Health Information Technology Oversight Council August 4, 2016 1 - - PDF document
8/4/2016 Health Information Technology Oversight Council August 4, 2016 1 Agenda 12:30 pm Welcome, Introductions & HITOC Business 12:40 pm Health Information ExchangeOregon Context and National Initiatives 1:15 pm Health
August 4, 2016
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12:30 pm Welcome, Introductions & HITOC Business 12:40 pm Health Information Exchange—Oregon Context and National Initiatives 1:15 pm Health Information Exchange—Panel Presentations 2:20 pm Break 2:35 pm Group Discussion on Health Information Exchange 3:10 pm Updates 3:35 pm Public Comment 3:40 pm Closing Remarks
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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 Marta Makarushka
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Oregon’s HIT Strategic Plan:
actionable patient information to coordinate and deliver “whole person” care.
available to care team
efforts, gaps (white spaces), and barriers
The HIE group discussion is intended to inform OHIT’s strategic plan, which will include:
data should be freely shared)
efforts, are there gaps in the available technologies or opportunities)
In addition, we would like the discussion to inform one of
(e.g., For providers who face gaps or in regions where there is no HIE, what are we onboarding them to?).
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transfer of health information between two or more health IT systems
– Sometimes HIE can also refer to an organization that provides this service
systems to communicate and exchange data between them, and make use of that data
– Finding (query); Sharing (send), Exchanging (receive) – Viewing; Using:
– Direct secure messaging (e.g., via EHRs, HIEs, CareAccord) – EDIE/PreManage – Public health reporting (e.g., Immunization registry, PDMP) – HIE-enabling (Provider Directory, FlatFile Directory for Direct
secure messaging addresses)
– Regional HIEs (JHIE, RHIC) – Vendor-driven solutions/National networks:
– Federal Network (Sequoia: eHealth Exchange)
– Organizational efforts:
hosted EHRs, etc. that support sharing information across users
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WASHINGTON PACIFIC OCEAN CALIFORNIA NEVADA IDAHO
Astoria Saint Helens Tillamook Hillsboro Portland Hood River The Dalles Moro Condon Heppner Pendleton La Grande Enterprise Baker City Canyon City Fossil Madras Salem Dallas Newport Albany Eugene Bend Prineville Coquille Roseburg Burns Vale Lakeview Klamath Falls Medford Grants Pass Gold Beach McMinnville Oregon City Corvallis Clatsop Columbia Tillamook Washington Multnomah Hood River Wasco Sherman Gilliam Morrow Umatilla Union Wallowa Baker Grant Wheeler Jefferson Marion Polk Lincoln Linn Lane Deschutes Crook Coos Douglas Harney Malheur Lake Klamath Jackson Josephine Curry Yamhill Clackamas Benton
Enrolled hospitals & clinics Enrolled clinics Some Interest in participating Currently no activity 12
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– Smoking status – Vital signs – Care plan field(s), including goals and instructions – Procedures – Care team members – Immunizations – Unique device identifier(s) for a patient’s implantable device(s) – Demographics – Allergies – Medications – Diagnoses – Problem List – Clinical summary – Continuity of Care Document – Labs – Imaging
Sources include the Common Clinical Data Set from ONC’s Interoperability Roadmap
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The following are required for HIE to occur:
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– Geographic (Rural – Urban) – Organization/provider type (Non-EP* – EP) – Organization/provider affiliation (Not affiliated – affiliated)
– Technological (Basic – sophisticated) – Interoperability (Low – high) – Resources (Low – high)
*EP=Eligible Provider
A B C D E F
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A: Rural Urban B: Non-EP* EP C: Unaffiliated Large system D: Basic Tech High Tech E: Low Interop. High Interop. F: Low Resource High Resource *Eligible Professional
A B C D E F A B C D E F A B C D E F
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1: Few gaps (minimal white space)
system
some partners (med- high interoperability)
funding (high resources)
2: Medium gaps (moderate white space)
independent practice
interoperability
3: Large gaps (significant white space)
larger health system
address (uses DSM)
A B C D E F
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A: Rural Urban B: Non-EP* EP C: Unaffiliated Large system D: Basic Tech High Tech E: Low Interop. High Interop. F: Low Resource High Resource *Eligible Professional
A B C D E F A B C D E F A B C D E F
federal or national opportunities when it makes sense
– Included as a principle in Oregon’s HIE Business plan framework
happening/changing at the national level
– Footprint in Oregon – Consider leveraging these as resources to help fill HIE gaps
HealthTech Solutions, LLC.
