HITSC 2010 06-30 slides

HIT Standards Committee

Meeting

Wednesday, June 30, 2010

9:00 am ET

Call to Order

1. Call to Order– Judy Sparrow, Office of the National Coordinator for Health

Information Technology

2. Opening Remarks

3. Review of the Agenda

4. ONC Update: NHIN Direct Specifications; Standards & Interoperability Framework;

Concept of Operations

5. NHIN Governance

6. Lunch

7. Privacy & Security Tiger Team Update

8. Enrollment Workgroup Update

9. Clinical Quality Workgroup Update on Survey

10. Clinical Operations Workgroup: Electronic Document Standards for Discharge

Summary & Other Encounter Summaries

11. ONC Update: Temporary Certification Program

12. Public Comment

13. Adjourn

Agenda

Opening Remarks

1. Call to Order

2. Opening Remarks – David Blumenthal, MD, MPP, National Coordinator for Health

Information Technology




5. NHIN Governance

6. Lunch







12. Public Comment

13. Adjourn

Agenda

Review of Agenda

1. Call to Order

2. Opening Remarks

3. Review of the Agenda – Jonathan Perlin, Chair



5. NHIN Governance

6. Lunch







12. Public Comment

13. Adjourn

Agenda

John Halamka

1. Call to Order

2. Opening Remarks

3. Review of the Agenda – John Halamka, ONC



5. NHIN Governance

6. Lunch







12. Public Comment

13. Adjourn

Agenda

ONC Update: NHIN Direct; Framework; Concept of Operations

1. Call to Order

2. Opening Remarks


4. ONC Update: NHIN Direct Specifications;

Standards & Interoperability Framework;

Concept of Operations – Arien Malec, ONC

– Doug Fridsma, ONC5. NHIN Governance

6. Lunch




10. Clinical Operations Workgroup: Electronic Document Standards for Discharge Summary &

Other Encounter Summaries


12. Public Comment

13. Adjourn

Agenda

Standards & Interoperability

Framework ConOps Overview:How to operationally deliver on the vision of the framework

HHS – ONC

June 30, 2010

Doug Fridsma

Acting Director, Office of Interoperability and Standards

ONC

7

Outline

» The need for the S&I Framework

» S&I Framework and NIEM

» Process Overview

» Roles and Key Artifacts

» Coordination

6/30/2010

The Need for an S&I Framework

6/30/2010

• Managing the Lifecycle : There needs to be a controlled way to

manage all the activities within the standards and interoperability

activities from identification of a needed capability to implementation and

operations

• Reuse: Standards development and harmonization efforts need to

accommodate multiple stakeholders and business scenarios so as to

ensure reuse across many communities.

• Semantic Discipline: The work products need to be developed in a

way to ensure computability and traceability throughout the entire

lifecycle.

S&I ConOps Organizing Principles

6/30/2010

• Representative Participation:

• ONC Strategic Plan affirms that this diversity is purposeful and should be encouraged.

• Framework needs to elicit capabilities and verify specifications, standards and guidelines across

a broad range of stakeholders and communities.

• Transparency and Openness:

• Need to established trust in the framework processes.

• Transparency and Openness of activities and work products will engender trust in the process.

•Responsive:

• Wide-scale, multi-community interoperability efforts can suffer agility due to scale.

• The framework must ensure timely attention in addressing emerging issues while remaining

flexible enough to accommodate planned activities.

•Accountability:

•While all work is collaborative, the framework must assign accountable roles for delivery of key

artifacts.

•Measureable and Planned Results:

• One objective of the framework is to build the factory that can achieve milestones and make

predictable progress in producing standards and specification.

