Governance Body Meeting Thursday, October 5, 2017 12:00 1:30 PM - - PowerPoint PPT Presentation

Governance Body Meeting

Thursday, October 5, 2017 12:00 – 1:30 PM EDT This meeting will be recorded for note taking purposes only

• 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 – October 5, 2017

FOR DISCUSSION USE ONLY – October 5, 2017

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 Communications – Jessica Cook

12:15 PM

Strategy – Alana Cheeks-Lomax, Ben Stratton

1. Feedback: Digital Bridge Operating Model 2. Feedback: Second Use Case Development Process

12:50 PM eCR Implementation – Laura Conn, Kirsten Hagemann, and Rob Brown 1:15 PM Legal and Regulatory Issues – Jim Jellison/Walter Suarez 1:28 PM Review decision and major actions – Charlie Ishikawa 1:30 PM Adjournment – John Lumpkin

Objectives: By the end of this meeting, the governance body will have… 1. Described what can be done to further achieve 2017-2018 Digital Bridge communication goals. 2. Articulated and discussed the parts of the draft

• perating model that are agreeable, and those

parts that are concerning or underdeveloped. 3. Agreed to a process for selecting the next Digital Bridge use case(s) by January 2018. 4. Articulated and discussed any concerns they have over the progress of eCR implementation and identified what they can do to further advance full implementation by January 2018. 5. Agreed that a key design objective for any future eCR approach is to improve the scalability of the eCR solution through modifications to the current Digital Bridge eCR approach, and that work to identify possibilities needs to begin immediately.

FOR DISCUSSION USE ONLY – October 5, 2017

Communications

Jessica Cook

FOR DISCUSSION USE ONLY – October 5, 2017

Updated Communications Plan (2.0)

• Goals
• Audience descriptions (same)
• Communication approaches
• Messages for different goals and audiences
• Channels and tools for communicating (expanded)
• Report on communications activity from last year
• Timeframe of plan is 9-12 months. Anticipate the plan will need to

be adjusted this spring.

FOR DISCUSSION USE ONLY – October 5, 2017

Communication Goals

• Persuade (potential funders)

that Digital Bridge is a viable public-private partnership for effective information sharing between health care and public health.

• Communicate what Digital Bridge is and its

long-term vision.

• Address the problems that Digital Bridge

solves.

• Communicate the success of the first project.

Emphasize more will come.

• Increase understanding and

uptake of the Digital Bridge approach to electronic case reporting (eCR).

• Keep audiences informed of the

implementation sites’ progress and timeline.

• Address concerns around legal issues and

sustainability.

• Reinforce the value of this approach to specific

audiences.

FOR DISCUSSION USE ONLY – October 5, 2017

Communications Approaches

FOR DISCUSSION USE ONLY – October 5, 2017

• 1. Development Strategy

For increasing support of Digital Bridge

• We have a clear vision for Digital Bridge—and we can engage

potential funders in our purpose.

• We understand and can communicate what problems Digital Bridge

solves.

• We have a core story for Digital Bridge that inspires others to get

involved.

• We leverage our existing relationships to open new doors.

FOR DISCUSSION USE ONLY – October 5, 2017

• 2. Diffusion of Innovations Theory

For increasing uptake of the eCR approach

Innovators and Early Adopters

• Conference and webinar presentations
• Building a network of champions for eCR

Majority

• Conference and webinar presentations
• E-newsletters, social media, SEO to expand

reach

• New tactics: webinar series, blogging, focus on

health care

Late Adopters and Laggards

• Not a focus this year. As implementation sites

are evaluated, we can highlight wins and develop success stories.

From Digital Bridge Responsibilities:

• Develop and execute targeted marketing strategies to ensure uptake of solutions at a

national level.

FOR DISCUSSION USE ONLY – October 5, 2017

Activities

• New on Basecamp:
• Communications plan/executive summary
• FAQs and talking points (revised)
• Upcoming Digital Bridge/eCR sessions at APHA

and AMIA conferences

• Recognized in the recent Senate Labor-HHS

Appropriations Subcommittee report:

Questions and Discussion

FOR DISCUSSION USE ONLY – October 5, 2017

Digital Bridge Strategy

Alana Cheeks-Lomax, Ben Stratton

FOR DISCUSSION USE ONLY – October 5, 2017

Digital Bridge Operating Model

FOR DISCUSSION USE ONLY – October 5, 2017

Digital Bridge Use Case Operating Models

Incubate & Handoff Incubate, Handoff, Coordinate, & Support Operations Incubate, Handoff, & Own Future Operations Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100% Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100% Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100%

Digital Bridge Activities

Incubation Period

Develop use case requirements, and define infrastructure and standards. Develop legal agreements needed for the use case. Select and manage pilot sites. Identify future

• perating entity and develop hand-off plan.

