state hie webinar 010509

8/14/2019 State Hie Webinar 010509

1/58

State HIE ProgramWebinarJanuary 5th , 2010

1


2/58

Agenda for State HIE Program Webinar

2

State HIE Program Updates and Q&A

20 min

NHIN Update, IFR Update and Q&A

40 min

State HIE Program Technical Assistance: Resources for Grantees Facilitated through theState HIE Leadership Forum

45 min

o a. Overview

o b. State-HIE Toolkit Overview and Demonstration

o c. State HIE Planning Using the Toolkit

Next Steps

15 min

o a. Feedback

o b. Release of Additional Modules

o c. Listserv Ongoing Forum Communication


3/58

Grants ProgramsHigh-Level Summary/Status

3


4/58

Agenda

A. Overview of Funding Opportunities 15 min

o 1. Regional Extension Centers

o 2. Beacon

o 3. SHARPo 4. Workforce

B. HIE Overview and Resources Providing

Guidance 5 min

4


5/58

Currently Available Funding Opportunities

5


6/58


6


7/58


7


8/58

REC Application, Award Process, andTimeline

8

DEC JAN FEB MAR

2009 2010

21Due Diligence

NGAIssuance

NOV

3

FOA

Updated

18

Prelim

AppsDue

22 6

Full

AppsDue

29

ObjectiveReviewCompletion

31

Cycle One

Cycle Two

11

15

NGAIssuance

Full

AppsDue

Due Diligence

PreliminaryAppReviewCompletion

ObjectiveReviewCompletion


9/58

REC Overview

9

The purpose of the Regional Centers is to furnish assistance,defined as education, outreach, and technical assistance, tohelp providers in their geographic service areas select,successfully implement and meaningfully use certified EHRtechnology to improve the quality and value of health care.

Priority shall be given to providers that are primary-care

providers (physicians and/or other health care professionalswith prescriptive privileges, such as physician assistantsand nurse practitioners) in any of the following settings: Individual and small group practices (ten or fewer

professionals with prescriptive privileges) primarily focused onprimary care;

Public and Critical Access Hospitals; Community Health Centers and Rural Health Clinics; and Other settings that predominantly serve uninsured,

underinsured, and medically underserved populations.


10/58

Beacon, Sharp, and Workforce Timeline

10**Applications which do not meet Completeness and Responsiveness criteria will not pass on to Objective Review.

Execution ofCooperative

Agreements

Key Steps and Anticipated Dates

FOAReleased

Letterof

Intent

FullApplication**

11/25/2009 1/22/2010 3/20101/6/2010

12/15/2009 1/14/2010 3/20101/4/2010

12/17/2009 1/25/2010 3/20101/8/2010

12/17/2009 1/2010 3/20101/2010

BEACON

WORKFORCECommunity College

WORKFORCECurriculum

Development

WORKFORCEUniversity Training

WORKFORCECompetencyExamination

SHARP

12/02/2009 1/1/2010 3/20101/8/2010

12/17/2009 1/25/2010 3/20101/8/2010


11/58

Beacon Overview

Will provide funding to communities to build and strengthen their health IT

infrastructure and exchange capabilities to demonstrate the vision of the futurewhere hospitals, clinicians and patients are meaningful users of health IT, andtogether the community achieves measurable improvements in health care quality,safety, efficiency, and population health.

Awards will be made in the form of cooperative agreements to 15 qualified non-profit organizations or government entities representing geographic health carecommunities.

Beacon Communities will generate and disseminate valuable lessons learned thatwill be applicable to the rest of the nations communities as they strive to build andleverage their health IT infrastructure for healthcare improvement.

Will include $220 million in grants to build and strengthen health IT infrastructureand health information exchange capabilities, including strong privacy and securitymeasures for data exchange, within 15 communities. An additional $15 million willbe provided for technical assistance to the communities and to evaluate thesuccess of the program.

