The Ne Th e New S Statewide Cl e Clinical Da Data R a Repo - - PowerPoint PPT Presentation

WSHIMA 2016 Annual Mee1ng

April 29, 2016 Lynnwood, WA

Th The Ne e New S Statewide Cl e Clinical Da Data R a Repo eposit sitory

Session Objec1ves

• Background – how we arrived here
• The WALink4Health Clinical Data Repository (CDR)
• Clinical informaDon exchange, the state HIE and

accessing the CDR

• Data segmentaDon, privacy and security
• ParDcipaDon requirements
• The Role of the HIM Professional
• GeMng started with the CDR

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The Framework for Strategic Ac1on

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“We will have failed those we serve if we don’t overcome the interoperability challenges that make it difficult to deliver connected and coordinated care.”

Mee1ng Emerging Needs

Sponsor Clinical Data Repository (CDR) Pla5orm

More orgs going at risk for performance, need info/analy>cs to help manage that risk New organiza>onal arrangements (ACOs) require capabili>es

• utside tradi>onal

enterprise HIT resources Needs include repository, analy>cs, repor>ng, individual care and popula>on management tools Data needs go beyond current claims and ADT, include clinical summaries, care plans, assessments

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The Strategy: Advance Health IT Beyond Organiza1onal EHR’s with a CDR CDR

• The WA Link4Health iniDaDve is part of the State’s long-

term efforts to improve health care quality, beVer manage costs and improve health outcomes for all Washingtonians.

• HCA is iniDaDng Washington Link4Health, a mulD-year

iniDaDve to advance the statewide electronic exchange of near real Dme, consolidated clinical records.

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Staged Implementa1on- Mul1 Year Effort

• IniDal services purchased

– Clinical portal – ReporDng portal

• ImplementaDon underway
• IniDal lives commiVed

– Apple Health Enrollees assigned to Managed Care (1.4M) – More lives over Dme such as Public Employees, fee for service, other sponsors.

• IniDal data sets

– Care Summaries from Provider EHR systems – Eligibility data – Claims/Encounter data (6 mth in clinical portal & 2 years in reporDng portal)

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What is the Clinical Data Repository?

• A Clinical Data Repository or CDR is a database designed

to collect and index clinical content for specific uses.

– Create a longitudinal view of all care provided on a single paDent (paDent-centric, point-of-care access for pracDDoners) – Clinical Portal – Aggregate data that can be used in populaDon analyDcs – Aggregate data for performance reporDng to providers across all lives managed by the provider – ReporDng Portal

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Par1cipa1on in Link4Health Helps Meets Stage 2 MU Requirements

• Drive adopDon of clinical data sharing via the State HIE

through purchasing efforts and Meaningful Use.

• Reduce the need to build expensive point to point interfaces

with mulDple trading partners outside your organizaDon.

• Enable eligible professionals and hospitals to meet MU

requirements and tap into remaining incenDves. Note: HCA is working with CMS to ensure contribuEng data (CCDA) to the CDR meets MU requirements for exchanging summaries of care across vendor plaMorms.

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CDR Features and Benefits

• Leverages standards for sharing clinical

summaries

• Supports clinical data exchange with
• rganizaDons without similar plaborms
• Offers common place to share

informaDon for those parDcipaDng in different arrangements

• Aggregates clinical and administraDve

data into longitudinal paDent record

• Available beyond Medicaid and PEB
• May help providers meet ongoing

Meaningful Use ObjecDves and qualify for addiDonal incenDve payments

• Provides the care team a more

comprehensive understanding of the paDent’s medical history.

• Provides mainstream quality reporDng

capabiliDes

• Enables large data extracts for

advanced analyDcs and populaDon health Features Benefits

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CDR Portals

• Clinical: View individual paDent health informaDon for care decisions

and coordinaDon.

– Builds comprehensive medical record including diagnoses, meds & allergies. – Enables data sharing regardless of the EHR vendor system. – Provides a single source to view full paDent profile and medical record – Results in lower administraDve costs and improved paDent safety by lowering the frequency medicaDon errors

• Repor>ng: View aggregate de-idenDfied data for clinical quality

reporDng and populaDon management.

– Receive, parse and sort clinical and administraDve informaDon from a variety

• f sources and in various forms and formats.

– Use a “digital envelope” to inform clinicians, providing real-Dme reporDng on paDent quality at the point of care. – Store disintegrated data so that physicians can access data they need to deliver evidenced-based medicine and high quality care management. – Develop, interpret and report on standard CMS and state specific quality measures.

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High Level Timeline and Gates

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What Does Provider Par1cipa1on Look Like?

