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    can address important research questions related to quality clinical effectiveness public health and safety The Markle Connecting for Health First Principles for Population Health Data Sharing and Decision Making apply the key attributes of the Markle Common Framework to population health initiatives The First Principles emphasize a distributed network of networks approach where data on individual patients remain with local data holders while only summarized anonymous data are aggregated for large scale analysis The First Principles outline an initial set of policy and technical principles to enable broad scale information sharing while protecting individual patient privacy Some technical challenges need to be addressed to allow for broad scale implementation of this model For example it is difficult to find and delete duplicate anonymized records that may be counted unintentionally in multiple summary statistics However there is promising research in the area of distributed models as well as compelling examples of successful models that address a range of population health questions 7 8 Due to the enormous potential for societal benefit further research and development is warranted Back to top Does the Markle Common Framework address the sustainability of health information sharing efforts The Markle Common Framework is rooted in the premise that sustainability cannot be achieved unless efforts are grounded in clear and explicit health goals and improvements in health care quality and cost effectiveness are valued and supported 9 Although federal spending under the Health Information Technology for Economic and Clinical Health HITECH Act of the American Recovery and Recovery Act of 2009 ARRA has resulted in an unprecedented level of federal funding to foster the application of health IT and health information sharing long term sustainability will depend on aligning improvements in health care quality and cost effectiveness with financial and non financial incentives In addition the private sector needs to demonstrate clear and substantial support for these types of improvements in order to sustain health information sharing A true return on investment can only be realized when this happens Back to top What is the Markle Common Framework s network approach The Markle Common Framework offers an approach to information sharing that is predicated on a network of networks like the Internet and designed to enable health information sharing with a policy and technology framework that promotes innovation and protects privacy The Markle Common Framework is built on the assumption that all health information sharing decisions are best made between the patient and the provider with whom the patient has a relationship The network of networks design is distributed allowing information to be kept at its source and transmitted when authorized to appropriate recipients In this model patients and the doctors they trust can decide with whom to share personal health information and for what purposes Finding the location of a patient s health information is described in the Markle Common Framework using an index called the Record Locator Service RLS that points users to the authorized records they are requesting The RLS does not contain actual clinical data or clinical metadata After identifying where the clinical information is stored each provider holding records has the discretion to disclose those records depending on the decisions the providers have made with their patients Transfers of health information may then be accomplished via fax or secure e mail or by secure computer to computer transfers over the Internet depending on the level of information sharing available Providers and sources that routinely collaborate may exchange data automatically and electronically Thus there are two decisions to be made locally whether to index and whether to share This two step process helps ensure that the system does not increase exposure of personal health information while making record location fast and efficient even in environments where electronic records are not fully available Additional information on the RLS can be found in T1 The Markle Common Framework Technical Issues and Requirements for Implementation As reflected in the Markle Common Framework policies must be crafted in parallel with the design and deployment of technology and in an ongoing manner Both policy and technology evolve with new information sharing needs and objectives and therefore will remain important objectives Back to top How has the landscape changed since release of the Markle Common Framework The health information sharing landscape has changed dramatically since release of the Markle Common Framework in 2006 Over recent years the level of federal leadership new regulation and public investment around health information sharing have increased substantially In addition use of health IT has grown among providers and individuals alike Early efforts to establish an infrastructure for health information sharing were bolstered in 2004 through an Executive Order which established the Department of Health and Human Services HHS Office of the National Coordinator for Health Information Technology ONC and made possible efforts for standards harmonization use case development and the certification of electronic health record EHR products By 2006 the health care sector was struggling to overcome challenges of policy technology and capital investment to advance health information sharing Adoption of health IT in clinical settings was weak In 2006 only 29 2 percent of physicians reported any electronic