11


12/58

Beacon Overview (contd)

12

1. Extend existing (advanced) health IT and exchange infrastructure

2. Leverage this infrastructure to achievespecific and measurablehealthcare improvements

Demonstrate vision of the future where hosp itals,

clinicians and patients are meanin gful users of health IT, and

together the community achieves measurable

improvements in health care quality, safety,

efficiency, and popu lation health

15 Communities


13/58

SHARP Overview

The purpose of the Strategic Health IT Advanced Research Projects(SHARP) Program is to fund research focused on achievingbreakthrough advances to address well-documented problems thathave impeded adoption of health IT and to accelerate progresstowards achieving nationwide meaningful use of health IT insupport of a high-performing, continuously-learning health care

system.

ONC expects to award four cooperative agreements:

Security of Health Information Technology

Patient-Centered Cognitive Support

Healthcare Application and Network Platform Architectures

Secondary Use of EHR Data

13


14/58

Workforce Overview (contd)

14

The Curriculum Development Centers program will provide $10 millionin grants to institutions of higher education (or consortia thereof) tosupport health information technology curriculum development.

ONC plans to make up to 5 grant awards that will support curriculumdevelopment to enhance programs of workforce training primarily atcommunity college level.

The materials developed under this program will be used by themember colleges of the five regional consortia as well as be available toinstitutions of higher education across the country.


15/58


15

The Community College Consortia to Educate Health Information TechnologyProfessionals in Health Care program seeks to rapidly create HIT academicprograms at Community Colleges or expand existing ones.

Students will be able to complete training in one of six roles within six months

or less. Academic programs may be offered through traditional on-campus instructionor distance learning modalities, or combinations thereof.

It is expected that by the end of the two-year project period, collectively all ofthe Community Colleges participating in the program will have establishedtraining programs with the capacity to train at least 10,500 students annuallyto be part of the HIT workforce. Anticipated training capacity of the consortium as a whole must average 150 students per member College.

Training at all consortium member Colleges will be expected to begin by September 30, 2010 Colleges should have a plan collaborate with regional extension centers and state health information

exchange programs


16/58


16

The purpose of the Information Technology Professionals in Health Care: Programof Assistance for University-Based Training grants is to rapidly increase theavailability of individuals qualified to serve in specific health information technologyprofessional roles requiring university-level training. Four-year colleges or

universities are eligible to apply for funding under this program, which willemphasize programs that can be completed by the trainee in one year or less.

The six roles targeted by this funding opportunity are: Clinician/Public Health Leader

Health Information Management and Exchange Specialist

Health Information Privacy and Security Specialist

Research and Development Scientist

Programmers and Software Engineer Health IT Sub-specialist


17/58


17

The Competency Examination for Individuals Completing Non-DegreeTraining program, one component of the workforce program, will provide $6 millionin grants to an institution of higher education (or consortia thereof) to support the

development and initial administration of a set of health IT competencyexaminations.

The examinations will assess basic competency for individuals trained throughshort-duration, non-degree health IT programs, and for members of the workforcewith relevant experience or other types of training who are seeking to demonstratetheir competency in certain health IT workforce roles integral to achievingmeaningful use of electronic health information.


18/58

State HIE Program

Cooperative agreements will be awarded through the StateHealth Information Exchange Cooperative Agreement Programto states and qualified State Designated Entities (SDEs). Objective: To develop and advance mechanisms for information sharing across the

health care system.

A cooperative agreement is a partnership between the grant recipient and theFederal government.

States and SDEs will be required to match grant awards beginning in 2011.

Under these State cooperative agreements $564 million willbe awarded to support efforts to achieve widespread andsustainable health information exchange (HIE) within andamong states through the meaningful use of certifiedElectronic Health Records (EHRs). The goal of meaningful use of EHRs is for health care providers to use this

technology to improve the quality and efficiency of care.

18


19/58

State HIE Program (contd)

The grant programs will support states and/or SDEs inestablishing in developing and implementing strategic andoperational plans which address and facilitate HIE capacityamong health care providers and hospitals in their

jurisdiction.

Grant performance will be evaluated on a quarterly basis todetermine if there is improved capability for providers toactively exchange healthcare data focusing specifically onelectronic order and receipt of labs and test results as wellas e-prescribing.

The respective state governments, federal government(complimentary grants programs) and private sector will all

play important roles in advancing HIE among health careproviders through the grant programs.

