HIT Policy CommitteeHIT Policy CommitteeInformation Exchange Information Exchange WorkgroupWorkgroup

Micky Tripathi, Massachusetts eHealth Collaborative, ChairDavid Lansky, Pacific Business Group on Health, Co-Chair

September 13, 2010

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Agenda

Information Exchange Workgroup• Public Health Taskforce Scoping• Update on Provider Directory Taskforce• Provider Directory Taskforce Work plan

Provider Directory Taskforce• Finalize Presenters for September 30th hearing• Finalize Questions for Panels

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Public Health Taskforce

Meaningful Use• Opportunities for rapid progress to enable MU reporting and data exchange requirements –

public health departments, HIEs, providers– Electronic reporting to immunization registries– Notifiable disease reporting– Electronic syndromic surveillance

Standards Harmonization/Adoption• Key steps to harmonize standards and drive adoption (MU, CDC, NHIN Direct, state systems,

PHIN)• Are translation services one viable pathway?

Public Health Capacity, Platform• Universal migration path for public health so every state and local agency does not have to

reinvent the wheel?• Opportunities to increase uniformity in public health data platforms (health care providers have

EHR certification, what can be done for public health)?• How to promote economies in public health interoperability development across

states/regions?

Leveraging Provider Directories• How to best leverage provider directories for public health communications and alerts? How

leverage public health provider directories for HIE?

Stage 1 Meaningful Use Public Health Menu Set Objectives

1 Unless an EP, eligible hospital or CAH has an exception for all of these objectives and measures they must complete at least one as part of their demonstration of the menu set in order to be a meaningful EHR user.

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Public Health Taskforce Scoping

• What problems are we trying to solve?– Enabling Stage 1 population and public health objectives– Aligning funding and HIT standards/efforts to facilitate

electronic public health reporting– Others?

• Taskforce Membership• Timeline

– Recommendations to HITPC November 19th

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Public Health Taskforce Membership

Current Membership• David A. Ross PHII• Jim Buehl CDC• Deven McGraw Center for Democracy & Technology• Jonah Frohlich California Health & Human Services• Steven Stack AMA• George Hripcsak Columbia University• Seth Foldy DHS, Wisconsin• Walter Suarez Kaiser Permanente

• Additional volunteers from the committee or suggestions for outside members to

join the Taskforce?

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Provider Directory Taskforce

• Update on Provider Directory Taskforce

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Provider Directory Taskforce

Co-Chair: Jonah Frohlich, California Health and Human Service AgencyCo-Chair: Walter Suarez, Kaiser Permanente

Members:• Hunt Blair Vermont Medicaid• Sorin Davis CAQH• Paul Egerman• Judy Faulkner Epic• Seth Foldy DHS, Wisconsin• Dave Goetz Dept. of Finance and Administration, TN• James Golden Minnesota Department of Health• Steven Stack AMA• George Oestreich Missouri Medicaid• Sid Thornton Intermountain Healthcare• Keith Hepp HealthBridge• Lisa Robin Federation of State Medical Boards• Jessica Kahn CMS• JP Little Surescripts

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ONC Charge on Provider Directories

• What are the priority uses for state level provider directories or directory services? Who would use them and for what?

• Based on identified priority uses, what standards, requirements and policies are necessary to enable the creation and sustainability of provider directories or directory services at the state level?

• What are the requirements and strategies to ensure that directories are:

– Authoritative: contain accurate and up-to-date data necessary to enable the routing of health information among and between health care providers and health care entities (i.e. pharmacies, labs, physician practices, etc);

– Comprehensive: contain information on all licensed providers, and potentially other health care entities (clinical labs, radiology facilities) within a geographic region; and

– Open: are available for use by multiple parties (i.e. HIO, IDN, NHIN Direct User, public health) and for multiple uses (I.e. public health alerts, sharing care summaries across unaffiliated providers, etc.), and support interoperability.

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High-level approach

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Requirements

• Coverage – What groups of individuals should the directory approach cover? What jurisdiction/geography is covered by the provider directory? What level/type of information is needed to support providers who practice at multiple unaffiliated sites (e.g. ability to distinguish provider between different practice locations)?

• Content – What type of information is needed for each individual and entity? (may need different information for a provider vs. a practice)

• Standards – What standards are needed on the data elements?• Architecture – How should the directory approach be architected? What are the different models

(federated vs. repository vs. other approaches)? What level/type of information is needed to support providers who practice at multiple unaffiliated sites?

