Digital Bridge Governance Principles • • Transparency: Stakeholders will have Utility: The governance body will prioritize visibility into the governance body’s work use of existing information technology and opportunities to provide input. standards and infrastructure as it pursues shared and realistic goals that benefit all • Respect for Process: Governance body parties. members will adhere to an agreed upon • decision-making process. Members will Representativeness: Governance body observe delineated and agreed upon roles members will represent their broader field and responsibilities. and be responsive to the goals of the Digital Bridge partnership. • Outreach: The governance body can solicit • opinions and presentations from Trust: Governance body members will stakeholders to inform its decision-making. honor commitments made to the Digital Bridge effort. FOR DISCUSSION USE ONLY – November 16 th , 2018
Governance Body Meeting Friday, November 16 th , 2018 12:00 – 1:00 PM ET This meeting will be recorded for note-taking purposes only FOR DISCUSSION USE ONLY – November 16 th , 2018
FOR DISCUSSION USE ONLY – November 16 th , 2018
Meeting Agenda Time Agenda Item Purpose: 12:00 PM Call to order – John Lumpkin The purpose of this meeting is to work toward a common vision for exchanging actionable information between health care and public health. 12:03 PM Agenda review and approval – John Lumpkin 12:05 PM Consent agenda – John Lumpkin Consent Agenda • Workgroup updates 12:10 PM Risk log Risk Log • eCR Implementation progress – Laura Conn • Implementation progress update 12:30 PM Action – John Lumpkin For Action • Adding and Modifying eCR Demonstration Sites through • Issue Brief: Considerations for Adding and August 2019 Modifying eCR Demonstration Sites through August 2019 12:45 PM Discussions – Troy Willitt (APHL) For Discussion • Difficulty of BAA approach • Difficulty of BAA approach • Exploring Alternate Legal Frameworks • Issue Brief: Exploring Alternate Legal Frameworks 12:50 PM Announcements – Jelisa Lowe and Charlie Ishikawa 1:00 PM Adjournment – John Lumpkin FOR DISCUSSION USE ONLY – November 16 th , 2018
Consent Agenda | November 2018 John Lumpkin (Chair) FOR DISCUSSION USE ONLY – November 16 th , 2018
Governance Meeting Consent Agenda Protocol November 2018 Consent Agenda Items 1. Pre-meeting: 1. Workgroup updates: a. Chair places items that are believed to be a. eCR Implementation Workgroup non-controversial or routine b. Evaluation Committee b. Items should be received with sufficient c. Pilot Participation Workgroup review time d. Transition Workgroup 2. Start of meeting: a. Chair asks if any member wishes to move an item into regular discussion b. All items left on the consent agenda are documented as approved by governance body c. Any item removed will be discussed during the meeting FOR DISCUSSION USE ONLY – November 16 th , 2018
Risk Log: eCR Implementation Progress Laura Conn and Monica Coley (eCR Implementation Taskforce Co-Chairs), Rob Brown (Digital Bridge PMO) FOR DISCUSSION USE ONLY – November 16 th , 2018
Update: eCR Implementation Workgroup Utah Houston Testing summary: Testing summary: • Multiple successful end-to-end workflow testing; • Target production date: November 14 retesting the test cases • Able to trigger on problem list – SNOMED • 32 defects identified (25 resolved) • SNOMED translated to ICD-10 when diagnosis is not • IMH pushed eICR/ triggering functionality to production triggered without sending messages through the firewall to AIMS • Within one week – 3,000 eICRs generated for 1,800 Challenges: unique patients for five pilot conditions • Epic product does not trigger from diagnosis fields; Challenges: diagnosis trigger codes are being triggered out of • Generation of new test patients was more time- and problem list resource-intensive than originally anticipated • Using production environment for testing • Timing of how eICRs are generated within the EHR to • minimize duplicate eICRs is being revisited Lab tests were not coded as LOINC at HM– APHL TA is • Intermountain test environments and interfaces have providing support for mapping local codes to LOINC been up and down, preventing testing and creation of codes some test patients 8 Consent Agenda | Digital Bridge Governance Meeting | For Discussion Only FOR DISCUSSION USE ONLY – November 16 th , 2018
