Presentation on theme: "What’s New in ONC? The Office of the National Coordinator for Health Information Technology Panel: Insight into Emerging Policy Copyright 2009. All Rights."— Presentation transcript:
1 What’s New in ONC?The Office of the National Coordinator for Health Information Technology Panel:Insight into Emerging PolicyCopyright All Rights Reserved.
2 AgendaVision 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 PriceCopyright All Rights Reserved.
3 John Glaser, PhD Senior Advisor to the National Coordinator OFFICE OF THE NATIONAL COORDINATORJohn Glaser, PhD Senior Advisor to the National CoordinatorVision for Meaningful UseSlides that follow are from a draft set of recommendations made by a Work Group of the HIT Policy Committee on June 16, 20093Copyright All Rights Reserved.Copyright All Rights Reserved.
4 Achievable Vision for 2015Prevention, and management, of chronic diseasesA million heart attacks and strokes preventedHeart disease no longer the leading cause of death in the USMedical errors50% fewer preventable medication errorsHealth disparitiesThe racial/ ethnic gap in diabetes control halvedCare coordinationPreventable hospitalizations and re-admissions cut by 50%Patients and familiesAll patients have access to their own health informationPatient preferences for end of life care are followed more oftenPublic healthAll health departments have real-time situational awareness of outbreaksCopyright All Rights Reserved.
5 HIT-Enabled Health Reform Achieving Meaningful Use 2009201120132015HIT-Enabled Health ReformMeaningful Use CriteriaHITECH Policies2011 Meaningful Use Criteria (Capture/share data)2013 Meaningful Use Criteria(Advanced care processes with decision support)2015 Meaningful Use Criteria (Improved Outcomes)Copyright All Rights Reserved.
6 Improve Quality, Safety, Efficiency 2011 Objectives Capture data in coded formatMaintain current problem listMaintain active medication listMaintain active medication allergy listRecord vital signs (height, weight, blood pressure)Incorporate lab/test results into EHRDocument key patient characteristics (race, ethnicity, gender, insurance type, primary language)Document progress note for each encounter (outpatient only)Use CPOE for all order typesUse electronic prescribing for permissible RxImplement drug-drug, drug-allergy, drug-formulary checksManage populationsGenerate list of patients by specific conditions (outpatient only)Send patient reminders per patient preferenceCopyright All Rights Reserved.
7 Improve Care Coordination 2011 Objectives Exchange key clinical information among providers of care Perform medication reconciliation at relevant encountersCopyright All Rights Reserved.
8 SummaryJourney to a transformed health system requires meaningful use of transformation-capable HITMigration of HIT readiness from current situation to fully HIT-enabled ecosystem will evolve over timeProposed MU criteria for 2011 and beyond provides escalating capabilities, balancing urgent need for reform and feasibility of what is achievableCopyright All Rights Reserved.
9 OFFICE OF THE NATIONAL COORDINATOR Carol Bean, PhD, MLS, MPH Acting Director, Office of Interoperability and StandardsStandards and Certification9Copyright All Rights Reserved.Copyright All Rights Reserved.
10 HHS Interoperability Standards “Recognized” in“Accepted” in January 2009EHR Laboratory Results Reporting (IS01)Biosurveillance (IS02)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)Medication Management (IS07)Personalized Healthcare (IS08)Consultations and Transfers of Care (IS09)Immunizations and Response Management (IS10)Public Health Case Reporting (IS11)Patient-Provider Secure Messaging (IS12)Remote Monitoring (IS77)Updates to IS02, IS03, IS04, IS05Copyright All Rights Reserved.
11 Eight Technology Priority Areas for HIT in ARRA Privacy and SecurityHIT InfrastructureCertified Health RecordDisclosure AuditImprove QualityIndividually Identifiable Health Information (IIHI) UnusableDemographic DataNeeds of VulnerableSource: John HalamkaCopyright All Rights Reserved.
12 Tiger Teams Focus Areas: Business Cases vs Use Cases A new EHR Centric Interoperability Specification to meet ARRA requirementsSecurity, Privacy & InfrastructureQuality MeasuresData Architecture (Element, Template, and Value Set)Exchange Architecture and Harmonization FrameworkClinical ResearchTiger Team membership 232 technical expertsSource: John HalamkaCopyright All Rights Reserved.HITSP – enabling healthcare interoperability
15 Jodi Daniel, JD, MPH Director, Office of Policy & Research OFFICE OF THE NATIONAL COORDINATORJodi Daniel, JD, MPH Director, Office of Policy & ResearchPolicy Activities15Copyright All Rights Reserved.Copyright All Rights Reserved.