medical record EMR or EHR in their office based practice 10 An EMR EHR is a medical or health record system that is either all or partially electronic excluding systems solely for billing That same year 26 health information exchanges HIEs reported being operational and transmitting data for use by their health care stakeholders 11 Enactment of the HITECH Act in February 2009 marked a new level of federal leadership regulation and investment for health information sharing Aiming to address many of the challenges facing the health care sector the HITECH Act codified into law the U S Department of Health and Human Services HHS Office of the National Coordinator for Health Information Technology ONC established federal advisory committees to advise ONC on policy and standards decisions invested in state HIE set forth an EHR incentives program for Medicare and Medicaid providers established new initiatives to support the education and training of the health IT workforce modified particular aspects of the Health Insurance Portability and Accountability Act of 1996 HIPAA and established new programs to foster individual engagement with health IT On the heels of the HITECH Act broad scale health care reform legislation the Patient Protection and Affordable Care Act of 2009 ACA was enacted Aspects of ACA aim to further leverage health IT in efforts to transform health care For example it calls for the creation of a Shared Savings Program to deliver seamless high quality care for Medicare beneficiaries through Accountable Care Organizations ACOs which must apply health IT in order to meet care coordination requirements Recent investments have recognized health IT and health information sharing as critical to improving the quality and efficiency of health care in the U S as reflected by rising adoption rates Preliminary data indicate that 43 9 percent of physicians reported any EMR EHR in their office based practice in 2009 12 By 2011 85 HIEs were reported to be operational 13 A recent Markle Survey on Health in a Networked Life uniquely compares the core values of physicians and patients on deployment of IT in health care Seventy four percent of doctors surveyed said that they would prefer computer based means electronic networks secure email or portable storage devices to paper and fax when sharing patient information with each other Up to 74 percent of doctors agreed that patients should be able to share information with their doctors electronically At least 59 percent of the public agreed with this statement The survey results also indicate that personal health record PHR adoption is on the rise with 10 percent of the surveyed public reporting having a PHR in 2010 compared to 3 percent in 2008 14 Back to top How does the Markle Common Framework align with state and federal efforts Since its release in 2006 health information sharing efforts have used the Markle Common Framework to develop architecture specifications and policies for the private and secure sharing of health information Many states cite the Markle Common Framework in their operational and strategic plans to ONC as part of the State HIE Cooperative Agreement Program States also refer to the Markle Common Framework in their online policy and technology materials 15 The Markle Common Framework is also closely aligned with federal policy efforts For example the EHR incentive program reflects many elements of the Markle Common Framework setting forth minimum necessary standards to allow for flexibility and innovation within the marketplace as well as requiring the submission of aggregate quality data to minimize risk of exposing patient data 16 17 In the area of population health ONC recently announced new efforts to explore and further the application of distributed networks 18 The important role of foundational principles policies and practices like those of the Markle Common Framework in supporting the trusted sharing of health information is recognized by the federal government For example in March 2012 ONC released a Program Information Notice titled Privacy and Security Framework Requirements and Guidance for the State Health Information Exchange Cooperative Agreement Program that builds upon the Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information and sets forth guidance centered on FIPPs based principles for states to apply in developing their privacy and security policies and practices In addition the Health IT Task Force a joint initiative of the ONC and Office of Management and Budget called for select federal agencies to coordinate health IT investments around a shared set of policy and technology principles to maximize the benefits of health IT In September 2010 Vivek Kundra the Federal Chief Information Officer and David Blumenthal the National Coordinator for Health IT articulated a set of policy and technology principles for agencies to use as a guide in planning for and using health IT investments that emphasized five principles Improve health and health care Promote open government and provide patients with a secure timely electronic copy of their own information Share health information between providers Protect privacy and security aligning with FIPPs and Use a distributed data architecture versus centralized data warehouses 19 Back to top How does the Markle Common Framework for Private and Secure Health Information Exchange relate to the Markle Common Framework for Networked Personal Health Information The Markle Common Framework approach based on Fair Information Practice Principles FIPPs has been applied to create two bodies of work These two frameworks share the same foundational attributes and principles The