8/4/2016 Health Information Technology Oversight Council August 4, 2016 1 Agenda 12:30 pm Welcome, Introductions & HITOC Business 12:40 pm Health Information Exchange—Oregon Context and National Initiatives 1:15 pm Health Information Exchange—Panel Presentations 2:20 pm Break 2:35 pm Group Discussion on Health Information Exchange 3:10 pm Updates 3:35 pm Public Comment 3:40 pm Closing Remarks 2 1
8/4/2016 Goals of HIT-Optimized Health Care 1. Sharing Patient 2. Using Aggregated 3. Patient Access to Information Across Data for System Their Own Health the Care Team Improvement Information • Providers have access to • Systems (health systems, • Individuals and their meaningful, timely, CCOs, health plans) families access their relevant and actionable effectively and efficiently clinical information and patient information to collect and use use it as a tool to improve coordinate and deliver aggregated clinical data their health and engage “whole person” care. for quality improvement, with their providers. population management and incentivizing health and prevention. • In turn, policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. 4 Health Information Exchange in Oregon Susan Otter Marta Makarushka 4 2
8/4/2016 HIE is Critical to Healthcare Transformation Oregon’s HIT Strategic Plan: • Goal 1 : Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver “whole person” care. • Requires EHR adoption; rates in Oregon are high • Next step is to make the electronic patient health information available to care team • Updating the strategic plan and the state’s role • Requires examination of current health information exchange efforts, gaps (white spaces), and barriers • Involves identifying HIE options • Includes an exploration of HIE priorities 5 HIE Group Discussion Purpose The HIE group discussion is intended to inform OHIT’s strategic plan, which will include: • Overarching principles (e.g., raising all boats to a minimum level, data should be freely shared) • Priorities (e.g., focus on provider types that are priority for the waiver or the CCM) • Strategies (e.g., to what extent do we want to leverage the national efforts, are there gaps in the available technologies or opportunities) In addition, we would like the discussion to inform one of our current key strategies: the HIE Onboarding Program (e.g., For providers who face gaps or in regions where there is no HIE, what are we onboarding them to?). 6 3
8/4/2016 Defining Health Information Exchange • Health Information Exchange (HIE) – the electronic transfer of health information between two or more health IT systems – Sometimes HIE can also refer to an organization that provides this service • Interoperability – the ability of different health IT systems to communicate and exchange data between them, and make use of that data • Various levels of HIE : – Finding (query); Sharing (send), Exchanging (receive) – Viewing; Using: • View only • Static documents • Integration of information from other systems • Reuse of integrated data 7 Health Information Exchange Options • State-supported – Direct secure messaging (e.g., via EHRs, HIEs, CareAccord) – EDIE/PreManage – Public health reporting (e.g., Immunization registry, PDMP) – HIE-enabling ( Provider Directory, FlatFile Directory for Direct secure messaging addresses) • Other HIE – Regional HIEs (JHIE, RHIC) – Vendor-driven solutions/National networks: • Epic Care Everywhere, CommonWell, Sequoia: Carequality – Federal Network (Sequoia: eHealth Exchange) • Connection to federal agencies: SSA, CMS, VA, etc. – Organizational efforts: • By CCOs, health plans, health systems, IPAs, etc. • Including private HIEs, point-to-point interfaces, HIT tools, hosted EHRs, etc. that support sharing information across users 4
8/4/2016 Map of EDIE/PreManage 9 Map of Regional HIE Efforts 10 5
