1. Health IT standards, interoperability & exchange of health information Joseph W. Grubbs, Ph.D. VP & Chief Information Architect Binary Structures Corporation

2. Presentation agenda  Highlight business drivers of health IT standards, interoperability and health information exchange  Identify federal enabling legislation, agencies and programs framing the health IT agenda  Establish the purpose of health IT standards and how they support health information exchange  Provide an overview of the Commonwealth of Virginia’s adoption of health IT standards  Questions

3. Business drivers of health IT standards, interoperability & health information exchange  Patient access – Allow patients to become informed “co-producers” of their health and well-being  Enhanced care – Enable real-time collaboration among providers to foster high-quality health care  Quality improvement – Support health research and advances in clinical care and technology  Greater efficiency – Prevent fraud and reduce waste in legacy health record systems

4. Moving from this…

5. To this…

6. Federal enabling legislation  American Recovery and Reinvestment Act (Pub.L. 111–5)  Title XIII. Health Information Technology for Economic and Clinical Health (HITECH) Act  Patient Protection and Affordable Care Act (Pub.L. 111-148)  Medicaid IT Architecture (MITA) Framework 3.0

7. Federal agencies and programs  Centers for Medicare and Medicaid Services (CMS)  MITA framework  EHR incentives  Meaningful use standards/attestation  Office of the National Coordinator (ONC) for Health IT, U.S. Dept. of Health & Human Services  Meaningful use guidance  EHR certification program  Federal health IT strategic plan

8. Health information sharing Source: http://www.harrisonhealthlink.com/img/shared ata.jpg http://www.harrisonhealthlink.com/img/shared ata.jpg

9. Health IT standards for exchange  Provide an architecture, vocabulary and shared terminology for the exchange of health information across disparate systems  Developed, “balloted” and implemented by health care professionals to ensure relevance and usability in practice  Promulgated, published and maintained by independent standards development organizations (SDOs) for global adoption

10. Primary health IT standards  Health Level 7 (HL7) Clinical Document Architecture – XML-based code standard for structuring clinical documents  Logical Observation Identifiers Names and Codes (LOINC) – Standardized database of laboratory codes and observations  Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) – Systematically organized medical terminology and codes  ASC X12 (ANSI) – Standards for health care (payer) claims and payments

11. SDO harmonization efforts Source: http://library.ahima.org/xpedio/groups/public/documents/graphic/b ok1_043987.jpg http://library.ahima.org/xpedio/groups/public/documents/graphic/b ok1_043987.jpg

12. Health IT standardization in Virginia  Virginia’s Health Information Technology Standards Advisory Committee (HITSAC)  § 2.2-2699.7, Code of Virginia  Advises the CIO of the Commonwealth and the Secretaries of Technology and Health & Human Resources on health IT standards and technology  To date, advocated adoption of 125 health IT standards, including  Health Level 7 (HL7) Clinical Document Architecture  Logical Observation Identifiers Names and Codes (LOINC)  Systematized Nomenclature of Medicine (SNOMED)  ASC X12 for health claims and payments

13. HITSAC has “raised the standard”  Commonwealth of Virginia’s Enterprise Information Architecture (EIA) Strategy  Commonwealth Data Standardization Final Plan (Item 427, 2012 & 2013 Appropriation Acts)  Standardization of all “citizen-centric” data  Adoption of standards for other enterprise data  National Information Exchange Model (NIEM) across domains of state government  Cross Sector Digital Identity Initiative (CSDII)/ National Strategy for Trusted Identities in Cyberspace (NSTIC) – E-authentication and identity management for patient and provider access

14. Questions? Joseph W. Grubbs, Ph.D., VP & Chief Information Architect Binary Structures Corporation +1.804.467.7729 joeg@binarystructures.com