A Closer Look at HIE/HIO & the Direct Protocol: Exploring the Connection to Meaningful Use Stage 2 Implementation & Information Exchange

Transcription

1 December 18, 2013 A Closer Look at HIE/HIO & the Direct Protocol: Exploring the Connection to Meaningful Use Stage 2 Implementation & Information Exchange Facilitator: Lee Barrett, Executive Director, EHNAC Panelists Catherine Costello JD, Project Manager Ohio Health Information Partnership David Kibbe MD, MBA President/CEO DirectTrust Alex Kontur, Research Analyst, ehealth Initiative (ehi) Lee Stevens, Director, State HIE Policy, ONC Andrea Perry MPA, Privacy Officer, Ohio Health Information Partnership Andrew VanZee, Director Healthcare Strategies & Technology Indiana Family & Social Services Admin. For National ehealth Collaborative (NeHC) Mariann Yeager, Executive Director HealtheWay

2 Agenda L. Barrett: Panel Intro. & Setting the Stage L. Stevens: Review of current industry initiatives for exchanges and the Direct Protocol A. Kontur: ehi 2013 HIE survey and Summit key topics A. VanZee: NeHC Workgroup Certification/Accreditation Inventory initiative M. Yeager: HealtheWay Exchange Connectivity D. Kibbe: The role of DirectTrust and the Direct Protocol C. Costello/A. Perry: OHIP Case Study Q&A 2

3 Webinar Objectives Explore how organizations can assure interoperability and scalable trust; Explain the significant differences between EHR technology software certification and security/trust accreditation for HISPs, CAs and RAs who partner with EHRs; Provide best practice examples of how to facilitate security, interoperability and trust among exchange participants, fostering public confidence, and promoting the adoption and success of all exchange stakeholders; 3

4 Webinar Objectives cont. Describe ways to reduce PHI exposure risks through the demonstration of comprehensive risk management programs; and Outline how to prepare your exchange for implementation of secure communications in support of Meaningful Use requirements by the ONC. 4

5 Challenges Understanding the role of the various industry organizations What are the various exchange models in use today Stakeholder Trust Managing Risk & Risk Mitigation Privacy and security issues 5

6 L. Stevens: Nationwide HIE Strategy 6

7 Nationwide HIE Strategy Lee Stevens Director State Health Information Exchange Policy Office ONC

8 Information Securely Follows Patients Whenever and Wherever They Seek Care QUERY-BASED EXCHANGE MULTIPLE MODELS DIRECTED From Health Affairs, March 5, 2012 CONSUMER-MEDIATED EXCHANGE 8

9 HIE Market Reality HIE facilitated by a variety of organizations/sources including: HIOs HISPs EHR vendors National services providers Hospitals ACOs Health Center Controlled Networks Others 9

10 ONC s Approach HIE is a journey, not a destination Leverage government to create conditions of exchange Health information exchange is not one-size-fits-all Multiple approaches will exist side-by-side Build in incremental steps don t let the perfect be the enemy of the good 1 0

11 ONC s Role Reduce Cost and Increase Trust and Value To Mobilize Exchange COST Standards: identify and urge adoption of scalable, highly adoptable standards that solve core interoperability issues for full portfolio of exchange options Market: Encourage business practices and policies that allow information to follow patients to support patient care HIE Program: Jump start needed services and policies ONC VALUE Payment reforms Meaningful Use Wide-scale adoption TRUST Identify and urge adoption of policies needed for trusted information exchange 11

12 The State HIE Program (data as of Q2 2013) WA OR ID NV UT CA AZ Other states and territories AK HI AS CNMI DC PR GU USVI MT WY NM CO ND SD NE KS TX OK MN IA MO AR LA WI IL MS IN MI TN AL KY OH GA WV SC PA FL MD VA NC VT NH NY ME MA RI CT NJ DE Directed Exchange Color Legend Directed Directed exchange exchange mechanisms available mechanisms in regions broadly available Directed exchange mechanisms being piloted Directed exchange mechanisms not available Query-Based Exchange Pattern Legend Query-based exchange mechanisms broadly available Query-based exchange mechanisms available in regions Only 3 territories do not have operational exchange options available for providers today Most states now offer both directed and query exchange options to providers