Develop use case requirements, and define infrastructure and standards. Develop the legal agreements needed for the use case. Select and manage pilot sites. Identify future operating entity and develop hand-off

• plan. Develop plan to scale use case.

Develop use case requirements, and define infrastructure and

• standards. Develop legal agreements needed for the use case.

Select and manage pilot sites. Develop plan to scale use case.

Hand-off Period

Execute hand-off plan with future operating entity. Execute hand-off plan to operating entity, and transition to support role. Begin to execute scaling plan. Begin to execute scaling plan.

Operation Period

• Perform support role for operating entity. Use best practices to onboard

new users while executing the scaling plan. Leverage the convening power of Digital Bridge to adjudicate new standards, changing needs of the use case, and any other needed collaboration. Continue scaling, operating, and leveraging the Digital Bridge convening power to operate the use case at a national scale. If necessary, identify external operations to support use case (i.e. standards development, etc.)

1 2 3

Incubate & Hand-off

1

Incubate, Hand-off, Coordinate, & Support Operations

2

Incubate, Hand-off, & Own Future Operations

3

FOR DISCUSSION USE ONLY – October 5, 2017

Digital Bridge Use Case Operating Models

Incubate & Handoff Incubate, Handoff, Coordinate, & Support Operations Incubate, Handoff, & Own Future Operations Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100% Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100% Percentage of Incubation FTEs Time

Handoff Period Incubation Period Operation Period

0% 100%

Digital Bridge Activities

Incubation Period

Develop use case requirements, and define infrastructure and standards. Develop legal agreements needed for the use case. Select and manage pilot sites. Identify future

• perating entity and develop hand-off plan.

Develop use case requirements, and define infrastructure and standards. Develop the legal agreements needed for the use case. Select and manage pilot sites. Identify future operating entity and develop hand-off

• plan. Develop plan to scale use case.

Develop use case requirements, and define infrastructure and

• standards. Develop legal agreements needed for the use case.

Select and manage pilot sites. Develop plan to scale use case.

Hand-off Period

Execute hand-off plan with future operating entity. Execute hand-off plan to operating entity, and transition to support role. Begin to execute scaling plan. Begin to execute scaling plan.

Operation Period

• Perform support role for operating entity. Use best practices to onboard

new users while executing the scaling plan. Leverage the convening power of Digital Bridge to adjudicate new standards, changing needs of the use case, and any other needed collaboration. Continue scaling, operating, and leveraging the Digital Bridge convening power to operate the use case at a national scale. If necessary, identify external operations to support use case (i.e. standards development, etc.)

1 2 3

Incubate & Handoff

1

Incubate, Handoff, Coordinate, & Support Operations

2

Incubate, Handoff, & Own Future Operations

3

FOR DISCUSSION USE ONLY – October 5, 2017

Proposed Body of Participants

Board of Directors

• Run and attend quarterly Board of

Directors meeting

• Update membership body on relevant

topics related to Digital Bridge

• Oversee the development of new use

cases

• Give final approval of use cases
• Reach out to government (federal, state,

local) and private organizations for financial and tactical support

• Manage member recruitment to the Board
• f Directors (if necessary) and general

membership

• Establish and oversee workgroups, tiger

teams and taskforces to support the development of deliverables and milestones

• Approve long-term by-laws and the
• rganizational structure for Digital Bridge
• Approve functional and technical

requirements (for approved use cases)

• Approve Digital Bridge members
• Maintain equitable representation of all

three stakeholder groups, as on the governance body

Membership

• Attend monthly members meetings
• Support strategic direction of Digital

Bridge (i.e., to support a new use case)

• Participate in voting on new use cases

to be developed by Digital Bridge

• Oversee development (via

workgroups) of functional and technical requirements for approved use cases

• Oversee development and

maintenance of personnel/organization member directory and technical system directory

