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 – March 7th, 2019

Governance Body Meeting

Thursday, March 7th, 2019 12:00 P.M.– 1:00 P.M. ET This meeting will be recorded for note-taking purposes only

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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

12:25 PM Action – John Lumpkin

• eCR Transition – Bob Harmon / Michael Iademardo

12:40 PM Discussions – John Lumpkin

• Proposed Legal Frameworks for eCR services – John Loonsk

12:55 PM Announcements – 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
• Expansion of Pilot Conditions – Hepatitis C
• Jan 2019 in-person mtg: Executive meeting

summary and suggested action items

Risk Log

• Implementation progress update
• Transition management

For Action

• eCR Transition Recommendations

For Discussion

• Proposed Legal Frameworks for eCR services

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Consent Agenda | March 2019

John Lumpkin (Chair)

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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

March 2019 Consent Agenda Items

1. Workgroup updates a. eCR Implementation Workgroup b. Evaluation Committee c. Pilot Participation Workgroup d. Transition Workgroup e. Legal, Policy, and Regulatory Workgroup 2. Expansion of Pilot Conditions – Hepatitis C 3. In-person Meeting Executive Summary and Suggested Actions

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Risk Log: eCR Implementation and Transition Progress

Laura Conn and Kirsten Hagemann (eCR Implementation Taskforce Co-Chairs), Rob Brown and Jim Jellison (Digital Bridge PMO)

FOR DISCUSSION USE ONLY – March 7th, 2019

Update: eCR Implementation Workgroup

• Hepatitis C
• The latest RCTC contains trigger codes to support

Hepatitis C

• All demonstration sites have the opportunity to add
• n as a sixth condition
• RCKMS has been updated to accommodate this

condition Implementation Activities

• The Houston site went live on November 14, 2018
• Currently in parallel production
• The Utah site went live on December 20, 2018
• Currently in parallel production
• Remaining implementation sites will be participating in

RCKMS training activities & authoring jurisdictional rules

• AIMS connectivity and test planning activities are occurring

with the New York site

• IFH/ New York City & New York State

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Up Next

• Digital Bridge Technical Specifications will be updated as new RKCMS authoring process is

defined

• California, Michigan, Kansas are actively working on their vendor/ provider development

activities

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 Estimate- 2019 DRAFT

New York State - PHA Production New York State Connectivity/Onboardi ng/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/Testing Kansas Site Connectivity/Onboarding/Testing California Site Production Michigan Site Production California Site Connectivity/Onboarding/Testing Michigan Site Connectivity/Onboarding/Testing Note: Massachusetts site currently searching for provider to participate Houston in production – 11/14/18 Utah in production 12/20/18

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All Site Progress Summary

Activities MI UT CA KS NYC MA NYS HOU

Site Development Activities Onboarding End to End Testing Legal Readiness

Completed In Progress Not Started Not Currently Applicable

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ECR TRANSITION MANAGEMENT

Brief Update – Jim Jellison

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Action: eCR Transition Recommendations

John Lumpkin (Chair)

FOR DISCUSSION USE ONLY – March 7th, 2019

eCR Transition Recommendations

Question charged to answer

• “Beyond demonstrating and evaluating eCR,

what will Digital Bridge do for general eCR adoption and to assure eCR sustainability?” Purpose

• Share the workgroup's initial ideas with the

governance body and receive feedback to finalize recommendations for endorsement and implementation. Governance Action Schedule

• 1. Preliminary posted on 1/7
• 2. Discuss, modify and adopt by 1/23 – 1/24
• 3. Revised during Feb
• 4. Penultimate delivered on 3/6

Organization Name Designation Representing RWJF John Lumpkin – primary Hilary Heishman – alternate Member Sponsor CDC Michael Iademarco - Co-chair Bill Mac Kenzie – primary Laura Conn – alternate Member Sponsor Cerner/Epic Bob Harmon – Co-chair James Doyle – alternate Member Vendors Kaiser Permanente HealthPartners Walter Suarez – primary Richard Paskach–alternate Member Healthcare delivery ASTHO Mary Ann Cooney – primary Mylynn Tufte – alternate Member Public health APHL Scott Becker – primary Patina Zarcone – alternate Member eCR operators and public health CSTE Kathy Tuner – primary Jeff Engel – alternate Meredith Lichtenstein – tertiary Member eCR operator and public health PHII/Deloitte (PMO) Vivian Singletary – primary Andy Wiesenthal – alternate John Stinn–alternate Observer PMO FOR DISCUSSION USE ONLY – March 7th, 2019 13

Penultimate Report

Change summary

• 1. Incorporates decisions made during the

January in-person meeting

• 2. Adds ideas developed in breakout

sessions (e.g., governance "lite" for scale-up)

