HIT/HIE Community and Organizational Panel Office of Health - PDF document

10/13/2016 HIT/HIE Community and Organizational Panel Office of Health Information Technology October 13, 2016 Welcome, Introductions, and Agenda Review 1

10/13/2016 Agenda • New Member Introduction and Discussion Regarding Membership • HIE in Oregon: Current Thinking and Crosswalk • HITOC Strategic Planning Status Update HCOP Members ’ HIE Strategic Plans • – Governance – Roadmaps • HIE Onboarding Program: Update and Discussion • Prescription Drug Monitoring Program Update • Future Topics 3 Health Information Exchange in Oregon Susan Otter Marta Makarushka 2

10/13/2016 Health Information Exchange Bright Spots, Gaps, and Opportunities Current health information exchange platforms Level of information able to Type Examples be 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. 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 Behavioral health, LTSS, social services, EP status directly tied to incentive payment professional 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. 6 3

10/13/2016 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 HIT Crosswalk • At July 2016 HITAG/HCOP meeting, request was made for OHA to create a crosswalk of HIT services available to providers in Oregon • Planning to develop two versions – High level overview or roles of HIT (e.g., next slide) – Detailed Crosswalk of available services (e.g., outdated handout: Crosswalk of JHIE and OHA ’ s HIT initiatives) • Feedback: – What else should we consider adding? – What suggestions do you have for improvement? 8 4

10/13/2016 High-Level Overview of HIT Roles National HIE Initiatives HIE EHR Web portal- based tools (DSM) 9 Sample JHIE/OHA Initiatives Crosswalk • Integration with hospital and Overview physician EHR systems for • Overall goal/value bidirectional health information • Operating Organization exchange • Key Users • Registry Reporting • Timing Other features • Funding • Member File Management • Geographic Scope • Reporting and Analytics Data Scope • Meaningful Use • Data Sources • Healtheway National HIE • Data Types • Patient Search Services/Functions • Patient Matching and Record • Direct Secure Messaging Locator Service • Provider Directory • Privacy/Security • Clinical Referrals • Results Delivery 5

10/13/2016 HITOC Strategic Planning/Business Plan Update Susan Otter Director of Health IT 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 12 6

10/13/2016 ONC Interoperability Roadmap Milestones 13 Strategic Plan/Business Plan Update Timeline 2016- 2017 Potential March Meeting/ Retreat 2016 2017 14 7

10/13/2016 Development of Draft HIT Utility Governance Model • Building off EDIE Utility public/private model experience • Grant funding from OHA to OHLC to support the development of governance model to: – connect existing HIT systems, – support statewide HIT solutions, and – guide future investments to provide HIT solutions that support the health of Oregonians across payers, providers, and health systems • Model will be developed in partnership with OHA, HITOC and other stakeholders 15 Example “Network of Networks” Structure Governance Entity OHA/ State Stakeholders Shared Funding (including HIE Onboarding Funding) of Oregon Shared Principles, Policies, Agreements Shared Accountability (Oversight and Reporting) Provider TBD (MPI, PDMP Shared Directory (Gateway) Services query, etc.) Hosted Large ADT/ Hospital CareAccord Regional HIE EHR or Health Notifications other HIE System CCO CCO Hospital Hospital Hospital LTC Clinic Clinic Clinic EMS Behavioral Behavioral Corrections health health The diagram is highly simplified, not exhaustive, and represents HIE relationships to a governance entity and not necessarily between each other 16 8

10/13/2016 HCOP Members’ HIE Strategic Plans Governance As OHA is considering the development of a governing layer, we are interested in learning from each of your experiences. Please describe your governance structure. • What do you consider the critical components of your governance structure? – Specific committees? • Technology • Privacy & Security – What advice/reflections do you have on what it takes to bring stakeholders together? • For a state-level governance entity that is going to play a connecting role, based on your experiences, what advice would you offer? 18 9

10/13/2016 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: • Admission/ Encounter Date • Laboratory Test(s) • Basic Provider Identification • Laboratory Value(s)/Result(s) • Service Location * OHA Identified Minimum Data Element 19 HITOC Member Survey Importance Rating 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 20 10

10/13/2016 Opportunity in Oregon: Medicaid priorities Your Roadmap Given your current and planned efforts, what alignment or gaps do you see compared to: • the HITOC priority data elements? • the Medicaid priorities? What is on your longer-term roadmap? To what extent is your HCOP: member initiatives information (handout from June 2015) outdated? 22 11

10/13/2016 Break 23 HIE Onboarding Program Update & Discussion Lisa Parker Francie Nevill 12