# American Health Information Community

# Workgroup on Quality

# 

# Summary of the Web Conference 

# Held on Friday, September 22, 2006

# First Meeting of This Workgroup

## PURPOSE OF MEETING

### Introductions, Quality Workgroup Background, Agenda Highlights

The Quality Workgroup co-chair Carolyn Clancy introduced the new Interim
National Coordinator for Health Information Technology (HIT), Robert
Kolodner, on detail from his post as Chief Health Informatics Officer of
the Veterans Health Administration (VA), where he has helped oversee and
develop the VA's electronic health records systems. Dr. Kolodner noted
that one of the Secretary's highest priorities is use of Health
Information Technology (HIT) to improve healthcare quality and cut
costs.

Dr. Clancy noted that the Workgroup's **Specific** and **Broad Charges**
(see Key Topics, #1 below) also speak to the reason the Workgroup was
formed by The Community at its August 1, 2006, meeting. Overall, the
Workgroup's charge is to make stronger connections between HIT and the
healthcare quality enterprise. Much work is needed to ensure that HIT
serves the overarching goal of improving quality and value in health
care. It will be important for members to understand the **Charges**'
scope and how to interpret them. The Workgroup will present
recommendations, based on its **Specific Charge**, to The Community at
its next meeting, October 31, 2006. The Office of the National
Coordinator (ONC) staff will assist, as well as senior advisors and
clinicians from the Indian Health Service, the Department of Defense
(DOD), and the VA.

*Agenda Highlights:*

-   Discussion of the Workgroup **Specific** and **Broad Charges**

-   Overview of the Workgroup Process, FACA Guidelines, and October 31,
    2006, **Specific** **Charge** Recommendations to The Community

-   Presentations and Discussion on Current State of Ambulatory and
    Inpatient Measure Reporting --- A) Ambulatory Care Quality Alliance
    (AQA) Measures and Pilots, by George Isham, Health Partners; AQA; B)
    Hospital Quality Alliance (HQA) Measures and Current Tools for
    Hospital Reporting of Quality Measures, by Nancy Foster, American
    Hospital Association (AHA); C) Web-based Quality Measurement Tools,
    by Margaret O'Kane, National Committee for Quality Assurance
    (NCQA); D) Health Information Exchange/RHIOs Providing Data for
    Quality Reporting, by Marc Overhage, Indiana Health Information
    Exchange (IHIE); E) Status of Electronic Health Record (EHR)
    Certification Criteria Related to Quality Measurement and Reporting,
    by Alisa Ray and Mark Leavitt, Certification Commission for HIT
    (CCHIT); F) Principles for a National Data Strategy for Quality
    Measurement, by Margaret van Amringe, Joint Commission on
    Accreditation of Healthcare Organizations

-   Discussion of Core Set of Ambulatory and Inpatient Quality Measures

-   "Next Steps"---A) Additional Environmental Scan for the Workgroup
    October Meeting; B) Development of Recommendations for October 31,
    2006 Meeting of The Community; C) Visioning Process
    (November-December); D) Development of Detailed Work Plan; E)
    Confirmation of the Workgroup Meeting Dates.

## KEY TOPICS

1.  **The Quality Workgroup Charges**

**Specific Charge**: "Make recommendations to the American Health
Information Community that specify how certified health information
technology should capture, aggregate and report data for a core set of
ambulatory and inpatient quality measures."

**Broad Charge**: "Make recommendations to the American Health
Information Community so that HIT can provide the data needed for the
development of quality measures that are useful to patients and others
in the health care industry, automate the measurement and reporting of a
comprehensive current and future set of quality measures, and accelerate
the use of clinical decision support that can improve performance on
those quality measures. Also, make recommendations for how performance
measures should align with the capabilities and limitations of HIT."

*Discussion:*

The charges were formulated by a panel for The Community's August 2006
meeting. A first WORKGROUP task will be to keep the **Broad Charge** in
mind while making short-term progress within the **Specific Charge's**
scope. A first step will be trying to automate the collection of data
required by a select set of ambulatory and inpatient quality measures.

Discussion ensued on whether the Workgroup\'s task is to set national
goals and objectives for quality. It was noted that is not The
Community's intent, yet any process for developing quality measures is
constrained by the availability of relevant data. The Workgroup\'s focus
at present is to find a way to accelerate the use of HIT for reporting
and improving healthcare quality. The Workgroup does need to stay
informed on the progress of other groups working on national standards.
In addition, where HIT interfaces with these initiatives, the Workgroup
might be able to help considerations of feasibility and practicality.

