The Health eDecisions Initiative Launch June 6 th, 2012

Agenda Opening Remarks - Jacob Reider, MD, Acting Chief Medical Officer, ONC The Standards & Interoperability Framework - Doug Fridsma, MD, PhD Director, Office of Standards and Technology, ONC Initiative Introduction - Initiative Coordinator, Tonya Hongsermeier, MD, Principal Informatician for Clinical Informatics Research and Development, Partners Healthcare System Co-Coordinator, Bryn Rhodes, Software Architect – Veracity Solutions Co-Coordinator, Aziz Boxwala, Principal Consultant – Meliorix, Inc. History of Health eDecisions Problem: Inability to share/import CDS interventions Accomplishments of CDS intervention sharing research to date Health eDecisions Initiative Next Steps/Call for Participation Questions Resources 2

Office of Standards and Technology(OST) Promote compliance with validated information exchange standards, services and policies to assure interoperability between validated systems 3

Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: 4 Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services S&I Framework Overview

5 ONC Programs & Grantees Community S&I Framework FACAs SDOs State HIE Program & CoPs SHARP Program REC Program & CoPs Beacon Program Technology Vendors System Integrators Government Agencies Industry Associations Other Experts HL7 IHE CDISC NCPDP ASC X12 ASTM WEDI HIT Standards Committee HIT Policy Committee Tiger Team ISO/TC 215 IHTSDO NLM NQF Regenstrief Other health IT standards related organizations S&I Framework Coordination

S&I Framework Lifecycle Our Mission Promote a sustainable ecosystem that drives increasing interoperability and standards adoption Create a collaborative, coordinated, incremental standards process that is led by the industry in solving real world problems Leverage “government as a platform” – provide tools, coordination, and harmonization that will support interested parties as they develop solutions to interoperability and standards adoption. 6 Tools and Services Use Case Development and Functional Requirements Standards Development Support Standards Development Support Certification and Testing Harmonization of Core Concepts Implementation Specifications Pilot Demonstration Projects Reference Implementation Architecture Refinement and Management

S&I Framework Phases PhasePlanned Activities Pre-Discovery  Development of Initiative Synopsis  Development of Initiative Charter  Definition of Goals & Initiative Outcomes Discovery  Creation/Validation of Use Cases, User Stories & Functional Requirements  Identification of interoperability gaps, barriers, obstacles and costs  Review of Vocabulary Implementation  Creation of aligned specification  Documentation of relevant specifications and reference implementations such as guides, design documents, etc.  Validation of Vocabulary  Development of testing tools and reference implementation tools Pilot  Validation of aligned specifications, testing tools, and reference implementation tools  Revision of documentation and tools Evaluation  Measurement of initiative success against goals and outcomes  Identification of best practices and lessons learned from pilots for wider scale deployment  Identification of hard and soft policy tools that could be considered for wider scale deployments 7

8 Barriers exist to the adoption and implementation of Clinical Decision Support –despite research demonstrating effectiveness in improving quality and safety Lack of widely accepted, implementable standards –for importing and/or sharing proven CDS interventions (reminders, order sets, documentation templates) ONC and AHRQ have invested –in multiple research projects such as GLIDES, CDSC, ACDS and eRecs to advance CDS implementation, sharing and adoption At the April 2012 Face 2 Face Meeting, –stakeholders gathered from across the vendor, academic, and healthcare communities to discuss how to advance the shareability of CDS interventions and build on the research and existing standards to date Health eDecisions - a brief history

Goal Scenarios for sharing CDS interventions At the April 2012 Face 2 Face Meeting two use cases were identified 1.Vendor or user downloads importable CDS interventions from an external source into their local EHR for deployment 2.An EHR is able to send patient data to a CDS service, receive CDS interventions recommendations back, and insert those interventions into the desired relevant workflow 9

Content suppliers and EHR/PHR vendors all have proprietary formats and methods for exchanging, implementing, life-cycle managing, and executing CDS interventions Each content supplier-EHR/PHR vendor integration for CDS exchange is unique No widely accepted/adopted standards for exchange or services insertion Even within a vendor, clients cannot always exchange content with each other Healthcare systems with successful implementation of CDS are unable to share their proven interventions with others in an importable format, even if they wished to Current state of CDS sharing 10

Relevant Standards and Outstanding Work Identified at the April 2012 Face to Face Meeting (starting point) For more details and information on the meeting above please see the Health eDecisions Reference Wiki Face 2 Face Meeting Minutes:

Sharing CDS interventions is now the Health eDecisions Initiative With these scenarios and relevant standards in mind, broader stakeholder involvement and contribution is needed The ONC has enlisted the help of the S&I Framework to create a forum for this work CDS has now become the Health eDecisions Initiative –The Health eDecisions Initiative will take advantage of the collaborative tools, processes and community members within the S&I Framework to further our objectives 12

