Governance Body Meeting Thursday, February 16, 2017 12:00 PM 1:00 - - PowerPoint PPT Presentation

▶
governance body meeting
SMART_READER_LITE
LIVE PREVIEW

Governance Body Meeting Thursday, February 16, 2017 12:00 PM 1:00 - - PowerPoint PPT Presentation

Apr 12, 2023 181 likes •470 views

Governance Body Meeting Thursday, February 16, 2017 12:00 PM 1:00 PM EDT Audio: 1-866-516-9291 FOR MEETING DISCUSSION USE ONLY 2/16/2017 Governance Principles Transparency: Stakeholders will have Utility: The Governance Body will

slide-1
SLIDE 1

Governance Body Meeting

Thursday, February 16, 2017 12:00 PM – 1:00 PM EDT Audio: 1-866-516-9291

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-2
SLIDE 2

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 opinions 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.

Governance Principles

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-3
SLIDE 3

Agenda

Time Agenda Item

12:00 PM Call to Order & Roll-call – John Lumpkin & Charlie Ishikawa 12:03 PM Agenda Review and Approval – John Lumpkin, Chairman 12:05 PM Digital Bridge Initiative Progress (10 min) 1. Project timeline – Jim Jellison 2. Communications – Jessica Cook 3. Update on Governance Body vacancy – Charlie Ishikawa 12:15 PM Digital Bridge eCR Implementation Sites (30 min) 1. Presentation of the eCR implementation site cohort – Jim Jellison 2. Discussion and approval – John Lumpkin 12:45 PM Discussion and acknowledgement of workgroup products by governance: Legal and Regulatory, and Sustainability (15 min) 1. Discussion of products

  • Legal and Regulatory – Jim Jellison
  • Sustainability – Alana Cheeks-Lomax

2. Decisions – John Lumpkin Remaining Next Steps – Charlie Ishikawa 1:00 PM Adjournment – John Lumpkin Purpose

1. Describe progress of the Digital Bridge initiative; 2. Discuss and approve the implementation site cohort 3. Discuss and acknowledge final products from the legal and regulatory, and sustainability workgroups.

Materials and Preparation

  • Governance Body Decision Making

Procedure

  • For discussion and approval:
  • Site Selection Slides (*.pdf)
  • For discussion and acknowledgement
  • From Legal and Regulatory Workgroup
  • Legal and Regulatory Slides (*.pdf)
  • Recommendations for agreement types and

prioritization among data exchange partners (*.docx)

  • From Sustainability Workgroup
  • Preliminary Sustainability Plan
  • Initial Implementation Site Questions

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-4
SLIDE 4

Digital Bridge Initiative Progress

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-5
SLIDE 5

eCR Project Timeline

2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 and beyond

Governance Coordinate Workgroups (WGs) and Engage Stakeholders Requirements WG Technical Arch WG Provide Technical Guidance and Monitor eCR Implementations eCR Implementations

Ongoing Curation of Functional Requirements Evolve, Extend Information Exchange Capabilities Ongoing Submission

  • f ECRs

Legal and Regulatory WG

Articulate Business Case for eCR

Sustainability WG Articulate Business Case for eCR

Charter Communications Plan Identify New Use Cases Refine Charter Develop Project Plan Functional Requirements Refined Technical Arch Diagram Document Lessons Learned Site Application/Criteria Defined Preliminary Sustainability Plan Measure Success Sustainability Plan Model BAAs, DUAs Recommendations Sites Selected Declare MU eCR Readiness Onboard eCRs MU eCR Deadline

REV 12/7/16

  • Bus. Process Matrix Task Flow Diagram & Requirements Statements

Narrative Description & Trigger Sequence Diagram Assessment of eCR Implementation