variation in the frameworks is how these principles are specifically applied in two different information sharing contexts as outlined below The Markle Common Framework for Private and Secure Health Information Exchange released in 2006 The Markle Common Framework for Networked Personal Health Information released in 2008 Purpose Helps health information networks to share information among their members and nationwide while protecting privacy and allowing for local autonomy and innovation Purpose Recommends practices that encourage appropriate handling of personal health information as it flows to and from electronic PHRs and similar applications or supporting services Focus Specific to the context of the electronic exchange of patient information among health professionals and health care entities Focus Specific to the context of connecting individuals online to their own information such as via electronic PHRs or to other health related services and applications that use the individual s personal health information Back to top Appendix A Each of the Policies in Practice and the Policy and Technology Guides of the Markle Common Framework for Private and Secure Health Information Exchange Markle Common Framework addresses a subset of relevant core policy and technology principles The tables in this Appendix identify each resource and its corresponding core policy and technology principles Markle Connecting for Health Core Policy Principles Markle Connecting for Health has published a set of policy principles that provide the foundation for privacy and health information technology IT in a networked environment The Markle Connecting for Health approach dictates that these nine principles be balanced together and considered as part of one package Elevating certain principles over others would weaken any overall architectural solution to privacy protection in a networked health information environment In brief the principles and the corresponding resources are as follows CORE TECHNOLOGY PRINCIPLES MARKLE COMMON FRAMEWORK PRACTICE AREAS POLICIES IN PRACTICE 1 Openness and transparency There should be a general policy of openness about developments practices and policies with respect to personal data Individuals should be able to know what information exists about them the purpose of its use who can access and use it and where it resides P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records P6 Patients Access to Their Own Health Information P7 Auditing Access to and Use of a Health Information Exchange P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Individual Access Connecting Patients with Their Health Information 2 Purpose specification The purposes for which personal data are collected should be specified at the time of collection and the subsequent use should be limited to those purposes or others that are specified on each occasion of change of purpose P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records Consent Implementing the Individual Participation and Control Principle in Health Information Sharing 3 Collection limitation Personal health information should only be collected for specified purposes should be obtained by lawful and fair means and where possible with the knowledge or consent of the data subject P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More 4 Use limitation Personal data should not be disclosed made available or otherwise used for purposes other than those specified P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records P7 Auditing Access to and Use of a Health Information Exchange T1 The Common Framework Technical Issues and Requirements for Implementation T6 Record Locator Service Technical Background from the Massachusetts Prototype Community Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More 5 Individual participation and control Individuals should control access to their personal information Individuals should be able to obtain from each entity that controls personal health data information about whether or not the entity has data relating to them Individuals should have the right to Have personal data relating to them communicated within a reasonable time at an affordable charge if any and in a form that is readily understandable Be given reasons if a request as described above is denied and to be able to challenge such denial and Challenge data relating to them and have it rectified completed or amended P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P6 Patients Access to Their Own Health Information P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information T5 Background Issues on Data Quality T6 Record Locator Service Technical Background from the Massachusetts Prototype Community Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Individual Access Connecting Patients with Their Health Information 6 Data integrity and quality All personal data collected should be relevant to the purposes for which they are to be used and should be accurate complete and current P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P5 Authentication of System Users P6 Patients Access to Their Own Health Information T5 Background Issues on Data Quality T6 Record Locator Service Technical Background from the Massachusetts Prototype Community T7 Consumer Authentication for Networked Personal Health Information Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation 7 Security safeguards and controls Personal data should be protected by reasonable security safeguards against such risks as loss or unauthorized access destruction use modification or disclosure P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P4 Correctly Matching Patients with Their Records P5 Authentication of System Users P7 Auditing Access to and Use of a Health Information Exchange P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information T1 The Common Framework Technical Issues and Requirements for Implementation T2 Health Information Exchange Architecture Implementation Guide T6 Record Locator