August 4, 2016
HealthTech Solutions, LLC.
HealthTech Solutions, LLC.
Push information from a known entity to a known
HealthTech Solutions, LLC.
Problem being solved Solution Approach to solve problem Key components
Leading members (not exclusive list) Providers are not able to securely push rich data to another provider
related
(including
without EHRs) Governance and Trust Anchor Bundle/Network Services Push (send) information from entity to entity Security and Trust Framework for exchange via Direct Protocol at national scale and at strong level of Identity Assurance Policies for security/trust Federated Services Agreement Accreditation programs Trust bundle infrastructure Governance HISPs, Certificate Authorities, EHRs, PHRs, HIEs, Provider Organizations, Federal Agencies
HealthTech Solutions, LLC.
HealthTech Solutions, LLC.
Self-governing, nonprofit trade alliance of 150
Uses Direct Secure Messaging (DSM) exclusively Centralizes and simplifies policies, interoperability
Key Services: Accreditation and Audits Trust bundle of “Trust Anchor” Digital Certificates with
accredited HISPs
Impending provider directory for DirectTrust members
HealthTech Solutions, LLC.
Enables DSM exchange across different entities
From a provider perspective HISP Accreditation brings assurance HISPs add anchor certificates to trust bundle – allows for
provider to securely connect to many organizations
Allows providers to share data across vendor platforms and
Direct footprint in OR includes most hospitals and health
HealthTech Solutions, LLC.
Federated query retrieval: allows for simultaneous searches
A user must initiate a single query request which is
distributed to the search engines, databases, or other query engines participating in the federation.
Services Required: Patient Matching Query through distribution
& response listing with possible aggregation
HealthTech Solutions, LLC.
Problem being solved Solution Approach to solve problem Key components
Leading members (not exclusive list) Lack of an easily implemented HIE which provides access to patient- centric data across the continuum of care Governance and necessary support structure Patient record access built natively into HIT products such as EHR Centralize any necessary support structure Patient ID Manager Record Locator Query/Retrieve Broker HIT vendors, e.g., EHR, LIS, HIS, Portal, App, etc.
HealthTech Solutions, LLC.
HealthTech Solutions, LLC. Vendor created organization Formed in 2012 by seven founding member companies: Allscripts, Athenahealth, Cerner, Evident (CPSI), Greenway Health, McKesson,
and Sunquest
See all members here: www.commonwellalliance.org/members/ Supports and works with other HIT initiatives 4,700 provider sites (not organizations) – Oregon footprint: Hospital/health systems: Tuality, Adventist, Southern
Coos; +~40 provider sites.
See map here: http://www.commonwellalliance.org/providers/
Progressive solutions FHIR/API’s: Data not documents Consumer-driven exchange & directories
HealthTech Solutions, LLC.
Incorporated directly into the practice’s current HIT
Four main services: Person Enrollment Record Location Patient Identification and Linking Data Query & Retrieval Utilizes standards for locating and retrieving
HealthTech Solutions, LLC.
Problem being solved Solution Approach to solve problem Key components
Leading members (not exclusive list) Lack of HIE which provides access to patient-centric data across the continuum of care Governance and use existing standards for data sharing between participants Use of IHE protocols and patient matching to find and request copies of patient information DURSA legal framework Governance Operating policies/ procedures Technical services Federal Agencies, hospitals, medical groups, pharmacies, dialysis centers
HealthTech Solutions, LLC.
HealthTech Solutions, LLC.
The eHealth Exchange network was originally named
The ONC started the original governance and then
eHealthExchange is operated by The Sequoia Project
eHealth Exchange connects healthcare organizations,
Oregon footprint – Kaiser, Legacy, OCHIN, OHSU, The
HealthTech Solutions, LLC.
Problem being solved Solution Approach to solve problem Key components
Leading members (not exclusive list) Participants of
(e.g., regional HIE) cannot exchange information with participants of another network (e.g., CommonWell) Governance and set any new standards needed Convene a diverse cross- sector group to achieve collective agreement on technical specifications and rules for participation Technical specifications Common rules of the road Participant directory Physicians, Payers, Government Agencies, Public Health, Vendors
HealthTech Solutions, LLC.