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-6
SLIDE 6

Communications Update

  • Digital Bridge presentation next Tuesday, #HIMSS17, #EmpowerHIT
  • Session #126, Tuesday, Feb. 21, 2:30-3:30 p.m., Room W230A at HIMSS17
  • ASTHO/NACCHO webinar on March 24, 1:30-3:00 p.m. EST
  • Communicating to a broad audience about eCR and Digital Bridge
  • Updated fact sheet, talking points, conference material coming soon
  • Contact Jessica Cook (jcook@phii.org) if you have specific needs for an event or

meeting

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-7
SLIDE 7

eCR Implementation: Site Selection Recommendations

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-8
SLIDE 8

Session Objectives | eCR Implementation Sites

  • Review technical expectations of eCR implementation sites
  • Project management, communications, evaluation outside scope of today’s topic
  • Review decisions from Jan 18 Governance Body meeting
  • Confirm partners’ capacity for supporting eCR implementation sites
  • Prioritize eCR implementation sites

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-9
SLIDE 9

eCR Implementation Site Expectations

  • Site = public health agency, health care provider, EHR vendor (and/or HIE)
  • Health care provider, EHR vendor
  • Implements Reportable Conditions Trigger Code (RCTC) table, HL7 Electronic Initial Case

Report (eICR)

  • Sends eICRs to APHL Informatics Messaging Services (AIMS) platform (requires agreements)
  • Optional: Receives reportability responses from AIMS
  • Public health agency
  • Receives eICRs, reportability responses from AIMS
  • Sends acknowledgement to Health Care Provider
  • (via AIMS, Reportability Response? Details TBD)
  • HIE
  • TBD based on site and data flow

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-10
SLIDE 10

Governance Decisions from Jan 18 Meeting

Public Health Agency Health Care Provider EHR Vendor California UC Davis Epic Houston Houston Methodist Epic Kansas Lawrence Memorial Hospital Cerner Massachusetts Partners HealthCare Epic Michigan McLaren Health Center NetSmart (HIE-MiHIN) New York City Institute of Family Health Epic Utah Intermountain Healthcare Cerner

  • Provisional approval to 7 applicants pending more thorough analysis of applications
  • Second round of applications for missing Governance Body organizations
  • PMO analyzed all 7 applications (included some follow up communications with applicants):

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-11
SLIDE 11

Site Gov/WG Rep Experience Cases/Month

California/UC Davis/Epic (UC Davis Hosp.) Incomplete application No previous engagement AIMS: some experience (UC Davis) RCKMS: ? eCR: ? C 16; G 5; P 2; S 16; Z 0 Houston/Houston Methodist/Epic (Houston Methodist Hosp.)

  • J. Doyle

AIMS: ? RCKMS: planning, content validation (HHD) eCR: ASTHO eCR pilot; HL7 ADT pilot Hep C (HHD) C ~2; G ~1.5; P 0; S 3; Z 0 Kansas/Lawrence Memorial/Cerner (Lawrence Memorial Hosp. and 20 affiliated facilities)

  • S. Mosier
  • B. Harmon

AIMS: ELRs (KDHE) RCKMS: ? eCR: KDHE input on HL7 eICR C 16; G 3; P 0.1; S 1; Z 1 Massachusetts/Partners/Epic (MA General Hosp., Brigham and Women’s Hosp.)

  • M. Klompas
  • J. Doyle

AIMS: ELRs (MA DPH) RCKMS: planning, content validation (MA DPH) eCR: early adopter (ESPnet, Partners, MA DPH) C 90; G 20; P 5; S 5; Z 40 Michigan/McLaren/MiHIN HIE Michigan/Local HDs/NetSmart (McLaren Health Care, LHDs via MiHIN HIE)

  • J. Collins (WG)

AIMS: ASTHO eCR pilot (MDHHS, MiHIN) RCKMS: ? eCR: ASTHO eCR pilot (MDHHS, MiHIN) C ~2; G ~8; P <1; S <1; Z 0 NYC/Institute of Family Health/Epic (28 clinical settings in NYC and upstate)

  • A. Aponte

(WG)

  • J. Doyle

AIMS: ? RCKMS: provided UI input eCR: early pilot of CDA-based case reporting C 505; G 137; P 7; S 2; Z 21 Utah/Intermountain/Cerner (Logan Regional Hosp., Budge Clinic Pediatrics)

  • S. He, J.

