Digital Bridge Governance Principles Transparency: Stakeholders - - PowerPoint PPT Presentation

• Transparency: Stakeholders will have

visibility into the governance body’s work and opportunities to provide input.

• Respect for Process: Governance body

members will adhere to an agreed upon decision-making process. Members will

• bserve delineated and agreed upon roles

and responsibilities.

• Outreach: The governance body can solicit
• pinions and presentations from

stakeholders to inform its decision-making.

• Utility: The governance body will prioritize

use of existing information technology standards and infrastructure as it pursues shared and realistic goals that benefit all parties.

• Representativeness: Governance body

members will represent their broader field and be responsive to the goals of the Digital Bridge partnership.

• Trust: Governance body members will

honor commitments made to the Digital Bridge effort.

Digital Bridge Governance Principles

FOR DISCUSSION USE ONLY – November 16th, 2018

Governance Body Meeting

Friday, November 16th, 2018 12:00 – 1:00 PM ET This meeting will be recorded for note-taking purposes only

FOR DISCUSSION USE ONLY – November 16th, 2018

FOR DISCUSSION USE ONLY – November 16th, 2018

Meeting Agenda

Time Agenda Item 12:00 PM Call to order – John Lumpkin 12:03 PM Agenda review and approval – John Lumpkin 12:05 PM Consent agenda – John Lumpkin 12:10 PM Risk log

• eCR Implementation progress – Laura Conn

12:30 PM Action – John Lumpkin

• Adding and Modifying eCR Demonstration Sites through

August 2019 12:45 PM Discussions – Troy Willitt (APHL)

• Difficulty of BAA approach
• Exploring Alternate Legal Frameworks

12:50 PM Announcements – Jelisa Lowe and Charlie Ishikawa 1:00 PM Adjournment – John Lumpkin

Purpose:

The purpose of this meeting is to work toward a common vision for exchanging actionable information between health care and public health.

Consent Agenda

• Workgroup updates

Risk Log

• Implementation progress update

For Action

• Issue Brief: Considerations for Adding and

Modifying eCR Demonstration Sites through August 2019

For Discussion

• Difficulty of BAA approach
• Issue Brief: Exploring Alternate Legal Frameworks

FOR DISCUSSION USE ONLY – November 16th, 2018

Consent Agenda | November 2018

John Lumpkin (Chair)

FOR DISCUSSION USE ONLY – November 16th, 2018

Governance Meeting Consent Agenda

Protocol

1. Pre-meeting:

a. Chair places items that are believed to be non-controversial or routine b. Items should be received with sufficient review time

2. Start of meeting:

a. Chair asks if any member wishes to move an item into regular discussion b. All items left on the consent agenda are documented as approved by governance body c. Any item removed will be discussed during the meeting

November 2018 Consent Agenda Items

1. Workgroup updates: a. eCR Implementation Workgroup b. Evaluation Committee c. Pilot Participation Workgroup d. Transition Workgroup

FOR DISCUSSION USE ONLY – November 16th, 2018

Risk Log: eCR Implementation Progress

Laura Conn and Monica Coley (eCR Implementation Taskforce Co-Chairs), Rob Brown (Digital Bridge PMO)

FOR DISCUSSION USE ONLY – November 16th, 2018

Update: eCR Implementation Workgroup

Utah

Testing summary:

• Multiple successful end-to-end workflow testing;

retesting the test cases

• 32 defects identified (25 resolved)
• IMH pushed eICR/ triggering functionality to production

without sending messages through the firewall to AIMS

• Within one week – 3,000 eICRs generated for 1,800

unique patients for five pilot conditions Challenges:

• Generation of new test patients was more time- and

resource-intensive than originally anticipated

• Timing of how eICRs are generated within the EHR to

minimize duplicate eICRs is being revisited

• Intermountain test environments and interfaces have

been up and down, preventing testing and creation of some test patients

Houston

Testing summary:

• Target production date: November 14
• Able to trigger on problem list – SNOMED
• SNOMED translated to ICD-10 when diagnosis is not

triggered Challenges:

• Epic product does not trigger from diagnosis fields;

diagnosis trigger codes are being triggered out of problem list

• Using production environment for testing
• Lab tests were not coded as LOINC at HM– APHL TA is

providing support for mapping local codes to LOINC codes

Consent Agenda | Digital Bridge Governance Meeting | For Discussion Only 8 FOR DISCUSSION USE ONLY – November 16th , 2018

Update: eCR Implementation Workgroup (cont.)