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    s Letters Videos Search Results Search The Markle Foundation 1985 In this essay former Markle president Lloyd N Morrisett discussed the evolution of communications media since 1969 when the Markle Foundation adopted its mass communications focus and the corresponding adaptations made to the program Morrisett wrote In 1985 this focus has been broadened to include both mass communications and information technologies reflecting the technical advances and widening availability of new technologies This broadening included four new areas for exploration into the use of communications and information technologies to enhance political participation to benefit the aging population for electronic publishing and for home computing The Age of Television and the Television Age Twenty years into the Television Age former Markle president Lloyd N Morrisett examined the impact this medium was making on the lives of its viewers particularly its youngest viewers Morrisett wrote What needs to be asked and what is beginning to be asked by more and more people is the nature of television s responsibility to children and how this responsibility can be fulfilled Sesame Street at Ten In this essay former Markle president Lloyd N Morrisett examined the development and success of Sesame Street for lessons that could be applied in the development of new successful mass communications projects Morrisett wrote The story of Sesame Street has been well told in several studies but there is still reason I think to ask whether conclusions drawn from the Sesame Street experience can provide guidance for others who wish to turn the power of mass communications to new social goals While factors of timing and sheer luck account for much of the success of Sesame Street there seem to be a few lesson that have broad applicability Rx for Public Television In this essay former Markle president Lloyd N Morrisett discussed the background of public television and devised a prescription for success in its future This prescription is a set of three requirements to avoid localism to develop programming for special interest audiences and to create an incentive system to produce better programming for public broadcasting The Right To Know and The Right To Vote In this essay former Markle president Lloyd N Morrisett reflected on the Constitution and the rights of Americans in the electoral process In particular he focussed the shift in our Constitutional experience and suggested that the right to information should be considered a part of the right to vote He wrote The competence to participate and to vote intelligently depends on having access to information about candidates their character and the relevant issues Radio USA In this essay former Markle president Lloyd N Morrisett explored the radio s role in American media and noted that although radio was not receiving much public attention it was still a dominant medium in Americans lives As part of this exploration Morrisett discussed the history of radio from the study of electromagnetic fields at the end of the nineteenth century to 1976 He wrote in more detail about contemporary

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    Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Search Results Search The Markle Foundation 1975 In this essay former Markle president Lloyd N Morrisett discussed the 1969 creation of the mass communications program Markle s fourth area of concentration since its founding in 1927 In this discussion Morrisett wrote about the history of Markle s previous programs the process of selecting a new concentration the importance of mass communications as a research subject and the structure of the new program Habits of Mind and a New Technology of Freedom In this essay former Markle president Lloyd N Morrisett discussed habits of mind and their importance in the preserving democracy and understanding society Morrisett followed this discussion with an analysis of how communications technology especially E mail can affect habits of mind and promote freedom Getting Started in Broadcasting In this essay former Markle president Lloyd N Morrisett discussed opportunities in the broadcasting for first time job seekers and described the experiences of some young people who are already employed in the industry He wrote Taken together television and radio seem to offer everything glamour creative work exciting new technologies huge salaries and the chance to grow with an industry that is growing in all directions It is no wonder that many young people see their future in broadcasting s glowing electronic rainbow Electronic Democracy In this essay former Markle president Lloyd N Morrisett noted that there was a growing amount of disaffection among American voters after the 1988 presidential elections Morrisett discussed how technology can be used to improve six areas of the electoral process and enhance democracy in the United States The Computers Are Coming In this essay former Markle president Lloyd N Morrisett discussed the growth of the personal computer industry and the advantages of personal computing in communications and education Communications Technology and Education In this essay former Markle president Lloyd N Morrisett remarked on the reluctance to use communications technology in education Morrisett also explored the potential of these new technologies especially the computer and television as effective learning tools Cable TV Can More Be Better In this essay former Markle president Lloyd N Morrisett explored the benefits that could accompany the growth and spread of cable television Morrisett wrote It is possible that this different and seemingly prosaic method of transmitting television will bring about changes in opportunity for entertainment education and ideas as vast as those brought about by the introduction of television itself Broadcasting and