HealthTech Solutions, LLC.
Enables networks to securely exchange information with one
another (vendors, payers, labs, HIOs)
If a network joins Carequality and adopts the
Interoperability Framework, that network’s members can share data with participants of other Carequality joined networks
This is possible through the governance of the
interoperability framework and its common standards for data and security
Oregon footprint – Legacy health system Vendor “implementers”: athenahealth, eClinicalWorks, Epic, GE
Healthcare, Netsmart, NextGen, Surescriptions.
Supporters: Cerner, Greenway, Kaiser, Medicity, Mirth, Orion, etc. http://sequoiaproject.org/carequality/members-and-supporters/
HealthTech Solutions, LLC.
Rural vs. Urban Supports Non-MU Providers? Large System Affiliation Technological Sophistication Interoperability Accessible with limited resources? DirectTrust All Yes Yes, but not exclusively Yes Medium-content specific Yes CommonWell Vendor Specific No-driven by CEHRT vendors Yes Yes Medium-vendor specific No eHealth Exchange Depends
regional network No More likely to join No Medium No Carequality Depends
regional network No More likely to join No High No
HealthTech Solutions, LLC.
Alternative payment models are changing the value
Network of networks Less focus on State Designated Entities Exchange driven by relationships and economics Alternatives to regional solutions (e.g., CommonWell) Flexible alternatives: Data not document driven Policy focus: Interoperable Exchange of Health
Chuck Fisher, Advantage Dental Brandon Gatke, Cascadia Behavioral Health
Sonney Sapra, Tuality Healthcare Maili Boynay, Legacy Health
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What is your experience with health information exchange? – ADIN is our HIE
– Bridges communications gap: supports 7 PMs – Used in daily office work both at AD and other providers – Large outreach functionality that is being increased – 5 years and still going!
– Adoption (SOSDD) » Shared vision » Don’t need it » No PM to connect to
Highlight any national, state, or local HIE efforts you participate in
Do you use Direct secure messaging?
DSM
Who are your critical trading partners and priority data exchanged?
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What are your current information gaps and priorities?
– Gaps:
– Priorities:
What are the benefits and what are the top challenges?
– Benefit: the triple aim – Challenge: Finding practices who can become trading partners is near impossible (Money, Resources, Vision).
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What is your experience with health information exchange?
– Poor experience (varying technical capabilities, changing payment systems, resource limitations, etc…) Yet there is hope. – Not participating in any HIE beyond PreManage (event notification) – No direct secure messaging beyond ‘Secure Email Systems’ (not integrated into EMR or CareAccord) – Who are your critical trading partners and priority data exchanged?
PHTech/Payer Connection (claims processing), PreManage (that is evolving), CCOs (Outcomes and Encounter Info), County Agencies (ex. Multnomah & Clackamas)
What are your current information gaps and priorities?
– Gaps: Primary Care (including Dental), Medications, Labs, Housing, Insurance Information (eligibility) – Priorities: Medications and Hospitalizations
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What are the benefits and what are the top challenges?
– Benefits: Improved clinical care through accurate data (better
– PreManage is helping in this area. – Challenges: Limited resources, maturing technology for Behavioral Health,)
creating confusion and barriers to sharing data for better patient care.
Service vs. Hybrid Model)
take Medicaid) – Not being aware of currently available community resources
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What is your experience with health information exchange?
– In the Portland area, we mostly experience HIE as it exists on the Care Everywhere platform. We can access all EPIC providers (including some read access to ER notes, labs and imaging and discharge notes at Adventist) plus the VA. If a provider is not on EPIC, we are still using fax or phone. – We are planning to start using PreManage, but have not yet started
Do you use Direct secure messaging?
– We are in the process of starting to use this. We are building a connection between our own MH providers at the County (Evolve) and School Based Primary Care (OCHIN Epic). This will be a push notification between clinicians in the same SBHC who use these different records.
Who are your critical trading partners?
– Local hospitals, long term care/SNFs, behavioral health/mental health, addictions
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Priority data exchanged?