19


20/58

Aligning with Current & FutureState HIE Guidance

Statewide Strategic and Operational Plans should be developedand implemented based upon evolving guidance. States willreceive guidance from:

ONC

ONC State HIE Team

Technical Assistance Providers (State HIE Toolkit, etc.)

CMS (Meaningful Use NPRM, etc.)

ONC FACA Committees (HIT Policy NHIN Workgroup)

Other

20


21/58

Interim Final Rule and Notice ofProposed Rulemaking of Meaningful Use

An Interim Final Rule (IFR) on an initial set of standards, implementationspecifications, and certification criteria was issued on December 30, 2009,with a request for comments.

The Centers for Medicare & Medicaid Services (CMS) also issued a Notice ofProposed Rulemaking (NPRM) on the definition ofmeaningful use.

In order for professionals and hospitals to be eligible to receive payments

under the Medicare and Medicaid EHR incentive programs, provided throughthe Recovery Act, they must be able to demonstrate meaningful use of acertified EHR system.

The IFR will become effective 30 days after publication and will be open forpublic comment for 60 days after publication. The final rule will be issuedsometime in 2010.

More information on the IFR can be found at: http://www.federalregister.gov/inspection.aspx#special

Public comments can be made at:

http://www.regulations.gov/search/Regs/home.html#home

21
http://www.federalregister.gov/inspection.aspxhttp://www.federalregister.gov/inspection.aspxhttp://www.regulations.gov/search/Regs/home.htmlhttp://www.regulations.gov/search/Regs/home.htmlhttp://www.regulations.gov/search/Regs/home.htmlhttp://www.federalregister.gov/inspection.aspxhttp://www.federalregister.gov/inspection.aspx


22/58

Technical Architecture & theNHIN

In Support of the State HIEProgram

22


23/58

Agenda

A. Overview & Approach of the Nationwide Health Information Network (NHIN)

10 min

o 1. Industry Engagement &The Evolution of the NHIN

o 2. Governance for the NHIN

o 3. Trust, the DURSA, & the NHIN

o 4. Standards, Specifications, and Meaningful Use

B. Technical Architecture , NHIN, & State Health Information Exchange (HIE)

20 min

o 1. Key Principles & Information Exchanges to be Considered by States

o 2. Stakeholders Participating in HIE

o 3. Services to be Provided by &/or Used by States

o 4. Sharing Information with Current & Future NHIN Participants

o 5. Alignment with Current & Future Technical Architecture & NHINGuidance

23


24/58

Overview & Approach of theNationwide Health

Information Network (NHIN)

24


25/58

NHIN: An Overview

The Nationwide Health InformationNetwork (NHIN) is a collection ofstandards, protocols, legal agreements,specifications, and services that enables

the secure exchange of health informationover the internet. The NHIN provides a common platform for health

information exchange across diverse entities toachieve the goals of the HITECH Act.

This enables health information to follow theconsumer, be available for clinical decision making,and support use of healthcare information beyonddirect patient care to improve public health.

25


26/58

NHIN: An Overview

In its initial pilot implementations, the NHINprovides a vehicle for large and/or technologicallysophisticated organizations to securely exchangeelectronic health information on a commonplatform for HIE across diverse entities to achievethe goals of the HITECH Act.

Moving forward, the NHIN will accommodate uses ranging fromsimple local applications such as a healthcare providercommunicating a prescription to a pharmacy, to complexinterchanges involving nationwide participants and the attendantnetwork facilities and tools, and/or to consumers seeking accessto their health records from their local caregivers.

26


27/58


28/58

28


29/58

NHIN: Current Governance

As part of the 2009 NHIN limited production pilots, the

following interim governance structures were put in placeto support information exchange across the NHIN during theformal rulemaking process: The NHIN Technical Committee focuses on architectural and technical issues

such as prioritization of new functionality and approval of new or modifiedtechnical requirements and specifications.

The NHIN Coordinating Committee has the authority to establish and maintainthe set of policies and legal agreements and accountability measures for NHINparticipants.

