1. 0 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Presenters:Co-Chairs of the EHR-Centric IS Tiger Team Michael Nusbaum, BASc, MHSA, FHIMSS Manick Rajendran, BS, MBA Corey Spears EHR Centric Interoperability Specification Webinar #9 October 8, 2009 | 2:00 – 3:30 pm (Eastern)

2. Slide 1 HITSP – enabling healthcare interoperability 2009 Webinar Series Overview  Re-organization and re-purposing of all of HITSP’s 13 original Interoperability Specifications (IS) into an EHR-centric view — Aligned with the Health Information Technology (HIT) provisions of the American Recovery and Reinvestment Act of 2009 (ARRA).  Simplified framework for HITSP’s ongoing activities, making future work products easier to understand and simpler to implement.

3. Slide 2 HITSP – enabling healthcare interoperability 2009 Webinar Series Learning Objectives  During this 90-minute webinar, participants will: — Learn why this IS is important to EHR vendors and organizations — Understand how the HITSP EHR-Centric IS can support ARRA requirements — Learn how the EHR-Centric IS utilized the concepts of “capabilities” and “service collaborations” to simplify the specifications and facilitate ease of implementation — Discover how HITSP efforts going forward will further leverage Capabilities and Service Collaborations as re-usable components — Learn how to find and navigate the IS107 EHR Centric document

4. Slide 3 HITSP – enabling healthcare interoperability 2009 Webinar Series Agenda  What is HITSP?  What HITSP produces  What is ARRA?  What was the EHR-Centric IS Tiger Team asked to produce?  Introduction of new “building blocks” — Capabilities — Service Collaborations — A new HITSP approach — Navigating the IS107 Document  Conclusion  Questions and Answers

5. Slide 4 HITSP – enabling healthcare interoperability 2009 Webinar Series To serve as a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States. Mission

6. Slide 5 HITSP – enabling healthcare interoperability 2009 Webinar Series Overview  HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services — Created in 2005  HITSP develops Interoperability Specifications (IS) – documents that harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records — Production to date: 14 IS and 60 related constructs

7. Slide 6 HITSP – enabling healthcare interoperability 2009 Webinar Series  Patients  Consumers  Employers  General Practitioners  Outpatient Providers  Government Agencies  Hospitals HITSP Stakeholders  Review Boards  Practice Guidelines  Residential Care Providers  Standards Developers  Specialists  Payers  Suppliers Current Participation in HITSP: 800+ organizations1,000+ individuals Over 25,000 volunteer hours

8. Slide 7 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP members agreed that a standard is a well-defined approach that supports a business process and... — has been agreed upon by a group of experts — has been publicly vetted — provides rules, guidelines, or characteristics — helps to ensure that materials, products, processes and services are fit for their intended purpose — is available in an accessible format — is subject to an ongoing review and revision process Standards Harmonization is required when a proliferation of standards prevents progress rather than enabling it. HIT Standardization

9. Slide 8 HITSP – enabling healthcare interoperability 2009 Webinar Series What is ARRA?  Also known as the “economic stimulus package”  Signed into law by President Obama on February 17, 2009 What is HITECH?  A portion of ARRA referred to as the Health Information Technology for Economic and Clinical Health (HITECH) Act — TITLE XIII—Health Information Technology — TITLE IV—Medicare and Medicaid Health Information Technology  Contains numerous provisions related to Health Information Technology (HIT) and privacy with aggressive timelines for completion

10. Slide 9 HITSP – enabling healthcare interoperability 2009 Webinar Series To Address ARRA Requirements, Tiger Teams Were Created with Specific Focus Areas  A new EHR Centric Interoperability Specification to meet ARRA requirements  Security, Privacy & Infrastructure  Quality Measures  Data Architecture (Element, Template, and Value Set)  Exchange Architecture and Harmonization Framework  Clinical Research Tiger Team membership 232 technical experts

11. Slide 10 HITSP – enabling healthcare interoperability 2009 Webinar Series Released Accepted Recognized Federal projects must use HITSP recognized standards Per Executive Order 13410 Panel approved for submission to HHS Secretary of HHS has accepted for a period of testing Secretary of HHS has recognized the IS for immediate implementation Status: Interoperability Specifications

12. Slide 11 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 01 Electronic Health Record (EHR) Laboratory Results Reporting IS 02Biosurveillance IS 03Consumer Empowerment IS 04 Emergency Responder Electronic Health Record (ER- EHR) IS 05 Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management HITSP Interoperability Specifications (IS) Accepted Recognized

