Health Information Technology Oversight Council October 6, 2016 1 - PowerPoint PPT Presentation

Health Information Technology Oversight Council October 6, 2016 1

Agenda • 12:30 – Welcome, Introduction and HITOC Business • 12:35 – HITOC Membership Recruitment • 12:45 – The Regional Information Health Collaborative • 1:20 – HIE Gaps, Successes and Minimum Expectations • 2:25 – Break • 2:35 – HIE Gaps, Successes and Minimum Expectations Wrap-up • 2:50 – Strategic Plan and Program Updates • 3:30 – Public Comment • 3:40 – Closing Remarks 2

HITOC Membership Name Title Organizational Affiliation Location Term Maili Boynay IS Director Legacy Health Portland, OR 3 Ambulatory Community Systems Retired Advocate Allies for Healthier Oregon Portland, OR 2 Robert (Bob) Brown* (vice-chair) COO PacificSource Springfield, OR 4 Erick Doolen (chair) IT Director Advantage Dental Redmond, OR 3 Chuck Fischer CNIO Providence Health & Services Portland, OR 2 Valerie Fong, RN Director, Clinical Oregon Health & Science University Portland, OR 4 Charles (Bud) Garrison Informatics Brandon Gatke CIO Cascadia Behavioral Healthcare Portland, OR 3 Amy Henninger, MD Site Medical Director Multnomah County Health Department Portland, OR 2 Mark Hetz CIO Asante Health System Medford, OR 4 CIO Tuality Healthcare Hillsboro, OR 3 Sonney Sapra President Oregon Health Leadership Council Portland, OR 2 Greg Van Pelt *Bob Brown will be stepping down when a replacement is found Gaps to fill: • Consumer/advocate • Underserved areas: Rural/frontier, Tribes, small/unaffiliated provider • Social services, long term supports/services • Health information exchange • Supplemental behavioral health perspective 3

The Regional Health Information Collaborative (RHIC) HIE Kim Whitley, VP/COO, Samaritan Health Plans Klint Peterson, Project Manager, IHN-CCO Regional Health Information Collaborative 4

Regional Health Information Collaborative (RHIC)

Social Determinants of Health

Merging the Collective Knowledge

Community Contributors Existing and Proposed

Aggregated EHR Metrics RHIC EHR EHR EHR 1 2 3

Regional Health Information Collaborative Community Board

HIE Gaps, Successes and Minimum Expectations Susan Otter Director of Health IT Sean Carey HITOC Policy Analyst 15

Strategic planning process and progress Step in the process Status Timeframe Goals (confirm) Completed December 2015 Aims/objectives Completed December 2015 State’s role / Principles Initial discussion Summer 2016 Prioritizing objectives and Fall 2016 outcomes Assess environment: Ongoing Ongoing • Identify current state • Identify changing policies, etc. Define/refine strategies: End of 2016/2017 • Technology • Governance/Finance • Policy, legal, education, etc. • HIE Onboarding Program Roadmap/Final Plan 2017 16

ONC Interoperability Roadmap Milestones 17

Small Group Breakouts • HITOC has done significant work on HIE opportunities, including statewide efforts to share health info. • HITOC has also discussed gaps in HIE, along with overarching principles for HIE sharing and governance. • User stories are a way to test conceptual frameworks and identify missing components or areas for additional research. • The goal of the exercise is to view HIE in the context of one patient and explore the likely needs, gaps and opportunities for sharing healthcare information among different providers, settings and contexts. 18

Questions for Discussion – Who are the providers who need information? – What are the crucial data elements to exchange? – How will the information flow? – What are the potential gaps in the information exchanged? Are the gaps technological, organizational or resource-related? – What methods of HIE could address those gaps? 19

Small Group Debrief Discussion User Stories • Peter, 58, hypertension, emerging cardiac health issue • Bryan, 46, complex social and medical challenges, currently hospitalized • Sarie, 41, caregiver for child with chronic illness, currently moving across state Debrief Questions • What providers did your group identify? • What data elements were important to share? • Were any new gaps or barriers identified? • Do the methods align with the identified principles for HIE? 20

