HIT/HIE Community and Organizational Panel Office of Health - - PDF document

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HIT/HIE Community and Organizational Panel Office of Health - - PDF document

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2/22/2017 HIT/HIE Community and Organizational Panel Office of Health Information Technology February 22, 2017 Welcome, Introductions, and Agenda Review 1 2/22/2017 Agenda SHIEC and Patient Centered Data Homes New member

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HIT/HIE Community and Organizational Panel

Office of Health Information Technology February 22, 2017

Welcome, Introductions, and Agenda Review

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Agenda

  • SHIEC and Patient Centered Data Homes
  • New member introductions and all member updates
  • HITOC Strategic Planning Update
  • HIE Onboarding Program: Update and Discussion
  • Prescription Drug Monitoring Program Update
  • Future Topics

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SHIEC and Patient Centered Data Homes

Bob Steffel Dick Thompson Melissa Kotrys Teresa Rivera

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Patient-Centered Data Home

Oregon Health Authority February 22, 2017

S peaker Introduction

Robert Steffel Executive Director Strategic Health Information Exchange Collaborative (SHIEC) Teresa Rivera President and CEO UHIN

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The Problem

Every patient should have their complete, longitudinal health record available wherever and whenever it is needed for decisions about their care.

HIEs: Create and Maintain Critical Infrastructure

 Established with a regional / cultural centered view  Developed based on stakeholder centric needs  Built on stakeholder driven business / governance models

 Engenders trust – community data trust agents  Strong data use agreements  Privacy and consent models work within the legal framework of the region

 Built on platform / technical architecture supporting multiple apps  Robust identity management system and provider directories

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HIEs Work Across S ilos of Data, within Communities

 Collect, scrutinize, filter data (surveillance), alert  Identify individual, provider and content

 Establish relationships (data types, provider index, master person index)

 Determine where data needs to go  Determine how it needs to be routed

 “Push” – notify and / or deliver content  “Pull” – query access to longitudinal record (i.e. “home” HIE)

 Determine when it is needed

About S HIEC

 Association of HIE Networks

 “Where trust relationships and technical standards merge”

 Currently 47 members, representing > ½ of U.S. population  SHIEC members share

 Common vision  Best practices  Problem solving  Resources  Established national initiatives, e.g. Patient Centered Data HomeTM (PCDH)

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S HIEC’s Role

SHIEC: 47 HIE’s representing >½ of U.S. population

The Interoperability Challenge:

SHIEC members are “well connected” within their respective communities, but how do we connect the SHIEC member communities… …efficiently and effectively?

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The S

  • lution: Patient Centered Data

HomeTM

 SHIEC’s Advanced Interoperability Project

 “Exception” event surveillance – across boundaries  Simple and cost‐effective – use existing standards and technologies  Scalable  ZIP Code‐driven alerts  Providers can complete a targeted query (pull information) from other HIEs based upon a “trigger” event  Patient information is available when and where it’s needed  Data becomes part of the longitudinal record in patients’ home HIE

About PCHD

 Patient‐Centered Data HomeTM

 Creates THE comprehensive longitudinal patient record in the HIE where the patient resides  Provides real‐time clinical data

 No matter where care events occurs  Across domain and geopolitical boundaries – “No Wrong Door!”

 A cost‐effective, scalable method of exchanging patient data

 Care events automatically “monitored” by HIEs  Automatic care team notifications “triggered” by an event

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PCDH Guiding Principles

 Each HIE’s unique policies, technology, and values honored

 Governance preserved  Identity management processes sustained  Data use agreements honored and unchanged  Privacy and consent models maintained  Business model unchanged  Technical architecture preserved

S hared Vision / S hared S tandards

 ADT commonly used among participants

 Encounter notification system (alerts)

 Zip Code determines patient data home  MPI number added for output to PCDH HIE

 Downstream Alert delivery

 Determined by each HIE’s unique protocols

 XCA query (eHealth Exchange standard)

 Targeted query matched to MPI

 Triggered by an alert  Records retrieved become part of longitudinal record in HIE

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How PCDH Works

1

  • 1. Patient has care event in HIE 2,
patient’s home is determined by Zip code to be in HIE1’s geography. ADT message, with patient MPI#, is immediately pushed to HIE 1.
  • 2. HIE 1 receives ADT, adds
patient info into it’s MPI, acknowledges patient data availability to HIE 2 and may request data as required.
  • 3. HIE 2 may query HIE 1 as
needed; Responds when queried with complete data
  • n correct patient. Response
time is optimal and HIE 1 and 2 have needed patient info.
  • 4. At any point, HIE 1 may notify
providers via Alert, calculate eCQM’s or any other advanced HIE use case applications.

