Transcript HITSP_eTown Hall

2009-2010 Webinar Series
eTown Hall III
HITSP - Past, Present, Future –
The future of HIT Harmonization
and Interoperability
Webinar #12 January 22, 2010 | 1:00 – 2:30 pm (Eastern)
Presenter:
John D. Halamka, MD, MS, HITSP Chair
Sponsored by the HITSP Education, Communications and Outreach Committee
enabling healthcare interoperability
0
Agenda
 A brief overview and history of HITSP to date
 HITSP’s impact on the industry and valuable contributions
to the national initiative through its accomplishments
 Conclusions and lessons learned about HIT SDOs
and harmonization
 The future of HIT harmonization and interoperability
 Questions and answers
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 1
Mission
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.
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 2
HITSP Stakeholders: Who HITSP impacts

Patients

Specialists

Review Boards

Consumers

Payers

Practice
Healthcare
Guidelines
Providers


Employers
General


Suppliers
Hospitals

Residential
Care Providers
Practitioners


Outpatient
Government
Agencies
Current Stakeholder Participation in HITSP:
800+ organizations
1,000+ individuals
Over 53,000 volunteer hours
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Slide 3
HITSP Real World Use
Sites as of January 2010
 Beth Israel Deaconess Medical Center
(BIDMC)
 Boston Medical Center
 CareSpark
 eHealth Connecticut
 Health Bridge and HealthLinC
 Kaiser Permanente Medical Group
 Keystone Health Information
Exchange (Key-HIE)
 MedVirginia
HITSP – enabling healthcare interoperability
 The New York eHealth Collaborative
(NYeC)
 New England Healthcare EDI Network
(NEHEN)
 North Carolina Healthcare Information
and Communications Alliance (NCHICA)
 Regenstrief Institute
 Social Security Administration (SSA)
 Vermont Information Technology
Leaders (VITL)
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Slide 4
View the Complete Set of HITSP Deliverables
www.HITSP.org
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 5
HITSP was there . . .
Supporting from “ONCHIT” to ONC
 Covering two administrations and three heads of the Office of
the National Coordinator
David J. Brailer, M.D., PhD
National Coordinator for
Healthcare IT
2004 – 2006
Robert M. Kolodner, M.D.
National Coordinator for
Healthcare IT
2006 – 2009
HITSP – enabling healthcare interoperability
David Blumenthal, M.D., M.P.P.
National Coordinator
for Healthcare IT
2009 - Present
2009-2010 Webinar Series
Slide 6
Wave 1 of HITSP Accomplishments
The Bush Administration
Supporting the American Health
Information Community (AHIC) Use Cases
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Slide 7
Status:
Interoperability
Specifications
Released
Accepted
Recognized
Panel approved for
submission to HHS
Secretary of HHS has
accepted for a period
of testing
Secretary of HHS has
recognized the IS for
immediate
implementation
Federal projects must use
HITSP recognized standards
Per Executive Order 13410
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 8
HITSP Interoperability
Specifications (IS)
2006 – 2008
Recognized
IS 01
Electronic Health Record (EHR)
Laboratory Results Reporting
IS 02
Biosurveillance
IS 03
Consumer Empowerment
IS 04
Emergency Responder Electronic Health
Record (ER-EHR)
IS 05
Consumer Empowerment and Access
to Clinical Information via Media
IS 06
Quality
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Slide 9
During Initial Planning for
Interoperable EHRs . . .
Something VERY Big Happened
Aug 29,2005
Hurricane Katrina
 The pain and devastating struggles were not forgotten . . .
 Next time we WILL do better when someone needs to get
healthcare after an evacuation
 We have a plan . . . and now that plan is funded
for incentives for widespread adoption of EHRs
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Slide 10
HITSP Interoperability
Specifications (IS)
2008 – 2009
Recognized
Released /
Panel
Approved
IS 07
Medication Management
IS 08
Personalized Healthcare
IS 09
Consultations and Transfers of Care
IS 10
Immunizations and Response Management
IS 11
Public Health Case Reporting
IS 12
Patient – Provider Secure Messaging
IS 77
Remote Monitoring
IS 107 EHR Centric
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2009-2010 Webinar Series
Slide 11
Wave 2 – The Impact Magnifies
The Obama Administration
Supporting the American Recovery and
Reinvestment Act of 2009
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Slide 12
HIT Standards Committee, HITSP,
and NCVHS: Shared Members
John Halamka
HITSP Chair
HIT Standards Committee Vice-Chair
HITSP
1,000+
technical
experts
Walter Suarez
HITSP Board of Directors
HIT Standards Committee
NCVHS Committee
Christopher Chute
HITSP Volunteer
HIT Standards Committee
HIT
Standards
Committee
23 members
James Ferguson
HITSP Board of Directors
HIT Standards Committee
John Klimek
HITSP Volunteer
HIT Standards Committee
NCVHS
26 members
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2009-2010 Webinar Series
Slide 13
“Meaningful Use”
From existing Interoperability
Specifications, determine subset
required for “meaningful use” as
called for in the American Recovery
and Reinvestment Act (ARRA)
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2009-2010 Webinar Series
Slide 14
Impact &
Relationships
 HITSP is playing an integral role in the development of a Nationwide
Health Information Network (NHIN) for the United States
 Part of Certification Commission on Healthcare IT (CCHIT) certification
requirements includes proof of compliance to HITSP specifications
 “Recognized” HITSP Interoperability Specifications (IS) are required
on all new federal HIT project work and federal contracts.
 ARRA and the HITECH act call for “meaningful use” of EHRs.
HITSP worked with the HIT to help by providing reusable HIT standards.
 IHE Connectathons – Vendors Testing of HITSP Specifications
– 2009 IHE Connectathon – 50 vendors
HITSP – enabling healthcare interoperability
– 2010 IHE Connectathon – 75 vendors
2009-2010 Webinar Series
Slide 15
What is ARRA?