Hartsell (WG)

  • B. Harmon

AIMS: some experience (UT DOH) RCKMS: design, pilot test (IMH) eCR: recent pilots of HL7 eICR (all) C 10; G 0; P 5; S 1; Z 0

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-12
SLIDE 12

PMO Recommendations

Site Prioritization Rationale/Notes Relationship with AIMS? California/UC Davis/Epic Low Missing Letters of Support; Epic already represented WSDL connectivity to PHA; Quest, PAML(in production);* Houston/Houston Methodist/Epic High Epic expresses hesitation on readiness for HL7 eICR PHINMS connectivity to PHA; Part of original eICR pilot and received mock eICR through the interface;** Kansas/Lawrence Memorial/Cerner High PHINMS connectivity to PHA; receiving ELR from Quest and Cerner Hospitals;** Massachusetts/Partners/ Epic High Epic expresses hesitation on readiness for HL7 eICR WSDL connectivity to PHA; Quest Michigan/McLaren/Local HDs/MiHIN HIE High Case reports sent to AIMS via MiHIN HIE Direct connectivity to HIN in testing mode but will need VPN setup and additional work before going into production; NYC/Institute of Family Health/Epic High Epic expresses hesitation on readiness for HL7 eICR No connectivity to PHA Utah/Intermountain/ Cerner High PHINMS, XDR connectivity; Quest/PAML (in production);**

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-13
SLIDE 13

High-level Timeline (proposed)

Activity

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Review data sharing and business associate agreements Execute data sharing and business associate agreements Establish connection to AIMS platform Implement RCTC Implement HL7 eICR Develop test environment, synthetic data Test phase Production phase Evaluation (data collection) Evaluation (data analysis)

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-14
SLIDE 14

eCR Implementation: Site Selection Wrap-Up

  • Discussion
  • Motion(s) and decision(s)
  • Summarize decision and action items

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-15
SLIDE 15

Discuss and acknowledge of workgroup products: Legal and Regulatory, and Sustainability Workgroups

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-16
SLIDE 16

eCR Implementation: Legal & Regulatory Recommendations

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-17
SLIDE 17

Session Objectives | Legal & Regulatory

  • Outline recommendations for short-term vs. long-term approach for legal and

regulatory eCR compliance with privacy and confidentiality

  • Describe next steps for eCR implementation sites and Digital Bridge Governance

Body

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-18
SLIDE 18

eCR Overview

Health Care Provider Decision Support Intermediary Public Health Agency Public health case reports (true positives & false positives)

  • 3. Potential cases detected

using nationally consistent trigger criteria optimized for sensitivity. Public health case reports (true positives)

  • 4. False positive cases

filtered out by jurisdiction- specific public health reporting criteria optimized for specificity. Jurisdiction-specific reporting criteria (input) Nationally consistent trigger criteria (input)

  • 1. Public health agency

loads its case reporting criteria into Decision Support Intermediary

  • 2. Decision Support

Intermediary provides Health Care Providers with nationally consistent criteria for triggering potential case reports.

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-19
SLIDE 19

Recommended Agreements Framework – Short term for initial implementation sites

BAA = business associate agreement DUA = data use agreement MOU = memorandum of understanding TPA = trading partner agreement

Health Care Provider Decision Support Intermediary Public Health Agency BAA & DUA Decision Support Intermediary acts as a Business Associate of the Health Care Provider MOU & TPA Agreement between Public Health Agency and Decision Support Intermediary includes terms of MOU & TPA FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-20
SLIDE 20

Recommended Content for BAA/DUA (Draft posted to Basecamp)

Business Associate Agreement (BAA)

