Exhibit 300 (FY 2009) - OS ONC Prototype Nationwide Health Information Network (NHIN) Architectures

1. Date of Submission:

2008-02-04

2. Agency:

009

3. Bureau:

90

4. Name of this Capital Asset:

OS ONC Prototype Nationwide Health Information Network (NHIN) Architectures

5. Unique Project Identifier:

009-90-03-00-01-0002-00

6. What kind of investment will this be in FY2009?

Full-Acquisition

7. What was the first budget year this investment was submitted to OMB?

FY2005

8. Provide a brief summary and justification for this investment, including a brief description of how this closes in part or in whole an identified agency performance gap.

The Nationwide Health Information Network (NHIN) is the critical portion of the President's health IT agenda intended to facilitate development of a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers, and others involved in supporting health and healthcare. The NHIN would enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve health. The NHIN investment seeks to achieve these goals by coordinating stakeholders in the development interoperable standards and by engaging industry in the development of prototypes and trials. As a result, this investment will not develop or maintain a network, system, or application in support of a Nationwide Health Information Network. Instead, this investment focuses on its role of defining national standards for health information exchange and partnering with communities across the nation to promote the adoption of the NHIN standards. If successful, a Nationwide Health Information Network would provide the following benefits: * Improve coordination of care across providers (hospitals, labs, etc) * Ensure that consumers' health information is secure and confidential * Provide consumers with new capabilities for managing and controlling their personal health records (e.g., EHR) * Reduce risks from medical errors and supporting the delivery of appropriate, evidence-based medical care * Lower healthcare costs resulting from inefficiencies, medical errors, and incomplete patient information FY07 was a successful year for the NHIN initiative as four consortia designed, evaluated, and demonstrated standards-based prototype architectures for the NHIN. These prototypes demonstrated the following: capabilities to find and retrieve healthcare information inside of health information exchanges and between health information exchanges, methods for match patients to their data without a national patient identifier, the feasibility of large-scale deployment, and many other things. In FY08, NHIN will seek to further the work of the four consortia by focusing on trial implementations through state and regional health information exchanges. NHIN also will continue to leverage its role of defining national standards for health information exchange and coordinating HIT stakeholders in the pursuit of the national health IT agenda.

9. Did the Agency's Executive/Investment Committee approve this request?

yes

9.a. If "yes," what was the date of this approval?

2007-06-26

10. Did the Project Manager review this Exhibit?

yes

11.a. What is the current FAC-P/PM certification level of the project/program manager?

DAWIA-Level-3

12. Has the agency developed and/or promoted cost effective, energy-efficient and environmentally sustainable techniques or practices for this project.

no

12.a. Will this investment include electronic assets (including computers)?

no

12.b. Is this investment for new construction or major retrofit of a Federal building or facility? (answer applicable to non-IT assets only)

no

13. Does this investment directly support one of the PMA initiatives?

yes

If yes, select the initiatives that apply:

Initiative Name
Expanded E-Government

13.a. Briefly and specifically describe for each selected how this asset directly supports the identified initiative(s)? (e.g. If E-Gov is selected, is it an approved shared service provider or the managing partner?)

The NHIN supports Expanded E-Government by working to harmonize standards for electronic information exchange. These standards will ultimately support standardized health information exchange among commercial IT providers and federal agencies that become part of the trust network.

14. Does this investment support a program assessed using the Program Assessment Rating Tool (PART)?

yes

14.a. If yes, does this investment address a weakness found during the PART review?

no

14.b. If yes, what is the name of the PARTed program?

2006: OS - Office of the National Coordinator

14.c. If yes, what rating did the PART receive?