16 American Recovery and Reinvestment Act of 2009 (ARRA) Policy ActivitiesAmerican Recovery and Reinvestment Act of (ARRA)Established two Federal Advisory CommitteesRequires 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 processAdded Privacy ProtectionsEstablished two Federal Advisory CommitteesHIT PolicyHIT StandardsRequires the Secretary to promulgate regulationsStandards, Certification Criteria, and Implementation SpecificationsTwo Step ProcessCertified EHR (which is also qualified) andMeaningful UseAdded Privacy ProtectionsIncreased HIPAA penaltiesAllows OCR to keep a portion of the recoveryApplies penalties to Business AssociatesBreach Notification16Copyright All Rights Reserved.Copyright All Rights Reserved.
17 Policy ActivitiesThe Nationwide Privacy & Security Framework for Electronic Exchange of Individually Identifiable Health InformationDraft Model Personal Health Record (PHR) Privacy Notice & Facts-At-A-GlanceReassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care PracticesHIPAA Privacy Rule Guidance Related to the Privacy and Security Framework and Health IT17Copyright All Rights Reserved.Copyright All Rights Reserved.
18 Other Policy Areas Policy Activities NHIN DURSA development Consumer preferencesPrivacy and Security501(c)(3) status for Health Information OrganizationsAnti-Fraud and health ITCLIA and the electronic exchange of laboratory dataOther Policy AreasNHINDURSA developmentMultiparty agreementAssumes participants in productionEstablishes authority for interim governanceDeveloped as part of ongoing NHIN activitiesFirst iteration was a Test Data DURSAApplies to “test data” (not PHI) for Trial ImplementationsExecuted by all participants in Trial Implementations in September 2008Production DURSAInitial draft Production DURSA – December 2008Revised draft for limited production – June 2009Initial version of production DURSA – limited production – January 2010Large, diverse multi-stakeholder team assembled to develop this agreement through a set of contracts and grants and with active engagement of Federal agencies.Consumer preferencesNHIN Cooperative is exploring technical capabilities to support consumer preferences, and permissions.Analysis under way to identify possible approaches for consumer preferences supported through the NHIN.Privacy and SecurityInformation is securely exchanged among participants in the NHIN – supported through the NHIN architecture and secure protocols.From a policy perspective – the NHIN Cooperative is working to establish a trust model that works within the current legal and policy framework, but that also enables and fosters health information exchange based on a nationwide basis. In addition, the NHIN Cooperative is developing:-A white paper that articulates how the NHIN addresses the 8 principles in the HHS Privacy and Security Framework-A set of NHIN participant security requirements – to identify the types of safeguards that participants agree to support as a condition of participating in the NHIN.501(c)(3) status for Health Information OrganizationsMedical Identity Theft/ Anti FraudCLIA guidance to allow for the electronic exchange of laboratory dataCopyright All Rights Reserved.
19 John Glaser, PhD Senior Advisor to the National Coordinator OFFICE OF THE NATIONAL COORDINATORJohn Glaser, PhD Senior Advisor to the National CoordinatorNationwide Health Information Network Future Direction19Copyright All Rights Reserved.Copyright All Rights Reserved.
20 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).Copyright All Rights Reserved.
21 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.Copyright All Rights Reserved.
22 Kelly Cronin Director, Office of Programs and Coordination OFFICE OF THE NATIONAL COORDINATORKelly Cronin Director, Office of Programs and CoordinationState Grants22Copyright All Rights Reserved.Copyright All Rights Reserved.
23 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.ONC intends to award grants to all states and territories that submit qualified applications.The program is in support of MU and they’ll be an expectation that HIE capacity will be developed overtime to enable information exchange among eligible professionals and providers in a way that qualifies them for Medicare and Medicaid meaningful use incentives.This makes coordination across the State grant and Medicaid programs at the state and federal level critical to success.Copyright All Rights Reserved.
24 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.Copyright All Rights Reserved.
25 Qualified State Designated Entities (QSDE) States may appoint a QSDE to carry out the work specified in Section 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 providersHealth plansPatient or consumer organizationsHIT vendorsHealth care purchasers/employersPublic health agenciesHealth professions schoolsUniversitiesClinical researchersUsers such as clerical staffCopyright All Rights Reserved.
26 OFFICE OF THE NATIONAL COORDINATOR Rachel Nelson, MHA Special Assistant to the Deputy National CoordinatorHealth Information Technology Extension Program26Copyright All Rights Reserved.Copyright All Rights Reserved.
27 Health Information Technology Extension Program National Health Information Technology Research Center (HITRC) Regional Centers Offering Direct Technical Assistance to ProvidersCopyright All Rights Reserved.