• Advise partner organizations in search

for funding to support the needed components to fulfill the Digital Bridge vision

• Support Digital Bridge operations
• Support strategic direction of Digital

Bridge through program management, incubation and operations coordinator roles

Staff

Sample Digital Bridge Operating Model

Board of Directors Launch national use cases Infrastructure Develop strategic recommendations Manage project and communications Membership Staff Data sharing platform Requirements Guide Digital Bridge mission Incubate and develop new use cases Operations and coordination support Analyze internal

• perations

Transition support Manage project and communications Carry out strategic communications Develop and test use cases Analyze internal

• perations

Strategic Objectives Process Technology Project Mgmt

FOR DISCUSSION USE ONLY – October 5, 2017

Digital Bridge Proposed RACI**

Digital Bridge Activities

R = Responsible, A = Accountable, C = Consulted, I = Informed

* – Trust and legal will be highly dependent on the finalized model recommended by the legal and regulatory workgroup. This line will be updated when the model is finalized. For example, if there are individual agreements and no centralized infrastructure, R, A from Infrastructure owner moves to vendors, public health and providers ** – Much of the matrix will need to be updated for individual use cases, for example other stakeholders may need to be involved in some way *** – These groups are also part of the membership of Digital Bridge, but they also have responsibilities and activities that fall outside of the purview of Digital Bridge

Activity Board of Directors Membership PMO Infrastructure Owner Vendors*** Public Health*** Providers*** Funders*** Governance R, A R, A A C C C C C Communication R, A A R I I I I I Project Management A A R, A C C C C C Standards Management R,A R,A R, A R,A R,A R,A R,A R,A Trust & Legal* R, A R, A R R, A C C C I Incubator & Hand-off R, A A R, A R, A R, A R, A R, A I Operations Coordination R, A A R, A R, A R, A R, A R, A I Funding R, A R, A R, A I I I I R Recruitment R, A R, A R C C C C C Administrative Functions A I R, A I I I I I

Digital Bridge Proposed RACI**

Non-Digital Bridge Activities

R = Responsible, A = Accountable, C = Consulted, I = Informed

** – Much of the matrix will need to be updated for individual use cases, for example other stakeholders may need to be involved in some way *** – These groups are also part of the membership of Digital Bridge, but they also have responsibilities and activities that fall outside of the purview of Digital Bridge

Activity Board of Directors Membership PMO Infrastructure Owner Vendors*** Public Health*** Providers*** Funders*** Regulatory & Policy I I I I I I I I Data Security I I I R, A R, A R, A R, A I Data Provision, Receipt, & Quality I I C R, A R, A R, A R, A I Training Technology & Adoption I I C R,A R,A R, A R, A I Onboarding & Technical Assistance I I C R, A R, A R, A R, A I Integration I I C R, A R, A R, A R, A I Systems Maintenance, Enhancements, & Development I I I R, A R, A R, A R, A I Systems Hosting I I I R, A R, A R, A R, A I Surveillance Science I I I I I R, A R, A I Funding (Digital Bridge Partner Organizations) C C C C C C C R, A Legal I I C R, A R, A R, A R, A I

Governance Body 0.5 FTEs Ex-Offico Members

Program Management 2.0 FTEs

Implementation Sites

Funding 1.0 FTEs Communication 2.0 FTEs Trust & Legal 0.25 FTEs

* Please note the number of FTEs for will increase as the number of use cases increases, as the initial number of FTEs are based on the implementation of one use case.

Funding 0.75 FTEs Standards Management 1.0 FTEs

Proposed Digital Bridge Organizational Structure

Workgroups

Governance Sub-groups Workstream Activities

Incubator 1.0 FTEs Operations Coordination 2.5 FTEs

Program Management 1.5 FTEs

PMO 7.0 FTEs

Administrative Functions 2.0 FTEs

Digital Bridge Use Case Development Process

Current Use Case Selection & Development Process

Generate Ideas for Next Use Case

• Greenhouse discussions generated additional potential use cases
• Strategy workgroup refines ideas and narrows down to be more explicit