The current governance mechanisms may be enhanced or modified based onrecommendations from the HIT Policy Committee NHIN Workgroup.

29


30/58

NHIN: Creating a Fabric of Trust

Those who might want to use the NHIN for simple exchanges of

information may not require the rigorous agreements that havebeen established for the exchange of data during the limitedproduction pilots. Therefore, even simple exchanges require:

The sender of information must be confident of the address of the recipient,

The receiver of the data is the intended recipient

The substance of the information has not been altered during transmission. Other usersmay have more extensive requirements to establish trust.

The NHIN will require a fabric of trust that can serve multipleusers and can provide multiple layers to establish confidence.

A lightweight layer

Additional layers

A wide range of key stakeholders will need to be involved in draftingnew, and revising existing, elements of the NHIN trust fabric (e.g.trust agreements, operating policies and procedures, and

Coordinating Committee processes.)

30


31/58

NHIN: DURSA A Fabric of Trust

Data Use and Reciprocal Support Agreement (DURSA) is a

comprehensive, multi-party trust agreement. The DURSA provides the legal framework governing participation in nationwide

information exchange by requiring the signatories to abide by a common set of termsand conditions that establish the Participants obligations and the trust fabric tosupport the privacy, confidentiality and security of the health data that is exchanged.

Key terms and conditions of the DURSA are noted below:

Multi-Party Agreement

Participants in Production

Privacy and Security Obligations

Requests for Data Based on Permitted Purposes

Duty to Respond

Future Use of Data Received Through the NHIN

Duties of Requesting and Responding Participants. Each Participant has certain

duties when acting as a requesting or responding Participant.o Breach Notification

o Mandatory Non-Binding Dispute Resolution

o Allocation of Liability Risk

o Applicable Law

31


32/58

NHIN: The Use of Standards

The NHIN references, leverages and utilizes approvedstandards. The Health IT Standards Committee, a federal advisory committee is

responsible for making recommendations to the National Coordinator forHealth IT on standards, implementation specifications, and certificationcriteria for the electronic exchange and use of health information.

The Health IT Standards Committee may be informed by standardsharmonization entities, standards development organizations (SDOs), etc.

To date The Health Information Technology Standards Panel (HITSP) has played a

significant role in harmonizing standards. Their work can be referenced here:http://www.hitsp.org/

32
http://www.hitsp.org/http://www.hitsp.org/http://www.hitsp.org/http://www.hitsp.org/


33/58

NHIN: The Development & Utilization ofSpecifications

The NHIN specifications which must be implemented in an

NHIN Gateway vary with the functionality an NHINParticipant wishes to support. NHIN Specification aredeveloped in alignment with approved standards.

Entities are encouraged to implement the complete set, sothat they may offer the full suite of NHIN services tomembers of its healthcare value chain.

The NHIN Specifications include: Messaging, Security, and Privacy Foundation

Discovery Information Services

Information Services Profile

To date The Health Information Technology Standards Panel (HITSP) has played asignificant role in harmonizing standards. Their work can be referenced here: http://

www.hitsp.org/

33
http://www.hitsp.org/http://www.hitsp.org/http://www.hitsp.org/http://www.hitsp.org/http://www.hitsp.org/


34/58

NHIN: Aligning with Meaningful Use

2009 2011 2013 2015

HIT-Enabled Health Reform

HITECHPolicies

2011 MeaningfulUse Criteria

(Capture/sharedata)

2013 MeaningfulUse Criteria(Advanced careprocesses with

decision support)

2015 MeaningfulUse Criteria(ImprovedOutcomes)

34


35/58

Meaningful Use and PreliminaryRulemaking Timeline

35

July2009 August2009 September2009

Late2009/Early

2010

Rulemaking

PreliminaryDefinition of MU

(HIT PolicyCommittee)

PreliminaryStandards

Identified toSupport MU

(HIT StandardsCommittee)

Work Begun toDevelop HHS

CertificationCriteria for MU(HIT Standards

Committee)

ONC IFRs &CMS NPRMs

Released

2010 andOnward

RegulationsWritten into Lawand Executed


36/58

Status of Rulemaking

An Interim Final Rule (IFR) on an initial set of standards, implementation specifications, andcertification criteria was issued on December 30, 2009, with a request for comments.

