Greetings from DC and welcome to the February issue of The Pulse!
As we start 2016, FHA has been busy advancing many of its initiatives and workgroups, as well as planning for conferences and workshops throughout the year. From having CONNECT validated as an eHealth Exchange Validated System to planning for the 2016 HIMSS Conference in Las Vegas, Nevada, 2016 has started off with a bang!
While 2016 is not even two months old, FHA continues to make great strides to advance our initiatives. Most recently our Directed Exchange workgroup finalized recommendations for the Governmental Trust Anchor Bundle which was adopted by the DirectTrust board the next day. We have all the details in this issue!
Ever wonder about architecture’s real world applicability? I know many of us sometimes forget how the work we do can impact someone’s life, so this month we review a real world example of possible health IT in motion and why the work we are doing is critical to ensuring great health care for all patients even in our most vulnerable times.
Speaking of real world demonstrations and examples, the
HIMSS 2016 Government Interoperability Showcase is less than a month away, taking place March 1-3, 2016. The FHA team has been hard at work planning the Interoperability Showcase and Federal Health IT Pavilion. As highlighted below, this year will again include many demonstrations and presentations from various federal and private agencies. If you plan to attend the HIMSS 2016 conference please stop by and say hi!
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From all of us at FHA to all of you and your families, stay warm and dry this winter season and we look forward to collaborating with you to advance the exchange of HIT throughout 2016!
Federal Health Architecture
The Direct Exchange Workgroup has worked to collaborate with DirectTrust to create a trust framework that meets the needs of the Federal agencies. After three years of work, the workgroup representatives and DirectTrust's Trust Anchor Approval Committee have agreed on terms for the new Governmental Trust Anchor Bundle. The Trust Bundle was then accepted by the DirectTrust board the following day.
The agreement means that participating Federal agencies will operate their Direct implementations within the Security and Trust Framework of DirectTrust. Secure electronic messaging and attachments may soon be replacing fax and mail for care coordination between clinicians in these government facilities and their counterparts in the private sector, with considerable and significant benefits expected for the care of veterans and active duty military personnel from this changeover.
The new Governmental Trust Anchor Bundle will also facilitate the many state agencies around the country which have need for Direct exchange, but also require the more stringent security controls included in the bundle. Qualifying state agencies include organizations such as Medicaid programs, Health Insurance Exchange programs, and state Health Departments.
While there is a still a long journey ahead, this first step has not only improved healthcare as patients, caregivers, and providers will receive health information faster and more efficiently, lending more time to fixing health problems and not waiting for health information but also exemplifies how federal-private partnerships can move interoperability and secure information exchange forward.
FHA is proud to announce that its interoperability exchange gateway, CONNECT, has passed all product testing, and can be officially recognized as a validated system under the eHealth Exchange. The eHealth Exchange completed the review of CONNECT under its Product Testing program in December. As an eHealth Exchange Validated Product, CONNECT will be listed on Sequoia Project's eHealth Exchange website.
For more information on eHealth Exchange Validated systems, please click the button below.
FHA supports the use of a model driven approach so that health information systems can be developed using an automated process. This can result in a reference-implementation that is open to everyone. These tools are not necessarily prescriptive, however, they can aid application developers so solutions they build can generate and/or use standards based data. Brian Book, who works with FHA part-time, has written and posted an article on utilizing model driven health tools. It can be found at
This year's FHA HIMSS Interoperability Showcase will have demonstrations ranging from federal and state collaborations around electronic health records to enabling consumer access to their own health records. This year's participants include the partnership of the Centers for Disease Control, the National Center for Health Statistics, and the University of California-Davis demonstrating their collaboration on vital health records. Substance Abuse and Mental Health Services Administration and the Office of the National Coordinator for Health IT (ONC) will also be featured, each focusing on different sample use case studies of how consumers can access and share their HIE. Additional presenters include federal agencies and private organizations showcasing demonstrations on data collection and transfer.
FHA will also be represented in the Federal Health IT Solutions Pavilion. This will provide the opportunity to meet with public and private sector parties and introduce them to the program, FHA’s various initiatives and milestones, and discuss the Federal Health environment.
FHA Director, Gail Kalbfleisch, will speak twice at the Pavilion, Tuesday, March 1 from 2:30-3:00 pm and Thursday, March 3 from 10:45-11:15 am, on how FHA provides a structured process for analyzing and presenting opportunities for federal, state, local, tribal and private health participants to engage and streamline information exchange criteria.
For more information about FHA at HIMSS, please contact
FHA is coordinating federal partner activities on the ONC Interoperability Roadmap Calls to Actions, Commitments and Milestones (CCM). This effort has the objectives of:
Collaborating with and supporting ONC Roadmap efforts
Cataloging federal partner activities mapped to CCMs
Identifying areas of overlap/conflict/gaps in partner activities
Coordinating “one-voice” for federal partner status and tracking
Ensuring data integrity and attribution necessary to feed the FHA EA
Focusing on first time-frame (2014-2016) of the ONC Roadmap
Identifying implementations of the roadmap that are either converging or diverging toward interoperability
FHA has completed initial data gathering and analysis activities. The next steps are to start engaging with federal partners to validate partner health stakeholder roles and share the related CCMs. FHA will leverage efforts of the IPO in this area for DoD and VA and the IPO will initially act as the point of contact for DoD and VA input.
