Presentation at NeHC: Overview of ONC's health information exchange standards-selection activities. Focuses on HITSC, the S&I Framework, and the S&I Query Health Initiative.

1. Update on Current Standards Efforts
Jitin Asnaani & Rich Elmore
Office of Standards and Interoperability, ONC
November 21, 2011

2. How do we achieve interoperable
healthcare information systems?
• EHR Certification • HIT Standards
• Meaningful Use Committee*
Assemble • Exchange
Accuracy & Team to • Direct Project
Compliance Solve
Problem
• S&I Framework
Solutions
& Usability
• Nationwide Health
Information Network * Federal Advisory Committee
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3. Example: curating incremental standards
to enable health information exchange
INTEROPERABILITY STANDARDS & SPECIFICATIONS
STACK (illustrative initiatives)
Vocabulary &
Code Sets HITSC
S&I ePrescribing S&I Lab
Transitions of of Discharge Results
Care Meds Power Interface
Content Team
Structure
Potential
solution for
Transport & S&I Certificate directed
Security Interoperability exchange of
clinical
Direct Project
summaries
S&I Provider
Access Directories –
Services Certificate Discovery
Use Case
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4. HIT Standards Committee
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5. Why the HIT Standards Committee?
• Charged with making recommendations to the
National Coordinator for Health IT on
standards, implementation specifications, and
certification criteria for the electronic exchange
and use of health information
• Focused on the implicit and explicit standards
needs driven by the policies developed by the
Health IT Policy Committee
• In developing, harmonizing, or recognizing standards and implementation
specifications, the Health IT Standards Committee will also provide for the
testing of the same by the National Institute for Standards and Technology
(NIST)
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6. HITSC Workgroups
• Clinical Operations Workgroup - make recommendations to HITSC on
requirements for EHR certification criteria, standards, and implementation
specifications related to clinical operations
– Has set up a Vocabulary Task Force to address vocabulary subsets and value
sets as facilitators and enablers of “meaningful use.”
• Clinical Quality Workgroup - make recommendations to HITSC on quality
measures that should be included in the definition of Meaningful Use and
future EHR certification requirements
• Privacy & Security Workgroup - make recommendations to HITSC on
privacy and security requirements that should be included in standards,
certification criteria, and implementation specifications
• Implementation Workgroup - bring forward “real-world” implementation
experience into HITSC recommendations, with special emphasis on
strategies to accelerate adoption of proposed standards
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7. Summer Camp for HITSC
• Analyze standards implications of HITPC
recommendations
– Prepare for Meaningful Use Stage 2
– Identify gaps in Standards
– Triage Standards Work
• Available tools: Hearings, Federal Register, Wikis,
working groups, S&I Framework
• Intense work effort
– 39 public meetings and hearings over 20
weeks
– Approximately 1 meeting every 3.6 days
– ANPRM from metadata team
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8. Summer Camp Power Teams
• Metadata Analysis Team - Identified metadata elements and standards
for Patient Identity, Provenance and Privacy. Recommended HL7 CDA R2
header elements (with modifications)
– ANPRM published August 9, 2011
• Patient Matching Power Team - Determined the data that should be
included in Patient Matching in order to achieve acceptable levels of
specificity (99.9%) and sensitivity (95%)
• Surveillance Implementation Guide Power Team - Converged on the use
of the HL7 2.5.1 standard across lab reporting to public health,
immunization reporting, and syndromic surveillance
– Recommended specific HL7 2.5.1 implementation guides
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9. Summer Camp Power Teams continued
• E-prescribing for Discharge Medications - Recommended standards for
electronic prescription of discharge medications, medication history, and
eligibility
• NWHIN Power Team - Evaluated specifications developed for the NwHIN
Exchange and Direct pilots and made recommendations for specifications
that could be used to support the secure transport and exchange of
electronic health information nationally
• Biosurveillance Power Team - Recommended a core set of 17 elements
and a set of 16 optional elements for biosurveillance reporting
• Vocabulary Task Force - Met under the auspices of the parent Workgroup
(Clinical Operations). Identified acceptable transition vocabularies to
support Clinical Quality Measure reporting
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10. Standards & Interoperability
Framework
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11. Why the S&I Framework?
• S&I Framework is a forum created by ONC that
enables a broad, open, transparent community*
of stakeholders to help guide the development of
realistic, implementable solutions that meet
standards needs for health information exchange
• Each S&I Initiative focuses on a narrowly-scoped,
broadly applicable challenge, tackled through a
rigorous development cycle
• S&I Framework supports the HITSC to accelerate the identification, piloting
and use of a parsimonious set of standards for MU
* As of 15 Oct 2011, ~900 people had registered on the S&I Framework wiki, and ~400 people representing ~300 organizations had
committed to specific S&I Framework initiatives
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12. Current S&I Initiatives
• Transitions of Care (ToC) - Creating clear implementation guidance for
each of the key information exchanges needed in core care transitions
scenarios
• Lab Results Interfaces (LRI) - Establishing the nationwide Implementation
Guide for electronic submission of Lab Results to Ambulatory EHRs
• Provider Directories (PD) - Establishing a standard for certificate
discovery, and the minimum data model for broader “electronic service
information” queries
• Certificate Interoperability - Investigating architectural and operational
options for cross-certifying Health ISPs (HISPs) with the Federal Bridge
Certificate Authority
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13. Current S&I Initiatives continued
• Query Health - Identifying the standards and services for distributed
population health queries to certified EHRs and other patient data sources
• Data Segmentation for Privacy - Focused on standards-driven data
segmentation to enable privacy of patient data based on consent
decisions, applicable law and policies
• Electronic Submission of Medical Documentation (esMD) - Providing a
new mechanism for submitting medical documentation to Medicare
Review Contractors; investigates technical transport/authentication and
proof of document authorship
• Community-Led Initiatives in Public Health and Longitudinal Coordination
of Care
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14. S&I Query Health Initiative
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15. Query Health: Improve community
understanding of patient population health
Questions about
disease outbreaks,
prevention activities, health
For more information, research,
visit QueryHealth.org quality measures, etc.
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16. Inside Query Health
Aggregated Count Data Patient Data
Note: All patient level data stays behind the firewall.
Data Source
1. EHR / Clinical
Query Record
& Results (Patient Data)
Reviewer
Translate patient
3. Distribute Query to Data Sources data to CIM
2. Clinical
Information Information
Requestor Model (CIM)
5. Sends Query Results to Information Requestor
4. Execute
Query , format
& return Results
Responding Organization
Firewall
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17. Query Health: Voluntary Networks
No Central Planning, No Central DB’s
Community of participants that voluntarily
agree to interact with each other. There will be
many networks; requestors and responders
may participate in multiple networks.
Query
Authorized Participating
Requestors Responders
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18. Query Health Scope and Approach
Standards &
Service
Query Health HIT Policy
EHRs & Other – Distributed Public / Private Committee:
Partnership
Clinical Records
Population Project Policy
Queries Guideposts
Practice drives standards
1. Rough consensus
2. Running code (open source)
Community
Driven,
Consensus-based
3. Pilot
4. Specifications
17 5. Standards

19. Query Health Policy Recommendations
• Reviews by
– Privacy and Security Tiger Team
– HIT Policy Committee
• Scope: ONC sponsored Query Health pilots
• Purpose:
– Policy guardrails for pilots
– ONC Governance recommendations based on pilot results
• Link to HIT Policy Committee Recommendations at QueryHealth.org
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20. Query Health Policy Recommendations
• Control of data disclosures by data holder
– Whether to run a query
– Whether to release any results
• Data being disclosed
– Aggregated de-identified data sets or aggregated limited data sets,
each with data use agreements (even in circumstances where they are
not required by law), or
– Public health permitted use under state or federal law providing the
minimally necessary and permitted information (which may include
identifiable information where permitted by law).
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21. Query Health Policy Recommendations
• Data Use Agreement:
– No re-identification
– Clarity of purpose (permissible uses)
• Small cells:
– Cells with less than 5 observations in a cell shall be blurred by
methods that reduce the accuracy of the information provided.
– Exception for regulated / permitted use
– (The CDC-CSTE Intergovernmental Data Release Guidelines Working
Group has recommended limiting cell size to three counts presuming a
sufficiently large population; this is also reflected in guidelines used by
several states.)
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22. Questions
Learn more at:
ONC website: http://www.healthit.gov/
HIT Standards Committee:
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__health
_it_standards_committee/1271
S&I Framework wiki: http://wiki.siframework.org
Query Health Homepage: http://www.queryhealth.org
Contact us:
Jitin Asnaani Rich Elmore
jitin.asnaani@siframework.org richard.elmore@hhs.gov
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