# Presentation: 923267

## American Health Information Community

***AHIC Recommendations-Implementation Status Report*****	****Electronic Health Records **
**	****Chronic Care**
**	****Population Health & Clinical Care Connections***** ***
**Robert M. Kolodner, M.D.**
**National Coordinator for Health Information Technology **
**June 12, 2007**

## Electronic Health Records Workgroup 

## Electronic Health Records WorkgroupRecommendations Summary

- _Recommendation_
- 1.0 (May 2006)
- 2.0 (May 2006)
- 2.1 (May 2006)
- 2.2 (May 2006)
- 3.0 (May 2006)
- 3.1 (May 2006)
- 4.0 (May 2006)
- 1.0 (August 2006)

## EHR Recommendation 1.0 May 2006

- 	Recommended that HHS take immediate steps to facilitate the adoption and use of endorsed standards and incentives needed for laboratory data results interoperability.
**	****Status:**
- HITSP EHR-Laboratory Results Reporting Interoperability Specification V1.2 accepted by the Secretary in December 2006.
- August 22, 2006 Executive Order 13410: “Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs”.
- Federal healthcare programs must use recognized HITSP standards in new systems, upgrades and care contracts.

**Notes:**
EHR Recommendation 1.0: “HHS should take immediate steps to facilitate the adoption and use of endorsed standards and incentives needed for interoperability of lab results within the current provider-centric environment.”

## EHR Recommendation 2.0 May 2006 

- 	Recommended HITSP identify and endorse a standard for laboratory result reporting for inclusion in the CCHIT interoperability criteria.
**	****Status:**
- HITSP EHR-Laboratory Results Reporting Interoperability Specification  V1.2 accepted by Secretary in December 2006.
- CCHIT and HITSP have formed a joint workgroup to plan for the incorporation of HITSP Interoperability Specifications in CCHIT interoperability certification criteria.

**Notes:**
EHR Recommendation 2.0:“HITSP should identify and endorse vocabulary, messaging, and implementation standards for reporting the most commonly used laboratory test results by 9/30/06, so as to be included in the CCHIT interoperability criteria for March 2007 certification. HITSP should consider CLIA and HIPAA regulatory requirements as appropriate.”

## EHR Recommendation 2.1 May 2006 

- 	Recommended Federal healthcare delivery systems that provide direct patient care develop a plan to adopt the HITSP endorsed Laboratory Results Reporting Interoperability Specifications.
**	****Status:**
- Executive Order 13410 (August 22, 2006).
- Department of Defense, VA, and Indian Health Service have all submitted work plans to Office of Management and Budget for adoption of HITSP Interoperability Specifications recognized by the Secretary.

**Notes:**
EHR Recommendation 2.1:“Federal healthcare delivery systems (those which provide direct patient care) should develop a plan to adopt the HITSP-endorsed standards for laboratory data interoperability by 12/31/06.”

## EHR Recommendation 2.2 May 2006 

- 	Recommended that Federal Agencies and Departments with health lines of business should include/incent the use of HITSP-approved standards in their contracting vehicles.
**	****Status:**
- Executive Order 13410(August 22, 2006).
- ONC working with all agencies that contract for health care services on behalf of the federal government to assure consistent language in health plan contracts.

**Notes:**
EHR Recommendation 2.2:“Federal Agencies and Departments with health lines of business should include/incentives the use of HITSP-approved standards in their contracting vehicles where applicable.”

NOTE: the workgroup recommended “use of HITSP-approved standards” as that was before HITSP named their work products “Interoperability Specifications” 

## EHR Recommendation 3.0 May 2006 

- 	**AHIC:  By September 30, 2006, HHS shall issue guidance on how to achieve patient centric flow of lab results under current CLIA and HIPAA regulations. HHS shall evaluate and report to the Secretary on other changes that could be needed beyond this guidance to achieve the goal of patient-centric data in the longer term.**
**	****Status:**
- ONC has worked with Centers of Medicare and Medicaid (CMS) to identify the possible models for current and historical lab results exchange. CMS and ONC will identify short and long-range solutions, and issue guidance as appropriate.

**Notes:**
EHR Recommendation 3.0:“By 9/30/06, ONC should review the possible models for the exchange of both current and historical lab information and determine which would require CLIA / HIPAA guidance, regulatory change, and/or statute change.”

## EHR Recommendation 3.1 May 2006 

- 	Recommended ONC contract with the NGA and other state-based organizations to identify and resolve state regulations and practices regarding electronic transmittal of laboratory data.
**	****Status:**
- National Governors Association contract initiated October 2006.
- State Alliance convened January 26, 2007.
- Three Task Forces: Health Information Protection, Health Care Practice, Health Information Communication & Data Exchange.
- Health Care Practice Taskforce will address this issue.

**Notes:**
EHR Recommendation 3.1:“Based on the findings from the recommendation above (3/0), by 12/31/06, ONC should engage the National Governors Association and other State-based organizations to resolve variations in “authorized persons” under the various State statutes, regulations, policies, and practices as a resource for clinical laboratories seeking to define access rights to electronic laboratory data.”