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    in triggering eligibility for approximately 34 billion in stimulus funding and consequently will have a high degree of influence over technology development and choice in a rapidly changing health IT market For these reasons HHS must structure the certification program carefully to focus only on those elements that are necessary to achieving its policy goals while avoiding unintended consequences Overall the proposed program takes an appropriately measured approach to certification as evidenced by its independence limits in scope emphasis on privacy and security and flexibility for future innovations Certification can be a tool for achieving some public policy goals but it is good for some objectives and not for others The role of HHS sanctioned testing and certification is an important but limited one The collaborative comments offer the following recommendations HHS should create clear standard language about the purpose and goals of its certification program and its limitations in addressing important public policy questions raised by the adoption and use of health IT HHS should establish labeling requirements for certified products that are consistent and clear to help providers and purchasers understand the scope of the testing and certification under the HHS program to implement ARRA financial incentives In particular the standard language should communicate the scope of certification as well as its limitations both in terms of implementation experience and privacy and security HHS should clarify the rules by which EHR modules may be exempt from testing against all privacy and security certification criteria Except for the specific circumstances in which such services are being used to help health care providers and hospitals qualify for Meaningful Use incentives under ARRA HHS should limit the scope of extending the current certification program to other forms of health IT such as electronic personal health records PHRs or health information exchanges HIEs In the eyes of the HHS sanctioned testing and certification program PHRs and HIEs should only be considered when packaged as EHR modules In other words when they are offered as components of a complete EHR or an EHR bundle they may be tested and certified under the same rules as EHR modules based on the limited scope of Meaningful Use Otherwise the public policy benefits are not clear for certifying PHRs or HIEs outside of the Meaningful Use context HHS should clarify the type and scope of modifications that would require a product to be recertified Connecting for Health A Public Private Collaborative Convened by the Markle Foundation There is a critical need to push health care into the information age Our nation faces an aging population a rising tide of consumerism escalating health care costs medical safety lapses and the increased complexity that advances such as genetic discoveries will introduce into clinical data analysis and application In the face of such challenges however health care is not taking full advantage of the information and communications technologies that have revolutionized other industries Enabling timely and efficient access to information can improve both the quality and cost effectiveness of

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    nationwide health information exchange that focus on security and privacy are rated as the highest priorities among survey respondents These same attributes are also rated as the top reasons for supporting the creation of an exchange or network Americans Want Benefits of Personal Health Records Over 70 percent of those surveyed believe PHRs would improve the quality of health care Over two thirds would use PHR features that are or may be available People with greater health care needs report the highest interest in using PHRs In addition people trust their doctors the most with authorized access to their PHR Finally nearly all are very concerned about privacy and keeping their health information secure but believe that technology provides appropriate protections Building a Trusted and Interoperable Health Information Exchange Environment In a keynote address at the NetSmart Connections 2008 Zoë Baird discusses the disruptive power of information technology to improve health care in the US Engaging Americans in their Health and their Health Care through Health IT Chairman Davis and distinguished members of the Committee on Government Reform thank you for inviting me to meet with you today Attention Has Intensified In the last few years public and private sector awareness of the need for information technology in health care has intensified dramatically Prominent government activities include the President s call for the creation of electronic health records for all Americans numerous legislative bills implementation of many agency pilots and programs the activities of the Office of the National Coordinator for Health Information Technology and most recently the establishment by Secretary Leavitt of the AHIC These efforts represent a