Health Information Technology Oversight Council February 2 nd , 2017 - - PowerPoint PPT Presentation
Health Information Technology Oversight Council February 2 nd , 2017 Agenda Welcome, Introductions & HITOC Business Oregon Health Policy Board Update Governance/ Network of Networks Models from Other States: Review and Learnings Oregon
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Information Across the Care Team
meaningful, timely, relevant and actionable patient information to coordinate and deliver “whole person” care.
Data for System Improvement
CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention.
aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development.
Their Own Health Information
families access their clinical information and use it as a tool to improve their health and engage with their providers.
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Susan Otter, Director of HIT Karen Joplin, OHPB member liaison to HITOC
– HITOC 2016 2-page report – Matrix of Key Actions, Priorities, 2017-19 plans, OHPB
– Opportunities for OHPB related to HIT work:
– Behavioral health, – Payment model, – Metrics alignment work
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– Few HIEs, near complete state coverage
– HIEs exchange a great deal of data, driven by customer needs – Data is routed as part of HIE function rather than state service – Statewide MPI, PD proposed/funded; receive little provider support
– Jointly decide on projects to cooperate on, grants to apply for
– Staffed by Governor's office, includes HIT Coordinator, payers, state offices, HIEs – No budget, acts as advisor on priorities – Focus of future federal grants
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– HIE is for-profit organization designated by state as the state HIE
– OneHealthPort operated as line of business – Medicaid is largest customer
– State designated OneHealthPort as single designated HIE
– Provides oversight on pricing (review and approval w/15% profit cap), privacy & security, information access policy – Not making operational decisions – HCA has 4 of 7 seats on board
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– Many HIEs, significant white space
– No state involvement in HIE at state or regional level – HIEs, provider orgs see little value in statewide services; rely on HIE services or national initiatives – Voluntary governance through consensus data sharing policies
– No state HIT Coordinator
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– Several HIEs, significant white space – Services facilitate inter-HIE exchange via query-based and directed exchange – Gateway services to federal agencies – Regional HIEs responsible for last mile data delivery, longitudinal community records, etc.
– Established THSA as non-profit through legislation
– Public funds allocated through legislation – Additional funds through participant fees, accreditation and certification programs
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– Several HIEs, some white space – Includes ADTs, registries, medication reconciliation, advance directives, care plans, immunization forecasts, SSO, lab
– Gateway services to state/federal agencies, national initiatives – Regional HIEs responsible for last mile data delivery, longitudinal community records, etc.
– Includes robust model for new services, assessing maturity – Participants play advisory role in operations
– Commission advises on priorities – Very active in operational committees
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Robust HIEs Robust Services
Washington Colorado California Texas Michigan
Complexity of Services Number of HIEs Governance Structure
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Robust HIEs Robust Services
Washington Colorado California Texas Michigan
a business
cooperation between HIEs
cooperation among HIEs
data sharing policies
public private partnership with stakeholder input
frameworks important
accredits participants
Board
advised by committees of participants
cooperation
State Involvement
board, no
responsibility
provides advice
governance
statewide services through public private partnership
provides advice
committees
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Robust HIEs Robust Services
Washington Colorado California Texas Michigan
designated HIE
designated HIE provides all services
added as sustainable business decisions
as SDE planning MPI and PD
provider support
and other state services
value in statewide services beyond convening, advocacy
to those that enable exchange among HIEs
federal agencies
national network technologies
services
gateways to state, federal agencies
service maturity
to sponsor, fund, develop new services
State Involvement
single statewide HIE
PD
funding/using services
governance through public private partnership
services
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Robust HIEs Robust Services
Washington Colorado California Texas Michigan
funded by for- profit HIE
added only if found business decision
activities self- funded by HIEs
designated entity will be future recipient of federal funding,
services through contracts to HIEs
active in grant funding
activities funded by member HIEs
authorized recipient of federal funding
HIEs active in grant funding
through public funds and participant fees
certification, accreditation
support
through member use fees
grants, pilots
State Involvement
(state is customer for public health and funding Medicaid specific clinical registry)
through legislation
new services
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– Providers in Colorado not supporting new development – California now abandoning all statewide services
– Not the same as statewide infrastructure; both infrastructure and exchange services
– Texas concentrating on inter-HIE exchange – Michigan adding other enabling services
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Sean Carey Policy Analyst
with governance over “network of networks”
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– Barriers include technology, organizational culture, trust
– HIE needs are heavily dependent on use case – HIE must consider provider workflow to be usable
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– Oregon’s network of networks model will have a significant impact on enabling HIE across the state – Clearly describing the model, objectives, and direction will be foundational to strategies that may evolve over time
– Do we have enough information about the landscape, approaches, risks and benefits to point in a direction? – If yes, is it one of the models or a hybrid approach? – If not, do we need additional information or do we develop the strategic plan with some ambiguity?