• The framework should measure schedules, level of effort, and other metrics in establishing and

improving framework processes

Mapping S&I Framework to NIEM

11

Analyze

Requirement

s

Map and

Model

Publish and

Implement

Add service and behavior

specification generation to

NIEM

Implementation, testing and

certification disciplines are

needed beyond NIEM

Scenario

Planning

Analyze

Requirement

s

Map &

Model

Analyze

RequirementsBuild &

Validate

Assemble &

Document

Publish &

Implement

Implementation

Specifications

Use Case

Development

S&I NIEM Process Outline

12

Scenario

Planning

Analyze

Requirements

Prioritize

Biz scenarios identified

by:

• Health community

• ONC

• Federal agencies

Document in wiki

• Business scenario

• Use cases

Elaborate tech

and business

requirements for

exchange

Map & ModelDevelop

computable UML

model for content

and/or transactions

RI

Build & Validate

Generate

implementable

code from model

Emergence

Pilot

Assemble &

Document

• Generate IEPDs

from UML model

• Package all

artifacts for

IEPDs

Harmonize

Standards

Testing &

Certification

Publish &

ImplementPublish

= Governance

Decision= S&I Activity

= NIEM IEPD

Lifecycle Phase

Continuous

Feedback

Publish IEPDs

to repository

Identify relevant

standards and

gaps

Coordinating Iterative and Incremental S&I

Processes

6/30/2010

•Artifacts: To support the requirement of computable and traceable resultant artifacts, the S&I

framework needs ensure the content and structure of the artifacts within the process are well defined

and provide continuity within the activities and the tools.

•Roles: Clear “ownership” of significant artifacts and activities must be assigned to ensure coordination,

lack of duplication and discontinuity throughout the process. An example of this is the Use Case

Stewart, but there are additional roles throughout the process.

•Control Points: At points in an iterative and incremental process, prioritization, validation or approval

of artifacts is required to ensure quality and alignment with goals. These points, and the approval

entities need to be well defined for the framework to operate smoothly.

• Not a “waterfall” Process: Developing and harmonizing

standards and service specifications across diverse

communities necessitates concurrent, agile activities, not

waterfall processes

•Need for Structured Coordination: To manage coordination

of the concurrent activities within the framework , we need well

defined:

• Artifacts

• Roles

• Decisions (Control Points)

S& I Overview of Roles and Controls

6/30/2010

Core artifacts

are versioned

and controlled

Artifacts are

“packaged”

and released

Each artifacts

has a

responsible

role

Artifacts and

releases have

prioritization

and approval

points, or

“controls”

Prioritization and Backlog Lists

6/30/2010

Strategic

Priorities

Operational

Priorities

“Day to Day”

Priorities within

each functional

team

Stakeholder coordination

6/30/2010

HITPC

VLER

NHIN CC

FHA

HIT SC

VLER

NHIN TC

FHA

S&

I and H

ITS

C

Activitie

s

NH

IN D

irect

Activitie

s

J J A S O N D J F M A M J J A S O N

Tools and Services

(Use Case Development, Harmonization Tools, Vocabulary Browser, Value Set Repository, Testing Scripts, etc)

Use Case Developmentand FunctionalRequirements

Standards Development

Certificationand Testing

Harmonization ofCore Concepts (NIEM

framework)

Implementation Specifications

Reference Implementation

Implementation Specifications

Pilot Demonstration Projects

Reference Implementation

HIT

PC

Activitie

s

HITPC P&S Tiger Team Policy

Framework

HITPC + HITSC

Specification Policy Review

HIT Standards Committee ReviewNHIN Inclusion

Evaluation

Other Standards

Governance

Evaluations

NHIN Direct Example

NHIN Direct Project Consensus Proposal

» Currently in consensus process

• Implementation group contains 60+ organizations representing

– Providers (small, large)

– Federal partners, State and Regional HIOs

– EHR, PHR, HIE and national network organizations serving a

variety of markets

» Lessons learned:

• Strong support for services that “meet providers where they are”

and offer an upward migration path to comprehensive

interoperability

• Strong support for IHE profiled SOAP services by EHR and HIE

technology vendors of all sizes and target markets

• Existing health care standards need work to be policy neutral for

these uses

6/30/2010

NHIN Direct Project Consensus Proposal

» Supports SMTP + S/MIME as the minimum backbone

protocol

• Universal addressing

• Secure transport of health information

• Separation of address metadata from content metadata

» Endorses use of strong content metadata

» Supports XDR for existing and future NHIN Exchange

participants

» Encourages development of exchanges that support both

SMTP and a modified XDR specification to support a

bridge to NHIN Exchange

6/30/2010

Source HISP Destination HISPRFC 5322

Headers + DNS

Reject

SMTP +

S/MIME

SMTP +

MIME

(+XDM)

Send

Locate

Destination

(s)

SMTP +

MIME

(+XDM)

POP/IMAP +

TLS

SMTP +

TLS

Receive

SMTP

+

S/MIM

E

S/MIME

Encrypt

S/MIME

Sign

SMTP +

TLS

Hold (encrypted)

Content

S/MIME

Verify

S/MIME

Decrypt

Where Next?

