Health IT Policy Committee Information Exchange Workgroup December 6, 2010 Meeting

1. HIT Policy Committee Information Exchange Workgroup MickyTripathi, MA eHealth Collaborative, Chair David Lansky, Pacific Business Group on Health, Co-Chair December 6, 2010

2. Today’s objectives Review HIT Policy Committee meeting Timeline for remaining provider directory recommendations Policy options for promoting entity-level provider directories (ELPD) Individual-level provider directories (ILPD) Today’s discussion will focus on policy options for promoting creation of ELPDs with recommended characteristics 2

3. Provider Directories - Where are we in process? Recommendations on Directory Requirements and Options Policy Recommendations Users and Uses Functions Content Operating rqmts Business models Policy issues Policy actions Who wants an entity directory? What do they want to use it for? What functions do users need for their desired uses? What data will be required in order to enable desired functions? What operating business requirements will be needed in order for this to be used? What are possible business models for meeting needs? Which business models should the government promote? What are the policy issues related to each of the suggested business models? What policy actions should be taken to address the policy issues? -- Entity-Level Provider Directory (ELPD) Recommendations approved by HITPC on 11/19 -- Recommendations on Policy levers for ELPD to HITPC for 12/13 -- ILPD Recommendations to HITPC for 2/2 meeting -- Recommendations to HITPC 12/13 3

4. HIT Policy Committee The ELPD recommendations were accepted by the Committee

5. HITPC-approved recommendations (1) Recommendation: The following entities should be listed in the ELPD Health care provider organizations (i.e., hospitals, clinics, nursing homes, pharmacies, labs, etc) Other health care organizations (i.e., health plans, public health agencies) Health Information Organizations (i.e., regional HIE operators, health information service providers) Other organizations involved in the exchange of health information (business associates, clearinghouses) Recommendation: ELPDs should support the following functionality Support directed exchanges (send/receive as well as query/retrieve) Provide basic “discoverability” of entity Provide basic “discoverability” information exchange capabilities (i.e. CCD, HL7 2.XX) Provide basic “discoverability” of entity’s security credentials 5

6. HITPC-approved recommendations (2) Recommendation: ELPDcontent should be limited to the following categories of information Entity ‘demographics’ and identification information Name, address(es) Other familiar names Human level contact Information Exchange Services Relevant domains (as defined by each entity); relevant website locations Protocols and standards supported for Information Exchange (SMTP, REST, CCD/CDA, CCR, HL7 2.x.x, etc) - Two Options: Include a ‘pointer’ in the directory to the entity’s information (recommended) Include the entity-level information in the directory General Inbox location, if applicable (for message pick-up/drop-off) Security Basic information about security credentials (i.e., type, location for authentication) 6 HITPC-approved recommendations (2)

8. Each registrar publishes directory information into a national provider directory registry system that, like DNS, will support identification of entities across registrar domainsELPDs: maintained by registrars; cross-referenced through system (similar to DNS) Possible roles of federal government: National standardization and harmonization Some agencies could be registrars themselves (i.e., Medicare, VA) Build on existing national/federal tools (i.e., PECOS, NPPES, NLR, others) 7 HITPC-approved recommendations (3)

9. Timeline Currently working to schedule WG and Taskforce calls for January 8

10. Discussion of Provider Directory Policy Recommendations 9

11. Policy Questions Which business models should the government promote? What are the potential government roles and levers? What is the appropriate level of depth in policy recommendations (and avoid stepping into role of Standards Committee) What is critical and necessary to meet our goals (minimal necessary principal) 10

12. 11 Policy Options 11

13. Key questions What approaches would best promote rapid adoption of an ELPD-network? Standards: In which areas would standards and guidelines facilitate creation of market-sustainable ELPDs? Infrastructure: Is a federal (or federally-mandated) infrastructure required to lay the foundation of a nationwide ELPD service? Federally created ELPDs? State-created ELPDs using state-level HIE funds? Federal accreditation of ELPD registrars? Participation and sustainability: How much carrot and stick is likely to be needed to launch a nationwide ELPD service that has high participation and can pay for itself (ie, no government funds needed) Is the creation of robust standards enough to catalyze a market-driven solution? Can government levers assist with creation and/or sustainability? MU requirement? Medicare registration requirement? NHIN Exchange or Direct participation requirement? Federal government contracting requirement? 12

15. Content: How should key content be represented in ELPDs?

16. Architecture: What technical guidelines should be promulgated to facilitate the federated architecture approach to ELPDs?

17. Interoperability

18. What standards should be used for ELPD registrars to communicate with each other?

19. What standards should apply to EHR vendors to consume ELPD services?

20. What standards should apply to source systems to enable automated population and updating of ELPDs?13

21. 14 Next Steps Based on the conversation today draft recommendations will be circulated among the WG to finalize for presentation at the December 13 HITPC meeting Provider Directory Taskforce will turn to individual-level provider directory