  • Definitions
  • General Provisions
  • General Uses and Disclosures
  • Obligations of APHL (BA)
  • Obligations of Provider (CE)
  • Insurance, Indemnification
  • Termination, Amendment
  • Obligations to Manage, Destroy Data
  • Regulatory References
  • Assignment, Severability
  • Entire Agreement, Jurisdiction, Waiver
  • Authority, Notices

Data Use Agreement (DuA)

  • Definitions
  • Permitted Use
  • System Access Policies
  • Use Cases
  • Expectation of Participants
  • Representations and Warranties
  • Disclaimers
  • Term and Termination
  • Miscellaneous Provisions

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-21
SLIDE 21

Recommended Content for MOU/TPA (Draft posted to Basecamp)

Memorandum of Understanding (MOU) / Trading Partner Agreement (TPA)

  • Purpose, Background, Definitions
  • Project/Opportunity
  • Joint Responsibilities of Parties
  • APHL Role and Responsibilities
  • PH Agency Role and Responsibilities
  • Open Records Laws
  • Data Retention/Security
  • Term and Termination
  • Ownership of Data
  • Warranties
  • Indemnification, Limitation of Liability
  • Amendment; Waiver
  • Severability
  • Entire Agreement; No Assignment
  • Governing Law
  • Notices

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-22
SLIDE 22

High-level Implementation Timeline (proposed)

Activity

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Review data sharing and business associate agreements Execute data sharing and business associate agreements Establish connection to AIMS platform Implement RCTC Implement HL7 eICR Develop test environment, synthetic data Test phase Production phase Evaluation (data collection) Evaluation (data analysis)

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-23
SLIDE 23

Long-Term Strategy

During initial eCR implementations (aka “short-term”), Digital Bridge will also plan longer term strategy for legal & regulatory compliance:

  • Increase acceptability among health care, governmental partners
  • Increase scalability through reduction of point-to-point agreements
  • Inform evolution of eCR technical architecture
  • Will likely entail examining “trust networks”, e.g.:
  • Sequoia/eHealth Exchange (http://sequoiaproject.org/ehealth-exchange/)
  • DirectTrust (https://www.directtrust.org/)

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-24
SLIDE 24

Next Steps | Legal & Regulatory

  • Engaging legal counsel (for short-term agreements and long term planning)
  • Facilitate agreements for eCR implementation sites
  • Developing new Legal & Regulatory Workgroup Charge addressing long-term

strategy

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-25
SLIDE 25

Sustainability Workgroup Products

FOR MEETING DISCUSSION USE ONLY – 2/16/2017

slide-26
SLIDE 26

Sustainability Workgroup

Workgroup Charge

Define a sustainability plan for eCR that articulates a business model for infrastructure support as described by the Digital Bridge Requirements and Technical Architecture Workgroups. Deliverables 1. Recommendations on site selection criteria for the eCR implementation phase of Digital Bridge and accompanying application process description 2. Preliminary sustainability plan for delivering electronic case reports using Digital Bridge technical infrastructure and shared services. 3. Assumptions and issues for any sustainability requirements, including the use of any specific technical standards, specific tools/shared services, project management and system maintenance functions and their availability for use in implementation sites, and underlying funding/business model to support any of them.

Update

  • Working group has been convening since the last

Governance Board meeting to finalize the preliminary Sustainability Plan to support the close

  • ut of Phase 2
  • Preliminary Sustainability plan outlines work and

deliverables completed by the workgroup and well as recommendations moving into Phase 3

  • As part of the final deliverables for Phase 2, the

workgroup has also drafted a number of sustainability questions to be passed along to the initial implementation sites. The sustainability questions serve to help the workgroup gain a better understanding of some of the larger sustainability topics of scalability and cost, and will be used to help inform a more robust plan in Phase 3.

slide-27
SLIDE 27

Next Steps

DBGB Meetings

  • Future meeting dates and times TBD

FOR MEETING DISCUSSION USE ONLY – 2/16/2017