3 2 4

Western PCDH Proj ect

Arizona: population 6.6M – HIE AzHeC

 MPI: 5.9M  21 hospitals and health systems  2 reference labs and imaging centers

Utah: population 3M – HIE UHIN

 MPI: 5.7M  All 4 major hospital systems and most clinics / labs  80% of all providers

Western Colorado: population .5M – HIE QHN

 MPI: .6M with clinical data  12 Hospitals, all reference labs and imaging centers  94% of all providers

Enlarged Interoperability ~10 Million Lives

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Technical Challenges

 Ensure that ADTs consistently have hospital identifying information  Notifications from “outside” HIEs

 Delivered according to existing protocols

 Automatic query – to do or not to do?  Process for identifying when clinical data is available

What do Providers S ee?

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S ample Detail

 Location of care event  Contact information  Providers noted

S ample CCD with Live Link Images

Live link to image Live link to image

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UHIN S tats Improved Workflow

 No workflow interruption

 Providers receive same notifications they’re used to  Their work with patients isn’t interrupted

 Greater insight into patient’s health

 Event triggered notifications

 Access to more comprehensive records  Reduced time with calls / faxes  Reduction in unnecessary duplicative tests / labs

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PCDH: Central Hub Pilot

 Phase 1: Basic ADT Routing

 Primary Function – ADT Exchange

 Originating HIE sends ADT routed to Home HIE  Home HIE acknowledges data on patient

 Subsequent Data Exchange

 Requires traditional interface (i.e. eHealth Exchange interface or other standard interface) – enriched with 100% matching

 Hub Roadmap

 Additional transactions

 Hub‐routed IHE profiles (i.e. eHealth Exchange transactions)  Hub‐routed QRY HL7 messages; MDM‐wrapped CCD responses  Hub‐routed FHIR transactions (by request)

 Tokenized patient context

PCDH - Central HUB

Patient‐Centered Data Home™ Central Hub

Initial Feature Set

  • Configurable routing/filtering
  • Governance controls
  • Policy gates – each interface, each

direction

  • Field mapping/formulas

Status: >65,000 ADT’s exchanged

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Future Plans

 Connect PCDH initiatives (12 HIEs)

 Western  Central  Heartland

 Connect additional SHIEC members  Establish SHIEC level governance  Identify and prioritize additional SHIEC use cases

PDCH Creating Interoperability Infrastructure

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Importance of HIE-to-HIE Exchange

 Puts patient in the center of his / her care  Allows timely information to be “centered around” the patient – everywhere  Care teams in divergent geographies can coordinate care  Better results  Lower costs

 Simple and comprehensive data collection

 Reduces need for unnecessary duplication (e.g. labs & radiology studies)

 Better medication management

 Builds more comprehensive longitudinal patient record

Benefits

 Leverages trusted local governance, laws, policies, privacy, security  Best opportunity to quickly achieve nationwide “Alerting”  Cost‐effective technology, building on what is already in place  Data aggregated / normalized in “Home” HIE where person resides  Leverages shared trust and shared national standards  Chance for accurate quality measurement (close loop on data quality problems)

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Questions

Robert Steffel

 robertsteffel@gmail.com

Teresa Rivera

 trivera@uhin.org

New HCOP Member Introductions

Chuck Fischer, ADIN Nancy Laney, Mercy HIE

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ADIN

Advanced Dental Information Network Chuck Fischer Advantage Dental

Background

  • Live in 2010
  • Publicly accessible via SSL based web service or GUI
  • MPI
  • Open query structure
  • Endpoint agent
  • Expanded in 2015 and 2016 to store encounters in the

field by our EPDH

The problem you are aiming to solve

  • Efficiently handle sharing of data
  • Meaningful Use compliance was a driving force from

the start

  • Reduce data entry time and errors
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The sources of data/participants contributing to your project

The users of the data

  • Providers in all 36 counties are using ADIN
  • All 43 Advantage Dental clinics leverage ADIN heavily
  • Over 100 providers are using ADIN in their private

practices

The use cases/value propositions you have identified thus far

  • Referrals
  • Demographics
  • Treatment History
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The stage your project is in

