Transcript The Office of the National Coordinator for Health

What’s New in ONC?
The Office of the National
Coordinator for Health
Information Technology Panel:
Insight into Emerging Policy
Copyright 2009. All Rights Reserved.
Agenda
Vision for Meaningful Use
John Glaser
Standards and Certification
Carol Bean
Policy Activities
Jodi Daniel
Nationwide Health Information
Network – Future Direction
John Glaser
State Grants
Kelly Cronin
Health IT Extension Program
Rachel Nelson
Nationwide Health Information Network
Ginger Price
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OFFICE OF THE
NATIONAL
COORDINATOR
John Glaser, PhD
Senior Advisor to the National Coordinator
Vision for Meaningful Use
Slides that follow are from a draft set of
recommendations made by a Work Group of
the HIT Policy Committee on June 16, 2009
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Achievable Vision for 2015
• Prevention, and management, of chronic diseases
– A million heart attacks and strokes prevented
– Heart disease no longer the leading cause of death in the US
• Medical errors
– 50% fewer preventable medication errors
• Health disparities
– The racial/ ethnic gap in diabetes control halved
• Care coordination
– Preventable hospitalizations and re-admissions cut by 50%
• Patients and families
– All patients have access to their own health information
– Patient preferences for end of life care are followed more often
• Public health
– All health departments have real-time situational awareness of outbreaks
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HIT-Enabled Health Reform
Achieving Meaningful Use
2009
2011
2013
2015
HIT-Enabled Health Reform
HITECH
Policies
2011 Meaningful
Use Criteria
(Capture/share
data)
Meaningful Use Criteria
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2013 Meaningful
Use Criteria
(Advanced care
processes with
decision support)
2015 Meaningful
Use Criteria
(Improved
Outcomes)
Improve Quality, Safety, Efficiency
2011 Objectives
• Capture data in coded format
– Maintain current problem list
– Maintain active medication list
– Maintain active medication allergy list
– Record vital signs (height, weight, blood pressure)
– Incorporate lab/test results into EHR
– Document key patient characteristics (race, ethnicity, gender, insurance type,
primary language)
• Document progress note for each encounter (outpatient only)
• Use CPOE for all order types
– Use electronic prescribing for permissible Rx
– Implement drug-drug, drug-allergy, drug-formulary checks
• Manage populations
– Generate list of patients by specific conditions (outpatient only)
– Send patient reminders per patient preference
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Improve Care Coordination
2011 Objectives
Exchange key clinical
information among
providers of care
Perform medication
reconciliation at relevant
encounters
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Summary
•
Journey to a transformed health system requires
meaningful use of transformation-capable HIT
•
Migration of HIT readiness from current situation to fully
HIT-enabled ecosystem will evolve over time
•
Proposed MU criteria for 2011 and beyond provides
escalating capabilities, balancing urgent need for reform
and feasibility of what is achievable
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OFFICE OF THE
NATIONAL
COORDINATOR
Carol Bean, PhD, MLS, MPH
Acting Director, Office of Interoperability and Standards
Standards and Certification
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HHS Interoperability Standards
“Recognized” in 2007-2008
“Accepted” in January 2009
• EHR Laboratory Results Reporting
(IS01)
• Medication Management (IS07)
• Biosurveillance (IS02)
• Consultations and Transfers of
Care (IS09)
• Consumer Empowerment (and
Access to Clinical Information via
Network, IS03)
• Emergency Responder EHR (IS04)
• Consumer Empowerment and
Access to Clinical Information via
Network (IS05)
• Quality (IS06)
• Personalized Healthcare (IS08)
• Immunizations and Response
Management (IS10)
• Public Health Case Reporting
(IS11)
• Patient-Provider Secure
Messaging (IS12)
• Remote Monitoring (IS77)
• Updates to IS02, IS03, IS04, IS05
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Eight Technology Priority Areas for
HIT in ARRA
1. Privacy and Security
2. HIT Infrastructure
3. Certified Health Record
4. Disclosure Audit
5. Improve Quality
6. Individually Identifiable Health
Information (IIHI) Unusable
7. Demographic Data
8. Needs of Vulnerable
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Source: John Halamka
Tiger Teams Focus Areas:
Business Cases vs Use Cases
• 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
Tiger Team
membership
232 technical
experts
• Clinical Research
Source: John Halamka
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HITSP – enabling healthcare interoperability