2.  **A. Overview of the Workgroup Process and FACA Guidelines**

Judy Sparrow encouraged members to read the Federal Advisory Committee
Act (FACA) Guidelines summary provided for the meeting. Some of the
highlights include:

-   The Quality Workgroup is operating in the public view.

-   All meeting dates must be reported in the Federal Register.

-   All meeting summaries and transcripts are made public in a timely
    manner, through the American Health Information Community (AHIC)
    Website.

-   Public comment periods are made available for each meeting.

-   The Quality Workgroup is acting in an advisory capacity to The
    Community.

-   Members should participate as often as possible or, if not, appoint
    designees.

**2. B. October 31, 2006, Specific Charge Recommendations to The
Community**

The **Specific Charge** refers to certified HIT and how that can enable
automated measurement and reporting. The recommendations will inform
information case development, which will guide the activities of the HIT
Standards Panel (HITSP), the CCHIT, and the NHIN over the next year.

Kelly Cronin noted that, in terms of information case development, core
HQA and AQA measures are specified in sufficient detail to assist the
process. Availability of an information case will put the standard
harmonization process into motion, as well as development of criteria
for CCHIT's work on ambulatory and in-patient Electronic Health Records
(EHRs).

Given that EHR adoption is relatively low in some portions of the
market, the Workgroup needs to think through how to get from the current
situation to the final goal of streamlined and automated reporting. One
place to start is to consider some of the issues that exist today with
respect to having to merge data from a variety of sources. In some areas
of the country, interested parties are heavily dependent on claims data;
in other areas, data are available through Pharmacy Benefit Audits
(PBMs). Pharmacy electronic data and lab data are also available. The
Workgroup needs to start pulling together what the data flow looks like
in the current environment and how, through certified technologies and
the data sources available today, automated measurement and reporting
can be improved.

Discussion ensued on who will be accountable for performance, both in
terms of cost and quality. Dr. Clancy commented that the President's
recently issued Executive Order sets the stage for public and private
payers using a core set of measures, from which accountability would
ensue. At present, no clear accountability map for every participant in
the healthcare system exists.

One member suggested that gaps and barriers to improvement through HIT
be identified. Dr. Clancy commented that the Workgroup's attention
should be focused on how simply adopting HIT does not necessarily equal
quality improvement advancement. Another member suggested that the
Workgroup influence the selection of use cases by other Workgroups so
that quality standards, goals, and objectives can be accomplished. Dr.
Clancy noted that reporting on quality of care could be facilitated
through EHRs and that the Workgroup will benefit from interaction with
other Workgroups, including the progress being made by the Workgroup on
EHRs. Ms. Cronin noted that before and after the Community's October
meeting, where presentations will be given by all the Workgroups, the
Quality Workgroup and staff will be working together to make sure data
content for the core set of measures has been identified.

3.  **Presentations and Discussion on Current State of Ambulatory and
    Inpatient Measure Reporting**

#### A. AQA Measures and Pilots

Dr. Isham referred members to
[www.aqaalliance.org](http://www.aqaalliance.org/) for the details of
his presentation. He focused on an overview of AQA, starter sets
recommendations by AQA, data aggregation and sharing, enabling quality
of reporting, and opportunities. AQA's four main goals are:

-   To reach consensus as soon as possible on a set of measures for
    physician performance that stakeholders can use in private health
    insurance plan contracts and with government purchases

-   To engineer a multiyear strategy to roll out and implement
    additional measurements sets

-   To create a model, including a framework and governing structure, to
    aggregate, gather, and steward data

-   To identify critical steps needed for reporting useful information
    to providers, consumers, and purchasers.

AQA has formulated an initial set of physician performance measures to
determine parameters for selective performance measures. A starter set
of 26 measures now exists for primary care based in part on measures
provided by the Centers for Medicare and Medicaid Services (CMS), the
American Medical Association's (AMA) physician consortium, and NCQA.
Considered criteria included clinical importance, scientific validity,
feasibility relative to physician performance, and consumer and
purchaser relevance. The starter set includes, but is not limited to:

-   Preventive measures

-   Coronary artery disease measures

-   Measures related to heart failure, diabetes, asthma, depression, and
    prenatal care

-   Quality measures addressing overuse or misuse of care.

