1. Draft – discussion only Advanced Health Models and Meaningful Use Workgroup February 17, 2015 Paul Tang, chair Joe Kimura, co-chair

2. Overview I.Introduction and Context for Roadmap Charge II.Charge and Overview of Use Cases in the Roadmap III.Draft Prioritization Process and Timeline IV.Draft Criteria for Prioritization Process V.Next Steps 2

3. 3 INTRODUCTION AND CONTEXT FOR ROADMAP CHARGE

4. 4 CHARGE AND OVERVIEW OF USE CASES IN THE ROADMAP

5. Purpose Of Use Cases & Prioritization The ultimate goal of this charge is to have a repeatable process that identifies the priority use cases that would have the greatest impact on triple aim goals of better care, healthier people/communities, and more affordable care. ONC has asked the Advanced Health Models Workgroup to: Make a recommendation on a repeatable process for the prioritization of use cases. Test that process and prioritize the use cases featured in the Appendix H of the Roadmap in order to: – Test to process to see if it works and is repeatable – Come up with a preliminary set of prioritized uses cases – Inform the Interoperability Roadmap Recommend a set of actors who should be involved in the prioritization process and in maintaining the list of priority uses cases. 5

6. Roadmap Use Cases Overview A use case is a descriptive statement that defines a scope (or boundary), interactions (or relationships) and specific roles played by actors (or stakeholders) to achieve a goal. The methodology is commonly used to support the identification of requirements and is a simple way to describe the functionalities or needs of an organization. Roadmap Appendix H provides a list of the priority use cases for nationwide interoperability most commonly submitted to ONC by federal, and other public and private stakeholders prior to release of the draft Roadmap. A defined process should help refine and prioritize this list of use cases to inform priorities for the development of technical standards, policies and implementation specifications. 6

7. Roadmap Actions Related to Use Cases 7 Table 1: Critical Actions for a Coordinated Governance Framework and Process for Nationwide Health Information Interoperability A1. Establishment of Coordinated Governance 3. Call to action: Public and private sector stakeholders across the ecosystem should come together to establish a single coordinated governance process to establish more detailed policies regarding business practices, including policies for identifying and addressing bad actors and to identify the technical standards that will enable interoperability for specific use cases A3. Standards1. The coordinated governance process should support three main functions related to technical standards: prioritization of use cases for which standards are needed, selection of standards to support priority use cases based on ONC's Interoperability Advisories and coordination across SDOs and implementers as standards are developed and refined Table 4: Critical Actions for Care Providers Partner with Individuals to Deliver High Value Care D2. Providers embrace a Culture of Interoperability and work with vendors and other supporting entities to improve interoperability 8. Call to action: Providers and their organizations should work with necessary parties to configure systems so that the presentation of information to providers is configurable based on use case, provider specialty and other characteristics, to facilitate usability and patient safety. Table 10: Critical Actions for Consistent Data Formats and Semantics J1. Common, list of interoperability standards 2. Technology vendors, certification programs and governing bodies should use ONC’s list of the best available standards when making decisions about the standards they will use to enable specific use cases. J2. Architecture in support of standards activities Through coordinated governance, public and private stakeholders will 1. Establish and maintain a prioritized set of use cases and associated functional requirements for delivery system reform and a learning health system 3. Define a necessary set standards activities that support the prioritized use cases and functional requirements and the agreed upon architecture J4. Vocabulary approach2. Health IT developers will provide accurate translation and adapter services where needed in order to support priority learning health system use cases J6. New standards that support new and evolving requirements and priorities 1. Through coordinated governance, public and private stakeholders will advance the development and maintenance of data format and vocabulary standards and implementation guidance necessary to support priority learning health system use cases

8. 8 DRAFT PRIORITIZATION PROCESS AND TIMELINE

9. Prioritization Process - DRAFT 1. Define Draft Process & Select Criteria 2. Subgroups create priority groupings 3. Define Process, Categorize & Prioritize 4. Recommend to HITPC 5. Sequence use case related standards activities 9 1.Define Draft Prioritization Process 2.Categorize Use Cases 3.Confirm Criteria for process, (e.g. Impact, Timing of Need, Readiness) 4.Assign use case categories to sub- workgroups for prioritization 1.Full WG reviews process, criteria, etc. and defines final replicable process for prioritization 2.WG discusses high priority use cases in each category and determines final prioritized list to illustrate process AHM co-chairs to brief HITPC on prioritization process and share preliminary set of priority use cases Feb 17, 2015 Mar 17 Apr 7, 2015 (HITPC) Work with HITSC to assess general feasibility and/or readiness of standards that support the priority use cases This will inform future priority setting for standards work (aka low hanging fruit or priority areas that need significant work/progress) May 2015 beyond (future scope of work) 1.Category- specific workgroups conduct dedicated calls for relevant use cases 2.Each subgroup determines low/medium/hi gh priority groupings for their use cases Feb 17, 2015 to Feb 27, 2015

10. 10 DRAFT CRITERIA FOR PRIORITIZATION PROCESS

11. Define Categories & Organize Use Cases by Category (Draft) 1.Public Health/Research 2.Community/Population Health 3.Consumer 4.Payer 5.Provider 11

12. Prioritization Criteria - DRAFT 12 I. Impact. Consider how important the use case is to make progress on key national priorities (e.g. on triple aim goals and related National Quality Strategy Priorities). Triple Aim Goals 1.Better Care 2.Healthy People/Healthy Communities 3.Affordable Care National Quality Strategy Priorities 1.Safety. Making care safer by reducing harm caused in the delivery of care 2.Patient Engagement. Ensuring that each person and family is engaged as partners in their care. 3.Care Coordination. Promoting effective communication and coordination of care. 4.Prevention. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease 5.Community. Working with communities to promote wide use of best practices to enable healthy living. 6.Affordable. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models. II. Timing of Need. Consider the timeframe in which the use case is needed to support key national goals. HHS Goals Better care, Smarter spending, Healthier people HHS Delivery System Reform Goals 30% of Medicare payments through alt. payment models by 2016, 50% by 2018 90% of FFS payments linked to quality and value by 2018 Interoperability Roadmap 2015 – 2017 - 3 Year: Send, receive find and use common clinical data set 2018 – 2020 - 6 Year: Expand interoperability and HIT users to improve health and lower cost 2021 – 2024 – 10 year: Achieve a nationwide learning health system III. Current Readiness. Considers whether currently available standards AND policies exist and are mature enough to support the use case. 12

13. DRAFT Framework for Prioritizing Use Cases to inform priorities for policy and standards work 13 Readiness Impact/Value of Use Case Prioritized Use Cases A.Use Case A B.Use Case B C.Use Case C D.… Low hanging fruit Gap in Policies or Standards Which use cases would be most impactful on triple aim goals? Priorities for policy and standards work

14. Impact Based Criteria Triple Aim Goals: Better Care, Healthier People, Affordable Care Timing CriteriaPriority Grouping Use Cases 1. Safety 2. Patient Engagement 3. Care Coordination 4. Prevention 5. Community 6. Affordable 7. DSR Goals 8. Roadmap Goals A+-+----+High B---+---+Medium C+-+-++++Low D---+---+ E+-+-+++-High F-+++---- Example of use case impact dashboard 14

15. 15 QUESTIONS and NEXT STEPS – Assignment for Subgroups and Subgroup Leads – Instructions and Template