broad commitment to bring about change But all this is merely prelude We continue to lack an information infrastructure that supports safe efficient evidence based medical care Even the best trained best equipped and best intentioned American health professional cannot provide high quality care in an information vacuum No research study or pilot program better highlights this point than the reality of Hurricane Katrina As you know hundreds of thousands of residents of areas hit by the hurricane were displaced from their homes and most are still living in shelters or temporary housing across the United States Neither the evacuees nor their current health care providers have access to their paper medical records many of which were destroyed by the hurricane A survey by the Kaiser Family Foundation and the Washington Post estimated that 40 percent of evacuees were taking prescription medications before the storm hit and many more need new or additional medications now Many of their medical records can never be recovered and have literally been washed away by the total devastation of their usual sources of care Piecing their medical histories together and figuring out what medications they were on is a daunting task for those providing their care now Health Information Technology Improving Quality and Value of Patient Care While we do not offer a prescription for which innovations in care will be most effective in improving

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    right information in the right hands at the right time is enormous In each of these areas we know that the effective and appropriate use of IT can literally save lives We also know that our nation s goals in both areas cannot be met without better use of IT Models for Data Storage Exchange Aggregate Data De identification and Re identification In this testimony Claudia Williams addresses this goal of maintaining public trust by making privacy a critical enabler of information sharing and health IT adoption and in particular the architecture choices needed to support trusted information sharing The remarks focus on three key points Adopt a Framework Based Approach The full array of foundational privacy principles sound network design and strong governance and accountability are all needed and must work together to assure trusted information sharing Ensure that Policy Guides Technology Policy goals must shape technology choices including standards and architecture and not vice versa Stimulate Innovative Models for Protecting and Sharing Information Public investments should support and encourage innovative models to achieve our health goals and protect information Implementing a Trusted Health Information Exchange Keynote speech which discusses Markle s mission programs and values the context of the current US health care the disruptive power of information technology Connecting for Health and the Common Framework the launch of Resources for Implementing Private and Secure Health Information Exchange and nine privacy protection principles Comments on FTC Breach Notification Rulemaking Section 13407 of the American Recovery and Reinvestment Act of 2009 ARRA 1 establishes temporary breach notification requirements for vendors of personal health records PHRs 2 and other entities not covered by the Health Insurance Portability and Accountability Act HIPAA and grants the FTC authority to issue interim final regulations governing these entities Similarly Section 13402 of ARRA imposes a new duty on entities covered by HIPAA and their business associates to provide notification to individuals when there has been a breach of unsecured protected health information PHI This latter provision applies to all PHI maintained by covered entities or their business associates including information in PHRs With respect to both of these provisions the term unsecured protected health information refers to PHI that is not secured through the use of a technology or methodology specified by the Department of Health and Human Services HHS in guidance as rendering the information unusable unreadable or indecipherable to unauthorized individuals 3 HHS has recently issued guidance on this issue the HHS Guidance on which we have submitted separate comments 4 Simultaneous with the issuance of the HHS Guidance HHS published a request for information RFI in advance of its rulemaking to implement the breach notification provisions that apply to HIPAA covered entities and their business associates We have also submitted comments on the RFI 5 The breach notification provisions in ARRA accomplish two important goals First they provide for individuals to receive notice in certain circumstances when their health information is at risk Second they create a powerful incentive for custodians

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    of messages to be used by government healthcare and consumer leaders to promote the benefits of electronic connectivity and to encourage patients and consumers to access their own health information Aligning Health IT and Health Reform Achieving an Information Driven Health Care System Key Themes The Recovery Act s investments in health IT can be a vital step toward our nation s health reform objectives improving health and reducing unsustainable cost growth but only if we make smart decisions now that align these efforts Alignment starts with setting the right goals for health IT efforts Success will be measured in lives saved quality of health care improved and growth in costs slowed The time is now to set the bar Markle the Center for American Progress and the Engelberg Center for Health Care Reform at Brookings seek a dialogue