13. Slide 12 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 08Personalized Healthcare IS 09Consultations and Transfers of Care IS 10Immunizations and Response Management IS 11Public Health Case Reporting IS 12Patient – Provider Secure Messaging IS 77Remote Monitoring IS 107EHR Centric HITSP Interoperability Specifications (IS) Released / Panel Approved Accepted

14. Slide 13 HITSP – enabling healthcare interoperability 2009 Webinar Series Utilizing the 13 recognized/accepted (as of 13Feb09) HITSP Interoperability Specifications...... in the context of the ARRA to produce an EHR-Centric IS... that is: simplified easily understood applicable beyond limitations of initiating use cases implementable leverages existing work EHR-Centric Tiger Team Produced the EHR-Centric Interoperability Specification (IS)

15. Slide 14 HITSP – enabling healthcare interoperability 2009 Webinar Series EHR-Centric IS Addresses ARRA / HITECH Priority Areas Eight Priority Areas for HIT in ARRA HITSP Phase 1 Tasks for ARRA 1 Security + Privacy 2 HIT Infrastructure 3 Certified Health Record 4 Disclosure Audit 5 Improve Quality 6 IIHI* Unusable 7 Demographic Data 8 Needs of Vulnerable EHR Centric Interoperability Specification Security and Privacy Service (Suite) Quality Measures project Supporting Deliverables Harmonization framework and information/ exchange architecture Data Element, Template, and Value Set * Individually Identifiable Health Information (IIHI) Unusable

16. Slide 15 HITSP – enabling healthcare interoperability 2009 Webinar Series ARRA Title IV (Division B) – Section 401 – Medicare Incentives HITSP Phase 1 Tasks for ARRA Meaningful Use to Include e-Prescribing Exchange of Information to Improve Quality of Care Reporting Clinical Quality Measures Certified EHR Defined EHR Centric Interoperability Specification Security and Privacy Service (Suite) Quality Measures project Supporting Deliverables Harmonization framework and information/ exchange architecture Data Element, Template, and Value Set EHR-Centric IS Facilitates Achievement of ARRA / HITECH Meaningful Use

17. Slide 16 HITSP – enabling healthcare interoperability 2009 Webinar Series New Harmonized Construction Rules Were Needed  Something every organization can use for its EHR  Takes advantage of opportunities to work smarter  Re-use and re-purpose

18. Slide 17 HITSP – enabling healthcare interoperability 2009 Webinar Series Putting the Pieces Together  HITSP created IS’s to harmonize standards and make them implementable  Before HITSP, there was a “custom puzzle” to build for every organization to talk to another organization  HITSP used existing Interoperability Specification (IS) constructs to create reusable Capabilities and Service Collaborations

19. Slide 18 HITSP – enabling healthcare interoperability 2009 Webinar Series Meeting Business Needs  Capabilities and Collaborations could be used to build any new Interoperability Specification to meet a particular business need

20. Slide 19 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Capabilities  Enable systems to address a business need for interoperable information exchange  Bridge between business, policy and implementation views: — Define a set of information exchanges at a level relevant to policy and business decisions — Support stakeholder requirements and business processes — Define information content and secure infrastructure — Specify use of HITSP constructs sufficiently for implementation — Include constraints and identify specific network topologies Created To Simplify Design and Use of HITSP Specifications for ARRA Efforts and Beyond

21. Slide 20 HITSP – enabling healthcare interoperability 2009 Webinar Series AHIC Use Case Interoperability Specification (IS)  Identifies the framework that is a solution for business need (use case)  Defines requirements including transactions and terminology  Addresses multi-year roadmap as needed Constructs available for reuse or repurposing Component Transaction Transaction Package Technical Notes Overview: HITSP Interoperability Specifications

22. Slide 21 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Glossary  Interoperability Specifications (IS) – Integration of all constructs used to meet business needs or the business needs specified in a Use Case Interoperability Specifications (IS) — Components (C) – Logical grouping of base standards that work together, such as messaging and terminology Components (C) — Transactions (T) – Logical grouping of actions that use components and/or composite standards to realize the actions Transactions (T) — Transaction Packages (TP) – Logical grouping of transactions Transaction Packages (TP)  Capability (CAP) – Specifies a business service that an EHR system addresses and specifies the contents and secure infrastructure needed for that business service Capability (CAP)  Service Collaboration (SC) – Defines a standards-based secure infrastructure needed for interoperable information exchanges and includes a secure transport mechanism with topology and other options regardless of content Service Collaboration (SC)

23. Slide 22 HITSP – enabling healthcare interoperability 2009 Webinar Series Standards “Real World” examples of Base and Composite Standards  XML (base)  IHE-XDS (composite)  HL7-CCD (base)  DICOM (base)  LOINC (base)  SNOMED-CT (base)  NCPDP-Script (composite)  etc. Base Standard  capable of fulfilling a discrete function Composite Standards  groupings of coordinated base standards Examples  Basic Specifications  Implementation Guides  Code Sets and Terminologies

