HITPC Meaningful Use Stage 3 RFC Comments

1. HITPC Meaningful Use Stage 3 RFC Comments July 22, 2013 Information Exchange Workgroup Micky Tripathi

2. Agenda • Review HITPC Meeting • Revisit provider directory recommendation • Data portability

3. HITPC Review • HITPC approved the query for patient record recommendation • HITPC approved the provider directory recommendation but requested the IE WG revisit the authentication principle

4. Revisit provider directory recommendation Revisit provider directory recommendation

5. Recommendation on Provider Directories • HITPC recommends that: • Search for provider: EHR systems have the ability to query external provider directories to discover and consume addressing and security credential information to support directed and query exchange • Respond to search: EHR systems have the ability to expose a provider directory containing EPs and EH addressing and security credential information to queries from external systems to support directed and query exchange

6. Principles for Provider Directories HITPC recommends that the following guidelines be used for establishing standards for provider directories: • Scope: Standards must address PD transactions (query and response) as well as minimum acceptable PD content to enable directed and query exchange • Continuity: Build on Stage 1 and 2 approaches and infrastructure for directed exchange where possible and allow use of organized HIE or cross-entity PD infrastructures where applicable and available (ie, remain agnostic to architecture and implementation approaches) • Simplification: Set goal of having PD query and response happen in a single (or minimal) set of transactions • External EHR system: An EHR system of another distinct legal entity, regardless of vendor

7. Principles for Provider Directories (continued) • Transactions: • Querying systems must have ability to: • Present authenticating credentials of requesting entity • Present provider-identifying information • Securely transmit query message • Provider directory must have ability to: • Validate authenticating credentials of requesting entity • Match provider • Respond with unambiguous information necessary for message addressing and encryption or acknowledgement of non-fulfillment of request • Provider directories must have administrative capabilities to: • Submit updated provider directory information (additions, changes, deletions) to external provider directories • Receive and process provider directory updates from external provider directories • Transaction details: • Provider directories should contain minimum amount of information necessary on EPs and EHs to address and encrypt directed exchange and/or query for a patient record messages • Provider directories should contain minimum amount of information necessary on EPs and EHs to disambiguate multiple matches (i.e. same provider at different entities, providers with the same name, etc)

8. Data Portability Data Portability

9. IEWG 103 Data portability

10. IEWG 103 Data portability

11. IEWG 103 Data portability

12. Data Portability • Do we still agree that using the CCDA for data portability is the right one to build upon? • If so, what additional clinical content should be added to the Common MU Data Set to improve data portability: • (i) Encounter diagnoses. The standard specified in § 170.207(i) or, at a minimum, the version of the standard at § 170.207(a)(3); • (ii) Immunizations. The standard specified in § 170.207(e)(2); • (iii) Cognitive status; • (iv) Functional status; and • (v) Ambulatory setting only. The reason for referral; and referring or transitioning provider’s name and office contact information. • (vi) Inpatient setting only. Discharge instructions. • Are their items not included in the CCDA (i.e. claims, other administrative data etc) that are important for data portability?