Impact of Federal Health IT Priorities on FHA Strategic Plan

Gretchen Wyatt, ONCDr. Lauren Thompson, Director, FHA

Agenda

• Federal Health IT Priorities

• Impact of Federal Health IT Priorities on FHA’s Strategic Plan

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Gretchen WyattOffice of the National Coordinator for Health IT

FEDERAL HEALTH IT PRIORITIES

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FHA Strategic Plan – Vision

A Federal health information technology environment that is interoperable with the private sector and supports the President’s health information technology plan enabling better care, increased efficiency, and improved population health

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Federal Health Architecture: Advancing National Health IT

FHA Moving Forward: 2014STRATEGIC GOALSEstablish a unified federal voice on health data exchange and interoperability• Establish FHA as a “convener of stature”, and broaden

participation• Institutionalize governance decision-making processes• Expand outreach and access to tools

Achieve adoption of interoperability specifications, leading to active data exchange in the Federal health community• Support S&I Framework by providing federal use cases

and pilots• Enable FHA partners to move from legacy to new solutions in

effective, coordinated manner

Align federal policies in healthcare data exchange• Provide a forum of cataloging and aligning federal policies

and practices

FHA Guiding Principles

StakeholderEngagement

Demonstratethrough Pilots

Open Communicationand Transparency

Commitmentto Action

Focus onSpecifications

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Impact of Federal Health IT Priorities

• FHA Strategic Plan grows and evolves to support federal health IT priorities

• FHA federal partners contribute to development of priorities, ensure addition of federal requirements

• FHA encourages federal agencies to adopt priorities to their unique health IT requirements

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Current FHA Health IT Priorities

• Healthcare Directory• Patient Consent & Authorization• Directed Exchange• CONNECT• Federal Health Information Model (FHIM)• Integrating with the Standards and

Interoperability Framework• Patient Identification

– This is an ONC priority that FHA supports.

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CONNECT Open Source Community Development

• CONNECT is moving to the open source community for management

• FHA will remain engaged to ensure developments include federal requirements

Join the CONNECT Open Community Collaboration today: http://www.connectopensource.org/developer-resources/forums

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Engagement in the Standards & Interoperability (S&I) Framework

• Support for Federal partner priorities such as Meaningful Use

• Direct support of Federal partner use cases

• FHIM provides semantic and syntactic modeling constructs to support the definition of information

• FHIM, combined with MDHT*, can be used to generate implementation standards using an MDA* approach

*MDHT - Model Driven Health Tools*MDA - Model Driven Architecture

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FHIM S&I

Requirements

Scope

Modeling

Data Collection

Publish

Discovery

Pre-Discovery

Pilot

Implementation

Evaluation

FHA Workgroups

• Core workgroups that support federal health IT priorities:– Architecture & Modeling– Data Exchange &

Interoperability– Communications &

Coordination – Directed Exchange

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Stay connected, communicate and collaborate

• Find out more about FHA on the ONC website: http://www.healthit.gov/FHA

• Contact us at: federal.health@hhs.gov

• Subscribe, watch, and share:

@ONC_FHA,

@CONNECT_Project

http://www.flickr.com/photos/federalhealtharchitecture/

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Applying RESTful Health Exchange, FHIR, and DirectONC Annual Meeting

Ollie Gray (TATRC)24 January 2014

Outline

• RESTful Health Exchange• RESTful Health Exchange Addresses Gaps• Research, Development, Testing and Evaluation

(RDT&E) with REST and Direct• RDT&E Outcomes• Summary

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RESTful Health Exchange

• Open source project to apply Web technologies to demonstrate a simple, secure, standards-based health information exchange – Builds the foundation for patient access to data via the Web and mobile

devices, facilitating broad electronic health data exchange– Offers a new approach to health data exchange:

– Replaces moving documents to linking to needed information

• Sponsored by the Federal Health Architecture (FHA) program in FY12, TATRC in FY13 and FY14, VHA in FY14– Addresses NwHIN Power Team recommendation to develop a specification

for RESTful exchange of health data– Applies RESTful health data exchange to key capability gaps

VHA=Veterans Health AdministrationNwHIN=Nationwide Health Information Networkhttp://wiki.siframework.org/RHEx

REST technology enables secure, Web-based health data exchange

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RESTful Health Exchange Addresses Gaps

• SMTP (Direct) does not scale to allow sharing of very large files, such as diagnostic images

• Lightweight exchange is needed to allow health information sharing with out-of-network providers

• Standing up CONNECT can be a challenge for small, independent providers and providers in rural areas

• CONNECT capabilities not needed for stateless transactions

Research, Development, Testing and Evaluation (RDT&E) with REST and Direct

Improved Coordination of Care ~ Timely Remote Record Access ~ Low barrier of entry 16

REST with Direct for Sharing Diagnostic Images

Demonstrated in a RDT&E environment that MHS and third-party providers can access diagnostic images

and associated records securely over the WebMHS = Military Health SystemPCM = Primary Care Manager

Improved Coordination of Care ~ Timely Remote Record Access 17

RDT&E Outcomes

• RDT&E initiatives successfully demonstrated that:– Physicians can securely share health data over the Web– Diagnostic images can be shared using REST with Direct– High volumes of data can be moved over the Web securely in support of HIE

patient data integration

• RESTful capability is being implemented across Maine to support small, independent providers and FQHCs in medically underserved areas

• New Pilot with TATRC in FY14– REST and FHIR technology being explored as possible solutions for

government HIE exchanges

• New pilot with VHA Office of Rural Health (ORH)– REST, FHIR, and Direct technology will support secure sharing of information

between VHA and third-party providers in support of home healthcare for Veterans in rural Utah

FQHC = Federally Qualified Health CenteriEHR = integrated Electronic Health Record 18

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Summary

• RDT&E initiatives with REST and Direct have addressed gaps in capability– Out-of-network providers can share information securely over

the Web using REST– Direct + REST can be used to share diagnostic images in a

scalable fashion– REST can be used to allow small, independent providers and

providers in rural areas to exchange health information

• RDT&E initiatives contributed to the goals of:– Improved care coordination– Equal healthcare for all– Timely remote record access– Low barrier-of-entry for small practices

• Applicability of FHIR is being exploredGoals map to :http://www.himss.org/ValueSuite

24 January 2014Deb Gallagher, GSA

FPKIPA Chair

ONC Annual MeetingFederal Priorities for Health IT Training Session

Federal PKICross-Certifictation Overview

Work Groups and Tiger Teams FPKI Overview FPKI Cross-Certification Process

Cross-Certified Affiliates PIV-I Providers

EGCA Overview and Purpose

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Agenda

Criticality of PKI

PKI provides identity authentication, integrity, confidentiality Formal controls for certificate issuance and management

enable trust in these services

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Consumer OnlineShopping and Banking

CAC Card Access to Systems and Facilities

Trusted B2B, G2B, C2B, C2G

Communications

PIV Card Access toSystems and Facilities

Trusted NetworkDevices and VPN

Signed Code for Trusted Execution

Public Key Infrastructure

• Government Trusted by Commercial Organizations• Commercial Organizations Trusted by Government• Policies and Governance

• Trusted Issuers• Trusted Algorithms• Revocation and Validation

PKI Enables

PKI TrustComponents

FPKI Purpose The FPKI facilitates federated identity

Throughout the Federal Government; and Between the Federal Government and external partners

Includes the FPKI Trust Infrastructure Federal Bridge Certificate Authority (FBCA)

– Cross-certification assures comparability of certificate issuance policies– Incorporates multiple assurance levels

Federal Common Policy CA (FCPCA) – Trust Anchor for the U.S. Federal Government

E-Governance CAs (EGCA)– Supports various ICAM Programs

The FPKI Policy Authority (FPKIPA) governs policies for operation of the FBCA, FCPCA, and EGCA Operates under the authority of the Federal CIO Council

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Cross-Certification Process Overview

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Currently Cross-Certified Affiliates

Federal Agencies Department of Defense (DoD); Department of State (DoS); Drug Enforcement Administration

(DEA CSOS); Government Printing Office

(GPO); Department of Treasury; United States Postal Service

(USPS); and United States Patent and

Trademark Office (USPTO)

Two PKI Bridges CertiPath:* Aerospace and

Defense– Eid Passport*– Cassidian*– Carillion*

Non-Federal PKIs State of Illinois Entrust* Verizon Business* Symantec* ACES – ORC & Identrust DoD ECAs DigiCert* ORC* Identrust Exostar

SAFE-BioPharma: Pharmaceutical and healthcare industries

• = PIV-I Provider25

EGCA – Supports ICAM The EGCA supports the ICAM mission by:

Enabling governance – control which endpoints participate and can be trusted for technical interoperability or information sharing.

Conveying trust between endpoints in a transaction – allow endpoints to determine trust at run time.

Facilitating secure communications between endpoints in a transaction – once endpoints have established trust, the ensuing communication between endpoints is secure.

The EGCA supports ICAM Assertion-based Initiatives• Issues certificates to devices and applications.• Issues different types of certificates to different types of endpoints.

Enables trusted access to government services for more participants and communities of interest (e.g., commercial and financial communities).

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Questions?

Deb GallagherGeneral Services AdministrationOffice of Governmentwide PolicyDirector, Identity Assurance and Trusted Access Division202.219.1627 (desk)202.604.5733 (mobile)Deborah.Gallagher@gsa.gov

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Q&A ???