13 State HIE Program Progress Adoption Total number of clinical and administrative staff enabled for directed exchange nationally Total number of clinical and administrative staff enabled for query-based exchange nationally CY Quarter 2, 2012 CY Quarter 2, , ,853 63, ,132 13

14 State HIE Program Progress Transactions CY Quarter 2, 2012 CY Quarter 2, 2013 Total number of directed transactions nationally Total number of patient record queries nationally 72,766, ,855,385 2,524,385 11,662,380 14

15 Focus on Exchange in the Stage 2 Meaningful Use Criteria E-prescribing Transition of Care summary exchange: Create & transmit from EHR Receive & incorporate into EHR Lab tests & results from inpatient to outpatient Public health reporting transmission to: Immunization Registries Syndromic surveillance Reportable lab results Cancer Registries Patient View, Download and Transmit to 3rd Party

16 Care and Payment Reform Activities Inter-professional Education & Inter-collaboratory Practice Models Patient Centered Medical Home (PCMH) Pay for Performance (P4P) Programs to pay for value; not for volume (outcome; not services) Accountable Care Organizations (ACO) Shared Savings Program (SSP) Advanced Payment ACO Model Pioneer ACO Model Center for Medicare & Medicaid Innovation Programs (CMMI) State Innovation Models Initiative (SIM) Comprehensive Primary Care Initiative (CPC) Bundled Payments for Care Improvement Program (BPCI) Community-based Care Transitions Program (CCTP) 16

17 Strategies to Advance Nationwide Exchange Enable a governance infrastructure, including a trust framework, that reduces barriers to exchange Coordinate across federal government partners on HIE funding, innovations and implementations Create shared learning opportunities to identify best practices and lessons learned to advance exchange Coordinate between real world implementers and the S&I Framework to test standards and develop implementation guidance Convene implementers to develop and implement solution packages to thorny and important exchange challenges to drive towards nationwide adoption 17

18 Strategies to Advance Nationwide Exchange Support HIE as an important element of meaningful use of EHRs Help vendor community (EHR and HIE) understand meaningful use requirements and options Help identify and resolve technical and policy issues Better understand vendor needs and challenges and help coordinate practical solutions 18

19 Strategies to Advance Nationwide Exchange Support state-level and community HIT-enabled care transformation Work with CMS and vanguard states to develop models for developing and deploying HIT infrastructure at the state level to support payment reform and care transformation Support states in using policy, contracting, regulatory and convening levers to build a stronger business case for exchange and address the exchange needs of payment reform Convene state policy leaders, federal partners and other leaders to tackle and resolve specific issues confronting on the ground implementers who are using HIT to support state-level care transformation including quality reporting, analytics, care coordination and patient engagement. 19

20 Conclusion Nationwide HIE will include directed, query and consumer based exchange There will be a variety of sources for exchange Exchange will develop incrementally MU and payment reform are important policy levers for exchange Governance is required to develop the trust that will enable data to flow between unaffiliated organizations Adherence to nationwide standards and certifications will remove the stove pipes States will continue to be a key strategic partner as HIE supports payment reform and state health goals 20

21 Stay Connected Browse the ONC website at: healthit.gov Contact us at: Follow our blog: Ask a question: BlueButton@hhs.gov Subscribe, watch, and HealthIT and Electronic Health Records

22 Alex Kontur: ehi 2013 HIE Survey and Summit Key Topics 22

23 2013 Data Exchange Survey Results

24 About ehealth Initiative Since 2001, ehealth Initiative is the only national, non-partisan group that represents all the stakeholders in healthcare. Represents over 15 different stakeholder groups and 39 states across the nation. Mission to promote use of information and technology in healthcare to improve quality, safety and efficiency. Last year, over 4500 individuals attended our events and 500+ individuals participated in our national councils and workgroups ehealth Initiative focuses its research, education and advocacy efforts in four areas: Data and Analytics IT Infrastructure to Support Accountable Care Technology for Patients with Chronic Disease Data Exchange & Interoperability 24

