Interoperability Workgroup Governance Subgroup

1. Interoperability Workgroup Governance Subgroup Christoph Lehmann, co-chair Carol Robinson, co-chair July 23, 2014

2. Agenda • Overview of Subgroup activities • ONC Governance Overview • Next Steps

3. Membership

4. Subgroup Charge • Identify the substance, scope, and process ONC should use to implement an approach to establish the “rules of the road” necessary for information to flow efficiently across networks • This approach should address the key problems that slow trust and exchange across diverse entities and networks that provide exchange services including: • misaligned/inconsistent security policies and practices • privacy policies and practices and operational/business • inconsistent policies and technical agendas of governance bodies at the local, state and regional levels

5. Meeting Schedule

6. Governance and ONCJodi G. Daniel, JD, MPHDirector, Office of PolicyOffice of the National Coordinator for Health IT (ONC)

7. Post HITECH Governance Activities

8. Background HIE Governance ONC Role HITECH Act - Required ONC to establish a “governance mechanism for the nationwide health information network.”

9. Background HIE Governance • Public Input • Health IT Policy Committee Recommendations – December 2010 • RFI - Nationwide Health Information Network: Conditions for Trusted Exchange - May 2012 • Response • ONC announced decision not to continue with formal rulemaking process - September 2012

10. ONC’s HIE Governance Definition The establishment and oversight of a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants.

11. HIE Governance Focus Health information exchange at a national level, to address challenges to exchange between different exchange organizations and across state boundaries.

12. ONC Governance Activities • Cooperative Agreements • Framework of Principles • HIE Governance Forum • Monitor Exchange Progress

13. Exemplar HIE Governance Program • In late March 2013 ONC awarded two cooperative agreements to existing HIE governance entities to: • develop and adopt policies, interoperability requirements and business practices that align with national priorities • overcome interoperability challenges • reduce implementation costs, and • assure the privacy and security of health information

14. Governance Framework for Trusted Electronic Health Information Exchange Principles

15. National HIE Governance Forum • Created under National eHealth Collaborative cooperative agreement with ONC • Forum for HIE governing entities convened in 2013 to identify their common challenges and potential common solutions

16. National HIE Governance Forum • Used the Governance Framework as a guide in prioritizing their areas of focus. • Developed resources to advance trust in health information exchange for consideration by the wider community of exchange entities: • Identity and Access Management: Level of Assurance (LOA) Continuum: This educational resource helps organizations examine identity management and progress along the LOA continuum to support secure exchange with a wider group of entities while reducing risk. • Trust Framework for Health Information Exchange: This whitepaper proposes a framework for exposing trust requirements between many stakeholders.  • HIE Certification and Accreditation Landscape: This presentation provides the results of a preliminary assessment of HIE certification and accreditation activities. 

17. Moving Forward

18. 10 Year Interoperability Vision • Leverage health IT to increase health care quality, lower health care costs and increase population health • Focus on supporting health broadly, including but not limited to health care delivery • Build incrementally over time from current technology – multiple methods of exchange required • Focus on establishing best minimum possible for all; this creates room for innovation • Maintain focus on and empower individuals

19. 10 Year Interoperability Vision

20. 10 Year Interoperability Vision • Increasingly diverse market of electronic exchange and network service providers • Service providers have enabled exchange through local governance, data use agreements, and other contractual arrangements • Scaling exchange is imperative and requires adherence to a minimum set of common privacy, security and business practices • ONC considering a more active role in aligning efforts and initiatives across the nation in order to support our interoperability goals

21. Moving Forward • Governance has a key role to play in enabling our national interoperability goals • ONC is looking to re-visit our governance strategy and set a new direction to promote interoperability • We have identified key governance problems impacting interoperability and HIE

22. Key Governance Problems Impending Interoperability and Information Sharing

23. Key Governance Problems Impending Interoperability and Information Sharing

24. Key Governance Problems Impending Interoperability and Information Sharing

25. Key Governance Problems Impending Interoperability and Information Sharing

26. Key Governance Problems Impending Interoperability and Information Sharing

27. Potential Straw Man GovernanceFramework Establishes high level, rules of the road applicable to entire ecosystem Overarching Governance Principles • Aimed at Governance Entities • Temporary program sunsets upon completion of the Perm. Prog. • Basic set of requirements built on top of base overarching governance principles • Such a program would have to be established through rulemaking Temporary Deeming Program Governance Entities Permanent Deeming Program Monitoring Program • Aimed at entities doing exchange (HIE’s) • Would create a core set of requirements • Each module would be service level specific, and include technical and policy specifications • Modules are meant to be quilted together to suit business model HIE Entities

28. Next Steps • Listening session planning call