## EHR Recommendation 4.0 May 2006 

- 	Recommended creation of additional AHIC workgroup that would address the cross-cutting confidentiality, privacy and security issues related to all the Community charges.
**	****Status:**
- Confidentiality, Privacy, & Security Workgroup convened August 2006.

**Notes:**
EHR Recommendation 4.0:“The Community should create a consumer empowerment sub-group comprised of privacy, security, clinical, and technology experts from each Community Workgroup. The subgroup should frame the privacy and security policy issues relevant to all Community charges and solicit broad public input and testimony to identify viable options or processes to address these issues that are agreeable to all key stakeholders.  The recommendations developed should establish an initial policy framework and address issues including, but not limited to: Methods of patient identification; Methods of authentication; Mechanism to ensure data integrity; Methods for controlling access to personal health information; Policies for breaches of personal health information confidentiality; Guidelines and processes to determine appropriate secondary uses of data; A scope of work for a long-term independent advisory board on privacy & security policies.”

## EHR Recommendation 1.0 August 2006 

- 	Recommended development of an emergency responder use case.
- 	**Status**:
- Use Case developed and finalized in December 2006.
- The HITSP Requirement, Design and Standards Selection document for the ER-EHR Use Case is open for public comment until June 14, 2007.
- The HITSP ER-EHR Interoperability Specification will be finalized in November-December 2007.

**Notes:**
EHR Recommendation 1.0: “Under the leadership of ONC, an emergency responder use case should be developed and prioritized for the attention of HITSP and the other ONC lead initiatives. The use case should describe the role that an emergency responder electronic health record will provide, comprising, at a minimum, demographic, medication, allergy and problem list information that can be used to support emergency and routine health care activities. The use case should leverage the work in related activities from the AHIC EHR Workgroup and elsewhere. In order to meet the needs of a variety of follow-up activities, this use case should be available in October of 2006.” 

## Chronic Care Workgroup 

## Chronic Care WorkgroupRecommendations Summary

- _Recommendation_
- 1.0 (May 2006)
- 1.1 (May 2006)
- 1.2 (May 2006)
- 2.0 (May 2006)
- 3.0 (May 2006)
- 3.1 (May 2006)
- 4.0 (May 2006)
- 4.1 (May 2006)

## CC Recommendations 1.0, 1.1, 1.2 May 2006 

- 	Three recommendations to develop and expand the evidence base for reimbursement of secure messaging.
**	****Status:**
- ONC to release Request for Proposal (RFP) in July 2007.
- RFP will test the value of secure messaging and assess merit of different payment methodologies.
- Award will go to three sites.
- Results expected by December 2008.

**Notes:**
EHR Recommendation 2.0:“HITSP should identify and endorse vocabulary, messaging, and implementation standards for reporting the most commonly used laboratory test results by 9/30/06, so as to be included in the CCHIT interoperability criteria for March 2007 certification. HITSP should consider CLIA and HIPAA regulatory requirements as appropriate.”

## CC Recommendation 2.0 May 2006

- 	Recommend HHS convene State agencies and professional societies to develop licensing alternatives that will allow the provision of electronic care delivery across State boundaries.
- 	**Status**
- July 6, 2007, Health Care Practices Task Force of National Governor’s Association will make recommendations to State Alliance to reduce licensing barriers to interstate telehealth care delivery.

## CC Recommendation 3.0 & 3.1 May 2006

- 	Recommend HITSP define standards for secure patient-clinician messaging transactions & CCHIT establish certification criteria for system interoperability.
- 	**Status**
- AHIC did not identify secure messaging as a priority for standards development in 2007.
- CCHIT did not identify secure messaging as a priority for certification in 2007.

## CC Recommendation 4.0 May 2006

- 	Recommend Agency for Healthcare Research & Quality (AHRQ) conduct a synthesis of current knowledge of health information technology use by elderly, ill, and underserved populations
- 	**Status**
- AHRQ's Evidence-based Practice Center Request for Task Order:  “Barriers and Drivers of Health IT Use for the Elderly, Chronically Ill and Underserved” .
- Put out for solicitation in May 2007.
- Contract award expected July 31, 2007.

## CC Recommendation 4.1May 2006

- 	Recommend HHS work with appropriate organizations to report on secure messaging availability through broadband across the country.
- 	**Status**
- Federal Communications Commission (FCC) tasked with expanding broadband technology across U.S.
- Current penetration rate is 45%.
- Nationwide, 79% of households have access to high speed connections.
- President’s goal is to have broadband access available to all U.S. households by 2014.