AQA formed a workgroup to consider the need for a uniformed approach to
collect, aggregate and share data. Guidelines have been developed, as
well as questions for data aggregation and data sharing projects. Data
aggregation pilots are now underway in five states and Phoenix, AZ. An
HIT subgroup of the data aggregation workgroup recognizes the need to
begin dialogue across performance measurement and HIT work. Principles
for HIT can be found on the AQA Website. In addition, AQA has
recommended principles for and some aspects of a proposal called
"National Health Data Steward," which can be found on the AQA Website.

To enable quality reporting, a uniform approach to measure, collect,
aggregate, and share data specified to the level of automated
information systems is needed, in part to reduce use of limited
resources. Principles to guide and components that support quality
reporting are needed. A standard approach to EHRs to routinely produce
quality databases on measures, such as AQA and HQA-approved measures is
needed as well. In addition, uniform operating rules and standards for
sharing and aggregating data, implementing guidance, and establishing a
framework for collecting and analyzing data, which the National Health
Data Stewardship might address is also necessary.

The AQA pilots will combine public and private information on clinical
quality, cost of care, and patient experiences to measure and report on
physician practice. In short, the pilots will serve as a learning lab
for testing different uses of different IT systems and technologies for
considering the impact of IT systems on quality outcomes, costs, and
value.

*Comments/Discussion*:

Early results from the pilots are expected relatively early in 2007. Dr.
Isham will provide the Workgroup with specifics at that time. Results
could be revealing about how a national system might operate, as well as
major issues and challenges.

### B. Hospital Quality Alliance (HQA): Measures and Current Tools for Hospital Reporting of Quality Measures 

Dr. Foster noted an update on hospital quality is now available on the
[www.hospitalscompare.HHS.GOV](http://www.hospitalscompare.HHS.GOV/)
site covering quality on a variety of measures for nearly 4,300
hospitals. She began her slide presentation by showing how HQA's
consensus work brings together a variety of stakeholders to share
information on hospital quality. Partners include hospital associations,
the AMA, government representatives, such as CMS, employers, consumers,
purchasers, and quality groups.

HQA measures in process include asking hospitals to participate in the
H-cap patient survey, which gauges patients' perception of the quality
of care they receive. In addition, HQA is asking hospitals to provide
data on alternative medicine integration (AMI), heart failure, and
pneumonia (30-day mortality), and on surgical care venous
thromboembolism (VTE), and infection. Subsequent phases will provide:

-   Pediatric asthma measures

-   Surgical care improvement project measures---perioperative heart
    attack prevention and respiratory complication prevention

-   Critical care measures---ventilator associated pneumonia prevention
    and central line associated blood stream infection.

A current HQA goal is to find the right infrastructure to sustain HQA's
work. Recent discussion has turned to working with national
organizations, such as the National Quality Forum, to identify the
appropriate set of priorities for measuring hospital-specific aspects.
Specific work underway includes:

-   Consolidating data streams to reduce burden and expand capacity for
    measurement

-   Analysis of cost

-   Identification of priorities for measurement---identification of
    more measures to use

-   Coordination with AQA on efficiency, harmonization of measures,
    pricing transparency, and pilots.

At present, in the world of quality measurement an improvement, there is
a great deal of effort to create and endorse measures, and several
organizations are working to select measures and collect data. The HQA
wants to know more about how to promote the results; how to link to
improvement strategies, and how to monitor impact.

Dr. Foster concluded that a national vision would facilitate creation of
an efficient system for collecting data along this continuum. Real
harmonization across the data elements would help, particularly in an
effort to collect data from medical records.

*Comments/Discussion*:

Dr. Clancy commented that Dr. Foster's conclusion about harmonization is
precisely the kind of feedback the Workgroup needs to provide to inform
use cases and development of requisite standards.

### C. Web-based Quality Measurement Tools

Dr. O'Kane began her slide presentation with an overview of the NCQA
process, which includes:

-   Standards for structural and procedural activities meant to ensure
    consumer protection on the payment and coverage front, quality
    customer service, and appropriate access to care

-   Measures (HEDIS) of the care that plan members receive in important,
    evidence-based aspects of care (plans are benchmarked and scored
    according to where they fall in national and regional distribution)

-   A consumer survey (CAHPS) of member experience with both the plan's
    direct administrative performance and members' experience with the
    delivery system.