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Legal Dispute Resolution
Connections Services
Monitor and adapt Standards
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– Legal/contractual mechanisms for exchange – Overseen by shared governance entity (ideally) regardless of NofN approach
– Under a statewide services model, technology will be a large focus of governance; under robust HIE model, technology
– Statewide services model allows for increased flexibility/ innovation based on “open pipelines”
– Ongoing assessment of current needs, market changes and
– Standards may be needed for HIE participation (minimum requirements/services) or network access
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alignment more difficult- large systems and HIEs need different enabling infrastructure to capitalize on core competencies
more disadvantaged in achieving robust exchange
– Regional HIEs are expected to grow and provide some exchange; – national efforts like Carequality, Commonwell and CareEverywhere will also meet some needs; – CareAccord and Direct Secure Messaging will continue a small but critical role in exchange; – many white spaces will remain.
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Lightweight facilitating infrastructure Labs Hospitals Health plans CCOs State Data Sources (e.g., public health registries) CareAccord
(Direct secure messaging)
PDMP Gateway* CQMR*
HIE
Provider Directory* Physicians and Clinics Behavioral Health Hospitals Pharmacies Physicians and Clinics Labs Hospitals CCO Pharmacies Physicians and Clinics EDIE
*Services/ programs in development
** Not shown: connections between organizations/ national frameworks for exchange
Lightweight Services
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Labs Hospitals Health plans CCOs
HIE HIE HIE
Physicians and Clinics Labs Hospitals Pharmacies Physicians and Clinics Labs Hospitals CCO Pharmacies Physicians and Clinics
*Services/ programs in development State Data Sources (e.g., public health registries)
** Not shown: connections between organizations/ national frameworks for exchange
Lightweight facilitating infrastructure CareAccord
(Direct secure messaging)
PDMP Gateway* CQMR* Provider Directory* EDIE Lightweight Services
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Behavioral Health Labs Hospitals Health plans CCOs HIE HIE Physicians and Clinics Labs Hospitals Pharmacies Physicians and Clinics Labs Hospitals CCO Physicians and Clinics
*Services/ programs in development Robust enabling infrastructure CareAccord
(Direct secure messaging)
PDMP Gateway
(and potentially
CQMR* Provider Directory* Notifications Hub Master Patient Index
Patient Provider Attribution Record Locator Service
State Data Sources (e.g., public health registries)
** Not shown: connections between organizations/ national frameworks for exchange
Lightweight Services
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Common Credentialing Provider Directory Notifications Hub MPI Provider / Patient Attribution Technical Assistance EDIE
contributes to supports required for contributes to model for contributes to contributes to
Record Locator Service Query Service
required for
supports all
required for
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– Some national efforts can benefit from network of networks infrastructure
– Common Rules of the Road (trust framework) and standardized implementation
– Driven by implementers– data sharing networks (could be vendor, HIE, or ‘network of one’) – No MPI/ Record locator service included in framework; some
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– Provides notifications to a patient’s home HIE when they receive care at a provider connected to another HIE – Patient’s data home can identify outside locations of care – Can provide reverse information to outside HIE
– HIE network operated by EPIC EHR system – Allows for record sharing among EPIC customers
– An alliance of vendors with a central Master Patient Index and Record Locator Service to find and query records – Vendors include Cerner, athenahealth, Allscripts, Greenway Health and others
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Statewide Network of Networks Approaches National Frameworks CareEverywhere Carequality Patient Centered Data Home (SHIEC pilots) Commonwell Status quo CareEverywhere provides significant exchange functionality for Epic systems Carequality useful for pulling records within established trading partner networks PCDH would have limited value with current HIE network Commonwell limited reach, but high value when connected Robust HIE services Neutral impact for CareEverywhere use Carequality useful for pulling records from
(e.g., out of state records) PCDH useful for bridging HIE networks when a patient has a “home” HIE Neutral impact for Commonwell use Robust statewide services Neutral impact for CareEverywhere use Carequality very useful for health systems/ large entities that can access
and determine locations to pull records from PCDH could amplify HIE value by utilizing statewide services to notify HIE for specific patient populations Neutral impact for Commonwell use
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Status Quo Model
Search and
provider contact info Send referral information Hospitals Health plans CCOs Physicians and Clinics
Sending provider Receiving provider Referral information is transmitted in multiple ways: through HIEs, through Direct secure messaging, by fax and through paper/ patient-driven methods.
