1. Office of Science & Technology
Enable stakeholders to come up with simple, shared solutions to common information exchange challenges
Curate a portfolio of standards, services, and policies that accelerate information exchange
Teams convened to solve problems
Solutions & Usability
Coordinate Federal Partners
R&D
I like to describe OST’s work as four-fold.
OST ENABLES stakeholders to come up with simple, shared solutions to common info exchange challenges through the S&I Framework. Rather than prescribing standards and specifications to the health IT community, ONC is asking the health IT community WHAT challenges need to be addressed, and then provides stakeholders with the administration and support they need in order to develop and harmonize standards and specifications. As an open government initiative, any interested stakeholder is welcome to participate and help create solutions.
Secondly, OST curates a portfolio of standards, services and policies that accelerate interoperability and health information exchange. These “building blocks” can be utilized to enable a wide range of uses and use cases for health information exchange.
Third, OST supports Innovation through its Innovation Challenge Grants program and the Strategic Health IT Advanced Research Projects (SHARP) program. OST is also responsible for interfacing with the international health IT community to share and leverage best practices from all around the world.
Finally, OST manages the Federal Health Architecture (FHA) program, an e-gov initiative designed to help federal agencies coordinate federal health IT priorities.
Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture
Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community

2. ONC’s Interoperability Strategy
Leverage government as a platform for innovation to create conditions of interoperability
Health information exchange is not one-size-fits-all; create a portfolio of solutions that support all uses and users
Build in incremental steps – “don’t let the perfect be the enemy of the good”
ONC’s strategy for standards development and interoperability is three-fold:
Do what government does best – use our powers of convening to help bring together members of the health IT community to prioritize and develop solutions to common health IT challenges. Rather than doing what we THINK is right – gather the community and have them TELL us what is right.
We need to make sure we are creating a portfolio of solutions, because different health IT users will have different uses and needs for interoperable health information exchange. Make sure that all interests are considered.
Finally, don’t let the perfect be the enemy of the good…we have to build incrementally or we will never get anywhere!

3. What is the S&I Framework?
The Standards and Interoperability (S&I) Framework represents one investment and approach adopted by the Office of Science & Technology (OST) to fulfill its charge of prescribing health IT standards and specifications to support national health outcomes and healthcare priorities
The S&I Framework is an example of “government as a platform”– enabled by integrated functions, processes, and tools – for the open community* of implementers and experts to work together to standardize
* As of April 2012, people had registered on the S&I Framework wiki, and 450+ people representing 300+ organizations had committed to the S&I Framework

4. Why the S&I Framework Approach?
Create a collaborative, coordinated incremental standards process,
Guided by ONC, with input from Federal Advisory Committees,
Enabled and led by the an open community of industry participants who are interested in solving real world problems
Value created through this approach:
Solve real-world issues to enable health information exchange
Harness the expertise and passion of the community to solve problems
Empower the community to create the best solutions for interoperability and standards adoption

5. ONC’s Interoperability Portfolio
Vocabulary & Code Sets
How should well-defined values be coded so that they are universally understood?
Content Structure
How should the message be formatted so that it is computable?
Transport
How does the message move from A to B?
Security
How do we ensure that messages are secure and private?
Services
How do health information exchange participants find each other?

6. S&I Initiative Portfolio Snapshot
Pre-Discovery
Use Case
Harmonization
RI, Test & Pilot
Evaluation
Direct Project
(S&I Archetype)
Transitions of Care
Balloted
Lab Results Interface
Balloted
Query Health
Provider
Directories
Data Segmentation for Privacy
Public Health Reporting
This snapshot describes the various initiatives that are currently in process as part of the S&I Framework and details their progress.
esMD
Longitudinal Coordination of Care
Laboratory Orders Interface
Health eDecisions
Automate Blue Button (ABBI)

7. S&I Framework Updates SDO Activities
IG’s for LRI and ToC successfully balloted
HQMF V2 under ballot
Initiatives in Progress
esMD
LOI/eDOS
Query Health (Pilots)
Longitudinal Care Coordination
PHRI
Initiatives Completed
ToC
LRI
Provider Directory
Support Activities:
Test data generation activities for MU2
CCDA Guide for BEACONS 7

8. Office of Science & Technology
Enable stakeholders to come up with simple, shared solutions to common information exchange challenges
Curate a portfolio of standards, services, and policies that accelerate information exchange
Teams convened to solve problems
Solutions & Usability
Coordinate Federal Partners
R&D
Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture
Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community

9. Nationwide Health Information Network
A portfolio of services, standards and policies that enable secure health information exchange over the Internet.

