ft FHIR AT SCALE TASKFORCE

ONC FHIR at Scale Taskforce (FAST).

Presenters

• ll

Chris Muir Stephen Konya

Director, Standards Division, Senior Innovation Strategist, HHS/ONC HHS/ONC

ONC Lead, FHIR at Scale Taskforce (FAST)

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Today’s Presentation Objectives & Goals

• Collaborative efforts are coming together to leveragethe power of APIs and the HL7 FHIR standard, taking the industry one step closer to improved digital dataaccess and exchange

• Carequality, Argonaut, and Da Vinci individually are working towards proposing approaches to addressthe future of digital data access and exchange inspecific domains towards goals such as reducing provider and administrative burden with health IT and empowering the patient

• Meanwhile, the FAST Initiative is working toaddress the infrastructural challenges holding back the deployment and adoption of these individualsolutions at scale

Goals • Raise awareness of the

FAST approach, goals and accomplishments to date

• Understand how FHIR collaborative efforts complement each otherand how FAST's work is set apart

• Highlight how workingcollaboratively providesvalue to reach a common goal and how you can get involved

CM 3

What is FAST?

The FHIR at Scale Taskforce (FAST), convened by the Officeof the National Coordinator for Health IT (ONC), brings together a highly representative group of motivated healthcare industry stakeholders and health information technology experts.

The group is set to identify HL7® Fast Healthcare Interoperability Resources (FHIR®) scalability gaps and possible solutions, analysis that will address current barriers and will accelerate FHIR adoption at scale.

CM 4

FAST Importance to/for the ONC

1) ONC is focused on connecting healthcare and health datathrough a national interoperable Health IT infrastructure.

2) ONC is working to reduce the regulatory and administrative burden related to the use of health IT, including EHRs.

3) ONC is working on ways to give clinicians more time tofocus on what matters – caring for their patients.

Supporting Documents; • ONC's Cures Act Final Rule

• Strategy on Reducing Burden Relating to the Use ofHealth IT and EHRs

• 2020-2025 Federal Health IT Strategic Plan (deadline for public comment extended to 4.3.20 at 11:59:59 PM ET!)

CM 5

ONC's 21st Century Cures Act Final Rule

Main Landing Page; https://www.healthit.gov/curesrule/

Putting the patient first in health technology Direct Links; enables the health care system to deliver: • Fact Sheets • Transparency into the cost and outcomes of their care • Webinars • Competitive options in getting medical care • Media/Press • Modern smartphone apps to provide them convenient access to their

records • Blog Post • An app economy that provides patients, physicians, hospitals, payers, and • Download Final Rule

employers with innovation and choice

CM 6

The FAST Journey

FAST Taskforce Antitrust Notice

• The ONC FHIR At Scale Taskforce (FAST) (Hereinafter “Taskforce”) is committed to full compliance with existingfederal and state antitrust laws.

• All members involved in the Taskforce effort, including its advisory groups, will comply withall applicable antitrust laws during the course of their activities. During Taskforce meetings and otherassociated activities, including all informal or social discussions, each member shall refrain from discussing orexchanging competitively sensitive information with any other member. Such information includes, but may not be limited to:

– Price, premiums, or reimbursement charged or paid for products or services – Allocation of customers, enrollees, sales territories, sales of any products or contracts with providers – Any other competitively sensitive information that is proprietary to a member company

• If you have any specific questions or concerns, seek guidance from your own legal counsel.

• Members should not bring confidential information or intellectual property (hereinafter “Intellectual Property”)owned by their respective member companies into Taskforce meetings. To the extent such Intellectual Propertyis shared with the Taskforce that shall not be construed as a waiver of member company’s rights to, or ownershipin, the Intellectual Property.

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P2 FHIR to FAST

Oct 2017 – Payer + Provider (P2) FHIR Taskforce Established Originally focused on Payer/Provider collaboration

Q1 2018 – Taskforce Charter Created Problem: Ecosystem and infrastructure barriers prevent wide-scale adoption and deployment of FHIR Purpose: Address ecosystem barriers and accelerate adoption of FHIR for production exchange of clinical information between payers and providers Need: Establish a national architecture for standardized exchange of information using FHIR Scope: Establish ONC taskforce that leverages “tiger teams” to focus on near term, practical approaches for the standardized exchange of information using FHIR

Initial Tiger Ecosystem Executive P2 Becomes FAST Technical & 14 Ecosystem Possible 1st FAST 101 Recommendations TLC Virtual SME Sessions & Team Calls Tiger Team Steering Jan 2019 Regulatory Use Cases v1 Solutions to Webinar for Regulatory Webinars Action Plan Commenced Identified & Committee Same mission, new Barriers v1 Published Tech Barriers Sept 12th Barriers Nov-Dec 2019 TBD Q2/Q3 2018 Prioritized 21+ Formed & 1st name to better reflect Published Q2 2019 Q3 2019 10amET Ongoing