• Identity-proofing – What level of assurance is needed to assure high use, and how will that assurance be provided?

• Data validity – What level of accuracy is needed? What is user tolerance for errors? • Distribution channels – How will users of the directories access the information?• Maintenance – What level of effort will be required to maintain the directories, who will pay for it,

and who will manage and execute it?• Funding – How much will be required to create such directories, and how will they be funded (up-

front and ongoing)?• Business terms – What trust framework is required for information sharing between provider

directories (how should governance operate, what qualifies an entity to be listed, do listing requirements need to be nationally uniform or, if not, ‘posted’ by each directory, what are violations and mechanism for de-listing, relisting, etc.)?

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Provider Directory Taskforce Work plan

Meeting/ Committee Focus Deliverables

September 13 IE WG Call Taskforce Work Plan

September 14 HITPC meeting

Present Taskforce work plans

September 23 Provider Directory Taskforce call

Finalize provider directories hearing

Review environmental scan

September 30 IE WG hearing

Provider directories

October 6 IE WG Call Provider directories recommendations

Finalize recommendations

October 20 HITPC meeting Present provider directories recommendations

Provider directories recommendations

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HIT Policy CommitteeHIT Policy CommitteeInformation Exchange Information Exchange Workgroup Workgroup Provider Director TaskforceProvider Director Taskforce

September 13, 2010

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Provider Directory Taskforce Agenda

• Overview• Discuss Panel Presenters and Questions for

September 30th Hearing

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What problem are we trying to solve?

• State HIE Cooperative Agreements and MU Stage 1 focus on “directed exchange” types of transactions, specifically lab results delivery and patient care summary exchange

• While there are multiple ways that these functions will be performed in the market (for example, through EHR-based hubs or state-level HIE activities) all of these approaches will need to have a way to handle provider identity and addressing

– While directed exchange transactions are the most immediate need, there are many other potential users such as public health, health plans, etc that also spend considerable effort on provider identity

• The lack of a universal approach to provider directories will be a barrier to progress in “directed exchange” and a missed opportunity to combine multiple streams of funding to yield a lower cost, higher quality service for all

• What, if anything, can federal and state governments do to catalyze and guide the creation of market-enabling provider directory approaches to serve the immediate needs of “directed exchange” transactions and also serve as a platform for broader needs in the future?

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High-level approach

Use cases: Biggest immediate need is to enable Care Summary Exchange

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Use Transaction Function Market need

Care summary exchange

• PCP to/from Specialist• Ambulatory to/from

Hospital

• Enable message routing Need solutions for Stage 1 Meaningful Use

Lab results delivery • Hospital lab to/from ambulatory

• Commercial lab to/from ambulatory

• Enable message routing

Existing solutions work today. Potential opportunity to provide lower cost & higher quality alternative to existing proprietary approach.

eRX • Ambulatory to pharmacy • Enable message routing

Public health reporting

• Physician to public health • Improve provider identity validation

• Provider authentication?Public health alerts • Public health to providers • Enable message routing Need solutions for

Stage 2 Meaningful Use

Claims & eligibility checking

• Health plan from providers • Improve provider profile creation Existing solutions work today. Potential opportunity to provide lower cost & higher quality alternative to existing proprietary approach.

Credentialing • Health plan from providers• Hospitals from physicians• State governments from

physicians

• Improve provider profile creation• Improve provider enrollment

process

CMS • NLR • Improve provider identity validation

Need unknown at present

User requirements translate to system requirements

A viable approach for any given user & use case must provide the right information in the right way at the right time according to the user’s business need

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The type and quality of the content required will vary by use case

What additional content is needed on each provider for each use case? What content is needed for Care Summary Exchange?

How accurate does each field need to be to satisfy the user business requirement? With respect to granularity? With respect to time?

How will users access this information?

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2. First name, Last name

3. Provider type (MD, DO, etc)

4. NPI number

5. License number, State

6. Specialty

7. Hospital affiliations

8. Names/address of practice locations

9. Practice & location telephone

10. Practice & location email address

11. ...

12. ...

13. ...