Also known as the “economic stimulus package”

Signed into law by President Obama on
February 17, 2009
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
HITSP – enabling healthcare interoperability
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Slide 16
Work Flow: A High-Level View
HIT Policy Committee
National Coordinator
Secretary
HIT Standards Committee
Recommendations
Pilot testing
HITSP – enabling healthcare interoperability
Organizations conducting standards
development or harmonization,
certification criteria development, or
composition of implementation specifications
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Slide 17
GOAL: Design where the Puck needs to go
It is not enough to follow the puck . . .
or go in the direction of the puck . . .
We are designing where the puck needs to go!
2015
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 18
Eight Technology Priority areas for HIT in ARRA
1. Privacy and Security
2. HIT Infrastructure
3. Certified Health Record
4. Disclosure Audit
5. Improve Quality
6. Individually Identifiable Health
Information (IIHI) Unusable
7. Demographic Data
8. Needs of Vulnerable
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Slide 19
2009: The HITSP Tiger Teams
 The Office of the National Coordinator (ONC)
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” that accomplished their tasks,
and submitted their results to the ONC
in mid-July.
HITSP – enabling healthcare interoperability
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Slide 20
The Power Behind the “HITSP Nation”
Technical Committee/Tiger Team Membership – 914 individuals
Technical Committees
Number of Members
Population Perspective
382 members
Consumer Perspective
231 members
Provider Perspective
265 members
Security, Privacy & Infrastructure Domain
347 members
Care Management and Health Records Domain
228 members
Administrative and Financial Domain
85 members
Tiger Teams
Number of Members
Clinical Research
147 members
Data Architecture
159 members
Quality Measures
123 members
Consumer Preferences
142 members
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2009-2010 Webinar Series
Slide 21
The “HITSP Nation”
Powered by 54,730 Hours in 3 years!!
Year
# of Volunteer Hours
2007
12,000
2008
19,000
2009
23,730
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 22
EHR-Centric IS Addresses
ARRA / HITECH Priority Areas
Eight Priority Areas for HIT in ARRA
HITSP Phase 1
Tasks for ARRA
1
2
3
4
Security
HIT
Certified
Disclosure
+ Privacy Infrastructure Health Record
Audit
EHR Centric
Interoperability
Specification
Security and Privacy
Service (Suite)
n
n
5
Improve
Quality
7
8
Demographic Needs of
Data
Vulnerable
n
n
Quality Measures
project
6
IIHI*
Unusable
n
n
n
n
Supporting Deliverables
Harmonization
framework and
information/
exchange
architecture
n
Data Element,
Template, and Value
Set
n
n
n
n
n
n
* Individually Identifiable Health Information (IIHI) Unusable
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 23
EHR-Centric IS Facilitates Achievement of
ARRA / HITECH Meaningful Use
ARRA Title IV (Division B) – Section 401 – Medicare Incentives
Meaningful Use
to Include
e-Prescribing
Exchange of
Information to Improve
Quality of Care
Reporting Clinical
Quality Measures
Certified EHR Defined
EHR Centric
Interoperability
Specification
n
n
n
n
Security and Privacy
Service (Suite)
n
n
HITSP Phase 1
Tasks for ARRA
n
Quality Measures
project
n
n
Supporting Deliverables
Harmonization
framework and
information/
exchange
architecture
n
n
Data Element,
Template, and Value
Set
n
n
HITSP – enabling healthcare interoperability
n
n
2009-2010 Webinar Series
n
Slide 24
Service Collaborations and
Capabilities in Action
Base and
Composite
Standards
Capabilities
Service
Collaborations
Constructs
Component,
Transaction, or
Transaction
Packages
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2009-2010 Webinar Series
Slide 25
Multiple Capabilities = Interoperability Specification
Interoperability
Specification
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 26
Education,
Communication and
Outreach Website
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 27
HITSP Education Materials
www.hitsp.org/webinars
 Archives of 2008 and
2009 Webinar Series
 Newly Published
Large Wall Posters
with description and
size posted
 HITSP Cross-
Reference Matrices
—
Summary of HIT
Standards and HIT
Policy Committee
Recommendations
—
Data Elements in
CDA, CCD and CCR
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2009-2010 Webinar Series
Slide 28
Webinar Series
www.hitsp.org/education_outreach
Postponed
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 29