Results Not Demostrated

15. Is this investment for information technology?

yes

16. What is the level of the IT Project (per CIO Council's PM Guidance)?

Level 3

17. What project management qualifications does the Project Manager have? (per CIO Council's PM Guidance)

(1) Project manager has been validated as qualified for this investment

18. Is this investment identified as high risk on the Q4 - FY 2007 agency high risk report (per OMB memorandum M-05-23)?

yes

19. Is this a financial management system?

no

20. What is the percentage breakout for the total FY2009 funding request for the following? (This should total 100%)

Area	Percentage
Hardware	0
Software	0
Services	100
Other	0

21. If this project produces information dissemination products for the public, are these products published to the Internet in conformance with OMB Memorandum 05-04 and included in your agency inventory, schedules and priorities?

n/a

22. Contact information of individual responsible for privacy related questions.

Name	Suzi Connor
Phone Number	202-260-5568
Title	OS Senior Privacy Official
Email	Suzi.Connor@hhs.gov

23. Are the records produced by this investment appropriately scheduled with the National Archives and Records Administration's approval?

no

24. Does this investment directly support one of the GAO High Risk Areas?

no

1. Provide the total estimated life-cycle cost for this investment by completing the following table. All amounts represent budget authority in millions, and are rounded to three decimal places. Federal personnel costs should be included only in the row designated Government FTE Cost, and should be excluded from the amounts shown for Planning, Full Acquisition, and Operation/Maintenance. The total estimated annual cost of the investment is the sum of costs for Planning, Full Acquisition, and Operation/Maintenance. For Federal buildings and facilities, life-cycle costs should include long term energy, environmental, decommissioning, and/or restoration costs. The costs associated with the entire life-cycle of the investment should be included in this report.

All amounts represent Budget Authority

Note: For the cross-agency investments, this table should include all funding (both managing partner and partner agencies).

Government FTE Costs should not be included as part of the TOTAL represented.

Cost Type	Py-1 & Earlier -2006	PY 2007	CY 2008	BY 2009
Planning Budgetary Resources	24.650	23.000	19.000	0.000
Acquisition Budgetary Resources	0.000	0.000	0.000	18.843
Maintenance Budgetary Resources	0.000	0.000	0.000	0.000
Government FTE Cost	0.568	0.284	0.284	0.284
# of FTEs	3	2	2	2

2. Will this project require the agency to hire additional FTE's?

no

3. If the summary of spending has changed from the FY2008 President's budget request, briefly explain those changes.

Initial funding estimates for FY2007 and FY2008 were $60.8M and $55.8M. FY2007 funding ($23.0M) is based on actual appropriation while FY2008 funding ($19.0M) is based on most recent versions of FY08 appropriation bills. FY2009 budget request is $18.843M to continue funding NHIN trials.

Agencies must use the following table to report performance goals and measures for the major investment and use the Federal Enterprise Architecture (FEA) Performance Reference Model (PRM). Map all Measurement Indicators to the corresponding Measurement Area and Measurement Grouping identified in the PRM. There should be at least one Measurement Indicator for each of the four different Measurement Areas (for each fiscal year). The PRM is available at www.egov.gov. The table can be extended to include performance measures for years beyond FY 2009.