• January 2016 MCOs sent HCA’s “Provider Par>cipa>on

LeQer” to their provider networks:

hVp://www.hca.wa.gov/HealthIT/Documents/Provider%20Requirements %20LeVer%202015%2012%2021.pdf LeQer Contained:

• 1. IntroducDon to the CDR to the provider community
• 2. List of the three criteria defining who is required at this Eme
• Contract with MCO to care for Apple Health enrollees
• Have an electronic health record
• Have a 2014 cerEfied EHR
• 3. ClarificaDon for providers that they need to begin geMng ready soon in

preparaDon for the February of 2017 deadline to be contribuDng data

• 4. Link to “how to get started” tools

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C-CDA = (Consolidated Clinical Document Architecture) – modular Na>onal standard for clinical info exchange Cer>fied EHRs designed to export and ingest C-CDA Early in the game – a work in progress

C-CDA – Clinical Document Standard

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CDR Business Model

• Sponsor pays for CDR

costs

• Trading Partners must

become HIE ParDcipants

– Most hospitals, some pracDces already parDcipate in HIE – HIE ParDcipants execute a common contractual framework

• HIE ParDcipants pay a

single annual subscripDon fee

– Covers all services, no transacDon fees

• HIE ParDcipant annual

subscripDon fees derived from matrix below

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Annual Organization Revenue Annual Subscription Fee $0 – $10 Million $600 $10 Million – $100 Million $6,000 $100 Million – $500 Million $12,000 $500 Million – $1 Billion $24,000 $ 1 Billion Plus $48,000

EHR Vendor Role

Vendors play a criDcal role in supporDng providers’ ability to meet C-CDA data contribuDon requirements

Ensure C-CDA meets file format conformance against na>onal standard Work with provider to classify data as N, R or V Set-up constraints for C-CDA message header Allow parameters to be set by provider to trigger data submission per Sponsor specifica>ons Automate C-CDA data submission process to the CDR

OneHealthPort Engaged with EHR Vendors

• OHP working with EHR vendors to address technical

requirements

• What your EHR vendor has to do to submit a C-CDA to

CDR will depend on where they are today

• OHP scheduling web casts for EHR vendors/technical IT

staff and other pracDce staff

• CDR Technical Webcast sign-up link

hVps://onehealthport.formstack.com/forms/ cdr_technical_webcast_registraDon

• CDR Provider Staff Webcast sign-up link:

hVps://onehealthport.formstack.com/forms/cdr_clinical_webcast_registraDon

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Access Controls and Data Classifica1on

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• AuthenDcate

connecDons

• Use Provider Directory

to route messages

• Facilitate exchange of

standard data

• Host API/web services
• API Directory
• Standards PropagaDon

C-CDA Response to API Query from/to EHR

Hospital EHRs push C-CDA to CDR aper each Medicaid encounter. Aper a criDcal mass of data is reached, hospitals can draw C-CDA from CDR into their EHR through the HIE, or view CDR through secure portal.

Push

EHR pushes C-CDA to CDR View only use of the CDR using Portal

Accessing the CDR

Sponsor bulk loads claims and eligibility data Sponsor and other authorized parDes can access reports and/or data 18

Data contributed to the CDR is classified to provide confiden1ality, data integrity and user accountability Data Classifica1on conforms to HL7 na1onal rules. Organiza1ons contribu1ng data are responsible for classifying the data prior to submiang to the CDR

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Data Classifica1on

• CDR data submissions must be classified

– Data classificaDon per HL7 specificaDons – ClassificaDon provides confidenDality, data integrity, and user accountability

• OrganizaDons contribuDng data are responsible

for classifying the data prior to submiMng to the CDR

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CDR Access Levels

• Access control is delegated to the provider enDty
• Leverage the OHP Single Sign-On service
• Seven access roles are established for the first stage
• Appropriate access guided by two key quesDons:

– What level of personally idenDfiable clinical data does this user need? – What need does this user have for populaDon-level reports?

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Repor1ng

• Reports based on aggregated clinical and claims

data

– Clinical summary data contributed by providers aper encounter – 2 years of historical claims plus monthly updates

• Individual Provider, Team/Dept., OrganizaDon and

Sponsor views of data available

• Dimensions reports map to the Quality Measures

that Sponsors have elected:

– Financial (e.g., high cost paDents, providers, PMPM) – ACO Reports – PQRS Reports – HEDIS Star Measures – Washington State Performance Measure Set

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Safeguarding Privacy and Confiden1ality

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• HCA is commiQed to pa>ent privacy and

accuracy of pa>ent records

• Current Efforts with inter-agency privacy

workgroup:

– Openness and Transparency principles – Data collec>on, use and disclosure principles – Safeguard principles (administra>ve, technical, physical, etc)

The Role of Health Informa1on Management

• Reinforce informaDon regarding the purpose and benefits
• f the CDR
• Collaborate with IT and clinical leadership on readiness

acDviDes (role-based access and business process analysis)

• Provide any guidance needed regarding the classificaDon of

data for data exchange

• Reinforce what data exchange is allowable under HIPAA
• Contribute comments/feedback to SAMSHA regarding

42.2CFR proposed rule-making

• Reinforce need for staff to complete CDR training

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Geang Started With the CDR

CDR Start Page provides all the steps needed for providers to onboard, test and contribute data for the Washington Link4Health CDR iniDaDve

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Next Steps/Ques1ons

• HCA and OneHealthPort welcome opportuni>es to expand on

today’s summary overview

• General ques>ons about CDR par>cipa>on email our HCA

Health IT team at HealthIT@hca.wa.gov (Put “CDR” in the subject line)

• For Ques>ons about your MCO contract: contact the provider

representaDve for the MCO

• Visit our website: www.HealthIT.wa.gov

– Short informa>onal webinars – FAQ and Decision Tree regarding CDR par>cipa>on – Other helpful reference materials

• General ques>ons about par>cipa>ng in the HIE or connec>ng

to the CDR: hVp://www.onehealthport.com/HCA_CDR

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