25 About the 2013 Survey 10 th annual survey Comprehensive survey to determine the state of the field; covers governance, sustainability, operations, stakeholder participation, privacy policies, and more 199 of 315 identified organizations completed the survey 90 community HIEs, 45 SDEs/state HIEs, 50 healthcare delivery organizations, others include public health, payers 25

26 What We ve Learned 84 have reached stage 5 (operational) or higher Who provides HIEs with data? Hospitals (160), ambulatory care providers (142), independent labs (85), community and/or public health clinics (82) Who accesses data? Ambulatory care providers (159), hospitals (145), community/public health clinics (105), behavioral or mental health (90) 26

27 What We ve Learned Interoperability is a major concern 142 respondents cited interoperability as a pressing challenge 151 organizations have had to build interfaces with disparate systems (68 have had to build 10 or more; 32 have had to build 5 or more) 65 participate in an ACO; 65 plan to do so in the future 90 currently use Direct Transitions of care is the most common use case (65) 30 are NOT planning to use Direct 27

28 What We ve Learned What services do HIEs offer? Connectivity to EHRs (125), exchange of health summaries (115), master patient index (114), results delivery (104), provider directory (84) What data types are available? Results (131), admission/discharge summaries (125), care summaries (125), diagnoses (115), CCDs (113), allergy info (113), patient histories (111), medication data/prescriptions (109) 28

29 What We ve Learned Who is funding HIE? Hospitals (79), state or federal funding (64), ambulatory providers (38), private payers (23), Medicaid (15) How? Memberships fees (71), assessment fees (66), fees for specific services (48), state funds (39) federal funds (34) Are they sustainable? About half (52) receive sufficient revenue from participants to cover operational expenses 29

30 What We ve Learned Opt-out is the most common consent model (115) 109 organizations do not offer patients granular consent controls controls for sensitive information are most common (43) Limited patient access 31 organizations offer patients access to their data 102 plan to offer access in the future 56 have no plans to do so 30

31 Looking Forward Evolving sustainability plans Private payers less emphasis on public sources shift to service fee model HIEs are turning the corner Interoperability is now a more pressing concern than sustainability 31

32 Looking Forward Health reform has helped create the business case for HIE, and service offerings will reflect this HIEs anticipate offering provider alerts (83), patient access (78), analytics (74), reporting to disease registries (66) 32

33 Thank You! Contact info: Alex Kontur

34 Andrew VanZee: NeHC Workgroup Certification/Accreditation Inventory Initiative 34

35 Definitions *As determined by the Accreditation & Certification workgroup Accreditation A process in which certification of competency, authority, or credibility is presented The accreditation process ensures that their policies and practices are acceptable, that organizations behave ethically and employ suitable quality assurance and, if appropriate, that they are competent to test and certify third parties Certification The process of certifying that a certain product has passed performance tests and quality assurance tests, and meets qualification criteria stipulated in contracts, regulations, or specifications 35

36 Forum HIE Accreditation and Certification Workgroup Workgroup Charge Develop an inventory of national, regional, and state accreditation and certification programs, providing a landscape of these efforts including their purpose, scope and source of authority Workgroup Purpose This landscape will provide stakeholders with an understanding of the categories of programs, where and why they are emerging, and what they are intended to address 36

37 Accrediting and Certifying Organizations Data Request Key accreditation and certifying bodies, including state designated entities, were invited to share information to provide understanding of the HIE accreditation and certification landscape Purpose of Accreditation/Certification program: Who is this accreditation/certification relevant to? Who is the target audience? What is the scope (technical, policy, etc.)? What are the issues that are addressed? What are the types of assurances that are gained? What is the source of the authority; i.e. state, regional, national organization? Is the program voluntary or required? Is it an evaluation or a registry? Are there any standards that are being used as a baseline for their certification or accreditation? Are you aware of any overlap in the industry regarding HIE accreditation and certification? If yes, please provide details on overlap. What are the gaps in current HIE accreditation or certification activities; i.e. what other matters would be best served by receiving an accreditation or certification by a third party? What type of entity is best suited to perform this additional verification? 37