• Site engagement and preparation for implementation continues; most active sites include

California, New York, Michigan, Kansas

• For detailed status of each site and timelines, please see appendices
• Governance body approved charter via email in July 2018
• Laura Conn (CDC) and Kirsten Hagemann (Cerner) will continue to chair the workgroup
• Kirsten will be out on leave starting in September, and Monica Coley (Cerner) will temporarily co-chair
• First meeting was held in August 2018
• Workgroup has reviewed and provided feedback on the Technical Specifications in the

Participation Agreement

• Workgroup is providing feedback and recommendations on proposed high-level onboarding

process

• Detailed drafts expected to be shared in November 2018

Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 June 2018 July 2018 Aug 2018 Sept 2018 Oct 2018 Nov 2018 Dec 2018

Utah Site Production

Digital Bridge eCR Implementation Timeline - 2018 DRAFT

RR Development & Testing Complete Production Environment Onboarding Environment

AIMS & RCKMS Milestones Utah Site Connectivity/Onboarding/Testing California Site Connectivity/Onboarding/Testing Michigan Site Connectivity/Onboarding/Testing New York City Site Connectivity/Onb

• arding/Testing

Kansas Site Connectivity/Onb

• arding/Testing

Cerner corporate eICR product complete Today

Houston E2E Testing Houston Site Production

(CDC managed eCR implementation)

FOR DISCUSSION USE ONLY – November 16th , 2018

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 June 2019 July 2019 Aug 2019 Sept 2019 Oct 2019 Nov 2019 Dec 2019

Digital Bridge eCR Implementation Timeline - 2019 DRAFT

New York State Site Production New York State Site Connectivity/Onboarding/Testing Potential Interested Implementation Sites:

• Allscripts
• Delaware
• Health & Hospitals
• Illinois
• Iowa
• Kentucky
• Maryland
• MDLand
• Minnesota
• North Carolina
• North Dakota
• Ohio
• Pennsylvania
• South Dakota
• Tennessee
• Wisconsin

Anticipate discussion of how eCR onboarding will be opened up as part of eCR transition

New York City Site Production Kansas Site Production New York City Site Connectivity/Onboarding/Tes ting Kansas Site Connectivity/Onboarding/Tes ting California Site Production Michigan Site Production California Site Connectivity/Onboardi ng/Testing Michigan Site Connectivity/Onboardi ng/Testing

FOR DISCUSSION USE ONLY – November 16th , 2018

Allscripts and California Parkinson’s Registry Update

Benson Chang (Digital Bridge PMO)

FOR DISCUSSION USE ONLY – November 16th, 2018

Allscripts/LA County Digital Bridge Site

FOR DISCUSSION USE ONLY

• Allscripts shared potential provider (LA LGBT Center) and local health department (LA County Department of Public

Health) interested in implementing eCR.

• LA LGBT Center only reports STDs (salmonellosis, Zika and pertussis are not relevant to their patient population)
• High volumes of syphilis, gonorrhea, and chlamydia – ~200-400 cases a month
• Allscripts expects to have eICR capabilities in their ambulatory product for LA LBGT Center to consume in April 2019
• LA County will need discussions with CDPH on where case reports will be sent first
• LA County can receive eICRs into their test environment
• Modifications that may be needed to RCKMS to identify the case report would need to go to both LA County and CDPH
• The Digital Bridge Pilot Participation Workgroup met to discuss Allscripts’ requests and was unable to make a decision

California Parkinson’s Registry Use Case

• In July, California Department of Health (CDPH) made it known that they were interested

in potentially using Digital Bridge to collect required reporting for the statewide Parkinson’s Registry

• Electronic reporting for Parkinson’s is mandated by statute by January 2019, although

clarifications by CDPH indicate providers have until March 2019

• PMO directed to perform additional investigation and requirements scoping with DSI

partners in August 2018, initial discovery session held August 29, 2018

• Epic has decided to focus solely on enabling their product to meet the provider needs in

California to generate required reporting to the Parkinson’s Registry directly, NOT through Digital Bridge at this time. Future inclusion in Digital Bridge is still possible, triggering will generate an eICR.