8/4/2016 JHIE Coverage Area as of Feb 2016 WASHINGTON Astoria PACIFIC Columbia OCEAN Clatsop Saint Helens Umatilla Hood River Multnomah The Dalles Wallowa Washington Pendleton Tillamook Moro Portland Hood River Morrow Hillsboro Gilliam Tillamook Sherman Enterprise Oregon City Yamhill La Grande Heppner Condon McMinnville Clackamas Union Wasco Polk Salem Fossil Dallas Baker City Marion Jefferson Newport Wheeler Baker Corvallis Albany Grant Madras IDAHO Lincoln Linn Benton Prineville Canyon City Crook Eugene Bend Vale Deschutes Lane Burns Coos Douglas Malheur Harney Roseburg Coquille Lake Curry Josephine Jackson Klamath Grants Pass Gold Beach Medford Klamath Falls Lakeview CALIFORNIA NEVADA Enrolled hospitals & clinics Some Interest in participating Enrolled clinics Currently no activity 11 Entities Participating in HIE • Primary care and ambulatory providers • Specialists • Nurses • Hospitals • Pharmacists • Laboratories and other ancillary service providers • Physical therapists and other allied care providers • Mental health and substance abuse services • LTPAC facilities such as nursing homes • Home and community-based services • Other support service providers • Care managers (e.g., health plans, CCOs) 12 6
8/4/2016 Priority Data • Priority data should be actionable • List of data to be considered for inclusion – Smoking status – Demographics – Vital signs – Allergies – Care plan field(s), including – Medications goals and instructions – Diagnoses – Procedures – Problem List – Care team members – Clinical summary – Immunizations – Continuity of Care – Unique device identifier(s) Document for a patient’s implantable – Labs device(s) – Imaging Sources include the Common Clinical Data Set from ONC’s Interoperability Roadmap 13 Components Needed for Coordinated HIE The following are required for HIE to occur: • Policies • Financing • Trust agreements • Governance • Operations and technical standards 14 7
8/4/2016 HIE Gaps (‘White Spaces’) in Oregon • HIE gaps exist on various dimensions – Geographic (Rural – Urban) – Organization/provider type (Non-EP* – EP) – Organization/provider affiliation (Not affiliated – affiliated) • Health system EHR • Health system HIE – Technological (Basic – sophisticated) – Interoperability (Low – high) – Resources (Low – high) • May vary by use case *EP=Eligible Provider 15 Dimensions of HIE “white space” A : Rural Urban A A A A B : Non-EP* EP F F F F B B B B C : Unaffiliated Large system D : Basic Tech High Tech E E E E C C C C E : Low Interop. High Interop. D D D D F : Low Resource High Resource *Eligible Professional • Center rings represent the left (“low”) side of the range • Outer rings represent the right (“high”) side of the range • “White space” dimensions affected by values in each area 16 8
8/4/2016 HIE Gaps (‘White Spaces’) Sample Profiles 1: Few gaps 2: Medium gaps 3: Large gaps (minimal white (moderate white (significant white space) space) space) • urban • somewhat rural • urban • PCP practice (EP) • PCP practice (EP) • BH clinic (non-EP) • part of a health • part of medium-sized • not affiliated with system independent practice larger health system • 2014 Certified EHR • 2011 Certified EHR • no EHR, has a Direct address (uses DSM) • Integrated HIE with • eRx, otherwise low some partners (med- interoperability • low interoperability high interoperability) • limited resources • low resources • available IT staff and funding (high resources) 17 Dimensions of HIE “white space” A : Rural Urban A A A A B : Non-EP* EP F F F F B B B B C : Unaffiliated Large system D : Basic Tech High Tech E E E E C C C C E : Low Interop. High Interop. D D D D F : Low Resource High Resource *Eligible Professional • Center rings represent the left (“low”) side of the range • Outer rings represent the right (“high”) side of the range • “White space” dimensions affected by values in each area 18 9
8/4/2016 National HIE Initiatives to Help Fill Gaps • Historically Oregon’s approach has been to leverage federal or national opportunities when it makes sense – Included as a principle in Oregon’s HIE Business plan framework • Want HITOC to be kept abreast of what initiatives are happening/changing at the national level – Footprint in Oregon – Consider leveraging these as resources to help fill HIE gaps GAPS AND SOLUTIONS: NATIONAL HIE INITIATIVES August 4, 2016 HealthTech Solutions, LLC. 10
8/4/2016 The Roles for National Initiatives HealthTech Solutions, LLC. Direct Secure Messaging Overview � Push information from a known entity to a known entity HealthTech Solutions, LLC. 11
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