Row	Fiscal Year	Strategic Goal Supported	Measurement Area	Measurement Grouping	Measurement Indicator	Baseline	Planned Improvement to the Baseline	Actual Results
1	2005	Effective Management of Human Capital/Information Technology/Resources	Mission and Business Results	Health Care Delivery Services	Established Office of the Nationwide Coordinator for Health IT	No office	Establish ONC Office	Office established
2	2005	Effective Management of Human Capital/Information Technology/Resources	Processes and Activities	Compliance	Performance metrics in place	No measures	Create performance metrics with new management team	Not achieved; new strategic direction for office implemented and management team changed
3	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Participation	# of Contracts awarded to winning contractors to build NHIN architecture prototypes.	0	4	4
4	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Innovation and Improvement	# of approved, harmonized use-cases that illustrate interoperability scenarios for a functional NHIN prototype (three per prototype) as shown through documented acceptance by the American Health Information Community (AHIC)	0	3	3
5	2006	Effective Management of Human Capital/Information Technology/Resources	Customer Results	Customer Impact or Burden	# of awareness briefings to provide information and awareness on the strategy, goals, and progress of the NHIN delivered to the deliberations of the American Health Information Community (AHIC)	0	2	2
6	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	User Requirements	# of public meetings (NHIN Forums) with broad stakeholder representation to share ideas, provide information, establish awareness, and gain stakeholder buy-in, accelerating secure and seamless exchange of health information across the nation.	0	1 Forum with 150 people in attendance	1 NHIN Forum conducted with 300 people in attendance
7	2006	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Data Standardization or Tagging	# of consensus-based sets of interoperability standards supporting three use-cases	0	1	1
8	2007	Effective Management of Human Capital/Information Technology/Resources	Processes and Activities	Innovation and Improvement	# of approved deployment plans (one per prototype) as seen through documented acceptance by the NHIN Project Manager.	0	3	TBD
9	2007	Effective Management of Human Capital/Information Technology/Resources	Processes and Activities	Innovation and Improvement	# of approved operational plans for a NHIN (one per prototype) as seen through documented acceptance by the NHIN Project Manager.	0	3	TBD
10	2007	Effective Management of Human Capital/Information Technology/Resources	Processes and Activities	Planning	# of approved revenue and cost models for the NHIN prototypes (one per prototype) as seen through documented acceptance by the NHIN Project Manager.	0	3	TBD
11	2007	Effective Management of Human Capital/Information Technology/Resources	Customer Results	Customer Impact or Burden	# of updates of the strategy, goals, and progress of the NHIN prototype project by delivering regular updates to the deliberations of the AHIC.	2	3	TBD
12	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	User Requirements	# of public meetings (NHIN Forums) with broad stakeholder representation to share ideas, provide information, establish awareness, and gain stakeholder buy-in, accelerating secure and seamless exchange of health information across the nation.	1	2	TBD
13	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Data Standardization or Tagging	# of consensus-based sets of interoperability standards supporting three use-cases	1	2	TBD
14	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Delivery Services	# of Prototype NHIN architectures that meet specified criteria of:- Deployed within & across 3 or more distinct health care markets	0	3	TBD
15	2007	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Security	Increase nationwide consensus and utilization of common security and privacy standards in health information exchange.	No nationwide security standards for health information exchange	Complete first consensus-based definition of security requirements for nationwide health information exchange	TBD
16	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Availability	Initiate standards-based health information exchange breakthroughs in local or regional areas.	TBD pending FY07 results	Standards-based health information exchange initiated in at least five local or regional areas
17	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Customer Impact or Burden	Provide information and gain stakeholder buy-in on the strategy, goals, and progress of the NHIN prototype project by delivering regular updates to the deliberations of the AHIC.	TBD pending FY07 results	3 updates annually
18	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	User Requirements	# of public meetings with broad stakeholder representation to share ideas, provide information, establish awareness, and gain stakeholder buy-in, accelerating secure and seamless exchange of health information across the nation.	TBD pending FY07 results	Conduct 2 NHIN Fora in FY08
19	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Data Standardization or Tagging	# of meetings with other HHS partners including HITSP, CCHIT, and HISPC to develop second round of interoperability standards. Demonstrate achievement by publishing documentation for public review.	TBD pending FY07 results	Monthly meetings coupled with partner consensus of third round interoperability standards supporting at least four additional use-cases
20	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Security	Increase nationwide consensus and utilization of common security and privacy standards in health information exchange.	TBD pending FY07 results	Complete second consensus-based definition of security requirements for nationwide health information exchange
21	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Delivery Services	# of Prototype NHIN architectures that meet specified criteria of:- Deployed within & across 3 or more distinct health care markets	TBD pending FY07 results	At least one refined NHIN prototype architecture
22	2008	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Compliance and Deviations	Interoperability specifications and other common services identified through the NHIN projects leveraged to develop network certification criteria.	TBD pending FY07 results	Initial certification criteria for networks defined
23	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Processes and Activities	Security	# of trusted partners	TBD pending FY08 results	Target TBD
24	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Technology	Data Standardization or Tagging	# of federal agency partners	TBD pending FY08 results	Target TBD
25	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Mission and Business Results	Health Care Delivery Services	# of external entities deploying prototype	TBD pending FY08 results	Target TBD
26	2009	S.O. 1.3 - Improve health care quality, safety, cost and value	Customer Results	Availability	# of community partners	TBD pending FY08 results	Target TBD

1. Is this investment included in your agency's target enterprise architecture?

yes

2. Is this investment included in the agency's EA Transition Strategy?

yes

2.a. If yes, provide the investment name as identified in the Transition Strategy provided in the agency's most recent annual EA Assessment.

