Current ONC Standards Activities


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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.

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  • (1) We are actively involved in the programs themselves (e.g., through the Direct Project Boot Camp);(2) We attend, participate and occasionally facilitate their CoPs (e.g., the REC FI-HIE CoP, the State HIE Provider Directory and Lab CoPs, etc);(3) We bring the CoPs to the table when S&I initiatives need input that will affect them, etc. 
  • Current ONC Standards Activities

    1. 1. Update on Current Standards Efforts Jitin Asnaani & Rich Elmore Office of Standards and Interoperability, ONC November 21, 2011
    2. 2. How do we achieve interoperablehealthcare 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 Committee1
    3. 3. Example: curating incremental standardsto 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 Case2
    4. 4. HIT Standards Committee3
    5. 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)4
    6. 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 5
    7. 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 team6
    8. 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 guides7
    9. 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 reporting8
    10. 10. Standards & Interoperability Framework9
    11. 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 initiatives10
    12. 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 11
    13. 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 12
    14. 14. S&I Query Health Initiative13
    15. 15. Query Health: Improve communityunderstanding of patient population health Questions about disease outbreaks, prevention activities, health For more information, research, visit quality measures, etc.14
    16. 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 Firewall15
    17. 17. Query Health: Voluntary NetworksNo 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 Responders16
    18. 18. Query Health Scope and Approach Standards & Service Query Health HIT Policy EHRs & Other – Distributed Public / Private Committee: PartnershipClinical Records Population Project Policy Queries Guideposts Practice drives standards 1. Rough consensus 2. Running code (open source) Community Driven, Consensus-based 3. Pilot 4. Specifications17 5. Standards
    19. 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.org18
    20. 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).19
    21. 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.)20
    22. 22. Questions Learn more at: ONC website: HIT Standards Committee: _it_standards_committee/1271 S&I Framework wiki: Query Health Homepage: Contact us: Jitin Asnaani Rich Elmore richard.elmore@hhs.gov21