Delaware Health Information Network Town Hall Wednesday, August 14, 2013 10:00 a.m. 11:00 a.m. Conference Room 107 Wolf Creek Boulevard Suite 2 Dover, DE 19901 Meeting Minutes Purpose To keep our public informed. Agenda What we are doing What we will be doing What should we be doing (public feedback?) I. CURRENT Activities Update DHIN has reached the 81% sign-off mark which means that 81% of practices enrolled are currently receiving results exclusively through DHIN. This is an important business milestone for DHIN; our business model relies on the data senders paying into DHIN, and they get greatest value if the only way they have to supply results is through DHIN. DHIN is ahead of the projection put forth in our business plan which was approved by the governor and general assembly. Out of State Atlantic General Hospital is now in production. AGH is now interested in expanding participation in DHIN to include more of their facilities in Ocean City, Maryland. DHIN has signed an MOA with Union Hospital in Elkton, Maryland. Union Hospital is a border hospital and data will be helpful in completing the community health records. DHIN is also in negotiations with Peninsula Regional Hospital.
DHIN has an agreement with the Maryland HIE (CRISP) to send ADTs from the Maryland hospitals for residents of Delaware and vice versa. DHIN is working on incorporating those feeds into our Event Notification System and working with Medicity to incorporate the Maryland data into ProAccess. The first to benefit from the connection with CRISP will be those who have subscribed to the ENS and ultimately it will be accessible as another data point in ProAccess. Public Health Immunization Reporting DHIN continues to make progress with immunization reporting; during the month of July 44% of all entries into the DelVAX state immunization registry were VXU messages submitted through DHIN. Representatives from the immunization program have been extremely happy. This has significantly not only improved their workload, but they no longer need to hire temporary staff to catch up. Electronic Lab Reporting Bayhealth and Beebe are now in full production and sending messages into Public Health. State epidemiologist have signed off that they are getting data they can use. St. Francis and Christiana Hospital are both still being content tested and it will be a few weeks before completed. DHIN is also in the planning stages with Nanticoke to receive their electronic lab reporting through DHIN into Public Health. Nemours will hold off until they are able to receive a complete system upgrade. DHIN will be bringing the Public Health lab on board as a data sender and expect to have them in production by end of the January. DHIN continues to work with Public Health on newborn screening, which will take place in several phases before the end users sees results. The initial phase will involve equipment and software upgrade for the hospitals. The Newborn Screening Kickoff took place last week with all involved players to ensure that the hospital hearing/testing equipment has the technical capability of sending the properly formatted messages electronically into Public Health. We are using grant funding to evaluate the hospital equipment to determine if upgrades are needed. If so, we will also use grant funding to help provide the correct equipment and tools to be able to send the messages electronically. CCD Exchange DHIN is in a pilot program with Delaware Health Net which is currently in testing. We are working through the minor snags of patient matching and connectivity; but plan to be in production later this month. Getting information into DHIN from ambulatory practices using their EHRs is a new data type for DHIN.
One of DHINs goals for FY14 is CCD Exchange. By the end of the fiscal year, we should have thirty practices sending CCDs into DHIN. Delaware Health Net uses Allscripts, which is an EHR that has a large footprint in Delaware. Once successfully tested with Delaware Health Net, we should be able to bring on other Allscripts practices and with each practice/different EHR come technical challenges. However, this is new ground for everyone involved and we are all committed. Event Notification System DHIN is working on a pilot with two Medicaid Managed Care Organizations; it is a limited pilot with CCHS and Bayhealth and involves notification when one of their members has been discharged from the emergency department of a hospital. ENS is proving to be a successful pilot and we are beginning to prepare to expand the services out to other health plans and practices participating in DHIN. We have already conversed with Highmark on behalf of the state employee benefits (DPCI) program and scheduling a call with Aetna. DHIN will be selecting a small handful of practices to do the testing. The practices most likely to receive the greatest value from ENS are those that have a high number of Medicare patients. There are two new Medicare Evaluation and Management (E&M) codes for transitional care management for which the provider can get paid. It will be required that they or someone in the practice contact the patient or their representative within 48 hours of discharge to schedule a face to face visit within one to two weeks. Planned Activities Update We continue to work hard to get other EHRs to have a certified interface with DHIN; we currently have thirteen. Quite a number of additional EHRs are either already in beta testing or have executed contracts. DHIN continues to work with EHR vendors on CCD Exchange, Immunization Exchange and lab result delivery. We have handful of EHR vendors that are committed to work with DHIN particularly on immunization update. DHIN has been working with DMMA on applying for federal funding to do clinical quality measure reporting through DHIN. DHIN/DMMA has a call scheduled to explore this further. DHIN also continues to explore both technical feasibility and business viability of several different new projects. Vendors are always approaching us with ideas that they believe would be of mutual value. We are currently working on a formal process in evaluating and determining which would be the best fit for the vision of DHIN; a formal way of saying yes or no. We currently have a few proposals and we need to formulate our process for evaluating opportunities and making decisions.