28 HITRC (National Research Center) Supports efforts to adopt, implement, and effectively use health IT:Offers Technical Assistance & Educational ResourcesDevelops or recognizes best practicesIncorporates input from Federal agencies, health IT users, others as appropriateServes as resource and forum for knowledge and best-practices exchangeCopyright All Rights Reserved.
29 Regional CentersIndividualized 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 caresCopyright All Rights Reserved.
30 Ginger Price Program Director, Nationwide Health Information Network OFFICE OF THE NATIONAL COORDINATORGinger Price Program Director, Nationwide Health Information NetworkNationwide Health Information Network30Copyright All Rights Reserved.Copyright All Rights Reserved.
31 The Nationwide Health Information Network NHINRHIOs and HIEsPersonal Health RecordsFederal AgenciesIntegrated Delivery NetworksCommunity Health CentersRegistries and RepositoriesThe Nationwide Health Information NetworkThe NHIN provides:Common legal framework for information sharingCommon infrastructure necessary for network security and connectivitySpecifications for interoperable servicesCopyright All Rights Reserved.
32 NHIN Architectural Principles Highly distributed: Patient health information is retained at the local health information exchange levelLocal autonomy: Each HIE must make their own determinations with respect to the release of patient informationFocus only on inter-organizational health exchange: The NHIN does not attempt to standardize implementations of the NHIN services and interfaces, only the communications between HIEsUse public internet: The NHIN is not a separate physical network, but a set of protocols and standards that run on the existing internet infrastructurePlatform neutral: The NHIN has adopted a stack (web services) that can be implemented using many operating systems and programming languagesCopyright All Rights Reserved.
33 Nationwide Health Information Network Copyright All Rights Reserved.33
34 Nationwide Health Information Network Standards and Services Messaging, Security and Privacy FoundationNHIN ServicesNHIN ProfilesMessagingMessage TransportServices DefinitionSecurityPublic Key InfrastructureEncryptionDigital SignatureAuthorization FrameworkRequestor AuthenticationRequestor AuthorizationDiscovery ServicesSubject DiscoveryAuthorized Case Follow-upQuery for DocumentsNHIE Service RegistryInformation Exchange ServicesRetrieve DocumentsQuery Audit LogHealth Information Event MessagingConsumer Preferences ProfileStore and exchange consumer preferences for sharing of personal health informationOther Profiles in DevelopmentGIPSE (Biosurveillance)Profiles describe how to implement services for a specific domain like consumer preferences for information sharing or biosurveillance 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 NHIECopyright All Rights Reserved.
35 “ ” NHIN 2008 Results However beautiful the strategy, you should occasionally look at the results..Sir Winston ChurchillDemonstrated Technical CapabilityCreated a Set of Initial Interoperable Specifications20+ disparate organizations participating in the NHIN CooperativeLaid foundation for data usage agreementsCompleted Trial ImplementationsStarted limited production pilots in 2009We have the building blocks….Copyright All Rights Reserved.35
36 NHIN Cooperative Participants Private HIEsState-Level HIEsProvider Orgs / IDNsFederalEntitiesCareSparkDelaware Health Information NetworkCleveland ClinicCDCCommunity Health Information CollaborativeNew York eHealth CollaborativeKaiserCMSHealthLINC (Bloomington)North Carolina Health Care Information and Communications Alliance (NCHICA)DoDHealthBridgeIHSIndiana(Regenstrief Institute)West Virginia Health Information Network (WVHIN)NCILong Beach Network for HealthNDMSLovelace Clinic Foundation (NMHIC)SAMHSAMedVirginiaSSAWright State UniversityVACopyright All Rights Reserved.
37 Lessons Learned from the NHIN Trial Implementations More directed activities with shorten cycles for work productsCreated processes and teams like the Specifications FactoryThe testing tools must be matured and processes automated.Providing Reference Implementation and automated test tools and scriptsBaseline the foundational services of the NHINNeed a stable platform that will not require retooling for 18 – 24 monthsLarge IDNs and federal data are significant attractor for private Health Information Exchange entitiesSSA, VA, Kaiser Permanente, DoDAn 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 flowGovernance includes strategic direction, representational oversight, and operating policies and procedures, and enforcement mechanismsCopyright All Rights Reserved.
38 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.Copyright All Rights Reserved.
39 SSA – MedVA Pilot Results weeksCurrently processing approximately 75% of predicted loadStarting with one provider network (Bon Secours) in FebruaryApproximately 3200 SSA eligibility requests for Bon Secours last yearIn discussions with 4 more provider groups to come online in 2009Copyright All Rights Reserved.
40 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 PreventionThe 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.Copyright All Rights Reserved.