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HIT Standards Committee PCAST Report Workgroup. Wednesday, April 20, 2011 Paul Egerman, Chair William Stead, Vice Chair. 1. Workgroup Charge. The PCAST Report Workgroup is charged to : Assist ONC synthesize and analyze the public comments and input to the PCAST report;

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Hit standards committee pcast report workgroup

HIT Standards CommitteePCAST Report Workgroup

Wednesday, April 20, 2011

Paul Egerman, Chair

William Stead, Vice Chair

1


Workgroup charge
Workgroup Charge

The PCAST Report Workgroup is charged to :

Assist ONC synthesize and analyze the public comments and input to the PCAST report;

Discuss the implications of the report and it’s specific recommendations to ONC on current ONC strategies;

Assess the feasibility and impact of the PCAST report on ONC programs;

Elaborate on how these recommendations could be integrated into the ONC strategic framework.

2


Workgroup members
Workgroup Members

Chair:Paul Egerman, Chair

Co-Chair:William Stead, Vice Chair, Vanderbilt University

Members:

Dixie Baker SAIC

Hunt Blair Vermont HIE

Tim Elwell Misys Open Source

Carl A. Gunter University of Illinois

John Halamka Beth Israel Deaconess Medical Center, HMS

Leslie Harris Center for Democracy & Technology

Stan Huff Intermountain

Robert Kahn Corporation for National Research Initiatives

Gary Marchionini University of North Carolina

Stephen Ondra Office of Science & Technology Policy

Jonathan Perlin Hospital Corporation of America

Richard Platt Harvard Medical School

Wes Rishel Gartner

Mark A. Rothstein University of Louisville School of Medicine

Steve Stack American Medical Association

Eileen Twiggs Planned Parenthood

3


Acknowledgements
Acknowledgements

The PCAST Workgroup would like to thank the following individuals who provided us with assistance in preparing this report:

Office of National Coordinator

Farzad Mostashari

Doug Fridsma

Jodi Daniel

Charles Friedman

Joy Pritts

Judy Sparrow

Jamie Skipper

Members of PCAST

Christine Cassel

Craig Mundie

William Press

4


Pcast report three major directions
PCAST Report: Three Major Directions

1. Accelerate progress toward a robust exchange of health information.

2. Establish a new exchange architecture with a universal exchange language (UEL) and interlinked search capabilities coupled with strong privacy and security safeguards. The exchange architecture will enable clinicians and patients to assemble a patient's data across organizational boundaries and facilitate population health.

3. Establish an evolutionary transition path from existing installations to the new exchange architecture.

5


Policy discussion highlights
Policy Discussion Highlights

  • Privacy and Security

  • Multi-patient, multi-entity analyses

  • Governance

6



Implementation team four use cases
Implementation Team: Four Use Cases

  • Push by patient between two points

  • Simple Search

  • Complex Search

  • De-identified aggregate data search and retrieval

8



Stage 2 meaningful use alternative 1
Stage 2 Meaningful Use Alternative #1

Patient Portal and Patient Access to Data: give patients

an option to obtain an electronic copy of their data, using tagged data

elements.

Suggested approaches include:

Direct download by patient

Provider to transmit their data directly to patient’s PHR

Implementation steps include:

Define the UEL Syntax: Begin with defining the syntax of the “Version Zero” Universal Exchange Language.

Include in Stage 2 certification the capability to transport data in the Version Zero UEL.

Create relevant policies to support this alternative

Commission a Naming Authority

10


Stage 2 meaningful use alternative 2
Stage 2 Meaningful Use Alternative #2

Certification criteria for exchange transaction: use

Stage 2 certification criteria to identify metadata standards for other

specific stage 2 transactions.

Implementation steps are identical to Alternative #1

Implementation steps include:

Define the UEL Syntax: Begin with defining the syntax of the “Version Zero” Universal Exchange Language.

Include in Stage 2 certification the capability to transport data in the Version Zero UEL.

Create relevant policies to support this alternative

Commission a Naming Authority

11


Summary
Summary

The PCAST report describes a national use of advanced technology. It provides a compelling vision for how that technology could be beneficially used as an important aspect of the learning health system

There are major policy and operational feasibility concerns with the proposed technology.

Aggressive and rapid progress is possible only with an incremental test-bed approach. Large operational tests are needed that resolve the policy and feasibility concerns.

12


Appendix
Appendix

Appendix

13


End state vision user perspective
End State Vision: User Perspective

1. Every American will have electronic health records and will have the ability to exercise privacy preferences for how those records are accessed, consistent with law and policy.

2. Subject to privacy and security rules, a clinician will be able to view all patient data that is available and necessary for treatment. The data will be available across organizational boundaries.

3. Subject to privacy and security rules, authorized researchers and public health officials will be able to leverage patient data in order to perform multi-patient, multi-entity analyses.

14



Path of least regret
Path of Least Regret

Proposed transactions for Stage 2 Meaningful Use

E-prescribing

Lab results reporting

Immunization reporting

Providing discharge summaries

Providing summary records

*These proposed stage 2 MU transactions do not conflict with PCAST implementation efforts

16


Path of least regret1
Path of Least Regret

Proposed Stage 2 Activities:

Patient Identity Matching initiatives

Vocabulary Efforts

Polices for trusted Intermediaries

Patient/User identity assurance and authentication

Communications protocols (e.g. the Direct Project)

Security standards and policies

Privacy policies

*Accelerated emphasis on these important and valuable steps is consistent with the PCAST recommendations

*Continued efforts through the NwHIN Exchange, HIE Organizations, vendor exchange efforts, the Direct Project, Beacon Communities, and SHARP grants will create critically important building block concepts and provide operational experience.

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