Issue Briefing
Health Information Interoperability
McLean, VA
April 18, 2008
This document is confidential and is intended solely for the use and
information of the client to whom it is addressed.
Table Of Contents
 The Interoperability Value Proposition
 Common Issues
 Key Components of Interoperability
– National Initiatives
– State/Local Initiatives
– Private Sector
 Moving Forward
 caBIGTM Example
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Interoperability is a critical component of the nation-wide
implementation of health information technology…
 Interoperability; defined as the effective exchange of health information among diverse
participants; advances high-quality, safe and efficient health care for patient and population
health purposes
– Patient focused health care -- moving electronic health information about an individual to
where and when it is needed to support individual heath care and health care needs
– Population health -- moving health information to support population-oriented uses such as
public health, biomedical research, quality improvement, and emergency preparedness
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…and has the potential to provide benefit to all stakeholders
involved in the healthcare continuum.
benefit from the capabilities
to promote their own health
and well-being by making
informed choices in a safe
and secure environment
benefit from obtaining
access to critical information
needed to reduce medical
errors and improve quality of
health care
and other organizations
benefit from meaningful
public health reporting,
bioterrorism surveillance,
quality monitoring, and
advances in clinical trials
benefit from the economic
efficiencies, fewer errors, and
reduced duplication that arise
from interoperability
benefit from streamlined processes, reduced
redundancies, and as a result greater cost-efficiency
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Table Of Contents
 The Interoperability Value Proposition
 Common Issues
 Key Components of Interoperability
– National Initiatives
– State/Local Initiatives
– Private Sector
 Moving Forward
 caBIGTM Example
4
Federal and State governments face similar challenges in the
adoption and creation of interoperable systems
Lack of Standards
Lack of Clearly Defined Value Proposition
Numerous standards developing organizations
currently exist, and although they are specific and
comprehensive, there remain many overlaps and
many gaps
While specific and comprehensive
messaging/transaction standards facilitate the
exchange of data between systems, they do
nothing to assure that the data will be understood
and correctly interpreted by the receiving entity
There are some conflicting goals of stakeholders
who do not want to share information – sense of
losing market share and customers.
There are large investments that need to be
made with unclear benefits for some stakeholders
Security and Privacy Concerns
Policy and Legal Concerns
Individuals and organizations have many
concerns about the inappropriate release or
dissemination of personal and protected health
information
There are no standards around consent. and
security and privacy issues; how do you manage
preferences regarding opt-in and opt-out?
HIPAA imposes requirements on all “covered
entities” using health information “at rest” and “in
motion,” this includes almost all health care
providers in the United States
Regulations surrounding the transmission of
health information or recognition of consent varies
state by state
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Table Of Contents
 The Interoperability Value Proposition
 Common Issues
 Key Components of Interoperability
– National Initiatives
– State/Local Initiatives
– Private Sector
 Moving Forward
 caBIGTM Example
6
A number of Federal initiatives related to priority setting,
standards development and harmonization have been created
 The American Health Information Community
(AHIC), was chartered to provide input and
recommendations to HHS on how to
accelerate the development of HIT, specifically
how to make health records digital and
interoperable
 The AHIC identified key focus areas for the
advancement of standards that will lead to
interoperability:
– Chronic Care
– Confidentiality, Privacy & Security
– Consumer Empowerment
– Electronic Health Records
– Personalized Healthcare
– Population Health and Clinical Care Connections
– Quality
http://www.hhs.gov/healthit/ahic
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The Healthcare Information Technology Standards Panel (HITSP)
was established due to the importance and need for
interoperability
The HITSP Mission:
To harmonize relevant
standards in the healthcare
industry to enable and
advance interoperability
The standards
harmonization process is an
open, inclusive,
collaborative, Use Case
driven process
www.hitsp.org
 HITSP functions as a partnership of the public and
private sectors
 The objective is to achieve standards that will enable and
support widespread interoperability among healthcare
information technology systems
 The HITSP harmonization process is open, inclusive,
and consensus driven
 HHS has formally recognized a set HITSP standards it
received a year ago, now requiring federal agencies, by
an executive order, to incorporate them into new systems
or upgrades, or to buy products that comply with the
standards.