Pulse Industry & Crowd Source for Ideas

• Reach out to industry groups for potential use case ideas and/or to solidify

current use cases as appropriate for the industry

• Narrow down on use case most appropriate for Digital Bridge

Identify Use Case Champion & Build Business Case

• Identify a champion to support the development of the use case
• Champion completes use case analysis form and feasibility criteria checks, and

compiles a detailed business case to present to the governance body

Present Use Case to Governance Body & Approve Use Case

• Governance body votes on use case
• Digital Bridge PMO begins implementation

Driven by the Strategy Workgroup

1 2

Digital Bridge Use Case Framework

Proposed Use Case Development Outreach

• The workgroup will begin outreach to professional groups and organizations to explore the

potential of the current broad use case topic – “Public Health Follow Up as a Service.”

• This service could support a variety of conditions, including those that came up at the May

Greenhouse: diabetes and opioids

• Connect with PHII Communications team to start a call for ideas
• Sample Organizations:
• American Health Information Management Association (AHIMA)
• National/Local Provider Groups
• National/Local Public Health Groups
• Sample Questions:

1. Does the current use case resonate with your organization/group? 2. How would you improve the use case to make it more effective for your stakeholder group (i.e., public health, vendor, provider, non-profit)? 3. Does this use case currently reduce a burden? 4. Would you join the Digital Bridge collaborative to participate in a pilot program to support the development of this use case?

Proposed Calendar

October 2017 January 2018 Present Plan to Governance Body Early October Develop Survey Questions & Begin Outreach Early October Collect Responses Mid-October/Early November Strategy WG Review Responses & Refine Use Case Late November

Vote on 2nd Digital Bridge Use Case (January Governance Body Meeting)

Identify Use Case Sponsor December

Additional Things to Consider

• Additional support needed to refine and “tweak” use case
• Need to identify a “champion” for the next use case
• Readiness to choose and start the development of a second use case

Appendix

Activity Stream Detailed Sub-Activities

Governance

• Attend governance body meetings
• Give final approval of all activities of Digital Bridge
• Reach out to government (federal, state, local) and private
• rganizations for support, both financial and tactical
• Set up and oversee workgroups, tiger teams, taskforces, etc.

for development of deliverables and milestones

• Oversee the development long term by-laws and the

Organizational Structure for Digital Bridge

• Give approval of long term by-laws and the organizational

structure for Digital Bridge

• Support strategic systems enhancement (i.e., to support a new

use case)

• Oversee development of use cases
• Give approval of use cases
• Oversee development of functional and technical requirements

(for approved use cases)

• Give approval of functional and technical requirements (for

approved use cases)

• Oversee development and maintenance of

personnel/organization member directory and technical system directory

• Advise partner organizations in search for funding to support

the needed components to fulfill the Digital Bridge vision (i.e., AIMS & RCKMS)

Communication

• Communicate activities Digital Bridge is taking part in
• Coordinate presentations at industry conferences as approved

by governance or an advisory group

• Communicate successes of Digital Bridge
• Get feedback from the community on Digital Bridge activities
• Generate interest in participating in initial implementations

and/or pilots in Digital Bridge

• Develop and execute targeted marketing strategies to ensure

uptake of solutions at a national level

• Develop and execute strategies for advocacy for Digital Bridge,

tailored to specific user groups

• Maintain and distribute digital and physical content related to

Digital Bridge through digitalbridge.us, social media, and other channels approved by governance or an advisory group

• Define communications methods and necessary technical
• perations during emergent scenarios (i.e. new infectious

disease outbreak, pushing new trigger codes ASAP to all Digital Bridge participants)

• Track and monitor the information being communicated about

Digital Bridge and where the communications are happening

Standards Management

• Ensure that standards are properly used, including

management of any governance approved certification criteria

• Ensure a common understanding of the standards and their

purpose

• Have a common understanding of the platform requirements
• Take an active role in standards identification, development,

and maintenance (i.e. identifying standards that are needed, communicating with the standards bodies, identifying liaisons, etc.)

Trust & Legal

• Develop common legal agreements to support a common

platform

• Develop of trust frameworks to support a common platform
• Support participants in understanding agreements and

frameworks

Program Management

• Manage workgroups, tiger teams, taskforces,

etc.

• Coordinate workgroups, tiger teams, taskforces,
• etc. meetings
• Assist in development of deliverables of

workgroups, tiger teams, taskforces, etc.

