eTown Hall II HITSP’s efforts to address HIT-related provisions of the American Recovery and Reinvestment Act of 2009

1. 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. 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. 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. Overview HITSP is acooperative 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. HIT Standardization 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.

6. HITSP Interoperability Specifications (IS) Recognized Accepted

7. Accepted Released / Panel Approved HITSP Interoperability Specifications (IS)

8. 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. 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. HIT Standards Committee & HITSP: Shared Members John HalamkaHITSP ChairHIT Standards Committee Vice-Chair Christopher ChuteHITSP VolunteerHIT Standards Committee James FergusonHITSP Board of DirectorsHIT Standards Committee John KlimekHITSP VolunteerHIT Standards Committee HIT Standards Committee 23 members HITSP1,000+ technical experts

11. 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 16th, 2009 • HITSP is working with the HIT Standards Committee to help achieve meaningful use by providing harmonized HIT standards

12. Timing and Incentives Physicians $24 to $44k depending on when they qualify for “1st year payment” 1st payment incentive $18,000 for those who receive 1st 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. HIT Standards Committee Recommendations Work Flow: A High-Level View HIT Policy Committee National Coordinator National Coordinator Secretary Organizations conducting standards development or harmonization, certification criteria development, or composition of implementation specifications Pilot testing

14. 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. Starting Point – ARRA Requirements and Tiger Teams

16. 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. 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. 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. 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. Quality Measures Tiger Team Accomplishments 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 Measurement criteria Quality Measurement Organization Hospital Clinician/Ambulatory Provider Quality Reports 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. 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. 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. 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. What We Mean by Harmonization Framework

25. What We Mean by Exchange Architecture

26. 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 areunder review this week at our HITSP Tiger Team/Technical Committee Face to Face Meeting in Chicago.

27. Next Steps – Milestones and Next Steps Final Recommendations August 20th - 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. 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. The 2009 Webinar Series www.HITSP.org/webinars       

30. Discussion / Questions Welcomed

31. View the Complete Set of HITSP Deliverableswww.HITSP.org

32. NEW HITSP Team Members ALWAYS welcome!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. Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.orgor contact: Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Jessica Kant, HIMSS Theresa Wisdom, HIMSS jkant@himss.orgtwisdom@himss.org Re: HITSP Technical Committees

34. Sponsor Strategic Partners www.HITSP.org