» Continued collaboration with HIT Policy Committee and HIT Standards

Committee

• Vetting of the consensus specifications against policy guidelines

• Continued development of privacy and security policy framework

» Detailed project work on:

• Documentation and Testing

• Security and Risk Analysis

• Open Source Reference Implementation

• Early Implementation Geographies

» Work with IHE to modify XDR specification to better meet policy

guidelines and usage needs

6/30/2010

NHIN Governance

1. Call to Order

2. Opening Remarks




5. NHIN Governance– Mary Jo Deering, ONC

6. Lunch







12. Public Comment

13. Adjourn

Agenda

HIT Standards Committee Meeting

Nationwide Health Information Network

Governance

June 30, 2010

Mary Jo Deering, PhD

ONC, Office of Policy and Planning

NHIN Policy and Governance

[email protected]

mailto:[email protected]

Current Request For FACA Committee Input

• Help us frame initial request for public input on

nationwide health information network governance:

what issues and questions should be included?

– HITPC June 25, 2010: Guidance on governance for

NHIN policies and services

– HITSC June 30, 2010: Guidance on governance for

NHIN standards

• The slides that follow reflect our experiences and

preliminary analysis

• We have identified possible questions whose answers

will shape the NPRM

• We will be seeking additional input from the HITSC and

HITPC in September to develop the NPRM

Background and Purpose of Rule Making

• HITECH directed the National Coordinator to “establish a

governance mechanism for the nationwide health

information network.”

– To be accomplished by rulemaking

• Rulemaking would establish foundational policies and

structures which would:

– Engender trust

– Assure effectiveness

– Meet or exceed consumer expectations

– facilitate use of the nationwide health information network

• Recognize that some governance is in place (e.g., HIPAA

Privacy and Security Rules); identify where complementary

governance mechanisms are necessary for evolving

nationwide health information network.

Scope of Rulemaking for Nationwide Health

Information Network Governance

Identify Governance Requirements in Domains of the HIE Trust Framework

• Agreed Upon Business, Policy and Legal Requirements: All

participants will abide by an agreed upon a set of rules, including (but not

necessarily limited to) compliance with applicable law and act in a way

that protects the privacy and security of the information and is in

accordance with consumer/patient expectations.

• Transparent Oversight : Oversight of the exchange activities to assure

compliance. Oversight should be as transparent as possible.

• Enforcement and Accountability: Each participant must accept

responsibility for its exchange activities and answer for adverse

consequences.

• Identity Assurance: All participants need to be confident they are

exchanging information with whom they intend and that this is verified as

part of the information exchange activities.

• Technical Requirements: All participants agree to comply with some

minimum technical requirements necessary for the exchange to occur

reliably and securely.

Scope of Governance

• Should participation or compliance with nationwide

health information network standards, services and

policies (or a subset) be:

– Optional

– Preferred – “seal of approval”/nationwide health information

network brand

– Mandatory

• How and where should governance apply?

• What are appropriate levers of governance?

– When should they be applied?

– Under what conditions?

Business, Policy And Legal Requirements And

Expectations – Key Issues

• When should patient consent be required and for what?

– Populate RLS

– Disclose/reuse PHI

– More granular (e.g. particular data elements)

• What requirements are necessary to assure data

integrity and quality?

• Should requirements (for consent, data use, etc.) vary

by exchange model?

– Exchange participants (query and lookup)

– Directed secure routing (known endpoints)

• How should we specify appropriate purposes for using,

exchanging and reusing data and minimize data

required for transactions?

Transparent Oversight – Key Issues

• Is there a role for federal and/or state oversight to

monitor and address abusive market behaviors?