Use Cases Meeting work FAST is doing Q2 2019 Q2/Q3 2018 Q4 2018 and broader

stakeholder SK engagement 9

FAST Organization & Community Engagement

UPDATES

FEEDBACK

EXECUTIVE STEERING COMMITTEE

(public-private mix)

TIGER TEAMS IDENTIFY: • Use Cases • Technical/Regulatory Barriers • Core Capabilities • Gap Analysis

COORDINATING Information Sharing COMMITTEE with TLC through: (public-private mix)

• Website • Periodic webinars

SEVEN TIGER TEAMS • Newsletters Ecosystem Use Cases • TLC Meetings Identity • LinkedIn Group TECHNICAL LEARNING Security COMMUNITY (TLC) Directory, Versioning and Scale

Exchange

Certification and Testing

Pilots SK

10

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Collaborative Efforts Towards FHIR Adoption

FHIR SOLUTIONS FOR VBC

SHARED Technical Challenges to

FHIR SCALABILITY

Common Scalability Approaches

RAPID INDUSTRY ADOPTION OF

FHIR-BASED SOLUTIONS

Patient & Provider Identity Management

Directory Services

Version Identification

Scale

Exchange Process/Metadata

Testing, Conformance & Certification

Security

INFRASTRUCTURE USE CASES

Payers/ Providers

CORE DATA SERVICES

Provider/ Provider

FHIR CONSUMER SOLUTIONS

Consumers

OTHER EFFORTS

Other Collaborative Efforts to Develop & Implement FHIR Solutions

FUNCTIONAL USE CASES

Contractual Enforcement

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Lack of Consistent Infrastructure Impacts Flow

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Well-Planned Infrastructure Creates Efficiency

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Organization

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Patient/ Member

User

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Patient/ Member

User

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Organization

Known Technical Barriers

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1 Directory Services 2 Identity 3 Security

4 Testing, Conformance, & Certification 5 Versioning 6 Scaling 14

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Recommended Infrastructure Solutions

FAST Solutions Process

FAST Solution Input • Tiger Teams • TLC • SME

ProposedInfrastructure Solutions

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Standards Process Regulation

Evaluation, Feedback, and Pilots

Ecosystem Use Case

Identity

Directory, Version & Scale

Testing & Certification

Exchange Process

Security Pilots

Ecosystem Use Cases

Core Capabilities

Technical Barriers

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FHIR Adoption - Technical Challenges & FAST Proposed Solutions

DIRECTORY, VERSIONS AND SCALE

DIRECTORY CHALLENGE: There are multiple places to find endpoints. Is there a place I can go to find all of them?

PROPOSED SOLUTION: A national solution for FHIR Endpoint Discovery

VERSIONS CHALLENGE: A way to communicate and manage multiple versions

PROPOSED SOLUTION: Supporting multiple production versions of FHIR

SCALE CHALLENGE: How can a high volume of FHIR transactions be consistently and predictably exchanged in a hybrid exchange model?

PROPOSED SOLUTION: Requirements for FHIR RESTful exchange intermediaries

ProposedInfrastructure Solutions

IDENTITY CHALLENGE: How can a requestor and receiver uniquely identify the patient/member?

PROPOSED SOLUTIONS: - Mediated Patient Matching - Collaborative Patient Matching - Distributed Identity Management

EXCHANGE PROCESS CHALLENGE: How do we enable consistent and reliable transaction exchange?

PROPOSED SOLUTIONS: - Reliable Routing with Metadata Across Intermediaries - Reliable Routing Across Intermediaries Using Destination Specific Endpoints

TESTING & CERTIFICATION CHALLENGE: A way to measure conformance to the standard

PROPOSED SOLUTION: ONC FHIR Testing and Certification Program

SECURITY CHALLENGE: How do we manage permissions & security across millions of patients/payers/providers?

PROPOSED SOLUTIONS: - Trusted Dynamic Client Registration - Tiered OAuth - UDAP Authentication & Authorization 16

Technical Barriers to HL7• FHIR• Solutions Scalability

The FHIR at Scale Taskforce (FASn has identi fied a series of tech nical barrier!. that need to be addre order to scale Fast Healthcare Interoperabili ty Resources (FH IR) as a ubiquitous technology that enab scale clinical in formation exchange between providers, payers, and ot her stakeholders. These barriers a lack of a FHIR endpoint locator, lack of common authenl ica!Kln and authorization approaches to en appropriale patient privacy, gaps in t he abi li ty to bridge pat ient identi ty across stakeholders, and a lac i ndustry wide governance and versioning for FHIR Applicatioo Programming lnteffaces {APls) .

The FASTiniliative brings together a h ighly representative. col labofat ive grou p of mot ivated heallhcar, st akeholders and health informat ion technology experts who are wOftl ing to anal)'Ze and synthesize thf

solutions across t he i ndustry. and to further ident ify infrastruct ural and scalabili ty gaps and barriers, 1

object ive to propose a suite of ~ut ions that w ill accelerate f HIR adopt ion at scale.

