Federal and State Update. John D. Halamka MD

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1 Federal and State Update John D. Halamka MD

2 NPRM Review The use of SNOMED-CT instead of ICD-10 for diagnosis. If the intent is to gather clinical data, SNOMED-CT is best. If billing classification is needed ICD-10 can be used. There needs to be some criteria of usability for data entry of diagnosis. When e-prescribing discharge medications, HL7 is often used inside an organization. The NPRM does not include an HL7 option. This may or may not be an issue because the NPRM does not describe workflows within an organization. The NPRM should include structured allergy vocabularies such as RxNorm for medications, UNII for individual ingredients, NDF-RT for categories, and SNOMED-CT for non-medications. Since RxNorm includes UNII and NDF- IT, RxNorm CUI codes may work for all. Transmission - the Workgroup recommended both SMIME/SMTP and SOAP be required For patient access to view/download/transport, the Workgroup recommended TLS for transport and CCDA for download. For Family history, the Workgroup highlighted the adoption of the Surgeon General's Family History XML Format and tools

3 NPRM Review Clarify Transport standards references Clarify intent of patient-accessible log Add certification criteria to secure channel for patient viewing and downloading; use same standards proposed for secure messaging with patients Change reference to limited set of users to authorized users Clarify that audit records may be purged after required retention period Adopt ASTM E , Standard Specification for Audit and Disclosure Logs for Use in Health Information Systems, as standard for defining auditable events and information to be recorded about those events rather than creating new standard language through a regulation Reduce specificity re how patient information may be appended 3

4 Stage 2 Requirements Accelerating HIE The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 65 percent of transitions of care and referrals. (Stage 1 was 50%, menu set) The EP, eligible hospital, or CAH that transitions or refers their patient to another setting of care or provider of care electronically transmits a summary of care record using certified EHR technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10 percent of transitions of care and referrals. (Stage 1 was one test)

5 Program Information Notice Individual access Correction Openness and transparency Individual choice Collection, use and disclosure limitation Data quality and integrity Safeguards Accountability 5

6 State Project schedule and updates Initiative Submit IAPD and SMHP to CMS Submit updated SOP to ONC EHR/HIE Vendor Roundtable Network Users Roundtable Eastern MA Network Users Roundtable Western MA CMS approval of APD-U/SMHP (all signs indicate) ONC approval of SOP and SOP budget (expected) RFR for Phase 1 services released to Infrastructure Vendors Completion date Very Soon Infrastructure Vendor selected Late April, 2012 Infrastructure Vendor under contract Late May, 2012 Go-live for phase 1 Information Highway (Direct Gateway) Oct 15, 2012 Go-live for Last Mile program Oct 15, 2012 Go-live for Impact program Oct 15, 2012 Go-live for phase 1 Public Health Gateway (CBHI, SS) Dec 14, 2012

7 Advisory Focus Areas to Support Statewide HIE Infrastructure Timeline HIE Services Deployment Activity HIT Council Advisory Focus Areas Lead WG Vendor selection Input as requested as appropriate in State procurement processes Tech/Imp Infrastructure Business Model Design/build/deploy Recommendations on key architecture and technical elements Tech/Imp Policy Governance Operations Governance Business Services Funding & Pricing HIE Participation Agreements Recommendations on near-term and longer-term Policy governance of statewide HIE services Recommendations on near-term and longer-term Operations governance of statewide HIE services Recommendations on HIE service offerings, participants, and associated Policies and Procedures Recommendations on funding approaches and pricing policies (not on actual pricing) Recommendations on contractual requirements for HIE services (requirements on State as well as Partcipants) Legal/Policy Legal/Policy Tech/Imp Sustainability Legal/Policy Pilot customers Input as requested on identifying and recruiting Pilot Participants Provider Adoption Communication, Marketing, and Recruitment EHR integration customers Web portal customers Recommendations on outreach and recruitment to EHR integration customers Recommendations on outreach and recruitment to web portal customers Provider Adoption Provider Adoption Consumer customers (tbd) Recommendations on outreach and recruitment to consumer customers (if Phase 1 services available to consumers) Consumer Engagement 7

8 8

9 Questions?

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