Current NCQA web-based tools that help reduce the burden of reporting
are:

-   The Interactive Survey System (ISS)

-   The Interactive Data Submission System (IDSS)

-   The Healthcare Organization Questionnaire (HOQ)

-   The Quality Compass 2006.

In addition, NCQA currently requires health plans to use Member
Connections Standards (MEM).

*Comments/Discussion*:

Dr. Clancy asked if the IDSS could be facilitated by EHRs---an important
question for the Quality Workgroup's **Specific Charge**. Dr. O'Kane
responded that NCQA is working on that, at the cutting edge. No one has
the capability at present.

D.  **Health Information Exchange /RHIOs Providing Data for Quality
    Reporting**

Dr. Overhage's slide presentation focused on the Indiana Health
Information Exchange (IHIE), a non-profit venture backed by a
collaboration of Indiana health care institutions. Its vision is using
information technology and shared clinical information to:

-   Improve the quality, safety, and efficiency of health care in
    central Indiana (Indianapolis region) and act as a referral center
    for much of the rest of the state

-   Create unparalleled research capabilities for health researchers

-   Establish a model of health information exchange for the rest of the
    country.

Health Information Exchange Services (HIES) moves data in a standardized
manner through negotiated access to hospitals, physicians' offices,
labs, public health, payers, and researchers. Services provided include:

-   Clinical messaging---pushing results to the ordering entity, with
    copy to providers; with a fee from source per message delivered, on
    a sliding \[scale?\] schedule based on volume

-   Medication reconciliation---pushing medication history to hospital
    or practice; with a fee from hospital per medication history
    delivered

-   Clinical quality services---pushing results to providers and payers;
    with a fee from payers per patient

-   Clinical abstract---pushing summary of patient's clinical data to
    doctor; with no charge to INPC participants

-   Results review---doctor pulls comprehensive patient clinical data;
    with no charge to INPC participants.

*Comments/Discussion*:

Responding to Dr. Clancy's question, Dr. Overhage confirmed that the
system is receiving electronic data from practices with investments in
EHRs. In some cases data such as on hemoglobin or cholesterol are coming
from EHRs, and in a few cases, the exchange is paying for medical
assistance for remote and secure entry of data via the Web.

Dr. Clancy noted that **Specific Charge** recommendations should focus
in part on "where we want to go" in this category, including, the use of
claims data potentially enriched by electronic data elements from
pharmacy labs, for example.

### E. Status of Electronic Health Record (EHR) Certification Criteria Related to Quality Measurement and Reporting 

Dr. Ray and Dr. Leavitt gave a slide presentation on "CCHIT
Certification and Quality Measurement and Reporting."

Dr. Ray summarized CCHIT's mission and highlighted key points of
progress:

-   Ambulatory E HR certification is fully operational, with evidence of
    strong marketplace acceptance

-   Updated ambulatory criteria and new inpatient criteria are under
    development and will take effect in May 2007.

-   General criteria for quality measurement have been included in CCHIT
    roadmaps, but specific standards guidance is needed soon for these
    to become firm requirements.

-   CCHIT looks forward to strong collaboration with the Quality
    Workgroup.

### F. Principles for a National Data Strategy for Quality Measurement

Dr. van Amringe gave a short briefing on the Joint Commission on
Accreditation of Healthcare Organizations' work with principles for a
National Data Strategy for Quality Measurement. The principles should be
available soon.

About a year ago, the joint commission was reviewing the progress made
toward a national HIT infrastructure. Discussion centered on the
benefits of a strategy to construct a data highway that could under gird
the collection, aggregation, and transmission of performance measurement
data and allow for aggregation of those data across multiple sites and
sources. Identification of issues and rules of the road were also
discussed, given the increasing number of entities now requiring
performance measurement for a number of different reasons, including pay
for performance. Concomitantly, there has been increasing interest in
linking data sources and using different sources to compare performance.

An expert round table was formed and held two meetings. A highly
preliminary white paper has been drafted that includes a set of 20
principles, clustered in three groupings. The first grouping addresses
the design characteristics a data highway would need to have, such as
standardized quality control methods for gathering, validating, and
aggregating data. Data quality is a very important joint commission
issue which Dr. van Amringe hopes the Workgroup will address. Other
principles in the first grouping address the need for an entity with
effective stewardship over both public and private sector activity in
collecting performance measurement; the data infrastructure need to
support data standards being developed by the National Health
Information Network (NHIN); and the concept that performance measurement
data would be a by-product of the care process.