24. Slide 23 HITSP – enabling healthcare interoperability 2009 Webinar Series Exchange a prescription with an Ambulatory or Long-Term Care Organization What Is an Example of a Capability?  Requirement: Hospital wants to exchange a discharge prescription with an patient’s physician’s office. — This diagram shows how Capability (CAP) 117 was assembled to support this requirement using Transaction, Transaction Package and Service Collaboration T40 T42 TP43 TP46 SC114 T40 T42 TP43 TP46 SC114 CAP117 – Communicate Ambulatory and Long Term Care Prescription System Roles Medication Order Prescriber Medication Order Filler Health Plan Health Information Exchange

25. Slide 24 HITSP – enabling healthcare interoperability 2009 Webinar Series SC114 – Administrative Transport to Health Plan TP46 – Medication Formulary and Benefits Information TP46 – Medication Formulary and Benefits Information TP43 – Medication Orders Details of Capability 117 CAP117 – Communicate Ambulatory and Long Term Care Prescription T42 – Medication Dispensing Status T40 – Patient Health Plan Eligibility Verification PHARMACYPHARMACY  Requirement: Hospital wants to exchange a discharge prescription with an patient’s physician’s office.

26. Slide 25 HITSP – enabling healthcare interoperability 2009 Webinar Series SC109 - Security Audit Collaboration T15 - Collect and Communicate Security Audit Trail T16 - Consistent Time SC108 - Access Control Service Collaboration Details of Service Collaboration 114 SC114 – Administrative Transport to Health Plan H E A L T H PLAN C19 - Entity Identity Assertion (Optional) T17 - Secured Communication Channel TP20 - Access Control TP30 - Manage Consent Directives T85 - Administrative Transport to Health Plan T17 - Secured Communication Channel Provider

27. Slide 26 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Capabilities

28. Slide 27 HITSP – enabling healthcare interoperability 2009 Webinar Series More HITSP Capabilities

29. Slide 28 HITSP – enabling healthcare interoperability 2009 Webinar Series And Yes... there are more HITSP Capabilities

30. Slide 29 HITSP – enabling healthcare interoperability 2009 Webinar Series Service Collaborations (SC)  Defines a standards-based secure infrastructure needed for interoperable information exchanges.  Includes a secure transport mechanism with topology and other options.  Uses HITSP Constructs to specify the secure infrastructure.  Does not specify the content of the information exchange but may include information to support the exchange (e.g., authorization information) Additional Keys to Simpler Definition and Implementation of HITSP Specifications

31. Slide 30 HITSP – enabling healthcare interoperability 2009 Webinar Series Service Collaboration – An Essential Component

32. Slide 31 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Service Collaborations (SC)  SC108 – Access Control  SC109 – Security Audit  SC110 – Patient Identification Management  SC111 – Knowledge and Vocabulary  SC112 – Healthcare Document Management  SC113 – Query for Existing Data  SC114 – Administrative Transport to Health Plan  SC115 – HL7 Messaging  SC116 – Emergency Message Distribution Element

33. Slide 32 HITSP – enabling healthcare interoperability 2009 Webinar Series Binds content definition with secure infrastructure for a set of interoperable information exchanges How It All Fits

34. Slide 33 HITSP – enabling healthcare interoperability 2009 Webinar Series Initial HITSP Approach – Use Cases

35. Slide 34 HITSP – enabling healthcare interoperability 2009 Webinar Series Capabilities Changed the Level at which We Work

36. Slide 35 HITSP – enabling healthcare interoperability 2009 Webinar Series Capabilities Allow Us to Develop New Technical Constructs As Needed

37. Slide 36 HITSP – enabling healthcare interoperability 2009 Webinar Series The Refined HITSP Framework HITSP Capabilities Component Service Collaborations Service Collaboration Transaction Constructs Transaction Transaction Package SDOs = Standards Development Organizations

38. Slide 37 HITSP – enabling healthcare interoperability 2009 Webinar Series “Meaningful Use” From existing Interoperability Specifications, determine subset required for “meaningful use” as called for in the American Recovery and Reinvestment Act (ARRA). Effort began on April 7, 2009.

