribing Lab Result Delivery Biosurveillance Other Priority Initiatives Reusable infrastructure for health initiatives Network Services Capabilities Functional Needs Distributed Query Support

8. Solutions Ensure value in information exchange Have unambiguous and detailed specifications Have very specific technical testing to ensure implementation and ease development Have a “reference implementation” of the standards for use Develop a community of use