New Paths to Certification:
In Brief (CCHIT Concept)
• Certified EHR Comprehensive [EHR-C]
– Rigorous certification of comprehensive EHR systems that significantly exceed
minimum Federal standards requirements
– For providers who seek maximal assurance of EHR compliance and
capabilities
• Certified EHR Module [EHR-M]
– Flexible certification of Federal standards compliance for EHR, HIE, eRx,
PHR, Registry and other EHR-related technologies
– For providers who prefer to integrate technologies from multiple certified
sources
• Certified EHR Site [EHR-S]
– Simplified, low cost certification of EHR technologies in use at a specific site
– For providers who self-develop or assemble EHRs from noncertified sources
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Source: “Town Call: New Paths to Certification ©CCHIT
Mapping Current CCHIT Programs to
the New Paths (CCHIT Concept)
• EHR-C
– Ambulatory and Inpatient EHRs
– Child Health, Cardiovascular, Enterprise add-on
• EHR-M
– Emergency Department, other specialties and settings under
development
– Stand-alone ePrescribing
– PHRs
– Health Information Exchanges
• EHR-S
– Ambulatory or Inpatient internally developed EHRs
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Source: “Town Call: New Paths to Certification ©CCHIT
OFFICE OF THE
NATIONAL
COORDINATOR
Jodi Daniel, JD, MPH
Director, Office of Policy & Research
Policy Activities
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Policy Activities
American Recovery and Reinvestment Act of
2009 (ARRA)
– Established two Federal Advisory Committees
– Requires the Secretary to promulgate regulations
related to the electronic exchange of health information.
– Provides incentives to eligible providers who are
meaningful users of certified EHRs.
• Two step process
– Added Privacy Protections
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Policy Activities
The Nationwide Privacy & Security
Framework for Electronic
Exchange of Individually
Identifiable Health Information
• Draft Model Personal Health
Record (PHR) Privacy Notice &
Facts-At-A-Glance
• Reassessing Your Security Practices in
a Health IT Environment: A Guide for
Small Health Care Practices
• HIPAA Privacy Rule Guidance
Related to the Privacy and Security
Framework and Health IT
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Policy Activities
Other Policy Areas
– NHIN
• DURSA development
• Consumer preferences
• Privacy and Security
– 501(c)(3) status for Health Information Organizations
– Anti-Fraud and health IT
– CLIA and the electronic exchange of laboratory data
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OFFICE OF THE
NATIONAL
COORDINATOR
John Glaser, PhD
Senior Advisor to the National Coordinator
Nationwide Health Information Network
Future Direction
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Nationwide Health Information Network
Future Direction
•
The NHIN is a set of conventions that provide the foundation to the
exchange of health information that supports meaningful use. The
foundation includes technical, policy, data use and service level
agreements and other requirements that enable data exchange,
whether between two different organizations across the street or
across the country.
•
The NHIN foundation supports both the local and nationwide
exchange of health information. The foundation does not
distinguish between the two.
•
Health information exchanged should be enabled for all clinical
information systems including at the edge systems (EHRs, PHRs,
etc.) (not quite sure of the definition of an edge system).
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Nationwide Health Information Network
Future Direction
• ONC will maintain overall responsibility for the
governance of the NHIN, the development and
management of the foundation and the demonstration
of new components of the foundation.
• ONC will identify an organization to assume
operational responsibility for CONNECT and the core
set of NHIN-wide infrastructure.
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OFFICE OF THE
NATIONAL
COORDINATOR
Kelly Cronin
Director, Office of Programs and Coordination
State Grants
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Section 3013: State Grants to
Promote HIT
• A program to facilitate and expand the electronic movement and use of health
information among organizations according to nationally recognized standards.
• Information exchange to improve the quality of health care is a requirement for the
meaningful EHR use incentives.
• Depending on maturity of efforts re: health information exchange, a state or state
designated entity will be eligible for either a Planning grant or an Implementation grant.
 Planning grants will assist states in developing a roadmap to implement statewide
health information exchange consistent with the meaningful EHR use criteria.