38 Organizations Who Provided Information National - Surescripts - EHNAC - CCHIT - DirectTrust - Healtheway Statewide - State of Indiana - State of Kansas - State of Pennsylvania - State of Vermont - Minnesota Dept. of Health - State of Texas 38

39 Initial Conclusions from Information Gathered from Accrediting and Certifying Organizations A continuing theme around these efforts is that to increase trust and interoperability. Much of the target audience consists of HISPS, HIOs, providers, vendors, or HIEs. The scope of the accreditation & certifications center around: Technology Policy/Legal including trust agreements Security Financial Sustainability including fee structures Approximately half are required and half are voluntary with some Texas being voluntary unless you would like to be listed as a trusted entity. The majority of accreditation & certifications are evaluations Many states are using national sources like EHNAC, DirectTrust, Healtheway, and CCHIT as a basis for their accreditation and certification efforts but some Vermont, Indiana mostly, and Pennsylvania pull from other sources as well. 39

40 Potential Gaps What are the gaps in current HIE accreditation or certification activities; i.e. what other matters would be best served by receiving an accreditation or certification by a third party? We do not yet have a reliable and comprehensive testing and certification service unique for HISP/STAs. These entities may be partially tested and certified when using specific EHR vendor modules as relied upon software within the context of the 2014 Edition Certificate Criteria. However, not all HISPs have these partnerships. 40

41 Additional Verification What type of entity is best suited to perform this additional verification? Initially at this early stage, state programs are adequate; however ultimately a public/private non-profit should be responsible Verification standards and other criteria should be set by a community entity or government Verification against criteria should be performed by an independent third party 41

42 Data Request of Non-Accrediting and Certifying Organizations Invited non-certifying bodies to provide information about accreditation and certification programs they are subject to. Organization Name: What HIE accreditation and certifications are you required to comply with? What voluntary HIE accreditation and certifications do you currently comply with? Are they evaluation or registries? Are you aware of any overlap in the industry regarding accreditation and certification requirements? What are the gaps in current HIE accreditation or certification activities; i.e. what other components would be best served by receiving an accreditation or certification by a third party? What type of entity is best suited to perform needed accreditation or certification? 42

43 Non-Accrediting and Certifying Organizations Who Provided Information - Great Lakes HIE (GLHIE) - Brooklyn Health Information Exchange (BHIX) - Rhode Island Quality Institute (RIQI) - Oregon Health Authority/CareAccord (OR HIE) - ConnectHealthcare - Advanced Answers on Demand, Inc. 43

44 Initial Conclusions from Non-Accrediting and Certifying Organizations The majority of respondents are not required to comply with any accreditation or certification programs although states (OR, NY) are slowly developing these programs that may be required in the future. Many are voluntarily certified and accredited with EHNAC and CCHIT. Many did not understand the question about registries vs. evaluations so we did not receive a good sense of their answer. Most were not aware of any overlap in the current requirements. Meaningful Use and HIE was cited by two respondents as a potential gap that could be filled by a third party. Two respondents cited an independent organization as the best one to administer the needed certification and/or accreditation. Some cited EHNAC or CCHIT. One suggested a government agency or accreditation commission. One suggested an entity who was fluent in the laws of the specific state. 44

45 Entities to Perform Needed Programs What type of entity is best suited to perform needed accreditation or certification? An entity best suited to perform accreditation or certification of Qualified Entities in New York State would be one that comprehends the complexity of the HIE environment from many perspectives, including but not limited to technical applications, policy and privacy concerns, overall operations as well as the business community. The entity would also need to be well versed in Federal Law, New York State Law as well as emerging New York State Policy Guidance which governs health information exchange. We believe the current ATCB process with entities like CCHIT are the best. 45

46 Suggested Next Steps Continue to inform and educate the community on the types of accreditation and certification programs, status, and progress. Raise awareness of the value proposition and business case for accreditation and certification. Identify a neutral, credible third-party organization and encourage them to keep track of current accreditation and certification programs for community reference. Encourage above organization to build on current landscape work and collaboratively identify gaps and consider how best to fill them. 46