The second grouping accommodates certain needs in the data highway;
issues to be considered include effectively protecting privacy while
assuring broad access to meaningful and relevant performance measurement
data when necessary, and ways to provide information that provides
longitudinal views of quality and safety across the continuum of care.

The third grouping addresses the qualities and characteristics of the
data highway. Data must be timely and data sources credible, but a
strategy is also needed for raising consumer awareness of the public
benefit of reported data. Another principle is the need to embrace
transparency and engender trust in whatever system is developed.

###### Action Item #1: The Joint Commission on Accreditation of Healthcare Organizations' expert panel's white paper and principles will be made available to the Quality Workgroup over the next few weeks for comment. 

*All Presentations Comments/Discussion*:

**Costs vs. benefits in quality improvement investment\--** There was
discussion of the relative costs of obtaining data through electronic
files vs. traditional methods in the interest of making the business
case for more rapid E HR adoption. It was noted that Dr. Overhage might
have such cost break-downs. It was noted that costs vs. benefits might
be an appropriate analysis for the AQA pilots.

Workgroup co-chair Rick Stephens agreed that a number of clinicians and
administrators are not willing to move to electronic files until they
know more about costs and benefits, noting that The Boeing Company is
certainly motivated by \$1.9-million in annual health care costs and,
therefore, would like to see more investment in electronic files.

###### Action Item #2: Dr. Overhage of IHIE will be asked to provide relevant data pertaining to costs of different data collection methods. AQA, HQA, and possibly other organizations will also be asked to provide data on costs and benefits. The goal will be to gain better understanding on returns on investments in quality improvement and in the infrastructure. 

Members also expressed interest in learning more about calculating costs
for multiple stakeholders, as well as what components of a national
information infrastructure are best accomplished locally and which are
best accomplished nationally.

Ms. Cronin noted that ONC is currently building cost and revenue models
for NHIN, in part by looking at the start-up and operational costs for
health information exchanges, like IHIE. Return on investment in the
infrastructure, when it pertains to quality reporting, can be derived
from that work.

### 4. Discussion of Core Set of Ambulatory and Inpatient Quality Measures 

As discussion began to move toward this agenda item, the following
points were raised:

-   the Workgroup members heard presentations today about starter sets
    of measures, yet these starter sets will most likely be superseded
    in the next year or two.

-   A more comprehensive set of measures that looks at care across the
    continuum, across settings, is needed.

-   Should the Workgroup focus on the starter sets or on a more
    comprehensive set of measures? What are the relative costs?

-   A realistic appreciation of time frame and resources is needed, so
    work on measures should be staged. In short, what is our vision of
    the future that aligns resources with time frames and
    accountability, as well as realistic expectations for what can be
    achieved?

Dr. Clancy said that the Workgroup should begin with the assumption that
the measures it should consider for a core set are measures in use or
expected to be in place by the end of 2006, for hospitals, specifically
AQA's 26-measure starter set and other AQA-endorsed measures, as well as
HQA's 21-measure starter set. Then the challenge will be to create a map
of what is necessary to automate this information through EHRs for
certification by the CCHIT in the relatively near future.

Dr. Clancy noted for future the Workgroup meeting discussion on aspects
of a broader, more comprehensive vision that, in some cases, information
will be needed from additional sources\--particular sites\--such as
ambulatory care or hospitals, as well as information that may be stored
elsewhere, such as from health information exchanges. Information will
be needed about which patients in the hospital have had a heart attack,
for example, and how many have received beta blockers. But information
about contraindications will also be needed. Another dimension could be
claims data enriched by electronic data elements from pharmacy and lab
data.

###### Action Item #3: What specific data elements are needed for a core set of measures---and where the data could be obtained\--will be identified by staff, based primarily on the AQA and HQA starter sets. Dr. O'Kane will assist in defining data elements as well as sources. Results will be communicated to the Workgroup members. 

### 5. "Next Steps"---A) Additional Environmental Scan for the Workgroup October meeting; B) Development of Recommendations for October 31, 2006 meeting of The Community; C) Visioning Process (November-December); D) Development of Detailed Work Plan; E) Confirmation of the Workgroup Meeting Dates. 

###### A./B. Action Item #4: In order to address other outstanding issues relevant to the Specific Charge, ONC staff, senior Workgroup advisors, and the Quality Workgroup co-chairs will conduct an environmental scan to be reported back to members prior to deliberation at the Workgroup\'s October meeting on recommendations to make to the Community. Evaluation of the starter set of measures in the environmental scan will include the ability to map terminology standards.

> **C./D.** All Workgroups are engaging in a Visioning Process that
> paints a picture of the ideal world down the road (2014), with
> streamlined and automated quality measurement and reporting of a broad
> set of measures. All Workgroups, including the Quality Workgroup, will
> then be working from that common vision backwards to what steps are
> needed to realize it, including for an interim state (2010). The
> result of discussions in November and December may not be a detailed
> road map, but the discussion will be high level and will shape the
> Quality Workgroup's work over the next year.

###### Action Item #5: ONC staff will send members further information about the Visioning Process before the November meeting.

E.  The Quality Workgroup's October meeting date, previously set for
    October 4, is subject to change. Members should attend in person, if
    possible.

###### Action Item #6: ONC staff will communicate a new October meeting date to members.

###### Other meeting dates are:

###### November 1, 2006 (time TBD)

###### December 13, 2006 (time TBD) 

**6. Public Comment**

> No public comment was received.

## 7. SUMMARY OF ACTION ITEMS: 

###### Action Item #1: The Joint Commission on Accreditation of Healthcare Organizations' expert panel's white paper and principles will be made available to the Quality Workgroup over the next few weeks for comment. 

###### 

###### Action Item #2: Dr. Overhage of INHE will be asked to provide relevant data pertaining to costs of different data collection methods. AQA, HQA, and possibly other organizations will also be asked to provide data on costs and benefits. The goal will be to gain better understanding on returns on investments in quality improvement and in the infrastructure. 

###### 

###### Action Item #3: What specific data elements are needed for a core set of measures---and where the data could be obtained\--will be identified by staff, based primarily on the AQA and HQA starter sets. Dr. O'Kane will assist in defining data elements as well as sources. Results will be communicated to the Workgroup members. 

###### 

###### Action Item #4: In order to address other outstanding issues relevant to the Specific Charge, ONC staff, senior Workgroup advisors, and the Quality Workgroup co-chairs will conduct an environmental scan to be reported back to members prior to deliberation at the Workgroup\'s October meeting on recommendations to make to The Community. Evaluation of the starter set of measures in the environmental scan will include the ability to map terminology standards.

###### 

###### Action Item #5: ONC staff will send members further information about the Visioning Process before the November meeting.

###### 

###### Action Item #6: ONC staff will communicate a new October meeting date to members. 

**[Workgroup on Quality]{.underline}**

**[Members and Designees Participating in the Web
Conference]{.underline}**

**September 22, 2006**

*Co-chairs*

Carolyn Clancy HHS/Agency for Healthcare Research and Quality (AHRQ)

Richard Stephens The Boeing Company

*ONC/OPC Director*

Kelly Cronin HHS/ONC

*Members*

Abby Block Centers for Medicare and Medicaid Services (CMS)

Janet Corrigan Board on Health Care Services

Helen Darling National Business Group on Health

Anne Easton Office of Personnel Management (OPM)

Nancy Foster American Hospital Association (AHA)

George Isham Health Partners; Ambulatory Care Quality Alliance (AQA)

Jane Metzger, First Consulting Group

Margaret O'Kane National Center for Quality Assurance (NCQA)

Susan Postal Hospital Corporation of America (HCA)

Gerald Shea AFL-CIO

Barry Straube CMS

Jonathan Teich Brigham and Women's Hospital

Reed Tuckson UnitedHealth Group

Josie Williams Quality and Patient Safety Initiatives

*Office of the National Coordinator (ONC)*

Robert Kolodner HHS/ONC/Interim National Coordinator for Health
Information

Technology

Judy Sparrow HHS/ONC/AHIC Director

*Presenters*

Nancy Foster American Hospital Association (AHA)

George Isham Health Partners; Ambulatory Care Quality Alliance (AQA)

Margaret O'Kane National Center for Quality Assurance (NCQA)

J. Marc Overhage Indiana Health Information Exchange (IHIE)

Alisa Ray and Mark Leavitt Certification Commission for HIT (CCHIT)

Margaret van Amringe Joint Commission on Accreditation of Healthcare
Organizations

***Disclaimer:** The views expressed in written conference materials or
publications and by speakers and moderators at HHS-sponsored conferences
do not necessarily reflect the official policies of the HHS; nor does
mention of trade names, commercial practices, or organizations imply
endorsement by the U.S. Government.*