HIT Policy CommitteeHIT Policy CommitteeStrategic Plan WorkgroupStrategic Plan Workgroup

Listening Session:Health IT Strategic Framework

Paul Tang, ChairPaul Tang, ChairPalo Alto Medical Foundation

Jodi Daniel, Co-ChairJodi Daniel, Co-ChairONC

April 6, 2010

Workgroup Members

Members:• Roger Baker, Department of Veterans

Affairs• Christine Bechtel, National Partnership

for Women & Families• Patricia F. Brennan, University of

Wisconsin• Janet Corrigan, National Quality Forum• Art Davidson, Denver Public Health• Don Detmer, University of Virginia• Carol Diamond, Markle Foundation• Paul Egerman, Consultant• Steve Findlay, Consumers Union• Mark Frisse, Vanderbilt• Charles Kennedy, WellPoint, Inc.

Members:• John Lumpkin, Robert Wood Johnson

Foundation• David McCallie, Cerner Corporation• Deven McGraw, Center for Democracy

& Technology• Marc Probst, Intermountain Healthcare• Cris Ross, CVS MinuteClinic• Steve Stack, American Medical

Association• Penny Thompson, Centers for Medicare

& Medicaid Services• Tony Trenkle, Centers for Medicare &

Medicaid Services• James Walker, Geisinger Health System

Chair: Paul Tang, Palo Alto Medical Foundation

Co-Chair: Jodi Daniel, ONC

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Listening Session Agenda

• Listening Session Overview & Purpose• Learning Health System

– Comments, Question & Answer

• Meaningful Use of Health Information Technology– Comments, Question & Answer

• Policy and Technical Infrastructure– Comments, Question & Answer

• Privacy and Security– Comments, Question & Answer

• Opportunities to Provide Comments

• Adjourn

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Health IT Strategic Framework Vision

Meaningful Use of Health Information TechnologyMeaningful Use of Health Information Technology

Policy and Technical InfrastructurePolicy and Technical Infrastructure

Privacy and SecurityPrivacy and Security

Learning Health SystemLearning Health System

“A learning health system is a system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.” Institute of Medicine

“A learning health system is a system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of new discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care.” Institute of Medicine

Health Information Technology Strategic FrameworkHealth Information Technology Strategic FrameworkFor A Learning Health SystemFor A Learning Health System

PatientsPatients

ProvidersProviders

ConsumersConsumers

ResearchersResearchers

BENEFICIARIESBENEFICIARIES

Conduct ResearchConduct Research

Engage ConsumersEngage Consumers

Provide CareProvide Care

Measure QualityMeasure Quality

Improve and InnovateImprove and Innovate

ACTIVITIESACTIVITIES

AIMS:AIMS: Patient-centered, Safe, Timely, Effective, Efficient, Equitable Patient-centered, Safe, Timely, Effective, Efficient, Equitable

Privacy and SecurityPrivacy and Security

Meaningful Use of Health Information Technology

Policy and Technical Infrastructure Policy and Technical Infrastructure

Individuals Population health

DataDataEducate Educate

PayersPayers

Public Health ProfessionalsPublic Health Professionals

IMPROVED CAREIMPROVED CARE

ENHANCED VALUEENHANCED VALUE

IMPROVED OUTCOMESIMPROVED OUTCOMES SHARED KNOWLEDGESHARED KNOWLEDGE

INFORMED PATIENTINFORMED PATIENT RESULTSRESULTS

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A Learning Health System &A Learning Health System &HITECH Act Framework for Meaningful Use of EHRsHITECH Act Framework for Meaningful Use of EHRs

• State grants for health information exchange

• Standards and certification framework• Privacy and security framework

• Regional extension centers• Workforce training

• Medicare and Medicaidincentives and penalties

Adoption of EHRsAdoption of EHRs Adoption of EHRsAdoption of EHRs

Meaningful use of Certified Meaningful use of Certified EHRsEHRs

Meaningful use of Certified Meaningful use of Certified EHRsEHRs

Exchange of health informationExchange of health information Exchange of health informationExchange of health information

Research to enhance Health Information TechnologyResearch to enhance Health Information Technology

DataIndividuals Population health

DataData

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Learning Health System

Goal:

Transform the current health care delivery system into a high performance learning system by leveraging health information and technology.

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Learning Health System

Principles:

1. Health information should be used to facilitate rapid learning and innovation in diagnosis, treatment, and decision making to improve health outcomes and to enhance health system value.

2. HIT should help engage patients and providers to take active roles in creation and application of evidence-based care.

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Learning Health System

Objectives:

1. Use HIT methodologies, policies and standards to foster creation of knowledge across a large network of distributed data sources, while protecting privacy and confidentiality.

2. Engage public- and private-sector stakeholders at the national, regional, and local levels to effectively leverage data and human resources to advance care delivery, align payment with outcomes, conduct research (e.g., clinical research, comparative effectiveness research), enhance public health (e.g., drug safety monitoring, outbreak surveillance), educate professionals and the public (e.g., K-12, colleges, professional schools, professional lifelong learning) and leverage social services to promote and maintain community health.