• Is there a need for a federal mechanism of oversight

over information exchange organizations?

• What are the appropriate federal and state roles?

• How can transparency and open processes be assured

for setting nationwide health information network

policies and technical requirements?

• How can transparency, oversight and accountability be

assured for the nationwide health information network

(e.g., auditing and alert capabilities, patient access,

correction, redress)?

Enforcement and Accountability – Key Issues

• Should there be a certification or accreditation program

for intermediaries (e.g., HISPs) or participants (e.g.,

Exchange)? If so:

– Key roles for certifying / accrediting body

– Certification / accreditation requirements

– Limits of certification / accreditation

• What other types of enforcement and accountability

measures should be considered?

– Regulatory requirements

– Contractual mechanisms (with federal government, between

participants)

Identity Assurance – Key Issues

• Should there be identity assurance requirements for:

– Provider access to clinical information systems/data?

– Patient/consumer access?

– For participation in nationwide health information network

transactions?

• Should there be mechanisms to validate identity

assurance processes and mechanisms, e.g.,

certification or accreditation?

Technical Requirements – Key Issues

• Do we need additional testing and oversight to assure

participant conformance with nationwide health

information network technical requirements? Potential

mechanisms:

– Threshold for exchanging with federal agencies/government

contracts

– Certification/meaningful use

– Government identifying best practices

• What level of interoperability in the nationwide health

information network is required to meet policy goals?

Discussion

Tiger Team Update

1. Call to Order

2. Opening Remarks




5. NHIN Governance

6. Lunch

7. Privacy & Security Tiger Team Update– Deven McGraw, Chair






12. Public Comment

13. Adjourn

Agenda


Privacy & Security Tiger Team Update

Deven McGraw, Co-Chair

Center for Democracy & Technology

Paul Egerman, Co-Chair

June 30, 2010

Broad Charge

• The Office of the National Coordinator for Health Information

Technology (ONC) formed a Privacy & Security Tiger Team

under the auspices of the HIT Policy Committee to address

privacy and security issues related to health information

exchange that must be resolved over the summer.

• Members of the Tiger Team are comprised of individuals from

the HIT Policy Committee and the HIT Standards Committee

as well as National Committee on Vital and Health Statistics

Tiger Team Members

• Deven McGraw, Center for Democracy & Technology, Co-Chair

• Paul Egerman, Co-Chair

• Dixie Baker, SAIC

• Christine Bechtel, National Partnership for Women & Families

• Rachel Block, NYS Department of Health

• Neil Calman, The Institute for Family Health

• Carol Diamond, Markle Foundation

• Judy Faulkner, EPIC Systems Corp.

• Gayle Harrell, Consumer Representative/Florida

• John Houston, University of Pittsburgh Medical Center; NCVHS

• David Lansky, Pacific Business Group on Health

• David McCallie, Cerner Corp.

• Wes Rishel, Gartner

• Micky Tripathi, Massachusetts eHealth Collaborative

• Latanya Sweeney, Carnegie Mellon University

Proposed Schedule of Topics

June

• Organize Team

• Address issues of message handling in Directed Exchange

• Report to Policy Committee on June 25

• Consumer Choice Technology Hearing on 6/29

July

• Continue Directed Exchange

• Develop policy framework for other HIO models

• Address issues of:

• Consumer Choice/Consent

• Sensitive Data

• Interstate Exchange

• Report to Policy Committee on July 21

August

• Governance

• Final Report to Policy Committee on August 19

Message Handling in Directed Exchange

• What are the policy guardrails for message handling in Directed

Exchange?

• Who is responsible for establishing “trust” when messages are

sent?

– The terms “message handling” and “directed exchange” refer to transporting

patient data from one known provider to another where both providers are

directly involved in the care of the patient who is the subject of the information.

We assume communication channels are encrypted.

Categories of Message Handling

To frame the discussion, message handling has been classified into four categories:

A. No intermediary involved (exchange is direct from message originator to message recipient)

B. Intermediary only performs routing and has no access to unencrypted PHI (message body is encrypted and intermediary does not access unencrypted patient identification data)

C. Intermediary has access to unencrypted PHI (i.e., patient is identifiable) - but does not change the data in the message body)

D. Intermediary opens message and changes the message body (format and/or data)

Recommendations

• Unencrypted PHI exposure to an intermediary in any amount raises privacy concerns.

