S&I+Framework+Initiatives

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 * //Current 2012 S&I Framework Initiatives:// **

=Transitions of Care (ToC) Initiative=
 * Initiative Coordinator:** Rich Elmore
 * Description:** Meaningful Use Stage 1 and foreseen Stage 2 requires information to be exchanged in transition of care. Implementers are often confused on how to use the specifications to exchange the required data. The exchange of clinical summaries is hampered by ambiguous common definitions of what data elements must at a minimum be exchanged, how they must be encoded, and how those common semantic elements map to MU specified formats (C32/CCD and CCR). Finally, the lack of a robust toolset to aid in development and validation of conformant templated clinical documents is a major impediment to the widespread adoption of the standards.

=Lab Results Interface (LRI) Initiative=
 * Initiative Coordinator:** John Feikema
 * Description:** There is a lack of harmonization to enable the exchange of lab results. The cost and time to initiate new electronic laboratory results interfaces hampers broad adoption of such interfaces. The field by field details of Hl7 v2 implementation guides used by clinical labs and EHR’s vary, creating a need for mapping or configuration per interface and the prevalence of core subsets of LOINC codes for common tests and analyses also varies, causing downstream issues in decision support and quality reporting.

=Provider Directories (PD) Initiative=
 * Initiative Coordinator:** Community-Driven
 * ONC Point of Contact:** Victor Palli
 * Description:** Health information exchange requires a mechanism to obtain a digital certificate or security information (public keys) and electronic address – such as Direct Address, NHIN Exchange Gateway Address, IP Address, SOAP service address, REST end point address, and other service addresses to facilitate secure exchange of health data. Today, this functionality is generally supported by consistent and standardized electronic means, but not adopted widely. A scalable and standardized solution will be needed in order to efficiently, accurately, and reliably query and obtain digital certificates or security information (public keys) and electronic address to enable health information exchange.

=Query Health Initiative=
 * Initiative Coordinator:** Rich Elmore
 * Description: **The nation is reaching a critical mass of Electronic Health Records (EHRs) that comply with data and vocabulary standards. The wide deployment of EHRs creates an opportunity to aggregate health care data to provide a broad range of benefits that can contribute towards improved health of individuals and the population as a whole. A standardized clinical information model and a common method for querying data sources are critical to enabling and simplifying data aggregation across widely distributed EHR systems. Use of these standards and services will result in increased speed and reduced transaction costs for stakeholders to analyze and apply information, ultimately reducing the cost of healthcare and improving the health of citizens.

=Electronic Submission of Medical Documentation (esMD) Initiative=
 * Initiative Coordinator:** Sam Elias
 * Description:** The purpose of the S&I Framework esMD initiative is to enable the electronic sending of medical document request letters to providers, and identify physician signature solutions needed to enable acceptance of electronic claims attachments. These goals will be addressed in multiple phases, aligned with CMS esMD Implementation objectives. The S&I Framework will support CMS’ esMD Phase 2 goals by developing simplified mechanisms to electronically send medical document request letters to providers. To support acceptance of structured claims attachments from providers to CMS (future esMD phase), the S&I Framework esMD Initiative will also develop solutions to enable signing of content records that can be trusted by CMS or other valid recipients, replacing the currently-used paper or scanned wet signatures.

=Data Segmentation for Privacy Initiative=
 * Initiative Coordinator:** Johnathan Coleman
 * Description: ** The purpose of this initiative is to enable the implementation and management of disclosure policies that originate from the patient, the law, or an organization, in an interoperable manner within an electronic health information exchange environment, so that individually identifiable health information may be appropriately shared for: 1) Patient treatment and care coordination; 2) Third party payment; 3) Analysis and reporting for operations, utilization, access quality and outcomes; 4) Public health reporting; 5) Population health, technology assessment and research. The goal is to define the use case and produce a pilot project allowing providers to share portions of an electronic medical record while not sharing others, such as information related to substance abuse treatment, which is given heightened protection under the law.

=Longitudinal Coordination of Care (LCC) Initiative=
 * Initiative Coordinator:** Community-Driven
 * ONC Point of Contact:** Victor Palli
 * Description:** As information moves across settings in the longitudinal care space, care team members need more information than standard chart summaries typically provide. To address this challenge, the Longitudinal Coordination of Care WG participants have identified several critical components to support and advance patient-centric interoperable health information exchange across the long-term and post-acute care spectrum. To promote Longitudinal Care Management between all relevant sites and providers built around the needs and experience of the patient, three sub-workgroups are charged with tasks supporting these critical components.

=Public Health Reporting (PHR) Initiative=
 * Initiative Coordinator:** Community-Driven
 * ONC Point of Contact:** Anand Basu
 * Description:** The S&I Public Health Reporting Initiative will develop and implement a standardized approach to electronic public health reporting from EHR systems to local, state and federal public health programs that addresses the needs of several different reporting use cases, with the long-term goal of reducing the difficulty (to both providers and public health agencies) of implementing electronic versions of the broad spectrum of public health reporting. The goal of the S&I Framework Public Health Reporting Initiative is to harmonize HIT standards and implementation guides for bi-directional interoperable communication between clinical care and public health entities for selected use cases.

=Certificate Interoperability Initiative=
 * Initiative Coordinator:** John Hall
 * Description: The analysis conducted under the Certificate Interoperability Initiative has been completed. A summary of the report was delivered to the HIT Standards Committee on August 17th, 2011. ** This initiative addresses the charge of the HIT Standards Committee for ONC to investigate “architectural and operational alternatives for cross-certifying Health ISPs (HISPs) with the Federal Bridge Certificate Authority, including an examination of potential benefits and implications on cost, market dynamics, and complexity.” Nationwide exchange of health information requires a fabric of trust that enables secure data transfer and identity assurance among providers, HIEs and other healthcare industry participants. A nationwide trust fabric is greatly facilitated by methods that are secure, standardized, and broadly adopted. This initiative aligns with Meaningful Use and aims to enable providers to electronically exchange and protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities.