The Ne Th e New S Statewide Cl e Clinical Da Data R a Repo - PowerPoint PPT Presentation

The Ne Th e New S Statewide Cl e Clinical Da Data R a Repo eposit sitory WSHIMA 2016 Annual Mee1ng April 29, 2016 Lynnwood, WA

Session Objec1ves • Background – how we arrived here • The WALink4Health Clinical Data Repository (CDR) • Clinical informaDon exchange, the state HIE and accessing the CDR • Data segmentaDon, privacy and security • ParDcipaDon requirements • The Role of the HIM Professional • GeMng started with the CDR 2

The Framework for Strategic Ac1on “We will have failed those we serve if we don’t overcome the interoperability challenges that make it difficult to deliver connected and coordinated care.” 3 |

Mee1ng Emerging Needs New organiza>onal Needs include arrangements (ACOs) repository, analy>cs, require capabili>es repor>ng, individual outside tradi>onal care and popula>on enterprise HIT management tools resources Data needs go beyond More orgs going at current claims and risk for performance, ADT, include clinical Sponsor need info/analy>cs to summaries, care help manage that risk Clinical Data plans, assessments Repository (CDR) Pla5orm 4

The Strategy: Advance Health IT Beyond Organiza1onal EHR’s with a CDR CDR • The WA Link4Health iniDaDve is part of the State’s long- term efforts to improve health care quality, beVer manage costs and improve health outcomes for all Washingtonians. • HCA is iniDaDng Washington Link4Health, a mulD-year iniDaDve to advance the statewide electronic exchange of near real Dme, consolidated clinical records. 5

Staged Implementa1on- Mul1 Year Effort • IniDal services purchased – Clinical portal – ReporDng portal • ImplementaDon underway • IniDal lives commiVed – Apple Health Enrollees assigned to Managed Care (1.4M) – More lives over Dme such as Public Employees, fee for service, other sponsors. • IniDal data sets – Care Summaries from Provider EHR systems – Eligibility data – Claims/Encounter data (6 mth in clinical portal & 2 years in reporDng portal) 6

What is the Clinical Data Repository? • A Clinical Data Repository or CDR is a database designed to collect and index clinical content for specific uses. – Create a longitudinal view of all care provided on a single paDent (paDent-centric, point-of-care access for pracDDoners) – Clinical Portal – Aggregate data that can be used in populaDon analyDcs – Aggregate data for performance reporDng to providers across all lives managed by the provider – ReporDng Portal 7

Par1cipa1on in Link4Health Helps Meets Stage 2 MU Requirements • Drive adopDon of clinical data sharing via the State HIE through purchasing efforts and Meaningful Use. • Reduce the need to build expensive point to point interfaces with mulDple trading partners outside your organizaDon. • Enable eligible professionals and hospitals to meet MU requirements and tap into remaining incenDves. Note: HCA is working with CMS to ensure contribuEng data (CCDA) to the CDR meets MU requirements for exchanging summaries of care across vendor plaMorms. 8 |

CDR Features and Benefits Features Benefits • May help providers meet ongoing • Leverages standards for sharing clinical Meaningful Use ObjecDves and qualify summaries for addiDonal incenDve payments • Supports clinical data exchange with organizaDons without similar plaborms • Provides the care team a more comprehensive understanding of the • Offers common place to share paDent’s medical history. informaDon for those parDcipaDng in different arrangements • Provides mainstream quality reporDng capabiliDes • Aggregates clinical and administraDve • Enables large data extracts for data into longitudinal paDent record advanced analyDcs and populaDon • Available beyond Medicaid and PEB health 9

CDR Portals • Clinical: View individual paDent health informaDon for care decisions and coordinaDon. – Builds comprehensive medical record including diagnoses, meds & allergies. – Enables data sharing regardless of the EHR vendor system. – Provides a single source to view full paDent profile and medical record – Results in lower administraDve costs and improved paDent safety by lowering the frequency medicaDon errors • Repor>ng: View aggregate de-idenDfied data for clinical quality reporDng and populaDon management. – Receive, parse and sort clinical and administraDve informaDon from a variety of sources and in various forms and formats. – Use a “digital envelope” to inform clinicians, providing real-Dme reporDng on paDent quality at the point of care. – Store disintegrated data so that physicians can access data they need to deliver evidenced-based medicine and high quality care management. – Develop, interpret and report on standard CMS and state specific quality measures. 10 |

High Level Timeline and Gates 11

What Does Provider Par1cipa1on Look Like? • January 2016 MCOs sent HCA ’ s “ Provider Par>cipa>on LeQer ” to their provider networks: hVp://www.hca.wa.gov/HealthIT/Documents/Provider%20Requirements %20LeVer%202015%2012%2021.pdf LeQer Contained : 1. IntroducDon to the CDR to the provider community 2. List of the three criteria defining who is required at this Eme - Contract with MCO to care for Apple Health enrollees - Have an electronic health record - Have a 2014 cerEfied EHR 3. ClarificaDon for providers that they need to begin geMng ready soon in preparaDon for the February of 2017 deadline to be contribuDng data 4. Link to “ how to get started ” tools 12

C-CDA – Clinical Document Standard C-CDA = (Consolidated Clinical Document Architecture) – modular Na>onal standard for clinical info exchange Cer>fied EHRs designed to export and ingest C-CDA Early in the game – a work in progress 13

CDR Business Model • HIE ParDcipant annual • Sponsor pays for CDR costs subscripDon fees • Trading Partners must derived from matrix become HIE ParDcipants below – Most hospitals, some pracDces already parDcipate in HIE – HIE ParDcipants execute a Annual Organization Revenue Annual Subscription Fee common contractual $0 – $10 Million $600 framework $10 Million – $100 Million $6,000 • HIE ParDcipants pay a $100 Million – $500 Million $12,000 single annual $500 Million – $1 Billion $24,000 subscripDon fee $ 1 Billion Plus $48,000 – Covers all services, no transacDon fees 14

EHR Vendor Role Vendors play a criDcal role in supporDng providers’ ability to meet C-CDA data contribuDon requirements Ensure C-CDA meets file format conformance against na>onal standard Work with provider to classify data as N, R or V Set-up constraints for C-CDA message header Allow parameters to be set by provider to trigger data submission per Sponsor specifica>ons Automate C-CDA data submission process to the CDR

OneHealthPort Engaged with EHR Vendors • OHP working with EHR vendors to address technical requirements • What your EHR vendor has to do to submit a C-CDA to CDR will depend on where they are today • OHP scheduling web casts for EHR vendors/technical IT staff and other pracDce staff • CDR Technical Webcast sign-up link hVps://onehealthport.formstack.com/forms/ cdr_technical_webcast_registraDon • CDR Provider Staff Webcast sign-up link: hVps://onehealthport.formstack.com/forms/cdr_clinical_webcast_registraDon 16

Access Controls and Data Classifica1on 17 |

Accessing the CDR Sponsor bulk loads claims and eligibility data • AuthenDcate EHR pushes C-CDA connecDons • Use Provider Directory to CDR to route messages • Facilitate exchange of standard data • Host API/web services • API Directory • Standards PropagaDon Push View only use of the CDR using Portal Hospital EHRs push C-CDA to CDR aper each Medicaid encounter. Aper a criDcal mass of data is reached, hospitals can draw C-CDA from CDR into their EHR C-CDA Response through the HIE, or view CDR through Sponsor and other to API Query secure portal. authorized parDes from/to EHR can access reports and/or data 18

Data contributed to the CDR is classified to provide confiden1ality, data integrity and user accountability Data Classifica1on conforms to HL7 na1onal rules. Organiza1ons contribu1ng data are responsible for classifying the data prior to submiang to the CDR 19

Data Classifica1on • CDR data submissions must be classified – Data classificaDon per HL7 specificaDons – ClassificaDon provides confidenDality, data integrity, and user accountability • OrganizaDons contribuDng data are responsible for classifying the data prior to submiMng to the CDR 20

CDR Access Levels • Access control is delegated to the provider enDty • Leverage the OHP Single Sign-On service • Seven access roles are established for the first stage • Appropriate access guided by two key quesDons: – What level of personally idenDfiable clinical data does this user need? – What need does this user have for populaDon-level reports? 21

Repor1ng • Reports based on aggregated clinical and claims data – Clinical summary data contributed by providers aper encounter – 2 years of historical claims plus monthly updates • Individual Provider, Team/Dept., OrganizaDon and Sponsor views of data available • Dimensions reports map to the Quality Measures that Sponsors have elected: – Financial (e.g., high cost paDents, providers, PMPM) – ACO Reports – PQRS Reports – HEDIS Star Measures – Washington State Performance Measure Set 22