State Innovation Model Planning Grant DHIN is closely involved in the State Innovation Models Planning Grant. The intent is to do a design of a delivery/payment system that is on a large enough scale and will involve multiple payers, multiple stakeholders and would cover 80 percent of the population. We have been working with many stakeholders on the design plan and the level of commitment and the participation from representatives across the state has been amazing. It has been very exciting to be in Delaware, being a small state many of the same people are involved in multiple initiatives which makes it much easier to connect. The first draft of the plan is on the Delaware Health Care Commission website and the second draft is in circulation/review and has not yet been posted. The State Innovation Models Grant is a design grant involving new models of health care delivery which focus on better coordination of care, especially for chronic conditions, and proposals for new payment models. Website address: http://dhss.delaware.gov/dhcc Affordable Care Act: Requires that each state stand up a Health Benefit Marketplace for those who do not have insurance through their employer. Anyone who needs to purchase insurance can go to the Health Benefit Marketplace and evaluate health plans that have been qualified by the state. As a qualified health plan, they must provide a specified minimal level of coverage to include clinical preventive services, behavioral health, and dental. One of the requirements that Delaware has included for a Qualified Health Plan is that participating plans need to be in DHINs data exchange. The website for Health Benefit Marketplace is: http://www.choosehealthde.com/health-insurance SIM Grant: DHIN is already involved in Meaningful Use Stage 2 work and using the Coop Agreement Plan. In addition, there are several new innovation grants that we have opportunities to apply for and under the second CMMI Grant; Consumer Engagement will be a major theme that we will go forward with in a very wide scale across state of Delaware. DHIN will be asked to expand the current provider portal which we already have in ProAccess. Some providers receive clinical results delivered through an inbox in ProAccess; while others receive results through methods to include interfaces to their EHRs. ProAccess is where providers are able to search for information that they do not know about a current patient and/or a new patient. Providers are looking for one place where they can go for anything they need related to health and health care communication. Expanding to a two way portal will allow providers to receive clinical results and communication from health plans; to include report cards/performance, information about patients, information regarding risk stratification about their patients and information on care gaps. Currently, providers have patients with multiple health plans and they are required to log on to each payer portals separately. A two way portal will be a more common and standardized way of
simplifying their search. DHIN is in the process of scheduling meetings to explore technical options for how we may proceed. Also part of the Innovation Model Design is the ability of the practices to contribute clinical data to a shared repository which is important in terms of ability to do the quality reporting and alerts, care gaps, etc. CCD exchange looks to be the way it will work and getting data in from the practices to common repository that will be linked to other data sources and will allow better overall analytics to be applied. itriage is available now as a free application and is the most widely downloaded health related application. Using the itriage health application, consumers can enter in symptoms they are experiencing and get feedback related to those symptoms and how and where they can go to be treated. In the basic itriage application there is valuable information that can assist the consumer; medication and possible side effects and medical procedures and options. DHINs technology vendor, Medicity, is in development efforts with itriage to provide a linkage to the community health record. In the enhanced itriage account, the consumer will receive a clinical inbox (which they will apply for) and it will come with a Direct address provided through the Medicity HISP. Before they can be given a Direct address, someone will need to authenticate their identity. If signed up by their provider, the provider will authenticate their identity. Consumers can also stop by the DHIN office and we will provide them with a Direct address after identity verification. Once consumers have a Direct address, the clinical data will be available to them, pushed out to their clinical inbox, and will be encrypted. A secure delivery of their health data that is held within the community health record and will be pushed out directly to the patient. DHIN was already marketing this to providers who need a solution for Meaningful Use Stage 2; Consumer Engagement objectives require the patients must have the ability to view, transmit and download their health data. In order to attest to Meaningful Use Stage 2, five percent of the provider s patients are required to view, transmit and download. Another Consumer Engagement objective is secure messaging between providers and their patients. Patients will have a direct address through itriage which becomes the methodology for secure messaging between provider and patient. A portion of the Cooperative Agreement grant will be used to assist in the funding.