The HITSP Story in Plain English PLEASE!!
What does all this mean to patients, families, and providers?
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 30
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Steve’s Story
The story of what standardizing the sharing of healthcare
information between electronic medical records will mean to
Patients, Families and Providers . . .
and the impact of interoperable Electronic Healthcare Records across our nation
Sponsored by the HITSP Education, Communications and Outreach Committee
enabling healthcare interoperability
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Steve’s story . . .
Before interoperability
 Patient is a 27-year-old man who had a brain
tumor removed as a child
 Over the years, he has been seen by many different
doctors and visited many healthcare facilities
 Steve’s health information is generally not available
to these organizations. Whether paper or electronic,
his medical history is not easily shared among providers
who need it in order to provide the best care
—
Data such as registration, patient’s problems,
allergies, medications, etc. must be repeatedly
collected
—
Tests and procedures must be repeated due
to a lack of previous test results and procedures
for comparison
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 32
Healthcare in an interoperable world . . .
The Future is Now
 HIT data exchange is becoming transparent so that the quality
of care delivered by providers and hospitals can be known no
matter where the patient is located
 Consumers are empowered to
—
get the right information at the right time
—
find appropriate, quality and safe care for themselves
and their families
—
assume that repeatable information will be safe and secure
while also being accessible by those who need it – before,
during and after a visit to a care provider
 Care providers are empowered to
—
provide safe, effective and evidence-based care with
information integrated within a clinical care workflow
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 33
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 34
HITSP 2004-2009: Lessons Learned
 The HITSP experience has taught us the value of
bringing stakeholders together to harmonize standards
and facilitate adoption
 Working with two administrations and 3 leaders at the head
of Office of the National Coordinator
 Achieving adoption requires much more than a named
list of standards
—
Unclear how to integrate multiple standards
—
Standards are not constrained for the use case – ambiguous
—
Implementation guidance is not provided
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 35
HITSP 2009 Accomplishments Include:
 Improved HITSP infrastructure
definition
—
Data Architecture (Element, Template,
and Value Set)
—
 EHR Centric Interoperability
Specification
—
constructs around EHR
Exchange Architecture and
requirements to facilitate ARRA
Harmonization Framework
EHR certification and meaningful
use goals.
 New Interoperability Specifications
—
Re-organizes all relevant HITSP
Clinical Research and Newborn
Screening
 Medical Home Requirements
Design and Standards Selection
HITSP – enabling healthcare interoperability
 Improved Specifications in
Support of ARRA
—
Security, Privacy, &
Infrastructure
—
Improved Quality Measures
2009-2010 Webinar Series
Slide 36
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
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 37
Two Key Documents Published January 13, 2010
 ONC Published – “Health Information Technology:
Initial Set of Standards, Implementation Specifications,
and Certification Criteria for Electronic Health Record
Technology” (Interim Final Rule – IFR)
—
Will become Final February 13, 2010
 CMS Published – “Medicare and Medicaid
Programs; Electronic Health Record Incentive Program” –
(Notice of Proposed Rule Making – NPRM)
—
Will become Final approximately April, 2010 and
be in effect 60 days later
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2009-2010 Webinar Series
Slide 38
HITSP Work: Foundational for the IFR
 The Interim Final Rule (IFR) contains the majority of base standards
recommended by HITSP including:
—
Summaries - CCD
—
Labs - HL7 2.5.1, LOINC, UCUM, SNOMED-CT
—
Problem Lists - SNOMED-CT
—
Immunizations - HL7 2.3.1, CVX
—
Medications - NCPDP Script 8.1, RxNorm —
—
Allergies - UNII
—
Biosurveillance - HL7 2.5.1
Public Health Reporting of Labs - HL7 2.5.1
 The transmission standards - REST and SOAP. Not as specific as
HITSP but consistent with its work and a good starting point.
 There are still many additional standards and implementation guides up to
the HIT Standards Committee to evaluate.
—