Update: eCR Implementation Workgroup (cont.) • Site engagement and preparation for implementation continues; most active sites include California, New York, Michigan, Kansas • For detailed status of each site and timelines, please see appendices • Governance body approved charter via email in July 2018 • Laura Conn (CDC) and Kirsten Hagemann (Cerner) will continue to chair the workgroup • Kirsten will be out on leave starting in September, and Monica Coley (Cerner) will temporarily co-chair • First meeting was held in August 2018 • Workgroup has reviewed and provided feedback on the Technical Specifications in the Participation Agreement • Workgroup is providing feedback and recommendations on proposed high-level onboarding process • Detailed drafts expected to be shared in November 2018
Digital Bridge eCR Implementation Timeline - 2018 DRAFT Jan 2018 Feb 2018 Mar 2018 Apr 2018 May 2018 June 2018 July 2018 Aug 2018 Sept 2018 Oct 2018 Nov 2018 Dec 2018 Production Onboarding AIMS & Environment Environment RCKMS Milestones RR Development & Testing Complete Utah Site Utah Site Connectivity/Onboarding/Testing Production Michigan Site Connectivity/Onboarding/Testing California Site Connectivity/Onboarding/Testing Kansas Site Cerner corporate eICR Connectivity/Onb product complete oarding/Testing New York City Site Connectivity/Onb oarding/Testing Houston Houston Site (CDC managed eCR implementation) E2E Testing Production Today FOR DISCUSSION USE ONLY – November 16 th , 2018
Digital Bridge eCR Implementation Timeline - 2019 DRAFT Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 June 2019 July 2019 Aug 2019 Sept 2019 Oct 2019 Nov 2019 Dec 2019 Michigan Michigan Site Site Connectivity/Onboardi Production ng/Testing California Site California Site Production Connectivity/Onboardi ng/Testing Potential Interested Implementation Sites: Kansas Site Allscripts • Connectivity/Onboarding/Tes Kansas Site Delaware • ting Production Health & Hospitals • Illinois • Iowa • Kentucky New York City Site • New York Anticipate discussion of Maryland Connectivity/Onboarding/Tes • City Site MDLand how eCR onboarding will ting • Production Minnesota • be opened up as part of North Carolina • New York State Site New York State Site North Dakota • eCR transition Connectivity/Onboarding/Testing Production Ohio • Pennsylvania • South Dakota • Tennessee • Wisconsin • FOR DISCUSSION USE ONLY – November 16 th , 2018
Allscripts and California Parkinson’s Registry Update Benson Chang (Digital Bridge PMO) FOR DISCUSSION USE ONLY – November 16 th , 2018
Allscripts/LA County Digital Bridge Site • Allscripts shared potential provider (LA LGBT Center) and local health department (LA County Department of Public Health) interested in implementing eCR. • LA LGBT Center only reports STDs (salmonellosis, Zika and pertussis are not relevant to their patient population) • High volumes of syphilis, gonorrhea, and chlamydia – ~200-400 cases a month • Allscripts expects to have eICR capabilities in their ambulatory product for LA LBGT Center to consume in April 2019 • LA County will need discussions with CDPH on where case reports will be sent first • LA County can receive eICRs into their test environment • Modifications that may be needed to RCKMS to identify the case report would need to go to both LA County and CDPH • The Digital Bridge Pilot Participation Workgroup met to discuss Allscripts’ requests and was unable to make a decision FOR DISCUSSION USE ONLY
California Parkinson’s Registry Use Case • In July, California Department of Health (CDPH) made it known that they were interested in potentially using Digital Bridge to collect required reporting for the statewide Parkinson’s Registry • Electronic reporting for Parkinson’s is mandated by statute by January 2019, although clarifications by CDPH indicate providers have until March 2019 • PMO directed to perform additional investigation and requirements scoping with DSI partners in August 2018, initial discovery session held August 29, 2018 • Epic has decided to focus solely on enabling their product to meet the provider needs in California to generate required reporting to the Parkinson’s Registry directly, NOT through Digital Bridge at this time. Future inclusion in Digital Bridge is still possible, triggering will generate an eICR.
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