Initiative Coordinator: Tonya Hongsermeier, MD, Principal Informatician for Clinical Informatics Research and Development - Partners Healthcare System Co-Coordinators: Bryn Rhodes, Software Architect –Veracity Solutions Aziz Boxwala, Principal Consultant – Meliorix, Inc. ONC Sponsors: Jacob Reider, MD, Acting Chief Medical Officer - ONC Alicia A. Morton, DNP, RN-BC, CDS Lead - ONC Support Team –Jamie Parker and Jennifer Brush – Project Management –Heather Stevens and Emily Mitchell – Use Case Support –Apurva Dharia – S&I Administrative Support Health eDecisions Initiative Team 13

Health eDecisions Project Charter Challenge 14 ‘‘The term ‘clinical decision support intervention’ align[s] with, and clearly allow[s] for, the variety of decision support mechanisms available that help improve clinical performance and outcomes. A CDS intervention is not simply an alert, notification, or explicit care suggestion. Rather, it should be more broadly interpreted as the user facing representation of evidence-based clinical guidance. Our goal in clarifying the nomenclature is to focus more on the representation of the guidance (the CDS intervention) that the EHR technology should offer to the user rather than prescribe the form of either the logical representation of the clinical guidance or how the intervention interacts with the user.” 45 C.F.R. § (a)(8) (2012) Effective Clinical Decision Support requires availability of computable biomedical knowledge, person-specific data, and a reasoning or inference mechanism that combines these elements to generate and present helpful information to clinicians, patients or caregivers in the right way – and the right time. In order to recognize these benefits, CDS interventions must be made more easily shareable so that anyone can easily acquire and deploy CDS interventions. To this end, standards must be advanced to enable either the consumption of CDS via a web service or the import of CDS interventions into CDS systems

Health eDecisions Project Charter Scope and Value Statements Scope Statement: To define standards that facilitate the emergence of systems and services whereby CDS interventions can be shared or accessed by any healthcare stakeholder via an importable format or via a CDS web service Value Statement: Health information technologies designed to improve clinical decision making are particularly attractive for their ability to address the growing information overload clinicians face and to provide a platform for rapidly incorporating evidence based knowledge into care delivery. Standardized expressions of Clinical Decision Support have a number of important benefits including: Increased quality of care and enhanced health outcomes Avoidance of errors and adverse events Improved efficiency, cost benefit, and provider and patient satisfaction Reduced latency from new clinical knowledge and evidence-based guidelines to incorporation in clinical practice Focusing the S&I Framework community on Clinical Decision Support through the Health eDecisions Initiative will enable the translation of interventions into implementable components, increasing the speed and ease of adoption by the provider community 15

Health eDecisions Project Charter Outcomes Repositories from which interventions can be “selected” for use in an EHR –Each intervention will represent a standardized expression of the clinical guideline that can be accessed by EHR system developers and users to simplify the process of incorporating clinical guidelines into EHRs Clinical Decision Support Services can interact with EHRs and/or other Health Information Technology implementations Alignment with other S&I Initiatives i.e. Query Health (HQMF) 16

Health eDecisions Project Charter Proposed Timeline Phase I: Pre-Discovery (In Progress) Phase II: CDSIF development (Early Summer through Fall 2012) Use Case Development Confirmation of Candidate Standards Pilots of the prototype CDSIF SDO Prep Phase IIIa: SDO ballot preparation (Mid/Late Fall 2012) Phase IIIb: SDO balloting (Winter 2013) Comment review and reconciliation Phase IV: Conduct pilots (Winter - Spring 2013) Finalize pilots, final SDO recommendations (Late Spring ) 17

Health eDecisions Project Charter Deliverables Use Case and Functional Requirements List of Relevant Standards Standards Support and Coordination Plan Implementation Guidance Pilot applications, plans and lessons learned 18

We will be meeting as a community every week on Thursdays This will be a 90 minute meeting Proposed Times: 11:00-12:30 EST 11:30-1:00 EST 12:00-1:30 EST 12:30-2:00 EST All Announcements, Meeting Schedules, Agendas, Minutes, Reference Materials, Use Case, Project Charter and General Health eDecisions information will be posted on the Health eDecisions Wiki page Logistics 19

Health eDecisions Wiki Home Page 20 Health eDecisions Wiki Page Join us for our next Work Group Meeting June 14 th, 2012 See the wiki page for the meeting updates

The ONC Health eDecisions Initiative is open for anyone to join This community will meet frequently by webinar and teleconference We use Wiki pages to facilitate discussion. Information on how to join the Community can be found on the Health eDecisions Sign Up Wiki: In order to ensure the success of our initiative and the subsequent pilot, we encourage broad and diverse participation from the community. This is your chance to have an impact on the creation and implementation of a pilot program in this important area of health IT development 21 Next Steps…

Please comment on the Proposed Project Charter Review the Project Charter: Complete the Health eDecisions Project Charter Comment Form: Join us for our next meeting June 14 th, 2012 The time and meeting information will be available on the Health eDecisions Wiki page: Details on the Health eDecisions launch including web meeting access and call in information are posted on the wiki : Next Steps cont.… 22

Questions and Open Discussion 23

24 Resources