Provider Directory Labs Hospitals Health plans CCOs Physicians and Clinics Custom Interface Patient-led HIE Fax
Lightweight enabling infrastructure
CareAccord
Statewide Service
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Robust HIE Model with lite services
Search and
provider contact info Send referral information
Sending provider Receiving provider Most referrals can be transmitted either within an HIE or through connections between HIEs. Some providers may still find value in building direct interfaces with trading partners, and some referrals may still occur with fax or be patient-driven.
Custom Interface Patient-led HIE Fax HIE HIE Hospitals Health plans CCOs Physicians and Clinics Labs Hospitals Health plans CCOs Physicians and Clinics Provider Directory
Lightweight enabling infrastructure
CareAccord
Statewide Service
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Robust Statewide Services Model
Search and
provider contact info Send referral information
Sending provider Receiving provider Some referrals are routed through statewide services (Direct secure messaging or EHR integrations), others
another outside, utilizing the statewide services as a pipeline
Custom Interface Patient-led HIE Fax HIE
Robust enabling infrastructure
Hospitals Health plans CCOs Physicians and Clinics Labs Hospitals Health plans CCOs Physicians and Clinics CareAccord Provider Directory Patient provider attribution Master Patient Index Notification Hub Record Record Locator Service 36
Status Quo Model
Patient arrives at hospital Send ADT alert Hospitals
Sending provider Receiving provider ED and hospital event notification is supported by EDIE. HIEs can also offer additional notification services.
EDIE Utility HIE
Hospitals Health plans CCOs Physicians and Clinics
Lite enabling infrastructure
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Robust HIE Model with lite services
Sending provider Receiving provider HIEs will provide support for many alert notifications. EDIE continues to provide some alert capabilities, efforts like the SHIEC patient centered data home model may provide sufficient HIE-HIE alerting capabilities.
EDIE Utility HIE HIE
Lite enabling infrastructure
Patient arrives at care location Send ADT alert
Labs Hospitals Health plans CCOs Physicians and Clinics Hospitals Health plans CCOs Physicians and Clinics HIE 38
Robust statewide services model
Labs Hospitals Health plans CCOs Physicians and Clinics
Sending provider Receiving provider A statewide notifications hub, building on patient-provider attribution services, could receive ADT information from a variety of sources and transmit notifications to care team members as appropriate. HIEs would provide support for some alert notifications within their own network, and could leverage the statewide hub to provide out-of- network notifications.
Patient arrives at care location Send ADT alert Hospitals Health plans CCOs Physicians and Clinics
Robust enabling infrastructure
Use Cases: Alerts
HIE HIE CareAccord Provider Directory Patient provider attribution Master Patient Index Notification Hub Record Record Locator Service 39
Status quo Model
Identify other involved providers Send/ request records
Care Team Other participating providers Care coordination outside of established networks is difficult and typically relies on patient/ caregiver identification of other care team members. Records are then requested through DSM, fax or other methods, but there is little infrastructure to support back and forth communication.
Labs Hospitals Health plans CCOs Physicians and Clinics Custom Interface Patient-led HIE Fax
Use Cases: Care Coordination
Labs Hospitals Health plans CCOs Physicians and Clinics Provider Directory
Lightweight enabling infrastructure
CareAccord
Statewide Service
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Robust HIE Model with lite services
Labs Hospitals Health plans CCOs Physicians and Clinics
Under a robust HIE model, care coordination within an HIE is enabled through record location and notification
supported by notification pilots like SHIEC patient centered data home model.
Custom Interface Patient-led HIE Fax HIE HIE
Identify other involved providers Send/ request records
Care Team Other participating providers
Labs Hospitals Health plans CCOs Physicians and Clinics Provider Directory
Lightweight enabling infrastructure
CareAccord
Statewide Service
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Robust Statewide Services Model
Statewide services allow for widespread record location and notification services. National frameworks like Carequality provide a mechanism to exchange needed records for Carequality participants and are enhanced by using statewide services. HIEs support coordination through record location and notification services that can be connected to a statewide system for out-of-network information and play a data curation role.