• Support onboarding of tasks for all groups
• Determine, publish, and coordinate lifecycle

plans for all Digital Bridge use cases (i.e., transitions to new standards, new technical infrastructure, sun setting of use cases if necessary)

Program Management Activity Details

Incubator & Hand-off

• Serve as an incubator facilitating the

development of pilots to test the functional, technical, business and legal approaches of each use case

• Establish a process to identify, evaluate and

define the entity or entities that will operate a solution at a national level including the ability to support participants signing agreements and frameworks

• Create a process to hand-off the

implementation and operation of an approach

• f a use case to the entity or entities that will
• perate the solution at a national level
• Perform ongoing monitoring and evaluation of

the national operations of the solutions for each use case

Operations Coordination

• Support and manage coordination among sites

during Digital Bridge onboarding process, technical troubleshooting, and systems updates

• Connect participants with appropriate POCs for

technical infrastructure

• Coordinate with Digital Bridge participants to

ensure they are able to satisfy the requirements for each use case

Funding

• Develop, pursue, secure, and manage a long-

term Digital Bridge funding strategy, including activities to produce ongoing revenue for the Digital Bridge

• Coordinate activities that are funded through
• ther organizations and/or agencies

Suggested Digital Bridge Second Use Case

• Name: Public Health Follow-Up as a Service
• Brief Description: Capability to transmit questionnaires/forms intended to gather further data back to

the delivery system/initial reporter. This will be triggered both by initial case reports of reportable conditions and by initial reports of chronic conditions. It may also be true for follow-up of initial syndromic surveillance reports. A service would be needed to provide both a toolkit for constructing further data inquiry forms, a library of existing common forms, and tools to augment or modify those forms in response to local conditions.

• Example: If an initial case report of diabetes is transmitted, the service would provide a stock

questionnaire back to the reporting entity looking for additional information like identifying additional patient information. If a diabetic was reported for the first time, the system could return recommendations for patient and family education along with specific community resources tailored to the patient’s address and clinical condition. It could also add additional elements of dietary history and family history not part of the initial report.

• Areas:
• Initial: Chronic
• Potential Future: Syndromic surveillance, infectious/reportable disease, public health emergencies

Digital Bridge eCR Implementation

• 1. Issues/ Risks| Timeline | Wave 1 and 2 Implementations |Cerner Update –

Laura Conn and Kirsten Hagemann (Taskforce Co-Chairs), Rob Brown

FOR DISCUSSION USE ONLY – October 5th, 2017

eCR Implementation – Risks & Issues

# Risk Impact Mitigation

1 Third party security assessment will not occur before initial implementations are in production Medium On eCR roadmap for March 2018 2 Legal agreements and data use agreements beyond initial implementation (risk for both Implementation and Strategy WG) High The Legal Workgroup is working on the creation of legal and data use agreements for the short term of the implementations and longer term 3 Reportability Response (RR) standards changing between balloting and November publication Medium Technical team will be involved in HL7 RR ballot reconciliation process 4 Technical Partners CSTE & APHL may have funding and sustainability shortfalls for FY18 High Funding shortfall for CSTE expected to last two weeks from 10/1 – 10/15, resource gaps will be identified and prioritized during this time. No APHL funding gaps at this time.

# Issue Impact Mitigation

1 Cerner implementation for eICR 1.1 support is delayed due to competing priorities Medium Cerner and Intermountain are working on an approach for eICR 1.1. The Implementation Taskforce and Digital Bridge PMO are assessing and monitoring the approach 2 An increase in the complexity and thoroughness of the test scenarios will cause a delay in the creation of the test eICRs High The set of 9 test scenarios are being finalized. Test scenario narratives may be provided to sites earlier than the full test scenario package. Complete test data was expected by the end of September, delayed. FOR DISCUSSION USE ONLY – October 5th, 2017

Revised Implementation Timeline - Wave 1 - Kansas, Michigan, Utah

Phase March April May June July August September October November 15 30 15 30 15 30 15 30 15 30 15 30 15 30 15 30 15 30 Planning RCKMS & AIMS Development and Testing Engagement With Implementation Sites Post Production

Site Selection

Planning Development & Test Engagement With Implementation Sites

RCKMS Criteria Testing (Internal, Jurisdictional Criteria) Performance Testing (Iterative) RCKMS Training Complete Integration Testing (AIMS & RCKMS Together) Functional Testing (AIMS & RCKMS Separate) AIMS Transport Onboarding End-to-End Testing Establish Post Production Support Finalize Test Scenarios & Test Data Legal Agreements

Complete In Progress Not Started

DRAFT

FOR DISCUSSION USE ONLY – October 5th, 2017

Cerner Implementation Brief

Criteria Key Information Notes/Other Considerations Is this approach consistent with the requirements and technical architecture approved for DB-eCR? DB-eCR Taskflow is Step 6: Build eICR in the Health Care Provider lane.