that builds on the comments they submitted jointly to the Office of the National Coordinator for Health IT ONC The comments supported by a broad range of organizations reflect a goal based results driven approach to the definition of meaningful use of health IT Under the Act providers and hospitals will receive financial incentives for meaningfully using IT a standard now being drafted by the U S Department of Health and Human Services The Achievable Vision for 2015 presented by an ONC advisory committee offers clear health and cost goals that will serve as a compelling north star for Recovery Act investments We strongly support targeting these goals and goals like them Achievable Vision for 20151 Prevent 1 million heart attacks and strokes Reduce heart disease so that it s no longer the leading cause of death in the US Reduce preventable medication errors by 50 percent Reduce the racial ethnic gap in diabetes control by 50 percent Reduce preventable hospitalizations and re admissions by 50 percent Provide all patients with access to their own health information Follow patient preferences for end of life care more often Provide all health departments with real time situational awareness of outbreaks We propose adding two 2015 goals to specifically address reducing growth in health care costs Identify duplicative services and reduce them by 50 percent Reduce the number of hours spent by physicians on administrative tasks by 50 percent Top public and private sector leadership must firmly embrace these goals We must keep this big picture clearly in mind as we prioritize the measures and actions that will most indisputably drive progress Our comments emphasize that the optimal standard for meaningful use should meet five key criteria Set Clear and Achievable Health and Cost Goals Tie Payment Tightly to Results Engage Patients in Achieving Meaningful Use Goals Focus on Information Use Not Technology Functions or Features Ensure that Standards and Certification Directly Support Meaningful Use and Foster Innovation Implications Recovery Act funds must pay for results improved health patient engagement better care processes rather than simply paying for technology and or meeting technical standards Innovation will be necessary to achieve these results Therefore the

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    am Carol Diamond Markle Foundation Panel Moderator Christine Bechtel National Partnership for Women Families Hunt Blair Vermont Health Access Steven Findlay Consumers Union David Lansky Pacific Business Group on Health Steven Waldren American Academy of Family Physicians Discussion and Q A Closing 10 55 am 11 00 am Todd Park Center for American Progress Getting Health IT Right Under the American Recovery and Reinvestment Act Agenda Meeting Agenda Newseum Washington DC 9 00 am 11 45 am EST Introduction 9 00 am Zoë Baird Markle Foundation Roadmap 9 15 am Carol Diamond Markle Foundation Implementing ARRA 9 20 am David Blumenthal Office of the National Coordinator for Health IT HHS Laying the Foundation for Health Reform 9 35 am Mark McClellan Brookings Institution Panel Discussion Getting Health IT Right Under ARRA 9 50 am Moderator Carol Diamond Markle Foundation Panelists Steven Findlay Consumers Union David Lansky Pacific Business Group on Health Farzad Mostashari NYC Department of Health and Mental Hygiene Peter Neupert Microsoft Health Solutions Group Marc Overhage Regenstrief Institute Steven Waldren American Academy of Family Physicians Health IT to Achieve Higher Quality and More Affordable Health Care 11 10 AM Todd Park Center for American Progress Wrap Up 11 20 am Zoë Baird Markle Foundation The Common Framework Glossary Glossary to terms to associate with The Common Framework Converging Health Care Reform and Medical Education Reform Opening session of the Mayo Clinic National Symposium on Medical Education Reform Visioning Scenarios A description of an ideal state circa 2015 in which health professionals consumers and others are connected across a secure network that supports decision making based on timely access to meaningful health information Consumers as Network Participants This document is part of the Markle Connecting for Health Common Framework for Networked Personal Health Information The framework proposes a set of practices that when taken together encourage appropriate handling of personal health information as it flows to and from personal health records PHRs and similar applications or supporting services This section explains why consumer participation can be transformative in health care as it has been in other sectors why networked PHRs are a vital tool to empowering consumers and how policies can help guide an emerging industry Electronic Health Data Exchanges Patient and Consumer Principles for System Design Improving health and health care depends upon accurate timely understandable and relevant information in the hands of consumers patients and health professionals where and when they need it To improve quality and prevent medical errors health care professionals must shift away from today s reliance on paper health records and adopt trustworthy methods to gather store and share patient data electronically electronic health data exchanges New technologies networks and organizations are emerging to provide greater electronic connectivity and data exchange across health care institutions and with consumers patients and families To ensure that our personal health information is used appropriately to protect privacy and to create a climate of public trust all of the many custodians of our health data should adhere

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