• Fewer privacy concerns for directed exchange are found in models A and B above, where no unencrypted PHI is exposed.

• Models C and D involve intermediary access to unencrypted PHI, introducing privacy and safety concerns related to the intermediary’s ability to view and/or modify data. Clear policies are needed to limit retention of PHI and restrict its use and re-use.

• Our team may make further privacy policy recommendations concerning retention and reuse of data, Model D also should be required to make commitments regarding accuracy and quality of data transformation.

• Intermediaries who collect and retain audit trails of messages that include unencrypted PHI should also be subject to policy constraints.

• Intermediaries that support Models C and D require contractual arrangements with the message originators in the form of Business Associate agreements that set forth applicable policies and commitments and obligations.

Establishing Exchange Credentials

We also addressed the question of whether establishing exchange “credentials” should be centralized or decentralized (i.e., who holds the “trust”?)

• The responsibility for maintaining the privacy and security of a patient's record rests with the patient's providers. For functions like issuing digital credentials or verifying provider identity, providers may delegate that authority to authorized credentialing service providers.

• To provide physicians and hospitals (and the public) with some reassurance that this credentialing responsibility is being delegated to a “trustworthy” organization, the federal government (ONC) has a role in establishing and enforcing clear requirements and policies about the credentialing process, which must include a requirement to validate the identity of the organization or individual requesting a credential.

• State governments can, at their option, also provide additional rules for these authorized credentialing service providers.

Discussion Regarding “NHIN Direct” Project

• The basic technical model for NHIN Direct should not involve intermediary access to unencrypted PHI (i.e., models A and B above).

• HHS should develop regulations, guidance and/or best practices to promote greater transparency to patients about direct electronic exchange of health information.

– Regional Extension centers should also play a role in helping providers to be transparent to patients about direct electronic exchange using this model.

Enrollment W G Update

1. Call to Order

2. Opening Remarks




5. NHIN Governance

6. Lunch


8. Enrollment Workgroup Update– Aneesh Chopra, Chair

– Sam Karp, Co-Chair





12. Public Comment

13. Adjourn

Agenda

Aneesh Chopra, Chair

Chief Technology Officer, OSTP

Sam Karp, Co-Chair

California Healthcare Foundation

June 30, 2010

HIT Policy & Standards Committees

Enrollment Workgroup

Workgroup Members

Members: Ex Officio/Federal:

• Cris Ross SureScripts Sharon Parrott, O/S, HHS

• James Borland Social Security Administration Nancy DeLew, HHS

• Jessica Shahin U.S. Department of Agriculture Penny Thompson, CMS/HHS

• Stacy Dean Center on Budget & Policy Priorities Henry Chao, CMS/HHS

• Steve Fletcher CIO, Utah Gary Glickman, OMB

• Reed V. Tuckson UnitedHealth Group John Galloway, OMB

• Ronan Rooney Curam David Hale, NIH

• Rob Restuccia Community Catalyst Paul Swanenberg, SSA

• Ruth Kennedy Louisiana Medicaid Department David Hansell, Administration for

• Ray Baxter Kaiser Permanente Children & Families, HHS

• Deborah Bachrach Consultant Julie Rushin, IRS

• Paul Egerman Businessman Farzad Mostashari, ONC

• Gopal Khanna CIO, Minnesota Doug Fridsma, ONC

• Bill Oates CIO, City of Boston Claudia Williams, ONC

• Anne Castro Blue Cross/Blue Shield South Carolina

• Oren Michels Mashery

• Wilfried Schobeiri InTake1

• Bryan Sivak CTO, Washington, DC

• Terri Shaw Children’s Partnership

• Elizabeth Royal SEIU

• Sallie Milam West Virginia, Chief Privacy Officer

• Dave Molchany Deputy County Executive, Fairfax County

Chair: Aneesh Chopra, Federal CTO

Co-Chair: Sam Karp, California Healthcare Foundation

Section 1561 of Affordable Care Act

1561. HIT Enrollment, Standards and Protocols. Not

later than 180 days after the enactment, the Secretary,

in consultation with the HIT Policy and Standards

Committees, shall develop interoperable and secure

standards and protocols that facilitate enrollment in

Federal and State health and human services

programs through methods that include providing

individuals and authorized 3rd parties notification of

eligibility and verification of eligibility.