Future Pilot Participation Workgroup Considerations (analysis not started)

New York City demonstration site requests

1. Addition of MDLand (EHR Vendor) to the NYC site

• Timing uncertain
• No provider selected
• MDLand has ability to move quickly

2. Addition of Health & Hospitals to the NYC site

• Public health care system with 11 high-volume hospitals and the correctional system
• Timing uncertain
• Epic provider

3. Incorporate Hepatitis C as a reportable condition into NYC site

• High volume will allow greater testing for the public health agency

FOR DISCUSSION USE ONLY

Action: Adding and Modifying eCR Demonstration Sites through August 2019

John Lumpkin (Chair)

FOR DISCUSSION USE ONLY – November 16th, 2018

Pilot Participation Workgroup: Processes and selection criteria

For modifying an eCR demonstration site For admitting additional and modifying existing demonstration sites

FOR DISCUSSION USE ONLY – November 16th, 2018

Discussion: Experiences implementing a business associate framework and alternate legal frameworks

Troy Willitt (APHL)

FOR DISCUSSION USE ONLY – November 16th, 2018

eCR Using a Business Associate Framework

FOR DISCUSSION USE ONLY – November 16th, 2018

Structure of Legal Agreement

Pilot Participation Agreement

• Agreement between pilot health care provider
• r HIE (a participant) and APHL
• Provides legal framework for pilot sites to

enable transmission of protected health information to APHL, and, if elected, for APHL to transmit those data to public health authorities in accordance with applicable law

• n participant’s behalf
• Makes explicit that pilot project only includes

a subset of all reportable conditions

Business Associate Agreement

• Formatted as an addendum to the Pilot

Participation Agreement

• Accounts for requirements as defined by

HIPAA (e.g., permitted uses and disclosures, additional obligations of APHL, breach reporting, ownership of information)

FOR DISCUSSION USE ONLY – November 16th, 2018

Lessons Learned to Date

• Challenges in negotiating the liability limit with the first three pilot participants
• Implications for APHL’s annual cybersecurity insurance coverage
• Remaining pilot sites are eager to review and sign the pilot participation

agreement

• Logistics of getting every provider/HIE onboarded
• Additional exploration needed if AIMS/ RCKMS to be used to facilitate

Parkinson’s disease reporting in California, beginning with UC Davis

FOR DISCUSSION USE ONLY – November 16th, 2018

Issue Brief: Exploring Alternate Legal Frameworks

Alternative legal frameworks, along with any prerequisite technical architecture modifications, should be discussed openly across the Digital Bridge collaborative, b/c…

• The business associate agreement model was

designed to be temporary and was viewed as the most expedient and practical route to eCR data exchange for the early demonstration sites.

• The potential addition of conditions that are not

consistently reportable across jurisdictions (e.g., Parkinson’s disease, HbA1c) may further increase demand for legal onboarding in the coming months.

• Conversations to develop onboarding timelines and

messages for sites beyond the initial demonstration (i.e., post-August 2019) are beginning to occur.

FOR DISCUSSION USE ONLY – November 16th, 2018

Exploring Alternate Legal Frameworks OPTIONS

• Option 1 – De-identification of eICRs
• Option 2 – Use of Limited Data Sets of eICRs
• Option 3 – Distributed RCKMS Reporting Logic / DSI

as a Contractor of Public Health Agencies

• Option 4 – DSI as Business Associate of Health Care

Providers, EHRs and HIEs (current approach for Digital Bridge eCR demonstration sites)

FOR DISCUSSION USE ONLY – November 16th, 2018

Announcements

Jelisa Lowe and Charlie Ishikawa

FOR DISCUSSION USE ONLY – November 16th, 2018

Communications Updates

• Communications support process
• Outlines services, steps to request support

and preferred timeline

• Digital Bridge Communications Basecamp
• Templates, past presentations, visuals, etc.
• CSTE abstract period open: Nov. 1, 2018-

Jan.7, 2019

• Reminder: Inform PMO of updates to

informational deck

FOR DISCUSSION USE ONLY – November 16th, 2018

NEXT MEETING Thursday, December 6th, 2018, 12:00 – 1:00 PM EDT Action Items …

FOR DISCUSSION USE ONLY – November 16th, 2018