10. eHealth Exchange Strategic Road Map
Initial Rollout
(2009 – 2011)
Mature, Grow, Scale
Sustainability
2014
Phase 1
Phase 2
Phase 3
Early adopters
Federal business cases
Shared infrastructure
Early lessons learned
Success / viability
ONC program pilot concludes
Production ramps up
Transition to public-private model
Grow participation and transactions
Refine and scale
Expand value cases
Align with NwHIN governance
Implement sustainability model
Continued growth in participant and transactions
Revenue model sustains operations
Nationwide deployment
Interoperable exchange among private entities

11. Office of Science & Technology
Enable stakeholders to come up with simple, shared solutions to common information exchange challenges
Curate a portfolio of standards, services, and policies that accelerate information exchange
Teams convened to solve problems
Solutions & Usability
Coordinate Federal Partners
R&D
OST ENABLES stakeholders to come up with simple, shared solutions to common info exchange challenges through the S&I Framework. Rather than prescribing standards and specifications to the health IT community, ONC is asking the health IT community WHAT challenges need to be addressed, and then provides stakeholders with the administration and support they need in order to develop and harmonize standards and specifications. As an open government initiative, any interested stakeholder is welcome to participate and help create solutions.
Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community
Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture

12. Investing in Innovation (i2)
ONC’s Challenges and Prizes program spurring private-sector innovation and engaging developers to address health problems that touch every person in America:
Care Transitions
Cancer Research
Heart Disease
Population Health
Sexual Abuse
Disabilities
Over 100 new applications developed
Winners have received $195,000 in prizes
Over 25 new challenges planned

13. SHARP – Strategic Health IT Advanced Research Projects
Automated complex decisions around health record exchange, assuring regulation compliance
Security of Health IT - Innovations in security and privacy required to build public trust in health IT systems
Developed techniques to analyze health records access logs to catch policy violations
Patient-Centered Cognitive Support – Innovations in health IT usability and clinical decision support
Piloted Rapid Usability Assessment Protocol for EHRs
Comparing usability across EHR systems via Usability Lab 13

14. SHARP – Strategic Health IT Advanced Research Projects
Healthcare Applications – New health IT architectures enabling substitutable applications
Created SMART platform – a test-bed for the substitutable app development
SMART-enabled i2b2, a data analytics platform, and Indivo, a PHR
Secondary Use of EHR Data – Enabling exchange through creating tools, services for large-scale data sharing
Conversion and normalization of lab messages & medication orders
Extraction of medication from narrative clinical documents

15. Office of Science & Technology
Enable stakeholders to come up with simple, shared solutions to common information exchange challenges
Curate a portfolio of standards, services, and policies that accelerate information exchange
Teams convened to solve problems
Solutions & Usability
Coordinate Federal Partners
R&D
Support Innovation through SHARP program, Innovation/Challenge Grants, and interfacing with international Standards community
Collaborate with federal agencies to coordinate federal health IT priorities as manager of Federal Health Architecture

16. Federal Health Architecture: Advancing National Health IT
FHA in 2012: Strategy and Architecture
New Governance
More strategic alignment within and across Federal partner agencies
Greater transparency and enhanced communications
Commitment to fulfilling original intent of FHA as E-Gov Line of Business
Strategy Planning
FHA Strategic Plan nearing completion
FHA Line of business (LoB) Service Plan delivered to OMB
Interoperability Architecture
Identify current and planned data exchanges among Federal agencies and partners
Develop FHA public-facing portal
Align with standards harmonization efforts (e.g. Standards and Interoperability Framework)
Demonstrate exchange methods beyond Direct and SOA – RHEx pilots 16

17. Federal Health Architecture: Advancing National Health IT
FHA in 2012: Innovations
CONNECT Open Source
CONNECT code on GitHub, sprint sessions open
Engaging open source community through code-a-thons, encouraging code contributions
Developing CONNECT 4.0, incorporating Direct specifications
RESTful Health Exchange (RHEx)
Two pilots
TATRC
HealthInfoNet 17

18. The CONNECT Gateway Project
The CONNECT gateway project was later established as a separate OMB E-Gov LoB
To form a federal health IT consortium to jointly govern and develop CONNECT as a shared investment toward a common solution that would be deployed and operated separately utilizing existing standards and terminologies/value sets
Provides transport gateway and adapter services for participants
CONNECT v4.0 just launched and is being demonstrated in the Interoperability Showcase!

19. Key Takeaways
Although not perfect, does it represent the best we have so far?
Is it the next step in an incremental approach to refining the standards and implementation guides?
Does it support our policy objectives?
Interoperability is not “one size fits all”:
Create modular standards and specifications that allow for innovation
i.e. Internet: we’re not building AOL; we’re creating the building blocks to make it possible for Facebook, Twitter, etc. to flourish
We are on a journey together!

20. Questions/Discussion
Learn more at:
ONC website:
S&I Framework Wiki: 20