Introduction to the HITSP

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eTown Hall II HITSPs efforts to address
HIT-related provisions of the American Recovery
and Reinvestment Act of 2009
Webinar 7 August 27, 2009 200 330 pm
(Eastern) Presenter John D. Halamka, MD,
MS, HITSP Chair
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Learning Objectives

• During this 90-minute webinar, participants will
• Get an update on the final definition of
  meaningful use released by the HIT Policy
  Committee.
• Examine the relationship between HITSP work
  products and meaningful use.
• Explore how HITSP will continue to work with the
  Office of the National Coordinator, the HIT
  Standards Committee, and the HIT Policy Committee
  to facilitate the development of needed standards
  and achieve interoperability.
• Learn more about the next work products for
  HITSP.
• Have an extensive period of time for QAs.

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Mission

• To serve as a cooperative partnership between the
  public and private sectors for the purpose of
  achieving a widely accepted and useful set of
  standards specifically to enable and support
  widespread interoperability among healthcare
  software applications, as they will interact in
  a local, regional, and national health
  information network for the United States.

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Overview

• HITSP is a cooperative partnership between the
  public and private sectors for the purpose of
  achieving a widely accepted set of healthcare
  interoperability standards.
• HITSP is a volunteer-driven, consensus-based
  organization that is funded through a contract
  from the Department of Health and Human Services
• HITSP develops Interoperability Specifications
  (IS) documents that harmonize and recommend the
  technical standards that are necessary to assure
  the interoperability of electronic health records

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HIT Standardization

• HITSP members agreed that a standard is a
  well-defined approach that supports a business
  process and . . .
• has been agreed upon by a group of experts
• has been publicly vetted
• provides rules, guidelines, or characteristics
• helps to ensure that materials, products,
  processes and services are fit for their intended
  purpose
• is available in an accessible format
• is subject to an ongoing review and revision
  process

Standards Harmonization is required when a
proliferation of standards prevents progress
rather than enabling it.
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HITSP Interoperability Specifications (IS)
IS 01 Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment
IS 04 Emergency Responder Electronic Health Record (ER-EHR)
IS 05 Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
Recognized
Accepted
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HITSP Interoperability Specifications (IS)
IS 08 Personalized Healthcare
IS 09 Consultations and Transfers of Care
IS 10 Immunizations and Response Management
IS 11 Public Health Case Reporting
IS 12 Patient Provider Secure Messaging
IS 77 Remote Monitoring
IS 107 EHR Centric
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What is ARRA?

• Also known as the economic stimulus package
• Signed into law by President Obama on February
  17, 2009

• What is HITECH?
• A portion of ARRA referred to as the Health
  Information Technology for Economic and Clinical
  Health (HITECH) Act
• TITLE XIIIHealth Information Technology
• TITLE IVMedicare and Medicaid Health Information
  Technology
• Contains numerous provisions related to Health
  Information Technology (HIT) and privacy with
  aggressive timelines for completion

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Federal Advisory Committees Formed under ARRA

• Office of the National Coordinator for HIT (ONC)
• Part of the Department of Health and Human
  Services (HHS), ONC is the principal Federal
  entity charged with coordination of nationwide
  efforts to implement and use the most advanced
  health information technology and the electronic
  exchange of health information.
• HIT Policy Committee
• Makes recommendations to ONC on an overall policy
  framework for the development and adoption of a
  national interoperable health information
  infrastructure, including standards for the
  secure and private exchange of patient medical
  information
• HIT Standards Committee
• Makes recommendations to ONC on standards,
  implementation specifications, and certification
  criteria for the electronic exchange and use of
  health information

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HIT Standards Committee HITSP Shared Members
John HalamkaHITSP ChairHIT Standards Committee
Vice-Chair Christopher ChuteHITSP VolunteerHIT
Standards Committee James FergusonHITSP Board of
DirectorsHIT Standards Committee John
KlimekHITSP VolunteerHIT Standards Committee
HIT Standards Committee 23 members
HITSP1,000 technical experts
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ARRA / HITECH calls for meaningful use of EHRs

• Not enough to implement EHRs need to
  meaningfully use them to improve patient care and
  efficiency
• Recommended criteria of meaningful use was
  approved by the HIT Standards Committee and
  submitted to the ONC on July 16th, 2009
• HITSP is working with the HIT Standards
  Committee to help achieve meaningful use by
  providing harmonized HIT standards