39. Slide 38 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP Capabilities Were Created from Previous Work Full copy of this file posted with the Webinar Slides @ www.hitsp.org/webinars

40. Slide 39 HITSP – enabling healthcare interoperability 2009 Webinar Series Example The Capabilities Map to ARRA Requirements

41. Slide 40 HITSP – enabling healthcare interoperability 2009 Webinar Series Capability End Result: The EHR-Centric IS was built using these Capabilities. Any IS can be assembled using Capabilities. Requirements EHR-Centric IS Supports Based on Capability Existing HITSP Constructs Organized by New HITSP Interoperability Specifications Service Collaborations

42. 41 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee Document Overview and Navigation Tips EHR Centric Interoperability Specification

43. Slide 42 HITSP – enabling healthcare interoperability 2009 Webinar Series You Can Find IS107 on www. hitsp.org

44. Slide 43 HITSP – enabling healthcare interoperability 2009 Webinar Series Scroll to the bottom to find IS107

45. Slide 44 HITSP – enabling healthcare interoperability 2009 Webinar Series IS107 EHR Centric Interoperability Specification

46. Slide 45 HITSP – enabling healthcare interoperability 2009 Webinar Series In the EHR-Centric IS, Each Capability Is Described by:  Detailed description  Design specification — Interacting Systems — Constraints & Assumptions — List of constructs (including Service Collaborations) — Specified Interfaces (mapped to construct/content) — Interface Conditions & content optionality — Uniform Modeling Language (UML) diagram — Capability options (content subsets and transport options)

47. Slide 46 HITSP – enabling healthcare interoperability 2009 Webinar Series Each Capability is written in this format  Communicate Ambulatory and Long Term Care Prescription Specification — 3.2.1 Overview — 3.2.2 Design Specification — 3.2.2.1 Interacting Systems — 3.2.2.2 Constraints and Assumptions — 3.2.2.3 List of Constructs — 3.2.2.4 Specified Interfaces — 3.2.2.5 Capability Options

48. Slide 47 HITSP – enabling healthcare interoperability 2009 Webinar Series Two Key Websites to Bookmark  www.hitsp.org www.hitsp.org  http://wiki.hitsp.org/docs http://wiki.hitsp.org/docs

49. Slide 48 HITSP – enabling healthcare interoperability 2009 Webinar Series NEW HITSP Team Members ALWAYS welcome! www.HITSP.org www.HITSP.org  All you need is passion to get the job done  Motivation to make a difference  Drive to push the nation forward  Volunteers ARE the life blood of HITSP to get the job done  If you knew enough to attend this webinar, you know enough to jump on in!

50. Slide 49 HITSP – enabling healthcare interoperability 2009 Webinar Series Webinar 1 Advances in Sharing Information in Healthcare IT Thursday, January 15, 2009 — 2:00-3:30 pm Eastern Webinar 7HITSP eTown Hall II with Dr. John Halamka Thursday, August 27, 2009 — 2:00-3:30 pm Eastern Webinar 2Personalized Healthcare Interoperability Specification (IS 08) Thursday, February 12, 2009 — 2:00-3:30 pm Eastern Webinar 8Medication Management Real World Sites Thursday, September 10, 2009 — 2:00-3:30 pm Eastern Webinar 3Consultations and Transfers of Care Interoperability Specification (IS 09) Thursday, March 12, 2009 — 2:00-3:30 pm Eastern Webinar 9HITSP EHR Centric Interoperability Specification Thursday, October 8, 2009 — 2:00-3:30 pm Eastern Webinar 4NHIN Real World Sites Thursday, April 16, 2009 — 2:00-3:30 pm Eastern Webinar 10Security, Privacy, and Infrastructure Thursday, November 12, 2009 — 2:00-3:30 pm Eastern Webinar 5HITSP eTown Hall I with Dr. John Halamka Thursday, June 18, 2009 — 2:00-3:30 pm Eastern Webinar 11Quality Management Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern Webinar 6Health Information Exchange (HIEs) in the Real World Thursday, July 9, 2009 — 2:00-3:30 pm Eastern NOTE: Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.  The 2009 Webinar Series www.HITSP.org/webinars        

51. Slide 50 HITSP – enabling healthcare interoperability 2009 Webinar Series Discussion / Questions Welcomed

52. Slide 51 HITSP – enabling healthcare interoperability 2009 Webinar Series View the Complete Set of HITSP Deliverables www.HITSP.org www.HITSP.org

53. Slide 52 HITSP – enabling healthcare interoperability 2009 Webinar Series Allyn Clemons, HIMSSTheresa Wisdom, HIMSS aclemons@himss.orgaclemons@himss.org twisdom@himss.orgtwisdom@himss.org Re: HITSP Technical Committees Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.org or contact:www.hitsp.org

54. Slide 53 HITSP – enabling healthcare interoperability 2009 Webinar Series Sponsor Strategic Partners www.HITSP.org