Over the next 6 months, the HIT Standards Committee will work closely with ONC,
HITSP, implementation guide writers, and SDOs to fill gaps in the IFR, no doubt
referencing HITSP’s products.
The IFR’s Security and Privacy section creates important policy guidance.
—
As these policies are implemented, constraints will be needed standards.
It’s likely the HITSP implementation guidance will be embraced over time.
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 39
HITSP Work: Foundational for the IFR
 Two Questions:
— Has HITSP's work been appropriately included?
— Was the Tiger Team effort leveraged?
 Answer:
— The answer to both questions is unequivocally
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2009-2010 Webinar Series
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HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
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Harmonization and Standards Adoption 2010 and
Beyond: What we need for Interoperable Healthcare
 Engage community of experts from all the SDOs and other key stakeholders
in HIT. Do not lose momentum from current engagement.
 Continue and intensify efforts to harmonize and integrate standards, providing
implementation specifications for all required use cases.
 Active and strategic involvement in standards development to ensure U.S.
priorities are met and that standards are built in a harmonious fashion.
 Continue production experience with HITSP specifications and subsequent
improvement of the specifications.
 Develop easy to use guidance and continue to educate and reach out to
the users and beneficiaries of HITSP specifications.
 Provide expert advice, support, and outreach to ARRA adoption efforts
such as Regional extension centers, Beacon communities, and workforce
training initiatives.
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 42
Recommendations for Harmonization
in the Future
Obstacles to Harmonization:
 No existing vocabulary
infrastructure
 SDO participation levels
 Prioritization
 Unclear Process
HITSP – enabling healthcare interoperability
Implementation remedies:
 Develop a vocabulary infrastructure
 Insure internal consistency and
coordination of harmonization
infrastructure
 Work with SCO Summit/
stakeholders to develop a
shared set of priorities for the
harmonization of both current
standards and prospective ones
2009-2010 Webinar Series
Slide 43
Milestones and Next Steps
 ONC Published – “Health Information Technology: Initial Set of
Standards, Implementation Specifications, and Certification Criteria for
Electronic Health Record Technology” (Interim Final Rule – IFR)
—
Standards IFR for inspection published December 30, 2009
—
Standards IFR published in Federal Register January 13, 2010
—
Standards IFR becomes EFFECTIVE on February 13, 2010
 CMS Published – “Medicare and Medicaid Programs; Electronic Health
Record Incentive Program” – Notice of Proposed Rule Making (NPRM)
—
EHR Incentive Program NPRM for inspection published December 30, 2009
—
EHR Incentive Program NPRM published in Federal Register January 13, 2010
—
Public Comment Period open until March 15, 2010
—
HIT Standards and HIT Policy Committees have until March 1, 2010 to submit official
response to NPRM to ONC and CMS leadership
—
Anticipated Publishing of Final Rule April, 2010 and becomes final 60 days later
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 44
Lessons Learned – Future Harmonization
Recommendations
HITSP’s Foundations Committee has compiled a list of relevant concerns for
future harmonization efforts, based on their work with SDOs, specifically:
 Harmonized implementation guide developers must
serve the needs of policy makers and implementers;
 A variety of expertise is required to develop
harmonized implementation guides:
— Terminology experts
— Messaging and Content Standards
— Subject matter experts
 A clear “roadmap” outlining the process from
requirements to implementation must be provided,
including:
— Business requirements
— Vendor development
— User adoption
CONCLUSION: The process works, but it remains unclear whether SDOs
can and will take steps to harmonize using agreed value sets
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 45
Questions
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
Slide 46
Sponsor
Strategic Partners
www.HITSP.org
HITSP – enabling healthcare interoperability
2009-2010 Webinar Series
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