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Timing and Incentives

• Physicians
• 24 to 44k depending on when they qualify for
  1st year payment
• 1st payment incentive 18,000 for those who
  receive 1st payment in 2011 or 2012
• Failure to demonstrate meaningful use by 2015,
  incur reimbursement penalties
• Hospitals
• Similar incentives for early adoption and
  penalties after 2015
• Incentive calculation includes
• Total Discharges
• Total Gross Revenue
• Charity Care Charges
• Medicare Inpatient Days
• Total Inpatient Days
• Medicare Share Ratio
• Revenue Ratio

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Work Flow A High-Level View
HIT Policy Committee
National Coordinator
Secretary
National Coordinator
Organizations conducting standards development
or harmonization, certification criteria
development, or composition of implementation
specifications
Pilot testing
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Getting It Done

• The Office of the National Coordinator (ONC) has
  asked HITSP to assist it in meeting its
  requirements for designating standards that
  support designated ARRA focus areas for
  healthcare, and ultimately, that support ARRAs
  notion of meaningful use
• HITSP paused its assigned 2009 work, and directed
  essentially all efforts toward this end
• HITSP organized into focused, quick-moving
  Tiger Teams accomplished their tasks and
  submitted their results to the ONC in mid-July.

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Starting Point ARRA Requirements and Tiger
Teams
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Tiger Teams Focus Areas

• A new EHR Centric Interoperability Specification
  to meet ARRA requirements
• Security, Privacy, Infrastructure
• Quality Measures
• Data Architecture (Element, Template, and Value
  Set)
• Exchange Architecture and Harmonization
  Framework
• Clinical Research

Tiger Team membership 232 technical experts
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Objective of the EHR-Centric Interoperability
Specification Tiger Team
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EHR-Centric Deliverables

• IS 107 EHR-Centric IS
• The first of a number of potential system-centric
  interoperability perspectives
• A menu of specification components that can be
  assembled to meet varied implementation needs
• All ARRA requirements met by at least one IS but
  gaps / enhancements were identified for future
  HITSP work
• Learn more Free HITSP webinar dedicated to IS
  107 will be held on October 8, 2009.

Current status Panel Approved on July 8, 2009
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Security, Privacy and Infrastructure (SPI) Tiger
Team Accomplishments

• Service Collaboration Definition
• A service collaboration is a composition of
  constructs into a reusable workflow.
• Restructured into Service Collaboration Suites
• SC 108 Access Control Service
• SC 109 Security Audit Service Collaboration
• SC 110 Patient Identification Management Service
  Collaboration
• SC 111 Knowledge and Vocabulary Service
  Collaboration
• SC 112 Healthcare Document Management Service
  Collaboration
• SC 113 Query for Existing Data Service
  Collaboration
• SC 114 Administrative Transport to Health Plan
  Service Collaboration
• SC 115 HL7 Messaging Service Collaboration
• SC 116 Emergency Message Distribution Service
  Collaboration

Current status Panel Approved on July 8, 2009
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Quality Measures Tiger Team Accomplishments

• Establishing and Reporting on Quality Measures is
  critical to ARRA and measuring Meaningful Use.
• HITSP Updated IS06-Quality Interoperability
  Specification to meet this need
• Ability to report patient level and aggregate
  quality information in document or message format
• Ability to exchange quality measurement criteria
  definitions

Current status Inspection Testing Complete
Inspectors comments under review this week at
our HITSP Tiger Team/Technical Committee Face to
Face Meeting in Chicago.
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Data Architecture Tiger Team Objectives

• Provide standardized definitions for the HITSP
  data structures
• Identify similar data elements used in
  healthcare standards
• Provide an inventory of HITSP data and values
• Provide structure to assure consistent use of
  the data elements across different information
  exchanges

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Accomplishment Data Architecture Technical Note
(TN903)

• Presents the HITSP Data Architecture Model
• Explains data elements, templates, and value sets
  in the HITSP context
• Data elements are the smallest unit of data in an
  information exchange.
• Templates are a set of business rules
  (constraints) used to create an artifact used in
  an information exchange.
• Value sets are a uniquely identifiable set of
  valid concept representations.
• Presents the metadata for each concept and
  discusses the use of metadata registries for
  storage and access to this information.