  • ADIN has been operational since 2010
  • Connected to EDIE with plans to expand to premange
  • Connections with JHIE and RHIC planned for 2017

Your top 2-3 successes

  • Going live
  • Able to add new clinics in days
  • Able to add new PM software in weeks

Your top 2-3 challenges

  • Finding partners
  • Finding practices
  • Reporting

Mercy HIE

HIT COMMUNITY & ORGANIZATIONAL PANEL FEBRUARY 22, 2017 NANCY LANEY IT DIRECTOR, MERCY ROSEBURG & ST. A’S PENDLETON

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Objective

Meaningful Use Community Integration Trauma Transfers Reduce duplication Referrals

Use Cases/Value Proposition

Emergency Department Follow‐up Care Transfers

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Providence

Me Mercy HI HIE

Mercy HIE

Grapevine

Tiani‐Spirit Hosted by INHS Healtheway Sequoia Project EFM Athena Umpqua OneChart GE Centricity Mercy Medical Center Wonderly Intergy

Jaworski eCW

NE OR Surgical Eastern OR Ortho SAH Clinics Roseburg Urgent Care eCW

  • St. Anthony

Hospital Pendleton OHSU VA PeaceHealth Cow Creek

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Your top 2‐3 successes

Community is onboard Leverage multi‐sites w/vendor Leverage Sequoia

Top challenges

1. Vendor Resources & Availability 2. Clinical Workflow adoption in ED 3. Education and Awareness

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GoLIVE Schedule

November 2016 Live

  • Mercy Meditech LIVE
  • St. Anthony Meditech LIVE

Feb 21, 2017 LIVE

  • EPIC/OHSU

Feb 27

  • eCW

Feb 28

  • Greenway
  • Athena
  • Qvera/GE Centricity

Next Steps

Home Health Sequoia Participants in Oregon:

  • VA
  • Cow Creek
  • PeaceHealth
  • Asante

Sequoia Participants in WA & CA:

  • Extend reach
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Veteran HCOP Members Brief Intros and Updates

  • Overview of initiative
  • Status updates

– Highlights of last 6-months

  • Progress
  • Challenges
  • Successes

Break

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HITOC Strategic Planning Update

Sean Carey Lead Policy Analyst

Network of Networks “Layers”

Governance Trust Framework

Legal Dispute Resolution

Infrastructure

Connections Services

Technology Coordination

Monitor and adapt Standards

5

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Achieving our Vision of “HIT-Optimized” Health Care Collectively Prioritized Initiatives and Improvements Achieving Key Interim Goals/Outcomes Optimal Investment of Available Resources

Governance Opportunity

HIT “Commons” Governance

Governance Roles

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Coordinate and Convene

Standardize and Offer

Centralize and Provide

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Opportunities from a Commons Approach

  • Encouraged spread of HIT innovations across Oregon,

including underserved areas.

  • Shared funding model leveraging state and federal

incentive dollars and spreading costs among participants equitably.

  • Accelerated system selection and procurement.
  • Accelerated implementation through best practices and

shared learnings.

  • Defined expectations and requirements for participation

and data sharing.

  • Alignment of stakeholders to prioritize HIT initiatives

which provide the greatest public good.

  • Sustain momentum and provide continuity of progress.
  • January – February: Initial Input and Research

– February 16 sensing session – February 23 HIT Advisory Group meeting for CCO input – Individual 1:1 sensing sessions with additional stakeholders – Research and reflection on other states’ models, successes, and challenges

  • Starting in March: Interim advisory group meets

to help formulate business plan

  • April/May: Draft business plan input

– OHLC, OHPB, HITOC, HITAG

  • May/June: Final business plan released

Timeline

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  • State partnership model

with governance over “network of networks”

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Problems to Solve

  • Basic movement of health information is improving but

significant gaps and white spaces remain

– Barriers include technology, organizational culture, trust

  • Significant value lies in services that “curate” data and

make it actionable

– HIE needs are heavily dependent on use case – HIE must consider provider workflow to be usable

  • Goal to have minimum core data available wherever

Oregonians receive care or services across the state

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Status Quo with Current Planned Investments

  • Some coordinating infrastructure
  • Some investments in expanding HIE coverage
  • Competing interests in exchange infrastructure will make

alignment more difficult- large systems and HIEs need different enabling infrastructure to capitalize on core competencies

  • Smaller providers, non-physical health providers likely to be

more disadvantaged in achieving robust exchange

  • Predictions:

