Connecting Health and Care for the Nation A Shared Nationwide Interoperability Roadmap FINAL Version 1.0 Contents Letter from the National Coordinator .......................................................................................................... iv Executive Summary ................................................................................................................................. vi Roadmap Introduction .............................................................................................................................. ix Shared Nationwide Interoperability Roadmap ............................................................................................. 1 Drivers ...................................................................................................................................................1 A. A Supportive Payment and Regulatory Environment ......................................................................................... 1 Background and Current State ..................................................................................................................... 1 Moving Forward and Critical Actions ............................................................................................................ 2 Policy and Technical Components ...........................................................................................................4 B. Shared Decision-Making, Rules of Engagement and Accountability ................................................................... 4 Background and Current State ..................................................................................................................... 4 Moving Forward and Milestones .................................................................................................................... 6 C. Ubiquitous, Secure Network Infrastructure ...................................................................................................... 8 Background and Current State ..................................................................................................................... 8 Moving Forward and Milestones .................................................................................................................... 9 D. Verifiable Identity and Authentication of All Participants ............................................................................... 11 Background and Current State ................................................................................................................... 11 Moving Forward and Milestones .................................................................................................................. 13 E. Consistent Representation of Authorization to Access Electronic Health Information ......................................... 15 Background and Current State ................................................................................................................... 15 Moving Forward and Milestones .................................................................................................................. 15 F. Consistent Understanding and Technical Representation of Permission to Collect, Share and Use Identifiable Electronic Health Information ......................................................................................................................... 17 Background and Current State ................................................................................................................... 17 Moving Forward and Milestones .................................................................................................................. 19 G. An Industry-wide Testing and Certification Infrastructure .............................................................................. 21 Background and Current State ................................................................................................................... 21 Moving Forward and Milestones .................................................................................................................. 21 Standards and Functions Overview ............................................................................................................. 23 ii TABLE OF CONTENTS H. Consistent Data Semantics .......................................................................................................................... 25 Background and Current State ................................................................................................................... 25 Moving Forward and Milestones ................................................................................................................. 26 I. Consistent Data Formats............................................................................................................................... 28 Background and Current State ................................................................................................................... 28 Moving Forward and Milestones .................................................................................................................. 29 J. Secure, Standard Services: ......................................................................................................................... 31 Background and Current State ................................................................................................................... 31 Moving Forward and Milestones ................................................................................................................. 32 K. Consistent, Secure Transport Techniques ...................................................................................................... 34 Background and Current State ................................................................................................................... 34 Moving Forward and Milestones .................................................................................................................. 34 L. Accurate Individual Data Matching ............................................................................................................... 36 Background and Current State ................................................................................................................... 36 Moving Forward and Milestones .................................................................................................................. 37 M. Health Care Directories and Resource Location ............................................................................................. 39 Background and Current State ................................................................................................................... 39 Moving Forward and Milestones .................................................................................................................. 40 Outcomes ............................................................................................................................................43 N. Individuals Have Access to Longitudinal Electronic Health Information, Can Contribute to that Information, and Can Direct It to Any Electronic Location ........................................................................................................... 43 Background and Current State ................................................................................................................... 43 Moving Forward and Milestones .................................................................................................................. 44 O. Provider Workflows and Practices Include Consistent Sharing and Use of Patient Information from All Available and Relevant Sources ...................................................................................................................................... 46 Background and Current State ................................................................................................................... 46 Moving Forward and Milestones .................................................................................................................. 46 P. Tracking Progress and Measuring Success ..................................................................................................... 48 Core Aspects of Interoperability Measurement: Defining Success .................................................................. 48 Measuring Success Through 2017 ............................................................................................................. 49 Measuring Success through 2018 and Beyond ............................................................................................ 50 Complete Milestones, Calls to Action and Commitments ........................................................................... 52 iii Letter from the National Coordinator We live in an exciting moment for health information technology (health IT). Today, rapid advancements in the field have led to new opportunities – everything from precision medicine to accountable care organizations. Best of all, improved health IT systems have led to newly engaged, empowered, and educated consumers. But we know that not everyone in this country has access to the health IT they need to support high quality, personalized care. Our long-term goal is simple: to build a strong foundation of health IT in our health care