FHA: A REAL WORLD EXAMPLE WHERE INTEROPERABILITY OF HEALTHCARE MEETS HOSPITAL OPERATION
FHA has the mission of working with the federal partners to identify solutions that provide opportunities for the partners to overcome barriers to implementing exchange standards in a manner in which all health information technology flows freely, not only through the federal health system, but through private industry as well. However, that does not help most people understand why interoperability is so complex, what can it really do to help a doctor improve the healthcare she or he provides, and of course, what does architecture have to do with any of that.
The capability to identify a patient, match them to their health records, and communicate health information from one hospital to another, even if these institutions share the same software system, does not currently exist across much of the healthcare environment. We were recently asked to focus on one example where interoperability could potentially go beyond the exchange of traditional eHR data. Take the example of the need to find beds when the system has encountered a stressor, such as hurricanes, explosions. That is difficult enough, but what about day-to-day operations within the private hospital industry, even without the stressor of a serious incident, that are often functioning at critical occupancy. Emergency Room beds may be available at multiple facilities, however, there is little to no bed capacity for follow-up care within the same hospital. Medical personnel spend time calling other facilities, looking for space to accommodate the patients’ secondary and tertiary needs, taking critical time away from administering immediate care.
In this arena, interoperability of systems could reduce to mere minutes, the time that is currently spent locating compatible health facilities for specific patients. Ideally, this capability could be placed in the hands of EMT, first responders and dispatchers. Enabling first responders’ access to a patient’s pertinent health information and to the availability of beds in various hospital departments, could help determine which medical facility is best equipped to handle that patient’s specific needs. For example, in the event of a gas leak, a patient with a history of respiratory ailments would potentially need specialty care. If the first responders had access to the patient’s history, they could chose to transport that patient to a facility that not only has ER beds, but on that also has beds available in the Pulmonary Care Unit as well. Although the facility may be a few miles farther than the closest hospital, it could provide more seamless care to that is tailored to this specific patient’s needs.
There is no doubt, that there are many issues that surround a process such as this, including cybersecurity of health information, HIPPA laws, and hospital policies; however once these issues are addressed, the actual technical solution to accomplish the interoperability of these systems can easily be developed.
This one example may be one that won’t be discussed for many more years. But it depicts a process that could be improved upon, streamlined, and then potentially automated to allow the flow of information to be where it needs to be, when it needs to be there. One of the primary goals of any architecture, including FHA, is to identify a current process, identify how to streamline the flow of information (manually or electronically); and then software can then be designed to meet the needs of the future system.
MHL7 C-CDA® Implementation-A-Thon - April 14 & 15, Chicago, IL
In September 2015, HL7 was awarded a grant by the Office of the National Coordinator (ONC) to help improve the consistency of Consolidated Clinical Document Architecture (C-CDA®) implementations across the healthcare industry. To support this initiative, HL7 is hosting a second C-CDA Implementation-A-Thon in Chicago to identify issues and potential trouble spots.
With an end goal to make implementations as easy as possible, the information gathered during the Implementation-A-Thon will be used to uncover inconsistencies in the C-CDA standard. Best practices for C-CDA implementations will subsequently be developed for use across the health care continuum.
The Health, Education, Labor, and Pensions (HELP) Committee cleared the Improving Health Information Technology Act (S.2511) on February 9, with unanimous support, sending the bill to the Senate Floor for a vote. The bipartisan act encompasses seven measures including; establishing an unbiased ratings system, developing a model framework and common agreement on the secure exchange of health information across networks, and a GAO study to review methods for secure patient ID.
HELP Chairman Lamar Alexander (R-TN) said that the “…goal is to make our country’s electronic health record system something that helps patients rather than something that doctors and hospitals dread so much that patients are not helped.” Ranking Member Patty Murray (D-WA) agreed, stressing, “If we want to continue to build a healthcare system that works for patients and families and puts their needs first, strengthening our nation’s health IT infrastructure must be a top priority.”
No date has been set for the Senate Floor vote.
CONNECT Presentation at Florida International University
On January 30, FHA was asked to present an overview of FHA and CONNECT to the Health Informatics graduate program students at Florida International University. The team provided a 101 on FHA’s goals and initiatives and an overview on the CONNECT product and the supported use cases/features. The presentation was well received by the students who were discussing the topic ‘Health Information Exchange’.
The Healthcare Provider Directory Workshop will convene public and private stakeholders to review past and current challenges, share success stories, and generate new ideas around provider directory standards and solutions. The Workshop will focus on interoperability, data quality, existing and evolving standards, and other technical aspects, but will consider non-technical (governance, sustainability, etc.) factors as appropriate. Our goal is to assist stakeholders involved in directory work in exchanging ideas and potential solutions that can further interoperability in the health care sector and to facilitate a productive dialogue that will encourage stakeholders to take action to help address directory related challenges.