– 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

Status Quo HIE Model

*Services/ programs in development

** Not shown: connections between organizations/ national frameworks for exchange

Lightweight Services

5 8

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Robust HIE networks

  • Invests resources in Health Information Exchanges as
  • pposed to increased statewide infrastructure
  • HIEs focus on moving information and sharing data.
  • Broad HIE coverage will increase value for larger

systems to connect to HIEs

  • Will require significant growth of HIEs to be useful - may

require designation of a ‘primary’ HIE for practical purposes

5

Labs Hospitals Health plans CCOs

HIE HIE HIE

Physicians and Clinics Labs Hospitals Pharmacies Physicians and Clinics Labs Hospitals CCO Pharmacies Physicians and Clinics

Robust HIE Model with lite services

*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

6

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Robust statewide services

  • Creates accessible infrastructure that supports both

HIEs and larger or more tech-sophisticated systems/ providers

  • Creates multiple options for unaffiliated providers to join

robust exchange networks

  • Infrastructure may reduce the desire of larger systems to

join an HIE

  • HIEs will find some statewide services redundant to their
  • wn offerings and competencies; may shift to provide

data services/ data relationship management as key

  • ffering to members.

6

Behavioral Health Labs Hospitals Health plans CCOs HIE HIE Physicians and Clinics Labs Hospitals Pharmacies Physicians and Clinics Labs Hospitals CCO Physicians and Clinics

Robust Statewide Services Model

*Services/ programs in development Robust enabling infrastructure CareAccord

(Direct secure messaging) PDMP Gateway (and potentially

  • ther Public Health)

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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Statewide Services as Building Blocks

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

6

HITOC February 2016 Meeting Discussion

  • Reviewed straw models and explored benefits, costs and

risks associated with each approach.

  • Strong consensus that the robust HIE approach

represented the best opportunity at this point in time

  • Agreement to keep robust statewide services in a future

state view

  • Next steps:

– Explore additional learnings from other states with a similar approach – Incorporate model into HIT Strategic Plan update planned for August 2017

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Questions?

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HIE Onboarding Program Update & Discussion

Kristin Bork, Lead Policy Analyst Francie Nevill, Policy Analyst

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Today’s Presentation

  • Sharing limited information today
  • Website for updates:

https://www.oregon.gov/oha/OHIT/Pages/HIE‐onboarding.aspx

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HIE Onboarding Program: Overview, Stakeholder Engagement, and Research

Francie Nevill, Policy Analyst

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CMS State Medicaid Director Letter 16‐003

  • HITECH 90% federal funding now available to support the
  • nboarding of a broader range of Medicaid providers to an

HIE entity or interoperable system

  • Onboarding includes:

– Legal activities, including establishment of user agreements – Technical development activities – Configuration – Testing – Workflow integration – Training – Post onboarding support (less than one year)

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CMS State Medicaid Director Letter 16‐003 (cont.)

Providers now included are:

1. Medicaid providers who are eligible for Medicaid EHR Incentive Program (Physicians, Dentists, NPs, and PAs in certain settings) 2. And those providers they need to communicate with to meet Meaningful Use, such as:

  • Behavioral health, including substance use treatment
  • Long‐term services & supports
  • Home health
  • Correctional health
  • Laboratory
  • Pharmacy
  • Emergency medical services
  • Public health providers

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What Oregon’s HIE Onboarding Program will do

  • Support HIE entities’ costs for onboarding priority Medicaid

providers

  • Support HIE entities who can support Medicaid objectives

(e.g., open participation, capable of inter/intra‐state exchange)

  • Support a combination of provider types—potentially in a

staged approach

  • Establish basic standards for HIE entities
  • Leverage existing infrastructure
  • Support a network of networks

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What Oregon’s HIE Onboarding Program will not do

  • Establish a state‐run HIE
  • Provide funding directly to providers, clinics, hospitals, or

health systems

  • Establish new HIEs
  • Support HIEs who do not support Medicaid objectives
  • Support the ongoing costs of HIE entities after onboarding is

complete

  • Support operational costs or purchase EHRs

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Parallel Bodies of Work

HIE Strategy—HITOC

Governance Model—OHA and OHLC

HIE Onboarding Program—HITAG

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HIE Onboarding Program Stakeholder Engagement

  • HIE Onboarding Program Advisory Group (now wrapped up)
  • Released a Request for Information (RFI) mid‐December