## Population Health & Clinical Care Connections Workgroup 

## Pop. Health & Clin. Care Connections WorkgroupRecommendations Summary

- _Recommendation_
- 1.0, 1.1, 1.2 (May 2006)
- 2.0 (May 2006)
- 3.0 (May 2006)
- 3.1 (May 2006)
- 4.0 (May 2006)
- 1.0, 1.1, 1.2 (October 2006)
- 2.0 (October 2006)
- 3.1 (October 2006)

## Pop. Health & Clin. Care ConnectionsRecommendation 1.0, 1.1, 1.2 May 2006 

- 	By 6/30/06, HHS, in collaboration with Federal, State, and local governmental public health agencies and clinical care partners, should establish, convene, and oversee a Data Steering Committee to carry out the following activities:
- identify the data elements and the appropriate filtering of data from ambulatory care settings, emergency departments and laboratories, as well as hospital utilization data needed to enable the key public health functions
- HITSP should identify the technical specifications for these initial data requirements by 9/30/06.
- CDC and others should provide HITSP with the public health expertise and funds needed to perform this task.
- Identify the data sources and requirements necessary to allow for collection of a more limited set of data across a broader geographic area.
- 	Status
- Biosurveillance Data Steering Group (BDSG) chartered.
- Recommendations presented to AHIC in October 2006.

## Pop. Health & Clin. Care ConnectionsRecommendation 2.0 May 2006

- 	For the purposes of the Biosurveillance Breakthrough Initiative, the CDC should establish memoranda of understanding (MOU) to enable simultaneous data flow from data providers to local, State, and Federal public health entities while preserving traditional investigation roles at local and State public health levels, whereby local and State jurisdictions continue to have lead roles in public health investigations.
- 	Status
- MOUs in place between CDC and all data providers sending data to BioSense
- Three states/locals public health jurisdictions receiving simultaneous data flow from data providers (4 more in progress), broader implementation is in progress, but many states/local public health jurisdictions don’t have infrastructure in place to accept data feed.

## Pop. Health & Clin. Care ConnectionsRecommendation 3.0 May 2006

- 	HHS should develop sample data use agreements to facilitate the sharing of data from health care providers to local, State and Federal public health agencies.  HHS should also offer practical implementation guidance to data providers and State and local public health agencies to address HIPAA concerns about transmitting data (with obvious identifiers removed) for public health purposes, to enable simultaneous data flow from data providers to local, State, and Federal public health entities while preserving traditional investigation roles at local and State public health levels, whereby local and State jurisdictions continue to have lead roles in public health investigations
- 	Status
- No action taken.

## Pop. Health & Clin. Care ConnectionsRecommendation 3.1 May 2006

- 	HHS, in collaboration with privacy experts, State and local governmental public health agencies and clinical care partners, should develop public communication materials to educate the general public about the information that is used for biosurveillance including the benefits to the public’s health, improved national security, and the protection of patient confidentiality by 9/30/06.
- 	Status
- Associate Director for Communication Science in NCPHI/CDC will collaborate with partners to develop communication message(s).
- CDC will convene meeting with partners in February  2008 & develop a 1-2 page communication message for use with public communications

## Pop. Health & Clin. Care ConnectionsRecommendation 4.0 May 2006

- 	The CDC, State and local governmental public health agencies, and clinical care partners with firsthand experience in managing ongoing biosurveillance programs should design and conduct evaluations of the biosurveillance breakthrough. These parties should establish goals, develop outcome measures and establish metrics for evaluation of the breakthrough by 9/30/06.
- 	Status
- The BioSense Round Table Meeting planned for June 19, 2007, will include discussions about goals, outcome measures and evaluation metrics of the biosurveillance breakthrough. Additional discussions are planned for the February  2008 meeting.

## Pop. Health & Clin. Care Connections BDSG Recommendation 1.0, 1.1, 1.2 October 2006

- 	The U.S. Department of Health and Human Services, in collaboration with state and local governmental public health agencies, should work with clinical care partners:
- to implement the short term Minimum Biosurveillance Data Set (MBSD) and enable simultaneous data access to local, state and federal public health entities for Biosurveillance purposes.
- should evaluate implementation models, costs, and determine availability of resources and establish a plan to effect a short term MBDS implementation.
- 	Status
- BDSG Recommendation 1.0 regarding the Secretary of HHS should adopt MBDS is completed.
- Significant progress made to collect the MBDS at BioSense hospitals, 365 hospitals are at some stage of implementing the MBDS.
- CDC will provide extramural funding as announced in RFP Accelerating Public Health Situational Awareness.
- CDC/NCPHI Centers of Excellence in Informatics are currently implementing the MBDS.

## Pop. Health & Clin. Care Connections BDSG Recommendation 2.0  October 2006

- 	Public health agencies and partners who implement the short term MBDS should filter out some components of the following data elements as appropriate:  date of birth, age, zip code, and diagnosis/injury code.
- 	Status
- CDC will provide extramural funding as announced in RFP Accelerating Public Health Situational Awareness to look at appropriate methods for filtering sensitive and confidential information that may be necessary for public health use.

## Pop. Health & Clin. Care Connections BDSG Recommendation 3.0 October 2006

- 	CDC should, no less than annually, involve local, state and federal public health agencies and clinical care partners, in an MBDS monitoring process for biosurveillance usefulness, and make appropriate modifications as evidence develops to support such modifications.
- 	Status
- MBDS will be discussed at BioSense RoundTable Meeting on June 19, 2007.
- February 2008 meeting planned with local, state, federal, and clinical care partners to discuss usefulness of MBDS.