Enrollment Workgroup Charge

• Inventory of standards in use, identification of gap,

recommendations for candidate standards for federal

and state health and human service programs in

following areas:

– Electronic matching across state and Federal data

– Retrieval and submission of electronic

documentation for verification

– Reuse of eligibility information

– Capability for individuals to maintain eligibility

information online

– Notification of eligibility

Potential Deliverables

1. Inventory of standards-based data exchange in use

today to enroll in health and human services

2. Candidate standards for data elements and

messaging

3. Proposed process to fill in gaps to rapidly turn

"requirements" into working prototypes/live

implementations to deliver world class eligibility and

enrollment services

Potential Candidate Standards

• Core data elements • Name, address, residence, income, citizenship, etc.

• Messaging • Checking eligibility and enrollment

• Consumer matching across systems

• Retrieving and sending “packages” of verification information including income, employment, citizenship

• Communicating enrollment information

• Privacy and security • Secure transport

• Authentication

Standards Requirements

We need to conceptualize standards that might be useful

and work across a variety of use cases or architectures

which might include:• Front end user-facing consumer portal* to conduct initial eligibility

checks and obtain and forward verification information

• Comprehensive eligibility system for Health and Human Services

programs

• State or Federal exchange portals

* online, mail and telephone based systems

Draft Policy Principles - Reprise

Standards and technologies must support and be in service to our policy goals:

• Consumer at the center

• Make enrollment process less burdensome; simplify eligibility process and make it seamless

• Enter/obtain information once, reuse for other purposes

• Make it easier for consumers to move between programs

• Focus on 2014 world

Draft Standards Principles - Reprise

• Keep it simple - Think big, but start small. Recommend standards as minimal as required to support necessary policy objective/business need, and then build as you go.

– Don’t rip and replace existing interfaces that are working (e.g., with SSA etc.)

– Advance adoption of common standards where proven through use (e.g., 270/271).

• Don’t let “perfect” be the enemy of “good enough” Go for the 80 percent that everyone can agree on.

– Opportunity to standardize the core, shared data elements across programs.

– Cannot represent every desired data element.

• Keep the implementation cost as low as possible – May be possible to designate a basic set of services and interfaces that can be

built once and used by or incorporated by states.

– Opportunity to accelerate move to web services

• Do not try to create a one-size-fits-all standard that add burden or complexity to the simple use cases

– Opportunity to describe data elements and messaging standards that would be needed regardless of the architecture or precise business rules selected.

Base Use Case – Draft – Under Discussion

Consumer-facing web portal that allows applicants to:

» Identify available services for which they might be eligible

» Conduct initial screening and enrollment checks

» Retrieve electronic verification information from outside sources

» Determine eligibility or forward eligibility “packet” (screening information and verification information) to programs for final determination

» Store and re-use eligibility information

This Base Use Case Supports Several Eligibility and

Enrollment Scenarios in 2014 – Draft Under DiscussionMakes recommendations more flexible, durable and useful

» Scenario One: Exchange portal• Screening, verification and eligibility for 2014 MAGI-eligible group: Medicaid,

CHIP and exchange • Send/receive applicant information “packets” with Medicaid

» Scenario Two: Medicaid/TANF/SNAP portal• Screening, verification and eligibility for residual Medicaid, TANF, and SNAP. • Send/receive applicant information “packets” with exchange• Re-use eligibility information to screen for other programs

» Scenario Three: Combined portal• All of Medicaid, CHIP, Exchange; other combinations

Diagram

Send eligibility info to

other programs

(human services, etc.)

Obtain

Verification Info: Electronically verify

identity, residency,

citizenship, household

size, income,

etc.

Check Current

Enrollment:

Check other systems

for existing coverage; first

match using single identifier,

probabilistic formula, or

other method; then obtain

enrollment info

Initial

Screening:

Applicant

provides basic

demographic info

Determine

Eligibility: Method

will depend

on system

capabilities.

IRS

DHS

State

systems

IEVS

DMV

VR

23

Medicaid MAGI, MA,

Exchange, State systems

1

5

Program

makes

eligibility

decision

4

Portal

makes

eligibility

decision

4b

Portal

sends

eligibility

packet to

program

4a

Enrollment

Notification

to Portal

SSA

Send enrollment

information to plans

6

Clinical Quality W G Update

1. Call to Order

2. Opening Remarks


4. ONC Update: NHIN Direct Specifications; Standards & Interoperability Framework; Concept of

Operations

5. NHIN Governance

6. Lunch



9. Clinical Quality Workgroup Update on

Survey– Janet Corrigan, Chair

– Floyd Eisenberg, Workgroup member10. Clinical Operations Workgroup: Electronic Document Standards for Discharge Summary &



12. Public Comment

13. Adjourn

Agenda


Quality Workgroup

Next Steps:

Quality Measures for 2013

Janet Corrigan, ChairNational Quality Forum

Floyd Eisenberg

National Quality Forum

June 30, 2010

Clinical Quality Workgroup Members

• Janet Corrigan, Chair, National Quality Forum

• Floyd Eisenberg, National Quality Forum

• John Derr, Golden Living, LLC

• Judy Murphy, Aurora Health

• Marc Overhage, Regenstrief

• Rick Stephens, Boeing

• James Walker, Geisinger

• Jack Corley, HITSP

• John Halamka, Harvard Medical School

• Walter Suarez, Kaiser Permanente

Presentation at a Glance

• Update on Retooling of Potential 2011 MU Measures

• Results of the ONC Environmental Scan of Leading

Health Systems

• Overview of NQF Fast Track Project

Measure Retooling Update

Measure Retooling Update

• 44 Ambulatory Measures

• Use the Quality Data Set to identify data elements

• Apply logic in human readable format

• Provide lists of codes (value sets) for each data element

ONC Environmental Scan

Scan of 12 leading healthcare systems

Responses from 9 organizations:

• American Board of Family Medicine

• Geisinger Health System

• Mayo Clinic

• Kaiser Permanente

• Aurora Healthcare

• Tenet Healthcare

• Interim Healthcare

• PointRight

• National Association of Home Care and Hospice

ONC Environmental Scan

Table 1 – Environmental ScanONC Environmental Scan

Condition /

Cross-Cutting Area Performance Measure*

Diabetes HbA1c<7%

Diabetic Screen for Peripheral Neuropathy

Monitoring HbA1c and LDL in Patients with Diabetes

Tobacco use in Diabetic Patients

Preventive Services Breast Cancer Screening

Colon Cancer Screening Rate

Cervical Cancer Screening Rates

Flu Vaccination

Obesity Weight Management

Hypertension High Blood Pressure

* Yellow highlighting indicates the measure or a comparable measure is included in the

set delivered to HHS.


Condition /

Cross-Cutting Area Performance Measure

Healthcare Associated

Infections

Decrease Use of Urinary Indwelling Catheters in

Patients 65 and Older

SCIP-Inf-3 Prophylactic Antibiotics Discontinued Within

24 Hours After Surgery End Time

SCIP-Inf-9 Postoperative Urinary Catheter Removal on

Post-op Day 1 or 2

Safety Events Total Falls per 1,000 Patient Days

Appropriate Use of High Risk Medications

High-Risk Pressure Ulcer Prevention and Chronic Care

Medication Management Medication Compliance




Condition /


Patient experience HCAHPS Survey Scores

Staffing Nursing Staffing Ratio

Nursing Turnover Rates

Skilled Nursing Chronic Care (CC) Percent of residents who have

moderate to severe pain.

Physical Restraints-Chronic Care (CC) Percent of

residents with daily physical restraints.