• 1. Generate public health case report [Yes]
• 2. Check for completion of mandatory fields [Yes with exceptions below]
• 3. Ability to send electronic initial case report (eICR) at any point in required time

frame clinical encounter if mandatory data are available [Yes]

• 4. Have the ability to track information relevant to a specific public health case as

information is shared between Health Care and Public Health [Yes] Is this approach a consistent, standards-based and nationally scalable solution?

• Initial implementation is not the long term Cerner solution, this approach will not

be released in Cerner’s product

• An eiCR is generated using available CDA sections
• Occurring at the time of trigger code match, by the provider (Intermountain

Healthcare) in Cerner software

• Intermountain Gateway (a component behind the Intermountain firewall) will

transport the eICR to the AIMS platform using the XDR connection Are there any issues with data completeness/ standards with this approach? The below data elements will not be provided in the eICR:

• Travel History
• History of present illness

Site Status in Preparation for Onboarding and Testing

Implementation Sites Vendor/HIE Activities Provider Activities Public Health Activities Site Connectivity with AIMS Additional Notes

Kansas

The Cerner & Intermountain development work for Utah can be leveraged for

• Kansas. For Public Health (PH), the activity remaining is the ability to receive

Reportability Response (RR). Completed PH connectivity with AIMS; will begin

• testing. Discussions with LMH connectivity beginning.

Michigan

For PH, the activities remaining are the ability to receive eICR 1.1 and ability to receive RR. Technical kick off occurred with Michigan site; AIMS completed VPN connectivity documentation and connection testing.

Utah

Cerner & Intermountain are working on an approach for eICR. PH is ready; their activities are complete. Completed PH connectivity with AIMS; will begin

• testing. IMH connectivity being established.

California

Epic’s software updates are released. Working through Provider concerns. PH is making progress.

Houston

Epic’s software updates are released. Provider and PH are making progress. AIMS is working with Provider and PH on Direct transport.

Massachusetts

Epic’s software updates are released. Provider and PH are making progress. For PH, the activities remaining are test and production environment setup and the ability to receive RR.

New York

Epic’s software updates are released. Working through Provider concerns. PH is making progress.

Complete – 100% In Progress – 50% Not Started – 0%

FOR DISCUSSION USE ONLY – October 5th, 2017

Legal and Regulatory Issues

Jim Jellison, Walter Suarez

FOR DISCUSSION USE ONLY – October 5, 2017

Overview of Legal Activities To Date

• Davis Wright Tremaine provided three legal options for the exchange of data between

health care and public health

• A decision was made to proceed, for the initial implementation sites, with the option

that allows the decision support intermediary (DSI) to act as a business associate (BA)

• f the provider
• An emerging long-term, nationally scalable approach for eCR implementation will

consist of two stages

• Stage 1 – Focus on provider consuming/executing national notifiable condition codes (90+%)
• Stage 2 – Focus on expanding provider’s capabilities to consume/execute jurisdictional-

specific condition codes

Legal Framework and Agreements For Initial Implementations

Health Care Provider (or HIE) Decision Support Intermediary (i.e. APHL) Public Health Agency Key Limitation: Requires BAAs between thousands (or more) Providers and APHL (host of AIMS)

Business Associate Agreement Health Information Exchange Contract Pending Stakeholder Input Business Associate

• f Provider

Initial Implementations

Provider (or HIE) – APHL Contracting Approach

• Privacy
• Protected Health Information (PHI) will be disclosed by Provider (or HIE on behalf of Provider) to

APHL for health care operations (i.e., public health reporting)

• Disclosure of PHI will be minimum necessary
• Due to technical approach, Providers/HIE will be reporting all potential cases to APHL
• APHL will act as Business Associate of Provider/HIE per multi-lateral Business Associate Agreement
• BAA will authorize APHL to disclose PHI to public health authorities as authorized or required by law
• Health Information Exchange
• A multi-lateral HIE agreement between Providers and APHL
• Option 1: New HIE agreement designed for initial eCR implementations
• Option 2: Use existing HIE agreement framework (e.g., eHealth Exchange, Carequality, DirectTrust,

etc.)

