The document provides an update on state health information exchange (HIE) programs. It discusses the evolving role of state HIE programs from focusing on developing a single statewide exchange network to catalyzing exchange through multiple approaches. Key strategies discussed include reducing exchange costs, filling gaps, ensuring interoperability, and giving providers options to meet meaningful use requirements through services like care summary exchange and lab results exchange. Challenges and emerging issues like sustainability, broader adoption, and alignment with payment reform are also addressed.

1. Update on the State HIE Program Claudia Williams, Director February 1, 2012

5. We are here today… Receipt of Discharge Information by PCPs *Respondents could select multiple responses. Base excludes those who do not receive report. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 27% Less than 48 Hours 29% 2 to 4 Days 26% 5 to 14 Days 1% More than 30 Days 6% Rarely/Never Receive Adequate Support 4% Not Sure/Decline to Answer 15 to 30 Days 6% Time Frame (n=1,442) 62% Fax 30% Mail 8% Email Remote Access 15% 1% Not Sure/ Decline to Answer 11% Other Delivery Method (n=1,290)* 19 percent of hospitals are exchanging clinical care records with ambulatory providers outside system (2010)

6. Will we soon see this curve? For care summary exchange? For lab exchange?

7. Texas White Space Office of the National Coordinator for Health Information Technology Texas White Space

8. State HIE program opportunities to fill gaps, lower cost of exchange and assure trust Office of the National Coordinator for Health Information Technology Opportunity Description White Space Large areas of state don’t have viable exchange options for providers Duplication Every exchange creates own eMPI, identity solution & directories Information Silos Unconnected exchange networks don’t support info following patient across entire delivery system Disparities Low capacity data suppliers do not have resources or technical capacity to participate in exchange Emerging Networks Emerging networks need resources and technical support Public Health Capacity States’ numerous reporting needs are resolved in one-off ways or aren’t electronic No Shared Trust/Interop Requirements Lack of common technical and trust requirements makes negotiations and agreements difficult and slows public support and exchange progress

9. Strategies Opportunity Strategies to Address Number White Space Directed Exchange - Jumpstart low-cost directed exchange services to support meaningful use requirements 51 Duplication Shared Services - Offer open, shared services like provider directories and identity services that can be reused 54 Information Silos Connect the nodes - Infrastructure, standards, policies and services to connect existing exchange networks 25 Disparities REC for HIE - Grants and technical support for CAHs, independent labs, rural pharmacies to participate in exchange 20 Emerging Networks Support local networks – Connectivity grants and trust/standards requirements for emerging exchange entities 5 Public Health Capacity Serve reporting needs of state - Support public health and quality reporting to state agencies 28 No Shared Trust/Interop Requirements Accreditation and validation of exchange entities against consensus technical and policy requirements 17

18. Measuring progress Office of the National Coordinator for Health Information Technology

20. Achieving Interoperability Doug Fridsma, MD, PhD, FACMI Director, Office of Standards & Interoperability, ONC

21. How do we achieve interoperable healthcare information systems? Team convened to solve problem Solutions & Usability Accuracy & Compliance Enable stakeholders to come up with simple, shared solutions to common information exchange challenges Curate a portfolio of standards, services, and policies that accelerate information exchange Enforce compliance with validated information exchange standards, services and policies to assure interoperability between validated systems

22. Transport is necessary, but not sufficient Direct and NwHIN Exchange focus at these levels How should well-defined values be coded so that they are universally understood? How should the message be formatted so that it is computable? How does the message move from A to B? How do we ensure that messages are secure and private? How do health information exchange participants find each other? Vocabulary & Code Sets Content Structure Services Transport Security

24. What will this transaction require? Office of the National Coordinator for Health Information Technology How should well-defined values be coded so that they are universally understood? How should the message be formatted so that it is computable? How does the message move from A to B? How do we ensure that messages are secure and private? How do health information exchange participants find each other? The physician ordered an outpatient lab test on a patient, and the lab sends the information to your office. The patient is here to discuss the results. Vocabulary & Code Sets Content Structure Transport Security Services X.509: to ensure it is safely transmitted to the intended recipient Direct: to securely send the lab result from the lab to the EHR DNS+LDAP: to find the recipient’s X.509 certificate LOINC: to code lab results & observations HL7 2.5.1: to format the lab result so EHRs can incorporate it

26. Direct Project Metrics - Ecosystem Direct Project Metrics – Ecosystem Direct Project Ecosystem Survey