Care Transition Re-hospitalization measures

Stratification of disposition based on discharge

assessment




Condition /


Home Care Acute Care Hospitalization after Home Health

Episodes of Care

Improvement in Management of Oral Medications

Stabilization in Self Grooming

Stabilization in Light Meal Preparation



NQF Fast Track Project – Two Objectives

1. Identify “types of measures” that might be appropriate for

2013 with input from:

• ONC Environmental scan of health systems

• Comments on Potential MU11 Measures

• Beacon Communities List of Measures

• Gretsky Group

• Other

2. Identify pathways to generate the desired types of

measures within the requisite time frame:

• Appropriate measures available

• “Similar” measures available that might be adapted

• Measures would need to be developed de novo

Next Step

• NQF Report due July 2010

• Intended to

o Inform Policy Committee’s September discussions

aimed at identifying types of MU measures for 2013

o Identify time-sensitive measure development work

that must get underway very quickly

o Input to Standards Committee’s Fall work aimed at

identifying specific measures available to satisfy

Policy Committee’s recommended measure types

Clinical Operations W G

1. Call to Order

2. Opening Remarks




5. NHIN Governance

6. Lunch




10.Clinical Operations Workgroup: Electronic

Document Standards for Discharge

Summary & Other Encounter Summaries– Jamie Ferguson, Chair


12. Public Comment

13. Adjourn

Agenda


Clinical Operations Workgroup

Workgroup Update

Jamie Ferguson

Kaiser Permanente

John Halamka

Harvard University

30 June, 2010

Problem Statement

• Implementers of CCR and CCD for transfers of care

also need other standard document types, e.g.,:

– Inpatient Discharge Summary

– ED Discharge Summary

• These documents may contain specialized content not

found in CCR or CCD, e.g.,:

– Discharge Diet

– Surgery Description

– Surgical Operation Note Findings

– Estimated Blood Loss

– Chief Complaint

Review: CCR and CCD

Medications

Allergies

Social History

Dem

ographics

Payer

. . . . V

ital Signs

Problem

s

A CCD based document

CCD: A collection of templates representing core content for

healthcare summary documents with template content from CCR

Family H

istoryCDA: A foundation standard enabling the definition of templates

for a broad range of healthcare documents

Extending And Reusing Existing Templates In

Other Documents

Medications

Allergies

Social History

Dem

ographics

Payer

. . . .

Vital Signs

Chief C

omplaint

Discharge

Diagnosis

Problem

s

A CCD based document

A CDA based document

compatible with CCDM

ode of

Transport

Ne

w S

ectio

n…

Template content from CCR

Family H

istory

Surgical Finding

Dis

ch

arg

e D

iet

CDA

CCD

Identified by the CCD document ID number

Identified by another identifier, e.g., an

ED Discharge document ID number

Discussion points

• We plan to make recommendations to the Standards Harmonization entity as outlined in the Concept of Operations plan

• General direction of WG: Recommend that the process should standardize templated CDA sections to build upon and extend what was done in CCR and CCD

• WG direction is consistent with NIST direction for testing

Discussion points, continued

• Must enable more documents and reuse existing work

• May also recommend this direction for attachments

• Identification of complete documents assembled from templates: – A few complete documents might have complete document IDs,

e.g., discharge summaries, ambulance services, etc.

– Otherwise, a general method for identification should be devised• Embedded or concatenated identifiers would avoid enumerating a

combinatorial explosion of complete documents assembled from templates

• Coordination of templates with value set standards– E.g.,: value sets for hospital readmission measures could be

coordinated with discharge summary template standards

Next Steps

• Seek HIT Standards Committee input

• Continue Workgroup discussions to create future recommendations to the full Committee

ONC Update: Temp Certification Program

1. Call to Order

2. Opening Remarks


4. ONC Update: NHIN Direct Specifications; Standards & Interoperability Framework; Concept of

Operations

5. NHIN Governance

6. Lunch




10. Clinical Operations Workgroup: Electronic Document Standards for Discharge Summary &


11.ONC Update: Temporary Certification

Program– Steve Posnack, ONC

– Carol Bean, ONC12. Public Comment

13. Adjourn

Agenda

Temporary Certification Program

Steve Posnack, ONC

Carol Bean, ONC

June 30, 2010

Steve/Carol


Adjourn

Meeting Adjourned

HITSC 2010 06-30 slides

Documents

Transcript of HITSC 2010 06-30 slides