Healthcare Information Technology Standards Panel 2006 2007 and

Healthcare Information Technology Standards Panel 2006, 2007 and Beyond John D. Halamka MD Chair, HITSP

A public-private “Community” was established to serve as the focal point for America’s health information concerns and drive opportunities for increasing interoperability HITSP includes 323 different member organizations and is administered by a Board of Directors 19 SDOs 263 Non-SDOs 28 Govt. bodies 13 Consumer groups The Community is a federally-chartered commission and will provide input and recommendations to HHS on how to make health records digital and interoperable, and assure that the privacy and security of those records are protected, in a smooth, market-led way. HITSP: Harmonizing standards to support the Nationwide Health Information Network 2

NHIN 2 Awardees Care. Spark Delaware Health Information Network Indiana University Long Beach Network for Health Lovelace Clinic Foundation Med. Virginia New York e. Health Collaborative North. Carolina. Healthcare. Informationand Communications Alliance, Inc. West Virginia Health Information Network HITSP: Harmonizing standards to support the Nationwide Health Information Network 3

NHIN Trial Implementations Participate in NHIN Cooperative -implement, test, and demonstrate core services: – Support of consumer access controls – Lookup and retrieval of clinical information – Exchange of patient summary records A foundation for other priorities in lab result reporting, medication history exchange, quality and public health HITSP: Harmonizing standards to support the Nationwide Health Information Network 4

2006 – the First “Turn of the Crank” Consumer Empowerment – Medications – Allergies – Demographics – Advance Directives Electronic Health Records – Laboratory including blood banking and microbiology – Ordering and results exchange Biosurveillance – Deidentified registrations – Labs – Radiology text results HITSP: Harmonizing standards to support the Nationwide Health Information Network 5

What did we do in 2006? Established the HITSP Organization and its committees Created the standards harmonization process including all coordinating committee sub-processes Harmonized standards for 3 use cases (accepted by Secretary Leavitt) and resolved three controversies along the way – To resolve CCR v. CDA, the CCD was successfully balloted – To resolve the need for Interim standards we accelerated CCD – An enhanced implementation guide for HL 7 2. 5. 1 was successfully balloted this Summer To align HITSP interoperability specifications with CCHIT functional criteria, the CCHIT/HITSP Joint Working group has established a joint timeline for the next 3 years HITSP: Harmonizing standards to support the Nationwide Health Information Network 6

HITSP Organization The Community HHS Secretary Mike Leavitt, Chair HITSP Member Populated Coordination Committees • Harmonization Readiness – Lynne Gilbertson • Business Plan – Steve Lieber • International Landscape – Bill Braithwaite • CCHIT JWG – Jamie Ferguson • Foundations – Bob Dolin & Steve Wagner • Process Review – Lynne Gilbertson & Erik Pupo HHS ONCHIT 1 PO, Dr. John Loonsk HITSP Dr. John Halamka, Chair Member Populated Board and Panel Program/Project Management Team Executive in Charge, F. Schrotter, ANSI Program Manager, L. Jones GSI Deputy PM, J Corley, ATI Project Manager, Julie Pooley, Booz Allen Panel Secretariat and Coordination Committee Management Michelle Deane, ANSI Technical Management Joyce Sensmeier, HIMSS HITSP: Harmonizing standards to support the Nationwide Health Information Network HITSP Member Populated Technical Committees • Care Delivery – Jamie Ferguson – Steve Wagner – Steve Hufnagel • Consumer Empowerment – Elaine Blechman, Ph. D – Charles Parisot – Scott Robertson • Population Health – Floyd Eisenberg, MD, MPH – Peter Elkin, MD – Shaun Grannis, MD • Security and Privacy WG – Glen Marshall – John Moehrke – Walter Suarez 7

Standards Harmonization Work Plan Tasks PROCESS I II IV Harmonization Identification Request Requirements of Candidate Standards Analysis V Gaps, Duplications Standards Selection and Overlaps Resolution VI VIII Construction of Inspection Interoperability Test Specification Interoperability Specification Release and Dissemination IX Program Management TASKS Requirements, Standards Selection, and Design Public Review and Input 3 weeks 3 months DOCUMENTATION Requirements, Standards Selection, and Design Interoperability Specification Construct Development 3 months Consolidated comments Inspection Test and Public Comment Resolution and Panel Approval Implementation Support and Testing 4 weeks 2 months On-going IS Docs V 1. 0 Review Draft Consolidated comments Summary of comment resolution HITSP: Harmonizing standards to support the Nationwide Health Information Network IS Docs V 1. 0 Annual Updates as Required Summary of comment resolution 8

HITSP Comments Received CY 2007 Population Health TC 73 Consumer Empowerment TC 30 Care Delivery TC 218 Security & Privacy WG 240 Misc (Project Mgmt, Cross TC, Process) 37 Total 598 HITSP: Harmonizing standards to support the Nationwide Health Information Network 9

