1. 0 enabling healthcare interoperability 2009 Webinar Series Sponsored by the HITSP Education, Communications and Outreach Committee eTown Hall II HITSP’s efforts to address HIT-related provisions of the American Recovery and Reinvestment Act of 2009 Webinar #7 August 27, 2009 | 2:00 – 3:30 pm (Eastern) Presenter: John D. Halamka, MD, MS, HITSP Chair

2. Slide 1 HITSP – enabling healthcare interoperability 2009 Webinar Series Learning Objectives  During this 90-minute webinar, participants will: — Get an update on the final definition of meaningful use released by the HIT Policy Committee. — Examine the relationship between HITSP work products and meaningful use. — Explore how HITSP will continue to work with the Office of the National Coordinator, the HIT Standards Committee, and the HIT Policy Committee to facilitate the development of needed standards and achieve interoperability. — Learn more about the next work products for HITSP. — Have an extensive period of time for Q&As.

3. Slide 2 HITSP – enabling healthcare interoperability 2009 Webinar Series To serve as a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States. Mission

4. Slide 3 HITSP – enabling healthcare interoperability 2009 Webinar Series Overview  HITSP is a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted set of healthcare interoperability standards.  HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services  HITSP develops Interoperability Specifications (IS) – documents that harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records

5. Slide 4 HITSP – enabling healthcare interoperability 2009 Webinar Series HITSP members agreed that a standard is a well-defined approach that supports a business process and... — has been agreed upon by a group of experts — has been publicly vetted — provides rules, guidelines, or characteristics — helps to ensure that materials, products, processes and services are fit for their intended purpose — is available in an accessible format — is subject to an ongoing review and revision process Standards Harmonization is required when a proliferation of standards prevents progress rather than enabling it. HIT Standardization

6. Slide 5 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 01 Electronic Health Record (EHR) Laboratory Results Reporting IS 02Biosurveillance IS 03Consumer Empowerment IS 04 Emergency Responder Electronic Health Record (ER- EHR) IS 05 Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management HITSP Interoperability Specifications (IS) Accepted Recognized

7. Slide 6 HITSP – enabling healthcare interoperability 2009 Webinar Series IS 08Personalized Healthcare IS 09Consultations and Transfers of Care IS 10Immunizations and Response Management IS 11Public Health Case Reporting IS 12Patient – Provider Secure Messaging IS 77Remote Monitoring IS 107EHR Centric HITSP Interoperability Specifications (IS) Released / Panel Approved Accepted

8. Slide 7 HITSP – enabling healthcare interoperability 2009 Webinar Series What is ARRA? What is HITECH?  A portion of ARRA referred to as the Health Information Technology for Economic and Clinical Health (HITECH) Act — TITLE XIII—Health Information Technology — TITLE IV—Medicare and Medicaid Health Information Technology  Contains numerous provisions related to Health Information Technology (HIT) and privacy with aggressive timelines for completion  Also known as the “economic stimulus package”  Signed into law by President Obama on February 17, 2009

9. Slide 8 HITSP – enabling healthcare interoperability 2009 Webinar Series Federal Advisory Committees Formed under ARRA  Office of the National Coordinator for HIT (ONC) — Part of the Department of Health and Human Services (HHS), ONC is the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.  HIT Policy Committee — Makes recommendations to ONC on an overall policy framework for the development and adoption of a national interoperable health information infrastructure, including standards for the secure and private exchange of patient medical information  HIT Standards Committee — Makes recommendations to ONC on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information

10. Slide 9 HITSP – enabling healthcare interoperability 2009 Webinar Series HIT Standards Committee & HITSP: Shared Members HIT Standards Committee 23 members HITSP 1,000+ technical experts John Halamka HITSP Chair HIT Standards Committee Vice-Chair Christopher Chute HITSP Volunteer HIT Standards Committee James Ferguson HITSP Board of Directors HIT Standards Committee John Klimek HITSP Volunteer HIT Standards Committee

11. Slide 10 HITSP – enabling healthcare interoperability 2009 Webinar Series ARRA / HITECH calls for “meaningful use of EHRs”  Not enough to implement EHRs – need to meaningfully use them to improve patient care and efficiency  Recommended criteria of “meaningful use” was approved by the HIT Standards Committee and submitted to the ONC on July 16 th, 2009  HITSP is working with the HIT Standards Committee to help achieve meaningful use by providing harmonized HIT standards

12. Slide 11 HITSP – enabling healthcare interoperability 2009 Webinar Series Timing and Incentives  Physicians — $24 to $44k depending on when they qualify for “1 st year payment” — 1 st payment incentive $18,000 for those who receive 1 st payment in 2011 or 2012 — Failure to demonstrate meaningful use by 2015, incur reimbursement penalties  Hospitals — Similar incentives for early adoption and penalties after 2015 — Incentive calculation includes:  Total Discharges  Total Gross Revenue  Charity Care Charges  Medicare Inpatient Days  Total Inpatient Days  Medicare Share Ratio  Revenue Ratio