– Problem list, meds, allergies, labs, progress notes, admit and discharge summaries and treatment plans – For managed care plans, it is claims, for pharmacies, it is fill history
What are your current information gaps and priorities?
– The SBHC use case listed above is a key gap and priority, MH and addictions are a major gap
What are the benefits and what are the top challenges?
– Benefits are around care coordination and continuity of care, information is available at the time it is needed and services are not
and lots of system generated messages that don’t contain useful content. – We would prefer to be able to log into one place that had the patient at the center, rather than trying to build up a picture based on bits of information from numerous connected systems
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What is your experience with health information exchange?
– Most of our patients are seen in a single hospital-owned clinic – All ER docs have access to this EHR, as do ER and hospital nurses – Referral hospital on same EHR through hospital-to-hospital partnership – No Direct secure messaging used
What are your current information gaps and priorities?
– Records from the VA clinic in town
What are the benefits and what are the top challenges?
– Benefit: no need for HIE due to rural area – Challenges: no HIE mechanism in place
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What is your experience with health information exchange?
– Commonwell – If our community providers have an EHR that is part
– Non-Commonwell – Point-to-point connections that exchange CCDAs, Orders and Results, and Discharge Documentation – EDIE and PreManage
Do you use Direct secure messaging?
– We use Direct through Cerner. They are a certified HISP within the Direct Trust. We have loaded the State’s Flat File Directory into Cerner so our providers can search for other providers with a Direct email address
Who are your critical trading partners and priority data exchanged?
– OHSU Partners – Community Providers – Business Case Requirements
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What are your current information gaps and priorities?
– We exchange CCDAs and Orders, Results and discharge documentation depending on need and requirements – Gaps are with specialties and giving the providers the data that they find valuable
What are the benefits and what are the top challenges?
– Benefits – getting basic information to the providers and somewhat
patient history. – Top Challenges – Pleasing providers with data that they receive, and making it so that it is specific to their needs. Not everyone wants the same information or thinks it is valuable. Standardization.
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What is your experience with health information exchange?
– National:
– Local/private:
– Do you use Direct secure messaging? Yes
Who are your critical trading partners and priority data exchanged?
– Legacy’s Clinically Integrated Network. Our priority is to exchange discrete claims and clinical data
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What are your current information gaps and priorities?
– Gaps 1. Standard specifications across EHR vendors and payors 2. Lack of discrete data 3. Sluggish industry development 4. National expectations for value based transition moving faster than technology development can keep up with. 5. Financial expense – Priorities
quality measure data warehousing/reporting for clinical and claims data
What are the benefits and what are the top challenges?
– Continuity of care – Community collaboration – Reduce costs
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Susan Otter
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The HIE group discussion is intended to inform OHIT’s strategic plan, which will include:
data should be freely shared)
efforts, are there gaps in the available technologies or opportunities, how do we set up the right partnership/coordinating role)
In addition, we would like the discussion to inform one of
(e.g., For providers who face gaps or in regions where there is no HIE, what are we onboarding them to?).
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with governance over “network of networks”
– HIE efforts have expanded independently with no oversight or governance role at the state level
– This model includes setting criteria to support statewide HIT
sanctioned HIE services and to be eligible for funding or other support
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in OR?
a) Is there a minimum data set? b) Prioritize certain types of users? c) Prioritize certain use cases?
place/being pursued in OR?
a) To what extent is there a gap involving a high priority area? What are our options? b) To what extent can national initiatives address gaps/meet needs? c) To what extent do we need to do something different?
a) What principles should we consider for a central coordination role?
to these questions?
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In the Oregon’s Business Plan Framework 2013-2017:
while anticipating changes
establish credibility
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The HITOC discussion of June 2016 implied several considerations or principles for moving forward with a coordination role for statewide HIE efforts including:
all boats”
model to extend current efforts into the “white spaces” where there are little or no HIE options
– Connecting the nodes or enabling connections (e.g., Provider Directory) – Services that are most appropriate statewide and/or have significant economies of scale if we do it together (e.g., EDIE)
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http://www.oregon.gov/oha/OHPB/Pages/health-reform/cms- waiver.aspx
HIT vendor letter
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Next Meeting: Thursday October 6, 2016 Location: Transformation Center Training Room 421 SW Oak St, Suite 775, Portland
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