 Implementation grants will assist states with acting on approved roadmaps to
build statewide health information exchange capacity consistent with meaningful EHR
use criteria.
 Planning and implementation should be done in coordination with Medicaid to ensure
the direct relevance and support for meaningful use of EHRs.
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Planning and Implementation Grants
• Planning and Implementation grants should be pursued in the public interest and be
consistent with the National Coordinator’s plans.
–
Federal – State partnership is key!
• Funds shall be used to facilitate and expand HIE according to nationally recognized
standards and to:
–
Enhance broad and varied participation.
–
Assist in identifying state or local resources to support a nationwide effort.
–
Complement other federal grants and programs.
–
Provide technical assistance to overcome barriers to exchange.
–
Promote effective strategies to support exchange in underserved communities.
–
Assist patients in utilizing health information technology.
–
Encourage clinicians to utilize Regional Extension Centers for technical assistance.
–
Support public health agencies authorized use of and access to health information.
–
Promote use for quality improvement, including reporting on quality measures.
• The Secretary shall ensure continuous improvement based on annual evaluation and
implementation of lessons learned.
–
Funding will be tied to approaches that lead towards the greatest improvement in quality of
care, decrease in costs and the most effective authorized and secure HIE.
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Qualified State Designated Entities
(QSDE)
States may appoint a QSDE to carry out the work specified in Section
3013. A QSDE should meet the following criteria:
•Be designated by the state as eligible to receive awards.
•Be a not-for profit entity with broad stakeholder representation on its governing board.
•Demonstrate that one of its principal goals is to use information technology to improve
health care quality and efficiency through the authorized and secure electronic exchange
and use of health information.
•Adopt non-discrimination and conflict of interest policies that demonstrate a commitment
to open, fair and non-discriminatory participation by stakeholders.
A QSDE should consult with and consider the recommendations of:
•
Health care providers
•
Public health agencies
•
Health plans
•
Health professions schools
•
Patient or consumer organizations
•
Universities
•
HIT vendors
•
Clinical researchers
•
Health care purchasers/employers
•
Users such as clerical staff
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OFFICE OF THE
NATIONAL
COORDINATOR
Rachel Nelson, MHA
Special Assistant to the Deputy National Coordinator
Health Information Technology
Extension Program
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Health Information Technology
Extension Program
National Health Information Technology
Research Center (HITRC)
Regional Centers Offering Direct Technical
Assistance to Providers
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HITRC (National Research Center)
• Supports efforts to adopt, implement, and
effectively use health IT:
– Offers Technical Assistance &
Educational Resources
– Develops or recognizes best practices
• Incorporates input from Federal
agencies, health IT users, others as
appropriate
• Serves as resource and forum for
knowledge and best-practices exchange
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Regional Centers
Individualized technical assistance to providers seeking
to adopt and effectively use health IT to exchange
information within appropriate policy frameworks
Technical Assistance with product selection, workflow
changes toward achieving meaningful use – including
helping with provider in-house work to connect to health
information exchange infrastructure, and in effectively
leveraging electronic health information and health
information technology to improve quality of cares
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OFFICE OF THE
NATIONAL
COORDINATOR
Ginger Price
Program Director, Nationwide Health Information Network
Nationwide Health Information Network
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NHIN Architectural Principles
• Highly distributed: Patient health information is retained at the local
health information exchange level
• Local autonomy: Each HIE must make their own determinations
with respect to the release of patient information
• Focus only on inter-organizational health exchange: The NHIN
does not attempt to standardize implementations of the NHIN
services and interfaces, only the communications between HIEs
• Use public internet: The NHIN is not a separate physical network,
but a set of protocols and standards that run on the existing internet
infrastructure
• Platform neutral: The NHIN has adopted a stack (web services) that
can be implemented using many operating systems and
programming languages
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Nationwide Health Information Network
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Nationwide Health Information
Network Standards and Services
NHIN Profiles
Consumer Preferences Profile
• Store and exchange consumer preferences
for sharing of personal health information
Other Profiles in Development
• GIPSE (Biosurveillance)
Profiles describe how to
implement services for a
specific domain like
consumer preferences for
information sharing or
biosurveillance
NHIN Services
Discovery Services
• Subject Discovery
• Authorized Case Follow-up
• Query for Documents
•NHIE Service Registry
Information Exchange Services
• Retrieve Documents
• Query Audit Log
• Health Information Event Messaging
Messaging, Security and Privacy Foundation
Messaging
• Message Transport
• Services Definition
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Security
• Public Key Infrastructure
• Encryption
• Digital Signature
Authorization Framework
• Requestor Authentication
• Requestor Authorization
Services describe
specific interfaces (web
services) used between
HIEs to discover and
exchange health-related
information
Messaging, Security
and Privacy
Foundation describes
the underlying protocols
and capabilities
necessary to send and
secure messages
between NHIE
NHIN 2008 Results
“
However beautiful the strategy,
”
you should occasionally look at the results..