OS Nationwide Health Information Network (NHIN)

3. Is this investment identified in a completed (contains a target architecture) and approved segment architecture?

no

4. Identify the service components funded by this major IT investment (e.g., knowledge management, content management, customer relationship management, etc.). Provide this information in the format of the following table. For detailed guidance regarding components, please refer to http://www.whitehouse.gov/omb/egov/.

Component: Use existing SRM Components or identify as NEW. A NEW component is one not already identified as a service component in the FEA SRM.

Reused Name and UPI: A reused component is one being funded by another investment, but being used by this investment. Rather than answer yes or no, identify the reused service component funded by the other investment and identify the other investment using the Unique Project Identifier (UPI) code from the OMB Ex 300 or Ex 53 submission.

Internal or External Reuse?: Internal reuse is within an agency. For example, one agency within a department is reusing a service component provided by another agency within the same department. External reuse is one agency within a department reusing a service component provided by another agency in another department. A good example of this is an E-Gov initiative service being reused by multiple organizations across the federal government.

Funding Percentage: Please provide the percentage of the BY requested funding amount used for each service component listed in the table. If external, provide the funding level transferred to another agency to pay for the service.

Row	Agency Component Name	Agency Component Description	Service Type	Component	Reused Component Name	Reused UPI	Internal or External Reuse?	Funding %
1	Record Linking / Association	Defines the set of capabilities that support the correlation between logical data and information sets.	Records Management	Record Linking / Association			No Reuse	7
2	Data Exchange	Defines the set of capabilities that support the interchange of information between multiple systems or applications; includes verification that transmitted data was received unaltered.	Data Management	Data Exchange			No Reuse	7

5. To demonstrate how this major IT investment aligns with the FEA Technical Reference Model (TRM), please list the Service Areas, Categories, Standards, and Service Specifications supporting this IT investment.

FEA SRM Component: Service Components identified in the previous question should be entered in this column. Please enter multiple rows for FEA SRM Components supported by multiple TRM Service Specifications.

Service Specification: In the Service Specification field, Agencies should provide information on the specified technical standard or vendor product mapped to the FEA TRM Service Standard, including model or version numbers, as appropriate.

Row	SRM Component	>Service Area	Service Category	Service Standard	Service Specification (i.e., vendor and product name)
1	Data Exchange	Component Framework	Data Interchange	Data Exchange	TBD following completion of prototypes
2	Record Linking / Association	Service Access and Delivery	Delivery Channels	Internet	Web Browser

6. Will the application leverage existing components and/or applications across the Government (i.e., FirstGov, Pay.Gov, etc)?

yes

6.a. If yes, please describe.

This investment leverages: Federal Health Architecture (FHA). multi-OPDIVs, multi-Federal Agencies

1. Does the investment have a Risk Management Plan?

yes

1.a. If yes, what is the date of the plan?

2007-05-31

1.b. Has the Risk Management Plan been significantly changed since last year's submission to OMB?

yes

1.c. If yes, describe any significant changes:

The Risk Management plan has been rewritten since last year's submission and is currently in the final review stages within ONC. Once the plan has been approved for submission to the PMT, the risk management worksheet data will be modified to reflect the changes, and this response will provide an overall summary of the modifications.

3. Briefly describe how investment risks are reflected in the life cycle cost estimate and investment schedule:

The NHIN Risk Management Plan is aligned to the HHS ONC Risk Management Plan, requiring all vendors to address technical, schedule and cost risks. Each NHIN vendor is required to rate each risk and provide a risk management strategy for managing risks that are rated as high priority. On a monthly basis, the vendors submit a monthly status report, which includes the vendor's risks. The vendors meet with ONC Project manager and other ONC support staff and discuss all identified risks and ways for managing them. Subsequent to the Monthly Status Report meeting, there is a follow up meeting with the vendors to track how the identified risk are being managed according to the vendors risk management plan.

1. Does the earned value management system meet the criteria in ANSI/EIA Standard 748?

yes

2. Is the CV% or SV% greater than ± 10%?

no

2.b. If yes, explain the variance.

.

3. Has the investment re-baselined during the past fiscal year?

no