 The work of HITSP is being implemented this year by the
Nationwide Health Information Network (NHIN)
Cooperative
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The CCHIT accelerates the adoption of health IT by creating
an efficient, credible and sustainable certification program
 The Certification Commission for Health Information Technology (CCHIT) was awarded a
contract in 2005 from HHS Office of the National Coordinator to conduct two discrete activities
– Establish the criteria and the process to determine the extent to which Electronic Health
Record products can be certified as functionally useful within a care setting, and can be
used as part of a nationwide health information network
– Use the criteria and the process to examine and certify specific vendor products
 CCHIT is a recognized certification body that, to date, has established certification criteria for
Ambulatory EHRs, Inpatient EHRs and a physicians guide on the value and importance of
certification
 CCHIT volunteer Work Groups develop criteria and inspection processes for each domain
– Ambulatory, Child Health, Emergency Department, Foundation, Inpatient, Secure
Interoperability, Network, Privacy & Compliance, and System Security
 HITSP and CCHIT have aligned forces between interoperability specifications and functional
criteria through the HITSP/CCHIT Joint Working Group
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HISPC, a federal initiative, encourages interoperability through
a collaboration of 42 states and territories to address security
and privacy challenges of health information exchange
 The Health Information Security and Privacy Collaborative (HISPC) plays a key role in laying a
policy groundwork to support widespread interoperable electronic health information exchange
(HIE)
 Each participating state or territory looks to local stakeholders for input to ensure that proposed
solutions are consistent and representative of local needs
 Each participating state is focused on a different “collaboratives” of security and privacy to try and
develop “common, replicable, multistate solutions” that can then be applied nationally
– Consent Laws
– Harmonizing Privacy Laws
– Consumer Education and Engagement
– Provider Education
– Adoption of Standards Policies
– Inter-organizational Agreements
http://privacysecurity.rti.org
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Through funding and support from a variety of public and
private entities, States and other organizations are advancing
and promoting HIE development
 A variety of organizations understand the
value and importance of promoting HIE at a
local level
 The recent AHIMA FORE report indicates
that there is significant HIE-related activity at
the state/local level
 Many progressive states, such as Indiana,
Tennessee, New York, Virginia, and North
Carolina, are making strides toward
statewide interoperability
 The AHIMA report concluded that publicprivate partnerships within states can assure
consistency among all stakeholder
perspectives while still maintaining a link with
the national HIE objectives.
http://www.ahima.org
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Certain state wide initiatives are advancing rapidly to meet
their HIE objectives
 Indiana Health Information Exchange has demonstrated interoperability with Community
Health Network through the delivery of clinical results to primary care physicians
– The EHR vendor has connected to 3 different practices, allowing the primary care
physician to see care their patients receive in other hospitals or other hospital
systems
– Interoperability is the critical piece of the success of this system and provides more
effective, time-efficient and quality care
– Regenstrief and Indiana have created the nation's only citywide electronic medical
records system
 New York has awarded $105.75 million in grants to promote interoperable health
information technology across the state (HEAL Initiative)
– Through this competitive grant process, the New York State Department of Health is
investing in projects that are advancing interoperability
– The strategic focus is to develop and implement New York's health information
infrastructure effectively by utilizing clinical information, and enables clinicians
through the availability of health information at the point of care
http://www.health.state.ny.us
http://www.ihie.com
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New York is developing a health IT infrastructure through a
common platform that embraces three components
SHIN NY
The New York architecture framework focuses
on interoperability with the Statewide Health
Information Network New York as a key
component
The New York Health IT Infrastructure has
three components: Apply, Aggregate and
Analyze, and Access
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The private sector is contributing and participating in the
interoperability of health information exchange as well
 American Health Insurance Plans (AHIP)
– AHIP is pushing the adoption of standard data elements for personal health records
(PHRs) to facilitate a portability model between health insurers
– AHIP determined through collaboration with other payors the critical data sets
necessary to allow easy transfer of information
 Dossia Corporation (AT&T, Applied Materials, BP, Intel, Pitney Bowes, Sanofi-Aventis
and Wal-Mart)
– A number of large companies have agreed to work together to build a database of
health records for all of their employees
– The health-records system called Dossia, will be able to supplement any data that
an individual provides with records from hospitals, labs, pharmacies, insurance
claims etc.
 Google
– Google has launched a pilot project with the Cleveland Clinic to provide patients the
results of their doctor visits, prescriptions, tests and procedures through Google's
secure Web service
– Designed to allow patients, medical providers and pharmacies to submit information
to the records
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Table Of Contents
 The Interoperability Value Proposition
 Common Issues
 Key Components of Interoperability
– National Initiatives
– State/Local Initiatives
– Private Sector
 Moving Forward
 caBIGTM Example
15
Interoperability is important at all levels of the healthcare
continuum
 Hospital perspective
– A hospital that achieves Stage 6
still may not even be addressing
issues related to interoperability
– The aim is not to just focus on
interoperability within an
healthcare entity – the ultimate
goal and ultimate utility of
interoperability is realized when
data is shared across the
healthcare continuum
 Example: Public Health Situational
Awareness
– By increasing sources of clinical
data, public health agencies are
able to detect public health
threats earlier and potentially
save more lives
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Table Of Contents
 The Interoperability Value Proposition
 Common Issues
 Key Components of Interoperability
– National Initiatives
– State/Local Initiatives
– Private Sector
 Moving Forward
 caBIGTM Example
17
Value Proposition Example: Cancer Biomedical Informatics Grid (caBIG)
 Due to the lack of a common system for individual researchers or institutions to easily share
data, researchers often operate in a near vacuum, or silo approach, without benefit of
information from outside their institution.
 caBIGTM was built to connect cancer research communities through a shareable and
interoperable infrastructure that required standards and common language to allow information
to be easily exchanged
 caTRIP (Cancer Translational Research Informatics Platform) leverages multiple data
repositories and allows users to query across a large number of caBIGTM data services. The
initial focus is on outcome analysis which allows clinicians to query across data from existing
patients with similar characteristics to find treatments that were administered with success.
“An interoperable infrastructure will provides users with the ability to share tools and data
to address cancer challenges in ways not currently possible”
http://cabig.nci.nih.gov
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