• May also need agreements between APHL and EHR companies governing technical details

Long-Term Goal for Legal Framework and Agreements

Health Care Provider (or HIE) Decision Support Intermediary (i.e. APHL) Public Health Agency

Health Information Exchange Contract (if done via HIE) Agent Agreement (type TBD) Agent of Public Health Authoritative source

• f National and

Jurisdiction-specific notifiable condition codes

Technical/Legal Approaches Notes

Initial Implementations

• DSI acts as BA of the provider/health information exchange (HIE) and as central, authoritative source of both

nationally notifiable condition codes and jurisdiction-specific condition codes

• Provider’s EHR hosts nationally notifiable condition codes (i.e., codes reflecting reporting requirements common to

all sites)

• DSI executes jurisdiction-specific case reporting, routing logic
• Consensus approach for initial

implementations

• Scalability issues due to HIPAA

concerns and administrative

• verhead of managing multitude
• f Business Associate Agreements

(BAAs) Long-term Implementations – Stage 1

• DSI acts as agent of public health authority and acts as the central, authoritative source of both nationally

notifiable condition codes and jurisdiction-specific condition codes

• Provider’s EHR consumes and executes only nationally notifiable condition codes (i.e., codes reflecting reporting

requirements common to all sites) which would address 90+% of all reportable cases, and submit to DSI

• Providers will need to process and execute jurisdiction-specific case requirements off-line, and submit to DSI
• DSI executes jurisdiction-specific case reporting, routing logic
• Addresses HIPAA risk
• Reflects limitations of current

technologies for distributing jurisdiction-specific public health reporting criteria Long-term Implementation – Stage 2

• DSI acts as agent of public health authority and acts as the central, authoritative source of both nationally

notifiable condition codes and jurisdiction-specific condition codes

• Provider’s EHR is able to consume and execute both nationally notifiable condition codes and jurisdiction-specific

condition codes, and report to DSI

• DSI routes case reports to appropriate public health agency
• Addresses HIPAA risk
• Leverages anticipated evolution of

health IT interoperability standards

Proposed Timeline

2018 Q1

Initial Implementations Future Implementations

9/27/17

Evaluation and Redesign Next Implementations

2017 Q4 2018 Q2 2018 Q3 2019 Q1 2019 Q2 2017 Q3

Evaluation and Redesign

2018 Q4

Public Health Reporting Regulations

• RWJF is interested in supporting a statewide legal review of public health

reporting laws and regulations

• The review is intended to support the long-term legal framework for Digital

Bridge (eCR, potentially other use cases)

• Need stakeholder input on design and scope of review
• Is reporting required by law, authorized by law, or does it require consent?
• If consent required, identify specific consent requirements
• Identify entities subject to laws (providers, any recipient of PHI, etc.)
• Prioritize use cases or scenarios to examine
• What existing work should inform this review?

FOR DISCUSSION USE ONLY – October 5, 2017

For approval by governance body: A key design objective for any future eCR approach is to improve the scalability of the eCR solution through modifications to the current DB-eCR approach, and that work to identify possibilities needs to begin immediately.

Review | Decisions & Actions

Charlie Ishikawa

FOR DISCUSSION USE ONLY – October 5, 2017

NEXT MEETING Thursday, November 2nd @ 12:00 – 1:30 PM EDT NOTICE Two-day in-person governance body meeting January 24 – 25, 2018

FOR DISCUSSION USE ONLY – October 5, 2017

Please complete the three-question post-meeting survey!

Meeting Performance Survey

• Organization
• Facilitation
• Worthwhile
• 1. Were all the meeting
• bjectives accomplished?
• 2. General suggestions or

feedback on governance body meeting facilitation

• 3. Priority topic for next

governance body meeting

FOR DISCUSSION USE ONLY – October 5, 2017