When shared with the SIMS planning workgroup, there was big excitement for the potential of engaging Delawareans in Choosing Health. The focus of the second CMMI Grant is for every Delawarean to have an itriage clinical inbox account. Also as part of the SIM Grant, we are looking at expanding the Alerts and Notification System. We can provide health plans and practices with notifications when one of their patients or members has been discharged from a hospital or emergency department but with expanded data capabilities we can provide a broader set of alerts. Claims Data Base: There is interest in establishing all payer claims data base; possibly starting with a government claims data base that would incorporate Medicaid data, data from state employee benefits program and potentially Medicare data so we can take government sources and create a government claims data base and in time, could also fold in commercial payers. DHIN is working on a Request for Proposal (RFP) for legal services to begin looking at the ways of establishing a claims data base and how it may relate to DHIN; the legal framework for using DHIN data in support of population level activities such as cost and quality reporting and clinical research. The two pieces that we need to ensure are done correctly are the patient consent for data which requires patient consent and some de-identified data which does not require patient consent. Also the business agreement, data use agreements that limit the uses DHIN can make of the data; by law the data does not belong to us, it belongs to the data sending organizations and we can only go by the data use agreements. State Innovation Model Design needs to be turned in by the end of October and we plan on applying for a follow up testing grant; it might be four to six months before grant awards are announced. We have an amazing coalition of stakeholders working together toward a goal that will benefit all Delawareans. These stakeholders are working on a resourcing plan on how Delaware can continue on expanding this functionality and service and what can be done in the short term before the grant awards are announced. Delaware Health Care Commission (DHCC) meetings are open to the public. Information on meeting schedules can be found on their website at: http://dhss.delaware.gov/dhcc. Public Comments: Q: (Joann Haase): On newborn screening, will it only be the hearing test that will be included?
A: Metabolic screening will also be included. Providers want a single report that incorporates all newborn screening; the hearing test is the most difficult. This will only be the first step in several phases. Q: Regarding the ENS pilot and practices that have high Medicare numbers; if reports from hospitalist have not been completed within 48 hours is there any way to pressure them to get information out sooner? Will they be penalized? A: This is one of those things that market pressure will sort out. Each hospital has their individual rules about the time frame in which discharge summaries must be completed and how quickly after discharge that the paperwork must be completed. ADT will provide an alert to the provider that their patient has been discharged from the hospital. When that provider logs on to ProAccess and cannot find a discharge summary to tell them what went on during that hospitalization, there will be a dialog that occurs between that primary care provider and the hospital. Over time as the ambulatory practices find value in receiving the information there will be peer pressure that occurs. Peer pressure will do much better than DHIN could do C: Regarding consumer engagement: unhappiness with whole hospital situation and disconnect between primary care physicians and hospitalist and how patients feel about it. Q: Assuming that Delawareans will be using the itriage application, will there be education provided and who is responsible for doing this? A: Some of it will fall on DHINs shoulders, part of the grant application will include money for marketing. Q: What can patients do in terms of checking corrupt/wrong information in their electronic medical records? A: DHIN does not and will not change anything data senders send to us; it is their data not ours and we do not make corrections/changes. However, if a patient calls something into question, it will be referred back to the source and they will have the obligation to make any corrections and resend the report back to DHIN. Patients do have the right to call into question any of the data they disagree with. Q: Does that exist now? A: Yes and it is currently done manually. Consumers can go to our website and under Consumer Section there is information about how to get a copy of your records from DHIN and what to do if something is incorrect. Right now it will require you to come into DHIN and request a copy of your information. If something is incorrect, DHIN would go back to the sender and have the information corrected manually.