13. Slide 12 HITSP – enabling healthcare interoperability 2009 Webinar Series Work Flow: A High-Level View SecretaryNational Coordinator Organizations conducting standards development or harmonization, certification criteria development, or composition of implementation specifications Pilot testing HIT Policy Committee HIT Standards Committee Recommendations National Coordinator

14. Slide 13 HITSP – enabling healthcare interoperability 2009 Webinar Series Getting It Done  The Office of the National Coordinator (ONC) has asked HITSP to assist it in meeting its requirements for designating standards that support designated ARRA focus areas for healthcare, and ultimately, that support ARRA’s notion of “meaningful use” — HITSP paused its assigned 2009 work, and directed essentially all efforts toward this end — HITSP organized into focused, quick-moving “Tiger Teams” accomplished their tasks and submitted their results to the ONC in mid-July.

15. Slide 14 HITSP – enabling healthcare interoperability 2009 Webinar Series Starting Point – ARRA Requirements and Tiger Teams

16. Slide 15 HITSP – enabling healthcare interoperability 2009 Webinar Series Tiger Teams – Focus Areas  A new EHR Centric Interoperability Specification to meet ARRA requirements  Security, Privacy, & Infrastructure  Quality Measures  Data Architecture (Element, Template, and Value Set)  Exchange Architecture and Harmonization Framework  Clinical Research Tiger Team membership 232 technical experts

17. Slide 16 HITSP – enabling healthcare interoperability 2009 Webinar Series Objective of the EHR-Centric Interoperability Specification Tiger Team Utilizing the 13 recognized/accepted (as of 13Feb09) HITSP Interoperability Specifications...... in the context of the ARRA to produce an EHR-Centric IS... that is: simplified easily understood applicable beyond limitations of initiating use cases implementable leverages existing work

18. Slide 17 HITSP – enabling healthcare interoperability 2009 Webinar Series EHR-Centric Deliverables  IS 107: EHR-Centric IS — The first of a number of potential system-centric interoperability perspectives — A menu of specification components that can be assembled to meet varied implementation needs — All ARRA requirements met by at least one IS but gaps / enhancements were identified for future HITSP work  Learn more: Free HITSP webinar dedicated to IS 107 will be held on October 8, 2009. Current status: Panel Approved on July 8, 2009

19. Slide 18 HITSP – enabling healthcare interoperability 2009 Webinar Series Security, Privacy and Infrastructure (SPI) Tiger Team Accomplishments  Service Collaboration Definition — A service collaboration is a composition of constructs into a reusable workflow.  Restructured into Service Collaboration Suites — SC 108 Access Control Service — SC 109 Security Audit Service Collaboration — SC 110 Patient Identification Management Service Collaboration — SC 111 Knowledge and Vocabulary Service Collaboration — SC 112 Healthcare Document Management Service Collaboration — SC 113 Query for Existing Data Service Collaboration — SC 114 Administrative Transport to Health Plan Service Collaboration — SC 115 HL7 Messaging Service Collaboration — SC 116 Emergency Message Distribution Service Collaboration Current status: Panel Approved on July 8, 2009

20. Slide 19 HITSP – enabling healthcare interoperability 2009 Webinar Series  Establishing and Reporting on Quality Measures is critical to ARRA and measuring Meaningful Use.  HITSP Updated IS06-Quality Interoperability Specification to meet this need: — Ability to report patient level and aggregate quality information in document or message format — Ability to exchange quality measurement criteria definitions Quality Measures Tiger Team Accomplishments Hospital Clinician/Ambulatory Provider Quality Measurement Organization Quality Reports Measurement criteria Current status: Inspection Testing Complete Inspectors’ comments under review this week at our HITSP Tiger Team/Technical Committee Face to Face Meeting in Chicago.

21. Slide 20 HITSP – enabling healthcare interoperability 2009 Webinar Series Data Architecture Tiger Team Objectives  Provide standardized definitions for the HITSP data structures  Identify similar data elements used in healthcare standards  Provide an inventory of HITSP data and values  Provide structure to assure consistent use of the data elements across different information exchanges

22. Slide 21 HITSP – enabling healthcare interoperability 2009 Webinar Series Accomplishment – Data Architecture Technical Note (TN903)  Presents the HITSP Data Architecture Model  Explains data elements, templates, and value sets in the HITSP context — Data elements are the smallest unit of data in an information exchange. — Templates are a set of business rules (constraints) used to create an artifact used in an information exchange. — Value sets are a uniquely identifiable set of valid concept representations.  Presents the metadata for each concept and discusses the use of metadata registries for storage and access to this information. Current status: Panel Approved on July 8, 2009