ONC-Identified Near-term Priority Data Domains • Individual Name* • Vital Signs • Sex* • Procedures • Date of Birth* • Care Team Members • Race/ Ethnicity* • Immunizations • Address* • Unique Device Identifier(s) for • Phone Number* Implantable Device(s) • Preferred Language* • Assessment and Plan of Treatment • Smoking Status • Goals • Problems • Health Concerns • Medications ** OHA also identified the following • Medication Allergies minimum data elements: • Laboratory Test(s ) • Admission/ Encounter Date • • Laboratory Value(s)/Result(s) Basic Provider Identification • Service Location * OHA Identified Minimum Data Element 21

Importance Rating HITOC Member Survey | N=9 High or Low Medium High Highest Highest Medications* 0 0 4 5 9 Medication Allergies* 0 1 2 6 8 Diagnoses 0 1 4 4 8 Discharge Summary 0 1 4 4 8 Allergies 0 1 5 3 8 Laboratory Value(s)/Result(s)* 0 1 5 3 8 POLST Registry (Physician Orders 1 0 5 3 8 for Life-Sustaining Treatment) Advance Directives 1 1 4 3 7 Imaging results 1 1 5 2 7 Medication History 0 2 6 1 7 Prescription Drug Monitoring Program 0 2 6 1 7 (PDMP) (i.e. opioid prescription history) Hospital Event (ADT) 1 1 2 4 6 Social Determinants (e.g. food/ housing 0 3 3 3 6 instability, ACE score, income) Problem list* 1 2 3 3 6 Vital Signs* 0 3 4 1 5 Care plan* 0 4 4 1 5 Procedures* 0 4 4 1 5 Behavioral Health Plan 0 3 5 0 5 Referrals 4 0 5 0 5 *ONC- Identified Near-term Priority Data Domain 22

Small Group Debrief Discussion User Stories • Peter, 58, hypertension, emerging cardiac health issue • Bryan, 46, complex social and medical challenges, currently hospitalized • Sarie, 41, caregiver for child with chronic illness, currently moving across state Debrief Questions • What providers did your group identify? • What data elements were important to share? • Were any new gaps or barriers identified? • Do the methods align with the identified principles for HIE? 23

HIE Governance Principles The HITOC discussion of June 2016 implied principles for moving forward with a coordination role for statewide HIE efforts. Are these principles in alignment with the HIE methods discussed? • Democratize the data • Establish minimums (not maximums) and work to “raise all boats” • Management to ensure appropriate and free use • Accountability • Rules of the road for data sharing/use • Inclusive • Trust/Transparency • Provider workflow and use is critical • Governance role

Break 25

Health Information Exchange Bright Spots, Gaps, and Opportunities Current health information exchange platforms Level of information able to be Type Examples shared Intra-system Sharing Kaiser, Legacy, Providence High Preferred Provider Networks Legacy, Providence High (sharing EHR) Association Networks IPAs High Intra-vendor Sharing EpicCareEverywhere High Collaboratives/ Integration Commonwell, Carequality Medium - High HIE JHIE, RHIC Medium - High Direct Secure Messaging CareAccord, DSM within EHRs Low - Medium claims-level: High Payer-based CCOs, BCBS case management: Low- Medium Subscription-based EDIE/ PreManage Low - Medium Personal Health Records Humetrix, Medyear, caresync Medium - High Public Health Registries Syndromic surveillance, PDMP Low - Medium This matrix is illustrative, not exhaustive. 26

Impact/Importance Examples Gap Dimension Highlighted Examples of Largest Gaps Critical access hospitals, high Medicaid Organizations may be limited by Availability of members, nonprofits, behavioral health, low/negative margins or business models Resources long-term services and supports that preclude IT investment Rural areas more likely to have one Small/solo practitioners, dominant system/network which creates Urban-rural specialty/complex care both opportunities and gaps; rural trading partners likely to be outside of local area Eligible-provider Behavioral health, LTSS, social services, EP status directly tied to incentive payment corrections, EMS availability Small/solo practitioners, independent Organizations may lack scale to achieve Practice size specialists efficiencies from IT adoption/use Higher acuity patients typically involve substantially more organizations but receive Less sick/privately insured patients less Patient acuity higher attention from Medicaid/ payers; low likely to be affected/ interested acuity patients may have lower coordination needs but also receive much less support More complex/less structured data typically Types of data Complex/unstructured data, setting- more difficult to exchange but likely to have shared specific data formats and definitions higher value This matrix of gap dimensions follows from the August 2016 HITOC discussion of HIE gaps. It is illustrative, not exhaustive. 27