Represents the first step in an incremental approach to adopting standards, implementationspecifications, and certification criteria to enhance the interoperability, functionality, utility,and security of health IT and to support its meaningful use.

The certification criteria adopted in this initial set establish the capabilities and relatedstandards that certified electronic health record (EHR) technology will need to include inorder to, at a minimum, support the achievement of the proposed meaningful use Stage 1(beginning in 2011) by eligible professionals and eligible hospitals under the Medicare and

Medicaid EHR incentive programs. In a related announcement, the Centers for Medicare & Medicaid Services (CMS) also issued a

Notice of Proposed Rulemaking (NPRM) on the definition of meaningful use.

In order for professionals and hospitals to be eligible to receive payments under the Medicare andMedicaid EHR incentive programs, provided through the Recovery Act, they must be able to

demonstrate meaningful use of a certified EHR system.

The proposed standards and certification criteria in the IFR are fundamentally linked to andspecifically designed to support the 2011 meaningful use criteria.

36


37/58


38/58

Technical Architecture: Key Principles

Statewide Strategic an Operational Plans are expected to

provide a technical architecture that describes the interactionsof stakeholders and technologies to achieve the statesstrategic health objectives.

Architecture the components of a complex system and therelationships and interactions among those components,whether they be parts of a house, objects in a software

application, or elements of state health informationexchanges. There are many moving parts encompassedwithin state HIE initiatives:

Exchanges of information among many different participants inthe healthcare value chain; Necessary technology infrastructure to facilitate these exchanges; and

Alignment to the national health IT agenda to ensure that these exchanges of health information are

secure and interoperable.

ONC realizes that States/SDEs may be at different levels of maturity and therefore isproviding additional guidance in the State HIE Toolkit and other TA Initiatives.

38


39/58

Technical Architecture: Key Principles &Health Information Exchange (HIE)

The development of and evaluation of state technical architectures

will be driven by well-defined principles that clearly advance thenational health IT agenda, namely:

States/SDEs should ultimately advance the key tenets of the healthreform agenda: Improving quality of care and patient outcomes

Improving the cost-effectiveness of care

Enhancing the capabilities of public health

States/SDEs should advance key priority areas for the meaningfuluse of electronic health records. These key priority areas wereoriginally defined by the HIT Policy Committee in July 2009 and it isanticipated that they will undergo review and update and will bewritten into law.

The priority areas which have been defined as short term (2011) include:o Electronic eligibility and claims transactions

o Electronic prescribing and refill requestso Electronic clinical laboratory ordering and results delivery

o Electronic public health reporting (i.e., immunizations, notifiable laboratory results)

o Quality reporting

o Prescription fill status and/or medication fill history

o Clinical summary exchange for care coordination and patient engagement

39


40/58

Technical Architecture: StakeholdersParticipating in HIE

States/SDEs should incorporate all key stakeholders

within the states healthcare value chain, including non-governmental entities such as providers, health plans,labs and pharmacies, as well as agencies with health-related missions at all levels of government. The architecture should also conform to national standards for health IT, and

should facilitate participation in the NHIN.

The scope of health information exchangeactivities includes exchanges between healthenterprises, both within a state (intra-state) andacross states (inter-state). Health Enterprise refers to an organization that maintains a common index

of patients and their associated documents/data, encompasses participantsthat have established trust and business relationships, and have agreed toadhere to common standards. The scope of a health enterprise could be assmall as a single practice, but it would also include large chains or deliverynetworks, existing jurisdictional HIEs/RHIOs, and state or county agencies.

40


41/58

Technical Architecture: Services to beProvided by and/or used by States

State technical architectures should describewhat shared or common infrastructure theyintend to supply to facilitate the informationexchanges described above. At a minimum, statetechnical architectures must describemechanisms to:

Provide or Participate in Location Services

Ensure Entities (Patients, Providers, etc.) are Discoverable

Provide services for trust, security and privacy

Integrate Medicaid Services

Integrate State-Level Registries

41


42/58

Sharing Information with Current andFuture NHIN Participants

New users will soon be joining the existing

NHIN activities Includes states, SDEs or other recipients of Federal

contracts to build and begin exchanging healthinformation.