23. Slide 22 HITSP – enabling healthcare interoperability 2009 Webinar Series Harmonization Framework and Exchange Architecture Tiger Team  Objectives — Harmonization Framework  Ensure consistency and listing for all 2009 Information Concepts — Develop Exchange Architecture  High-level rules for orchestrating HITSP defined systems, actions and content constructs to meet business requirements  Accomplishments — Produced Technical Note to explain Harmonization Framework and Exchange Architecture Current status: Panel Approved on July 8, 2009

24. Slide 23 HITSP – enabling healthcare interoperability 2009 Webinar Series What We Mean by Harmonization Framework

25. Slide 24 HITSP – enabling healthcare interoperability 2009 Webinar Series What We Mean by Exchange Architecture

26. Slide 25 HITSP – enabling healthcare interoperability 2009 Webinar Series Clinical Research Tiger Team Accomplishments  Requirements, Design, and Standards Selection document describes the exchange of a common set of information between electronic health records and clinical research systems — Submission of clinical data to a sponsoring agency based on sponsor’s protocol — Exchange of clinical data with research registries Current status: Public Comment (Closes August 28) Received comments are under review this week at our HITSP Tiger Team/Technical Committee Face to Face Meeting in Chicago.

27. Slide 26 HITSP – enabling healthcare interoperability 2009 Webinar Series Next Steps – Milestones and Next Steps  Final Recommendations — August 20 th - clinical quality, clinical operations, and security/privacy standards transmitted to ONC from HIT Standards Committee  Regulation Schedule — December 31, 2009 – Interim final rule adopt and publish an initial set of standards, implementation specifications, and certification criteria. (from ONC) — December 31, 2009 – Proposed rule regarding definition of meaningful use and Medicare/Medicaid incentives. (from CMS)

28. Slide 27 HITSP – enabling healthcare interoperability 2009 Webinar Series Conclusion: HITSP is Foundational Support to ARRA  On July 21, 2009 the HIT Standards Committee recommended that providers implement the HITSP endorsed standard capabilities, including: — Transmitting prescriptions — Structured data for discharge summary and continuity of care documents — Lab test results  HITSP is performing this critical function credibly in support of ARRA — HITSP support of the newly-formed HIT Policy and Standards Committees  HITSP in the “Real World” series — Medication Management Real World Sites — September 10, 2009

29. Slide 28 HITSP – enabling healthcare interoperability 2009 Webinar Series Webinar 1 Advances in Sharing Information in Healthcare IT Thursday, January 15, 2009 — 2:00-3:30 pm Eastern Webinar 7HITSP eTown Hall II with Dr. John Halamka Thursday, August 27, 2009 — 2:00-3:30 pm Eastern Webinar 2Personalized Healthcare Interoperability Specification (IS 08) Thursday, February 12, 2009 — 2:00-3:30 pm Eastern Webinar 8Medication Management Real World Sites Thursday, September 10, 2009 — 2:00-3:30 pm Eastern Webinar 3Consultations and Transfers of Care Interoperability Specification (IS 09) Thursday, March 12, 2009 — 2:00-3:30 pm Eastern Webinar 9HITSP EHR Centric Interoperability Specification Thursday, October 8, 2009 — 2:00-3:30 pm Eastern Webinar 4NHIN Real World Sites Thursday, April 16, 2009 — 2:00-3:30 pm Eastern Webinar 10Security, Privacy, and Infrastructure Thursday, November 12, 2009 — 2:00-3:30 pm Eastern Webinar 5HITSP eTown Hall I with Dr. John Halamka Thursday, June 18, 2009 — 2:00-3:30 pm Eastern Webinar 11Quality Measures Real World Sites Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern Webinar 6Health Information Exchange (HIEs) in the Real World Thursday, July 9, 2009 — 2:00-3:30 pm Eastern NOTE: Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.  The 2009 Webinar Series www.HITSP.org/webinars      

30. Slide 29 HITSP – enabling healthcare interoperability 2009 Webinar Series Discussion / Questions Welcomed

31. Slide 30 HITSP – enabling healthcare interoperability 2009 Webinar Series View the Complete Set of HITSP Deliverables www.HITSP.org www.HITSP.org

32. Slide 31 HITSP – enabling healthcare interoperability 2009 Webinar Series NEW HITSP Team Members ALWAYS welcome! www.HITSP.org www.HITSP.org  All you need is passion to get the job done  Motivation to make a difference  Drive to push the nation forward  Volunteers ARE the life blood of HITSP to get the job done  If you knew enough to attend this webinar, you know enough to jump on in!

33. Slide 32 HITSP – enabling healthcare interoperability 2009 Webinar Series Jessica Kant, HIMSSTheresa Wisdom, HIMSS jkant@himss.orgjkant@himss.org twisdom@himss.orgtwisdom@himss.org Re: HITSP Technical Committees Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.org or contact:www.hitsp.org

34. Slide 33 HITSP – enabling healthcare interoperability 2009 Webinar Series Sponsor Strategic Partners www.HITSP.org