Sir Winston Churchill
• Demonstrated Technical Capability
• Created a Set of Initial Interoperable Specifications
• 20+ disparate organizations participating in the NHIN Cooperative
• Laid foundation for data usage agreements
• Completed Trial Implementations
• Started limited production pilots in 2009
We have the building blocks…
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NHIN Cooperative Participants
Private HIEs
CareSpark
Community Health Information
Collaborative
HealthLINC (Bloomington)
State-Level HIEs
Provider Orgs
/ IDNs
Federal
Entities
Delaware Health
Information Network
Cleveland
Clinic
CDC
New York eHealth Collaborative
Kaiser
CMS
HealthBridge
North Carolina Health Care
Information and Communications
Alliance (NCHICA)
Indiana
(Regenstrief Institute)
West Virginia Health Information
Network (WVHIN)
Long Beach Network for Health
Lovelace Clinic Foundation
(NMHIC)
MedVirginia
Wright State University
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DoD
IHS
NCI
NDMS
SAMHSA
SSA
VA
Lessons Learned from the NHIN
Trial Implementations
– More directed activities with shorten cycles for work products
• Created processes and teams like the Specifications Factory
– The testing tools must be matured and processes automated.
• Providing Reference Implementation and automated test tools and scripts
– Baseline the foundational services of the NHIN
• Need a stable platform that will not require retooling for 18 – 24 months
– Large IDNs and federal data are significant attractor for private Health
Information Exchange entities
• SSA, VA, Kaiser Permanente, DoD
– An executable DURSA is needed to avoid complexity of point to point.
• The Data Use and Reciprocal Support Agreement (DURSA) developed by the NHIN
DURSA Team and the ONC Office of Policy and Research recently entered Federal
clearance. The DURSA pragmatically addresses the agreements needed to
exchange health information on the NHIN under conditions that exist today.
– Need a governance structure for real health information to flow
• Governance includes strategic direction, representational oversight, and operating
policies and procedures, and enforcement mechanisms
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Demonstration Projects
• NHIN limited production pilots are critical to the success
of demonstrating how standards and specifications are
implemented as working operational solutions for health
information exchange.
• MedVirginia and SSA entered into the first limited
production pilot in February, 2009.
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SSA – MedVA Pilot Results
• Starting with one provider network (Bon Secours) in February
• Approximately 3200 SSA eligibility requests for Bon Secours last year
• In discussions with 4 more provider groups to come online in 2009
1000
900
800
700
600
Expected Disability Requests
500
NHIN Requests from SSA
400
MedVA Returned Documents
300
200
100
0
1
2
3
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4
5
6
7
8
9
10
11
12
13
14
weeks
Demonstration Projects
Other organizations planning to demonstrate health information
exchange later this year:
HealthBridge
Indiana Health Information Exchange
Kaiser Permanente
Department of Veterans Affairs
Department of Defense
Centers for Disease and Prevention
The next NHIN pilot project demonstrations
will include onboarding the pilot partners into
the NHIN trusted community, performing
conformance testing and interoperability
testing, issuing a digital certificate, and
adding them into the NHIN service registry.
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NHIN and CONNECT
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To learn more about the Nationwide
Health Information Network:
Go to http://www.healthit.hhs.gov
and look for:
Nationwide Health
Information Network
Interested?
We’d like to hear from
you at [email protected]
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CONNECT Seminar
Presentations are Available
for Download Online at
http://www.connectopensource.org
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