The fo llowing technica l barriers ident ified by t he FASTteam were found to impede the adopt ion of f l­scale and will be t he basis for FAST-proposed scalability solutions,

1. Directory Services 4_ Testing Conformance & Certification

2. Identity 5. Versionina:

3. Securi~ 6. Scali!Jg

Regulatory/Policy Barriers to HL?" FHIR" Solutions Scalability

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The fH IR al Scale Taskforce (FAsn has identi f ied regulatory and policy barriers t hat need lo be addressed in

order to scale f ast Healthcare lnteroperabill ty Resources (FH IR) as a ubiquitous capabili ty t hat enables wide­scale c linica l information exchange between providers, payers. and ot her stakeholders.

These barriers include t he HIPAA m inimum necessary regu lations, t he naming of a standard In a way the l im its inooval ion, the lack of a si ngle patient ident ifier, and t he cost of accessing data via FHIR Application Programming Interfaces (APls).

The industry is i nterested in scaling FHIR use. The most recent Centers for MedlCare & Medicaid Services (CMS)

Notice of ProlX)sed Rulemaking (NPRMJ and t he Office of the National Coordinator for Health IT (ONCJ NPR M (published in t he federal register on March 4 . 20191 call for widespread use of AP ls to enable consumers to access t heir hea lth data and foster industry-wide adopt ion. However. the folkJwing regulatory and policy barriers impede scalable FH IR adopt ion, and t hey are t he focus for which FAST will identi fy potent ial solutions,

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Int roduction & Background

The- pu,pose of the fHIR at scale Taskforce (FAST} is to augme11t fAfTTechnica1 Barriers and support recent HL7e fast Healthcare Interoperability Resources (FHIRc-) efforts forusecl on ecosvsi:em issues that, if mitigated, Cilnaccelerateadoption.

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FAST use case model is unique in that it describes ecosystem needs as opposed co specific functional ts. Use cases far FAST ne derived in one of 3 appro..ches as desaibed in the i;raphic below.

Use Case Approaches CH Be UMd £11c:lu1h'ely 0t In Combln•tiOn to Oellne the DlffteMIOtls of ttltc Mo6et

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SUpporting Diagrams & FloW5

Solutio n #1: Real Time Patient Matching

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Patient Sma.tch ~equest Requestor Actor calls a To do: Patient Sma.tch operation pnwided by the Daine minimum and optional ~t of Responder Actor or a truned intermediary of the attributes t(I improve match scores. Responder Actor ..

List use cases where The Sma.tch request wil use Patient resource in onlyCen:ainMatches must be set to the request. The attribute •onlyeen:a.inMatches" true. will be set t(I true for Use cases involving Patient Ca.re Deivery. Identify recommended limits for

•count"foreicampleusecases AS an optional pre-cuBOr to the Smatc:h, the Requester may verify the Patient's demographics to the best of their ability, ranging from a manual verificationofidentificationsuchasDri~s Licenses to automated checks against non­healthcare databases such -as ere mt bureau records, if warranted.

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Published Content and FAST Artifacts

All content is available on the https://tinyurl.com/ONC-FAST 17

FHIR at Scale Tasklorce: 2019 End-01-Year Report

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FAST 2019 End of Year Report

2019 End of Year Report Summarizes progress made in 2019 and provides a sneak-peak of work in 2020

18

FAST Initiative Output & Communication Strategy Update

FAST Initiative FAST Regulatory FAST Solutions FAST 101 - Public Industry Speaking Use Cases, and Policy Barriers, (In Development/ Webinar Engagements Version 2 Version 1 Drafts)

FAST CONTENT FAST COMMUNICATION STRATEGY

FAST Initiative FAST Technical 2019 FAST FAST 101 and Technical Learning Core Barriers, End of Year Keystone Community

Capabilities Version 1 Report Presentations

All content is available on the https://tinyurl.com/ONC-FAST 19

FAST Focus

Patient & Provider Identity Management

Directory Services

Version Identification

Scale

Exchange Process/Metadata

Testing, Conformance & Certification

Security

Pilots

Join the Technical Learning Community to get updates and provide input on the technical and regulatory barriers, use

cases, and proposed solutions as they are developed.

SIGN UP!! &

JOIN THE LINKEDIN GROUP Almost 400 members & growing!

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20

Questions?

Thank You – Today's Presenters

Chris Muir Stephen Konya ONC ONC – FAST Lead

Christopher.Muir@hhs.gov Stephen.Konya@hhs.gov

For more information on the FAST Initiative, visit the FAST Project Page

or https://tinyurl.com/ONC-FAST

Have any further questions/suggestions?

Please contact Stephen Konya at Stephen.Konya@hhs.gov & Diana Ciricean at Diana.Ciricean@hhs.gov

22