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Learning Health System

Objectives:

3. Support individuals’ decisions to allow use of their data for societal benefit (e.g., research and public health), while protecting their individual privacy.

4. Leverage data from populations to expand knowledge and promote scientific discoveries that advance the understanding of health, disease, and treatments.

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Learning Health System

Strategies

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Meaningful Use of Health IT

Goal:

Improve health outcomes, quality, patient safety, patient engagement, care coordination, public health, and efficiency of the health care system through the adoption and meaningful use of health information technology.

Meaningful Use of Health IT

Principles:

1. Focus on health outcomes aligned with national health priorities set by national consensus groups.

2. Use Federal policy levers and ARRA programs to develop meaningful use criteria that align the HIT adoption programs with national health priorities.

3. Include patients and caregivers as primary participants in health information sharing.

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Meaningful Use of Health IT

Principles:

4. Balance achievability by a broad array of health care professionals with the urgency needed to stimulate significant progress toward improved health and health care.

5. Stage meaningful use criteria to provide a glidepath for phased implementation that avoids dead-ends.

6. Prioritize use of resources to provide support to areas and providers that have the greatest need.

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Meaningful Use of Health IT

Objectives:

1. By 2014, capture, manage, and meaningfully use health information to improve the health and health care for all individuals.

2. Leverage public sector resources and policy levers in coordination with the private sector to accelerate adoption of proven HIT that achieves health outcome goals.

3. Target HIT investments to address national high priority health issues. Use exemplars to “exercise” the entire HIT system and human interaction, and measure the health-outcome results.

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Meaningful Use of Health IT

Objectives:

4. Facilitate appropriate and secure exchange of health information to improve individual and population health and reduce disparities by providing decision makers (including patients, consumers and health care professionals) access to the right information at the right time.

5. Advance and promote HIT to inform and engage patients and caregivers in shared decision making on matters related to patients’ health and health care.

6. Improve efficiency in the health care system and reduce administrative burden on providers and patients through HIT.

Meaningful Use of Health IT

Strategies

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Policy and Technology Infrastructure

Goal:

Enable management and secure exchange of electronic health information to meet goals of Meaningful Use and a Learning Health System through the development and support of appropriate policies and technical specifications.

Policy and Technology Infrastructure

Principles:

1. Policies and technical specifications required and/or promoted by the Federal government should, at a minimum, allow providers to achieve meaningful use of HIT.

2. The Federal government should leverage market innovation in information and communications technologies to foster appropriate health information exchange.

3. Effective health information exchange should enable all participants in the exchange, including patients, to contribute toward achieving meaningful use.

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Policy and Technology Infrastructure

Principles:

4. Policies and technical specifications should be kept as simple as possible and be designed for implementation by all participants.

5. Policies and technical specifications should make possible and promote increased patient engagement and access.

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Policy and Technology Infrastructure

Objectives:

1. Establish policies, standards, implementation specifications and certification criteria that incrementally enhance the interoperability, functionality, utility, and security of HIT and that support its meaningful use.

2. Encourage, and facilitate development of market-sustainable mechanisms that ensure reliable, secure, and protected exchange of health information to improve health and health care.

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Policy and Technology Infrastructure

Objectives:

3. Increase market confidence in EHRs and other HIT products and solutions that support meaningful use health outcomes.

4. Increase the nationwide capability for health information exchange to enable meaningful use of HIT and a learning health system.

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Policy and Technology Infrastructure

Strategies

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Privacy and Security

Goal:

Build public trust and participation in HIT and electronic health information exchange by incorporating effective privacy and security solutions in every phase of its development, adoption, and use.

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Privacy and Security

Principles:

1. Privacy and security solutions should be consistent with the Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information.

– Individual Access– Correction– Openness and Transparency– Individual Choice– Collection, Use, and Disclosure Limitation– Data Quality and Integrity– Safeguards– Accountability

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Privacy and Security

Principles:

2. Solutions should enhance privacy and security while facilitating the appropriate access, use and exchange of health information to achieve health outcomes.

3. Privacy and security solutions should be flexible to adapt to evolving technical capabilities over time.

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Privacy and Security

Objectives:

1. Develop, promote and enforce privacy and security laws and appropriate policies for all aspects of HIT and health information exchange.

2. Increase understanding, implementation, and enforcement of policies and practices to protect the privacy and security of health information.

3. Review existing privacy and security laws to identify the need for potential modifications and policies to align with emerging HIT and health information exchange capabilities.

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Privacy and Security

Objectives:

4. Support availability of accurate electronic health information through safe and reliable health IT.

5. Increase consumer engagement in health maintenance, health care and accuracy of electronic health information through widespread consumer access.

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Privacy and Security

Strategies

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Discussion

Comments and Questions

Also, share your thoughts on the

Health IT Strategic Framework on the FACA blog at

http://healthit.hhs.gov/blog/faca/.

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