CareAccord Custom Interface Patient-led HIE Fax HIE
Robust enabling infrastructure
Provider Directory Patient provider attribution Master Patient Index Notification Hub
Record Locator Service Identify other involved providers Send/ request records
Care Team Other participating providers
Query Protocol Labs Hospitals Health plans CCOs Physicians and Clinics Labs Hospitals Health plans CCOs Physicians and Clinics 42
Status Quo Model Robust HIE Model Statewide Services Model Benefits and Opportunities E.g., Requires little agreement or coordination, and allows the private market to drive connections E.g., Allows for multiple, regional HIEs to meet exchange needs and avoids duplication at statewide level E.g., Builds on regional HIE
supports a “connect once” approach and allows for future statewide investments at lower costs Challenges and Risks E.g., Will result in duplication of efforts and significant gaps in exchange capacity will remain E.g., Will require significant additional investments in HIE
ensure critical mass
E.g., Will require extensive coordination and financial support from myriad stakeholders
Less Risk/ More HIE white space More Risk/ Less HIE white space Consider:
statewide?
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Statewide Approach Status Quo Model Robust HIE Model Statewide Services Model
Large integrated delivery systems Mid-sized health system and independent hospitals Smaller practice/ specialty clinic, safety net providers Behavioral health, oral health LTSS, social services, etc. CCOs, payers with alternative payment models Oregonians – individuals and their caregivers
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Susan Otter, Director of Health IT
– Given feedback from last HITOC meeting and work on network
HIE/network of networks – Consider roles: – trust framework, infrastructure, coordination
– Governance opportunities – Challenges – Advice/considerations
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Legal Dispute Resolution
Connections Services
Monitor and adapt Standards
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Kristin Bork, Lead Policy Analyst
Support Medicaid members over the next 4-5 years, with the help of 90% HITECH federal funds and 10% general funds, by:
1) Accelerating HIE and filling gaps for critical Medicaid providers’ ability to coordinate care through connecting to HIE entities 2) Incentivizing cross-organizational HIE by supporting Oregon’s critical HIE entities that make up its network of networks by funding
3) Establishing and formalizing the Oregon HIE network of networks by ensuring HIE entities in Oregon are able to support HITOC’s HIE
entities would need to meet to be eligible for funding
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HIE Onboarding Program—HITAG
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Francie Nevill, Policy Analyst
– Enthusiastic about moving forward with funding request – Good discussion about HOP priorities
– Wrapped up group output for the planned meetings – Overall, group was invaluable in fleshing out program concept – May reconvene some portion of group to help with RFA/RFP
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– Now available on website: https://www.oregon.gov/oha/OHIT/Pages/HIE-
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– Connect major trading partners early in the program – Most are now prioritizing behavioral health – Actual costs vs incentive payments – Long term care is important but challenging technically – HIEs must be skilled at communicating value to providers – Expect to spend more time and effort than predicted – Expect the unexpected
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Kristin Bork, Lead Policy Analyst
– Connection of larger systems creates value for smaller providers/systems – Leverage HIEs’ existing footprint – When expanding geographically, connect major trading partners
– Facilitate coordinated care across physical and non-physical health – Incentivize onboarding of some organizations that cover larger number
– Incentivize onboarding of major trading partners to set up smaller providers for success – Lay the groundwork and plan future phases with LTSS, social services, and other critical Medicaid providers
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Provider Type Specific Providers Covered Behavioral health Community Mental Health Programs, Certified Community Behavioral Health Centers, behavioral health homes, ACT teams, mobile crisis teams Oral health DCOs, Fee for Service Critical physical health Medicaid providers who participate in: PCPCH, FQHCs (incl. FQHC APM), RHCs, CPC+, tribal health, equity-focused clinics, corrections health Major trading partners Major trading partners, including those at interstate borders, and especially those that affect the value of HIE for smaller and rural/frontier providers
*Roadmap for later phases includes LTSS, social services, and
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Executed Agreement Simple Access (portal) Integrated Access Support (< 1 year)
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the required 10% match in budget; will vary from year to year
reporting requirements
run concurrently)
actual costs (with a cap), a set amount, and/or incentive-like payments
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Susan Otter, Director of HIT
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– Extending April – Or add May retreat
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