In addition, there are numerous Federal initiatives that

will depend upon information exchange via the NHIN,including the CDC biosurveillance pilots, the VirtualLifetime Electronic Record implemented by the DoD andthe VA, and the Social Security Administrations disabilitydetermination process.

42


43/58

Aligning with Current & FutureGuidance

Grantees are highly encouraged to plan for and participate

in the NHIN. Grantees Statewide Strategic and Operational Plans are

highly encouraged to address options for future NHINparticipation.

This may include planning for and implementation ofappropriate standards, specifications, technical architecture,

trust agreements, etc. Project Officers will evaluate Statewide Strategic and

Operational Plans based upon evolving NHIN guidance.

States will receive guidance regarding the NHIN from:

ONC

ONC State HIE Team

Technical Assistance Providers (State HIE Toolkit, etc.)

CMS (Regarding Meaningful Use)

ONC FACA Committees (HIT Policy NHIN Workgroup)

43


44/58

Questions & Answers(If Time Permits)

44


45/58

Technical Assistance &Toolkit Overview

45


46/58


47/58


48/58


49/58

State HIE Program TA Services and ResourcesWill Address These Type Questions

How do I get started (I dont know what I need or whoto choose to help)?

How do I pick a consultant/vendor?

What do I do to get ONC approval for my state plans?

What are the best practices across the states for

implementing effective HIE across the domains,especially governance?

What are the best practices across states forovercoming a particular issue/barrier?

What is ONCs position on a variety of issues?

What are the NHIN specs; what can we do with ourarchitecture to become compliant (and not rely on thevendors word)?

Is the proposal received from this consultant/vendor incompliance with ONC guidelines?


50/58

State HIE Technical Assistance Servicesand Resources


51/58

Technical Assistance Consultations

Include Helping states identify

strategies and addressissues within andacross the five domains

Supporting states tomeet milestones anddeliverables asrequired by cooperativeagreements with ONC

Do Not Include Directly meeting

milestones for thestates

Developing statesdeliverables


52/58

Technical Assistance Consulting ActivitiesDo Include.

Provide recommended best practices as identified bySLHIE and other ONC projects e.g. HISPC, State Alliance,NHIN. etc

Assist to develop strategies to address issues, reachmilestones or deliverables by:

Provide advice on direction or resolution of an issue

Analyze specific issues, suggest potential solutions

Synthesize different approaches and outline the alternatives

Identify case studies or other states efforts to resolve similarissues and bring these to attention where a state needs help


53/58


54/58

Anticipated Technical AssistanceTopics Evolving Across Stages


55/58

State HIE Toolkit

Purpose

Resource to support state grantees to plan and leadactivities to accomplish targeted milestones andexpectations outlined in state plans and cooperativeagreements

Design

Aligns with State HIE Program guidance (domains, generalareas)

Modules offer education, decision-making support,practical tools

States have ready access, ability to customize use

Iterative, expanding content to provide access to

emerging best practices, lessons learned in the field

Dissemination

Released in versions with ongoing updates

Available through Forum Web site and directly at http://www.statehieresources.org
http://www.statehieresources.org/http://www.statehieresources.org/http://www.statehieresources.org/http://www.statehieresources.org/


56/58

Toolkit Beta Release

Toolkit Contento Initial modules focus on planning fundamentals

Next Version releaseo Additional set of modules planned January 31, 2010

Feedback on Beta versiono Enhancements, expanded resources will address feedback

about states needs, priorities


57/58

Using the Toolkit

Tackling key fundamentals Establishing governance

Organizing to address key planning priorities


58/58

Next Steps

State HIE Forum Participants Sign up for Listserv through Toolkit or Forum Web site

SLHIE Project Will send Listserv request for feedback on the Toolkit States respond with suggestions, resource requests, etc Moderated communication will begin to circulate state inquiries, requests,

resource sharing

Beginning in 2010 T.A. assessments and planning Webinar series

state hie webinar 010509

Documents