– Now available on website: https://www.oregon.gov/oha/OHIT/Pages/HIE‐

  • nboarding.aspx
  • OHA Leadership Meeting in January 2017

– Enthusiastic about moving forward with funding request – Good discussion about HOP priorities

  • Meeting with CCOs tomorrow (HITAG, open to all CCOs)
  • Will continue ad hoc discussions with other internal/external

stakeholders while developing RFA/RFP

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Specific Stakeholders Engaged

Engagement To Date Engagement In Progress and/or Planned

  • Behavioral health
  • Oral health
  • Physical health
  • Long term services and support
  • Corrections health
  • HIE entities
  • Supported housing
  • Social services
  • Standing OHA groups
  • Frontier health
  • OHA Leadership
  • CCOs
  • Individual providers
  • Government to government:

new tribal liaison

  • Hospitals
  • Health systems
  • Intra‐agency
  • Additional/ongoing engagement with

groups already engaged

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Research on other states

  • Interviewed eight other states with HITECH‐funded
  • nboarding programs (AK, AZ, CO, MD, MI, NJ, NY, PA)
  • Detailed interviews yielded reference points, lessons learned
  • Lots of variation overall, but some common themes

– 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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Draft Oregon HIE Onboarding Program Concept

Kristin Bork, Lead Policy Analyst

Goals of Oregon’s HIE Onboarding Program

Support Medicaid providers connecting to HIEs, through 2021, 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 HIE entities that make up its network of networks by funding onboarding for critical Medicaid providers 3) Establishing and formalizing the Oregon HIE network of networks by ensuring HIE entities in Oregon are able to support HITOC’s HIE

  • bjectives and OHA’s Medicaid objectives by setting criteria that

entities would need to meet to be eligible for funding

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Possible Risks of the HIE Onboarding Program

  • Program does not support Medicaid/overall strategic goals
  • HIE entities selected do not provide enough value
  • Providers cannot cover provider‐side costs
  • Smaller/less resourced providers do not want to onboard

because the HIE does not include a critical mass of trading partners

  • Providers do not want to onboard due to privacy concerns
  • Program is developed/implemented too quickly, leading to

errors

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Draft Programmatic Parameters

  • Program will be implemented through 2021
  • Federal and state funding will be available for each year as OHA has

the required 10% match in budget; will vary from year to year

  • Scale of total program depends on funding
  • OHA will select HIEs via RFA/RFP, which will include criteria that HIE

entities must meet in order to qualify

  • Contracts will include oversight by OHA and reporting requirements
  • Program may have multiple phases with different priorities (may

run concurrently)

  • Program will use milestone‐based payments, and may reimburse

actual costs (with a cap), a set amount, and/or incentive‐like payments

  • Will periodically evaluate and adjust program as we learn

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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 Clinics contracted with Medicaid DCOs serving CCO members and Fee for Service population 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 in behavioral, oral, and critical physical health Major trading partners, including those at interstate borders, and especially those that affect the value of HIE for smaller and rural/frontier providers

Draft Phase I Provider Priorities

*Roadmap for later phases includes LTSS, social services, and

  • ther critical Medicaid providers

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Advancing HIE Connectivity: Three Potential Paths

Executed Agreement Simple Access (portal) Integrated Access Support (< 1 year)

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HIE Onboarding Program Tentative Schedule

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Next Steps

  • Funding request submitted to CMS soon
  • Public webinar, likely in March

– More details will be released on our website as we get closer – Everyone interested in the HIE Onboarding Program is encouraged to participate

  • RFA/RFP release likely in Summer 2017

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Questions?

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Prescription Drug Monitoring Program/ HB 4124 and Gateway Update

Susan Otter

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Process Check

  • Are you finding these meetings valuable?

– Most valuable? Least valuable?

  • What did you like about today’s meeting?

– Topics? – Format? – Discussion?

  • What would you like to see us change?

– What should we add? – What should we remove?

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Conclusions, Next Meeting, and Action Items

  • Upcoming 2017 HCOP meetings (all 1-5 pm on

Thursdays in Portland) – April 13th – July 13th – October 12th

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2/22/2017 45 For more information on Oregon’s HIT/HIE developments, please visit us at http://healthit.oregon.gov Susan Otter, Director of Health Information Technology Susan.Otter@state.or.us Marta Makarushka, Lead Policy Analyst Marta.M.Makarushka@state.or.us