1. Status Update Deven McGraw, Chair Center for Democracy & Technology Micky Tripathi, Co-Chair Massachusetts eHealth Collaborative May 19, 2010 0 HIT Policy Committee Information Exchange Workgroup

2. - 1 - Background and Summary Information Exchange Workgroup initially launched with broad charter Make recommendations on “policies, guidance governance, sustainability, architectural, and implementation approaches to enable the exchange of health information and increase capacity for health information exchange over time” Recognition that original IE WG charter was too large for single WG led to launching of NHIN and Privacy & Security WGs, which now allows IE WG to focus on breakthrough areas Breakthrough areas are those where policy barriers prevent providers and/or states from being effective enablers of broader and deeper health exchange Specific clinical transactions already identified as important to meaningful use Critical issues that get unearthed by the over $1.5 billion programs in state-level HIE, RECs, Beacons, and NHIN Direct IE WG will also act as conduit for state-level policy issues that need HITPC attention For issues in IE WG charter, Identify and recommend solutions to such issues to HITPC For issues outside of IE WG charter, navigate to most appropriate HITPC WG(s) and facilitate/coordinate as necessary Next steps for IE WG: Finalize agenda for the remaining calendar year aligned with other interoperability working groups and with Standards Committee agenda Adjust WG membership in accordance with more focused agenda Establish and manage an Advisory Panel of state-level HIT coordinators to create a communication channel to HITPC and relevant WGs (through the IE WG)

3. - 2 - Scope and Approach MU transactions Labs (Round 2) eRX (Round 2) Public health Administrative transactions Summary exchange Quality measurement and reporting Patient-facing applications Emerging issues HISPs Intersection of NHIN Direct and MU transactions Coordination with Medicaid programs 1.Is the transaction universally and affordably available in the market today? 2.If not, where are the gaps and what market and/or policy barriers have created and are perpetuating these gaps? 3.What market correcting or reinforcing actions could be taken to eliminate identified service gaps? 4.Which transactions might require more assertive role for government, and how might state and federal policies be orchestrated to complement market solutions and catalyze removal of service gaps? Evaluative frameworkFocus areasPolicy levers

4. - 3 - Some suggestions from a few state-level HIT coordinators on which issues the IE WG should address Not Necessarily in Priority Order where does the NHIN end and state-level HIE begin? which functions should be made available via the NHIN, and which should remain as state-level functions? what common principles should guide governance of state-level HIE activities? what requirements (if any) should be placed on governance of state-level HIE activities? through what authority? besides privacy, what other cross-border policy issues will hamper health exchange, and should these be addressed? how does state-level governance connect with NHIN governance? what is role of states in NHIN governance? how to balance desire for national solutions while preserving ability for state- level innovation? how can state- and regional-level HIT and HIE activities be used to maximize efficiency and effectiveness of Medicaid and public health programs? will HISPs require formalization in some way? if so, what (if anything) will be decided at federal level and what discretion will be left to states? what policies and approaches can be put in place to remove barriers to greater eRX and lab adoption? what is best policy and regulatory approach to align eRX and lab companies with national and state health exchange priorities? what state-level barriers to other clinical transactions exist, and what national approaches can be taken to overcome them? Integrating state-level HIE with the NHIN Governance of state- level HIE Federated governance Medicaid and Public Health HISPs eRX, Labs, and other clinical transactions Many of these topics will require joint deliberations with or handoff to other WGs

5. - 4 - Recommended next steps Adjust plan according to suggestions made today Adjust IE WG structure and composition to better fit future agenda -Membership changes -HIT Coordinators Advisory Panel Work with NHIN and P&S WGs on coordinated interoperability agenda for the next 3-6 months -Proposed priority areas: public health, labs, Medicaid coordination, summary exchange transactions, Present new work plan and IE WG structure and membership changes at June 25 meeting