Content

Some high-level depictions for discussion

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Panel Outline for Provider Directory Hearing

• Panels are focused on different use cases for provider directories:

1. State/regional Framing

3. Business requirements: Providers

5. Business requirements: Health Plans, Public Health and Others

7. Architecture approaches

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State/Regional Framing

• Potential Presenters– Regional Approach (Northeastern states)– Single state approach– Capture different architectures

• Potential questions for presenters – What are priority uses for a provider directory? Who would use them and for what? What

level of data accuracy do you need for at these purposes? What are key data elements?– What are the key challenges you are facing?– In what areas could this workgroup provide useful recommendations?– What set of providers and entities do you intend to include in provider directories? Data

sources?– What steps could we encourage regional collaboration in establish provider directories?– How can we work to ensure interoperability and access across provider directories being

created under the State HIE Cooperative Agreement Program? – What policy levers can state governments or the federal government use to assist in the

establishment of provider directories? Maintaining data accuracy and quality?– What trust framework is required for access to and information sharing among provider

directories? – What level of assurance is needed to assure high use, and how will that assurance be

provided?– What are the resource requirements to create and maintain directories and what are the

funding options(up-front and ongoing)?

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Business requirements: Providers

• Potential Presenters– Large IDN– CHC or RHC– Small practice representative– EHR vendors

• Potential questions for presenters – What uses cases do you have for an authoritative provider directory?– What set of providers and entities need to be included to enable your use cases?– What level of assurance is needed to assure high use, and how will that

assurance be provided?– What level of data accuracy is needed? What is your tolerance for errors?– What data could be made available on providers from your systems to establish

state level directories or directory services? Issues to be resolved?– What do you expect from your EHR system related to provider directories?– What are EHR vendors doing today, and what would they like to see in a provider

directory service?

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Business requirements: Health Plans, Public Health, and Others

• Potential Presenters– Commercial Health plan– Public health– Medicaid– CMS representative on NLR, NPI

• Potential questions for presenters – What uses cases do you have for an authoritative provider directory?– What set of providers and entities need to be included to enable your use cases?– What level of assurance is needed to assure high use, and how will that

assurance be provided?– What level of data accuracy is needed? What is your tolerance for errors?– What data could be made available on providers from your systems to establish

state level directories or directory services? Issues to be resolved?

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Architecture approaches

• Potential Presenters– EHR Vendor– NHIN Direct Project Staff– HIE Vendor– CAQH– Surescripts, Labcorps, etc– Identity management vendor (Initiate, SeeBeyond, etc)

• Potential questions for presenters– What type and level of information is needed on each individual and entity included to

allow for accurate routing of information? (e.g. ability to distinguish provider between different practice locations)?

– How can we ensure directories are not duplicative but complement and enhance the value of existing infrastructure (e.g., operating HIOs, networks, etc) and emerging federal initiatives (e.g., NHIN Direct/Connect/Exchange) to the end users (e.g., providers, hospitals, consumers, etc.).

– How should the directory approach be architected? What are the different models (federated vs. repository vs. other approaches)? What level/type of information is needed to accurately route to providers who practice at multiple unaffiliated sites?

– How should “technical” directories for specific HIE activities (e.g., NHIN Direct, regional HIO) interface with or interact with authoritative directories of all providers in a state? What data elements will link the two?

– What options/experience is there creating distributed infrastructure that links multiple provider directories?

– What trust framework is required for information sharing between provider directories?

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Next Steps

• Finalize and invite presenters by Wednesday, September 15th.

• Finalize list of questions by Friday, September 17th.

Backup slides

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Current/Potential Users and Sources – are there others?

Current and potential users

• HIE vendors

• EHR vendors

• NHIN Direct users

• HIOs

• State governments

• Public health

• Medicaid

• Licensing

• Federal government

• CMS NPI & claims

• NLR

• CDC

• Commercial identity software/service vendors

• Provider enterprise systems

• Commercial health plans

• Public health

• Transaction-specific vendors (e.g., Surescripts, LabCorps, etc)

• Credentialing

• SSA

Current sources

• HIE vendors

• EHR vendors

• HIOs

• State governments

• Public health

• Medicaid

• Licensing

• Federal government

• CMS NPI

• NLR

• Commercial directory content vendors

• Commercial identity software/service vendors

• Provider enterprise systems

• Commercial health plans

• Public health

• Transaction-specific vendors (e.g., Surescripts, LabCorps, etc)

• Membership organizations and medical societies

• SSA