Example Interoperability Specification Overview HITSP: Harmonizing standards to support the Nationwide Health Information Network 10

Example Interoperability Specification Standards * HITSP: Harmonizing standards to support the Nationwide Health Information Network 11

2007 – The second turn of the crank Privacy and Security standards Emergency Responder Personal Health Records Medication Management Quality HITSP: Harmonizing standards to support the Nationwide Health Information Network 12

Security Standards Collect and Communicate Security Audit Trails Consistent Time Document Integrity Manage and Control Data Access Manage and Control Privacy Consents Manage Entity Identity Credentials Non-Repudiation Secure Communications Channel User Authentication HITSP: Harmonizing standards to support the Nationwide Health Information Network 13

Consumer Access to Clinical Information HITSP: Harmonizing standards to support the Nationwide Health Information Network 14

Medications Management HITSP: Harmonizing standards to support the Nationwide Health Information Network 15

Quality HITSP: Harmonizing standards to support the Nationwide Health Information Network 16

HITSP 2007/2008 Timeline Overview 10/09/07 HITSP Board 07/09/07 HITSP Board 05/11/07 HITSP Panel MAY 5/08 – 5/10 TC F 2 F Arlington VA 09/07/07 HITSP Panel 07/16/07 HITSP Panel JUN E JUL Y AUG OCT NOV DEC JAN FEB 1/23 – 1/25 TC F 2 F Chicago 10/29 – 10/31 TC F 2 F Lombard IL 09/04 – 09/06 TC F 2 F Arlington VA 6/18 – 6/20 TC F 2 F San Diego CA 12/13/07 HITSP Panel 10/15/07 HITSP Panel SEP T 2/11/08 HITSP Board 2/20/08 HITSP Panel 3/27/08 HITSP Panel MAR APR 3/24 – 3/26 TC F 2 F DC Area Security and Privacy for All Use Cases and Emergency Responder EHR Use Case S&P and EHR-ER v 1. 0 05/17 – 06/14 RDSS Public Comment IS Construct Development Inspect Test and Public Comment Resolution and Panel Approval 07/20 – 08/17 05/17 – 07/19 Implementation Support, Testing, and Gap Resolution (with annual updates as required) 08/20 – 10/15 Consumer Access and Quality Use Cases Consumer Access and Quality v 1. 0 7/20 – 8/17 Public Comment Requirements Design and Stndrds Selection IS Construct Dev 05/07 – 07/10 7/11 – 9/14 Inspect Test and Public Comment Resolution and Panel Approval 9/17 – 10/12 Implementation Support, Testing, and Gap Resolution (with annual updates as required) 10/15 – 12/13 Medication Management Use Case Medications Management v 1. 0 9/17 – 10/12 Requirements Design and Stndrds Selection 6/18 – 9/14 Public Comment IS Construct Development 9/17 – 12/7 Inspect Test and Public Comment 12/10 – 1/11 HITSP: Harmonizing standards to support the Nationwide Health Information Network Comment Resolution and Panel Approval Implementation Support, Testing, and Gap Resolution 1/14 – 3/27 17

HIT Implementation Testing Web Site Preview HITSP: Harmonizing standards to support the Nationwide Health Information Network 18

AHIC Priorities and Use Case Roadmap HITSP: Harmonizing standards to support the Nationwide Health Information Network 19

Overall Timeline HITSP: Harmonizing standards to support the Nationwide Health Information Network 20

Summary Over the past year, HITSP has become an established, trusted organization with a multi-stakeholder, open, transparent process for standards harmonization In 2007, we will complete 4 additional use cases plus security/privacy In 2008, we will complete an additional 6 use cases CCHIT and HITSP are now aligned via a common schedule, an ongoing joint working group and a Memorandum of Understanding Our Foundations Committee will work on the medium to long term alignment of standards organizations and their work products in parallel with the Use Case work of the entire panel HITSP: Harmonizing standards to support the Nationwide Health Information Network 21

Contact Information For general HITSP-related questions please contact: Michelle Maas-Deane HITSP Secretariat American National Standards Institute Phone: 212 -642. 488 email: mmaasdeane@ansi. org For ANSI Document Library related questions please contact: Alison Ziegler Program Administrator, Standards Panels American National Standards Institute Phone: 212 -642. 4947 email: aziegler@ansi. org For Technical Committee questions: Joyce Sensmeier MS, RN-BC, CPHIMS, FHIMSS Vice President, Informatics HIMSS Phone: 312 -915 -9281 email: jsensmeier@himss. org or Jessica Kant Coordinator, Standards Harmonization Healthcare Information & Management Systems Society Phone: 312 -915 -9283 Fax: 312 -915 -9511 email: jkant@himss. org HITSP: Harmonizing standards to support the Nationwide Health Information Network 22