Current status Panel Approved on July 8, 2009
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Harmonization Framework and Exchange Architecture
Tiger Team

• Objectives
• Harmonization Framework
• Ensure consistency and listing for all 2009
  Information Concepts
• Develop Exchange Architecture
• High-level rules for orchestrating HITSP defined
  systems, actions and content constructs to meet
  business requirements
• Accomplishments
• Produced Technical Note to explain Harmonization
  Framework and Exchange Architecture

Current status Panel Approved on July 8, 2009
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What We Mean by Harmonization Framework
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What We Mean by Exchange Architecture
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Clinical Research Tiger Team Accomplishments

• Requirements, Design, and Standards Selection
  document describes the exchange of a common set
  of information between electronic health records
  and clinical research systems
• Submission of clinical data to a sponsoring
  agency based on sponsors protocol
• Exchange of clinical data with research registries

Current status Public Comment(Closes August
28) Received comments are under review this week
at our HITSP Tiger Team/Technical Committee Face
to Face Meeting in Chicago.
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Next Steps Milestones and Next Steps

• Final Recommendations
• August 26th (yesterday) final recommendation of
  meaningful use, standards, and certification in
  support of ARRA proposed from ONC to HHS
• Based on HIT Policy Committee and HIT Standards
  Committee recommendations
• Regulation Schedule
• December 31, 2009 Interim final rule adopt and
  publish an initial set of standards,
  implementation specifications, and certification
  criteria. (from ONC)
• December 31, 2009 Proposed rule regarding
  definition of meaningful use and
  Medicare/Medicaid incentives. (from CMS)

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Conclusion HITSP is Foundational Support to ARRA

• On July 21, 2009 the HIT Standards Committee
  recommended that providers implement the HITSP
  endorsed standard capabilities, including
• Transmitting prescriptions
• Structured data for discharge summary and
  continuity of care documents
• Lab test results
• HITSP is performing this critical function
  credibly in support of ARRA
• HITSP support of the newly-formed HIT Policy and
  Standards Committees
• HITSP in the Real World series
• Medication Management Real World Sites
• September 10, 2009

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The 2009 Webinar Series www.HITSP.org/webinars
Webinar 1 Advances in Sharing Information in Healthcare ITThursday, January 15, 2009 200-330 pm Eastern Webinar 7 HITSP eTown Hall II with Dr. John HalamkaThursday, August 27, 2009 200-330 pm Eastern
Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)Thursday, February 12, 2009 200-330 pm Eastern Webinar 8 Medication Management Real World Sites Thursday, September 10, 2009 200-330 pm Eastern
Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)Thursday, March 12, 2009 200-330 pm Eastern Webinar 9 HITSP EHR Centric Interoperability SpecificationThursday, October 8, 2009 200-330 pm Eastern
Webinar 4 NHIN Real World SitesThursday, April 16, 2009 200-330 pm Eastern Webinar 10 Security, Privacy, and InfrastructureThursday, November 12, 2009 200-330 pm Eastern
Webinar 5 HITSP eTown Hall I with Dr. John HalamkaThursday, June 18, 2009 200-330 pm Eastern Webinar 11 Quality Measures Real World Sites Tuesday, December 8, 2009 200-330 pm Eastern
Webinar 6 Health Information Exchange (HIEs) in the Real World Thursday, July 9, 2009 200-330 pm Eastern NOTERecent schedule changes reflect HITSPs response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.
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Discussion / Questions Welcomed
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View the Complete Set of HITSP Deliverableswww.HI
TSP.org
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NEW HITSP Team Members ALWAYS welcome!www.HITSP.o
rg

• All you need is passion to get the job done
• Motivation to make a difference
• Drive to push the nation forward
• Volunteers ARE the life blood of HITSP to get the
  job done
• If you knew enough to attend this webinar, you
  know enough to jump on in!

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Join HITSP in developing a safe and secure health
information network for the United States

Visit www.hitsp.org or contact
Michelle Deane, ANSI mmaasdeane_at_ansi.org Re
HITSP, its Board and Coordinating Committees
Jessica Kant, HIMSS Theresa Wisdom,
HIMSS jkant_at_himss.org twisdom_at_himss.org Re
HITSP Technical Committees
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www.HITSP.org