• 3. Eliminates redundant and unnecessary

discussions

• 4. Reduces over all page count
• 5. Focuses the Executive summary to one-

page

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Scale-up eCR Governance

Scale-up Governance

Digital Bridge Governance Body eCR Operations Group eCR Community

• f Practice

Group Relationship Purview Digital Bridge

• Gov. Body

Independent Issues with broad, nationwide or strategic impact; legal, architecture, standards eCR Operations CDC Partner eCR knowledge products (trigger codes and logic), on-boarding guidance, operational priority setting eCR CoP CDC Partner Advance eCR adoption and use, contribute expertise and perspective to

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Discussion: Proposed Legal Frameworks for eCR services

John Loonsk, MD FACMI, Consultant to APHL

FOR DISCUSSION USE ONLY – March 7th, 2019

eCR and Health Data Networks

John W. Loonsk MD FACMI, Consultant to APHL

FOR DISCUSSION USE ONLY – March 7th, 2019

eCR and Health Data Networks

• The current electronic case reporting (eCR) architecture:
• Helps to eliminate jurisdictional and program variability for clinical care
• rganizations and EHR vendors doing eCR
• Has raised some questions about technical and trust / legal scaling and

interoperability

• Health Data Networks (HDNs) offer the opportunity to address both scaling and

interoperability issues and make eCR services broadly and readily accessible

• APHL and others have engaged leading HDNs to discuss opportunities for eCR
• As in the context of TEFCA, the plan is to eventually have eCR services available on all

connected HDNs as a shared service

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• 1. Broad coverage of hospitals (75 percent of all U.S.), medical groups (70,000),

and federal agencies (4)

• 2. The “push” technical transactions that eCR uses (Direct and XDR)
• 3. An established “permitted purpose” to exchange data for public health use
• 4. Business associate authorities without the need for APHL to sign / negotiate

any additional agreements with participating providers

• The eHealth Exchange is becoming a business associate of its providers
• Like the eHealth Exchange hub contractor, APHL will be a business

associate as a contractor to the eHealth Exchange

• 5. It appears that there will be no indemnification requirements for APHL to

support

• 6. Eventual provision of eCR services to other HDNs through Carequality

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The eHealth Exchange offers the following:

• CommonWell is a promising eventual target, too. It has:
• An architecture that also supports business associate authorities (CommonWell is

a business associate of its providers, too)

• A rich community of participants
• CommonWell:
• Needs a public health permitted purpose and push transactions or viable

alternatives

• Has suggested that they would invite us to speak to their board to talk about eCR

in the future

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eCR and Health Data Networks

• DirectTrust:
• Has an established “push” technical transaction that eCR can use
• For it to be a viable target itself, it needs trust / legal agreements that support a public

health permitted purpose for exchange, shareable business associate authorities

• Carequality:
• Is more of a inter-HDN exchange agreement
• It would be good to promote eCR from eHealth Exchange to Carequality and develop

demand from CommonWell and other connected HDNs now and through TEFCA

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eCR and Health Data Networks

• Next steps:
• DWT and APHL to review draft terms for:
• An eHealth Exchange contract for APHL provision of eCR services
• DURSA and participant agreements for APHL eHealth Exchange membership
• Establish a “non-network” agreement that interested provider

participants and HIEs can sign if they are not represented in the eHealth Exchange

• Work to elevate interest in eCR in CommonWell and Carequality

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eCR and Health Data Networks

Additional Material

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eCR Demonstration Sites and the eHealth Exchange

Site Name Provider/HIE Represented in eHealth Exchange? Notes Houston Houston Methodist No Utah Intermountain Healthcare Yes Represented via Utah Health Information Network (UHIN) Michigan MiHIN Yes New York City Institute of Family Health Yes New York State SUNY Upstate TBD/ PMO Researching California UC Davis Yes Kansas Lawrence Memorial Hospital (now LMH Health) Yes Represented via Kansas Health Information Network (KHIN) Massachusetts None identified N/A

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eHealth Exchange (Federated Network) eHealth Exchange Hub APHL

Contracted eCR services (BA of eHealth Exchange ) Joins

Proposed Network Schematic (Phase I)

New DURSA and Participant Agreement BAA

• eHealth Exchange is establishing new DURSA

and participant agreements with business associate authorities for the eHealth Exchange

• APHL will then be a business associate of

eHealth Exchange to provide eCR services

• APHL would also join eHealth Exchange and

sign the DURSA and participant agreement establishing the public health permitted purpose

eHealth Exchange (Federated Network) CommonWell Carequality (Inter-network Connection Agreement) eHealth Exchange Hub Other networks and participants APHL

Joins

Proposed Network Schematic (Possible Phase II)

New DURSA and Participant Agreement BAA Contracted eCR services (BA of eHealth Exchange)

eCR and other services

Announcements

Jelisa Lowe and Charlie Ishikawa

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NEXT MEETING Virtual Meeting: April 4th, 2019, 12:00 – 1:00 PM EST Action Items

• TBD

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