Longitudinal Coordination of Care Pilots WG

Longitudinal Coordination of Care Pilots WG Monday, May 12, 2014

Meeting Etiquette Remember: If you are not speaking, please keep your phone on mute Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call • Hold = Elevator Music = frustrated speakers and participants This meeting is being recorded • Another reason to keep your phone on mute when not speaking Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know. • Send comments to All Panelists so they can be addressed publically in the chat, or discussed in the meeting (as appropriate). From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute  All Panelists

ReminderJoin the LCC WG & Complete Pilot Survey • http://wiki.siframework.org/Longitudinal+CC+WG+Committed+Member+Guidance • http://wiki.siframework.org/LCC+Pilots+WG ** If your contact information has recently changed, please send your updated information to Becky Angeles at becky.angeles@esacinc.com

Agenda

Pilot Work Group Purpose and Goals • Purpose • Provide tools and guidance for managing and evaluating LCC pilot Projects • Create a forum to share lessons learned and best practices • Provide subject matter expertise • Leverage existing and new partnerships • Goals • Bring awareness on available national standards for HIE and care coordination • Real world evaluation of parts of most recent HL7 C-CDA Revisions Implementation Guide (IG) • Validation of ToC and Care Plan/HHPoC datasets

Meeting Reminders S&I Framework Hosted Meetings: http://wiki.siframework.org/Longitudinal+Coordination+of+Care LCC Pilot WG meetings are every other Monday from 11:00– 12:00 pm Eastern • Focus on validation and testing of LCC Standards for Transitions of Care & Care Plan exchange LCC All Hands WG meetings are Mondays & Thursdays from 5:00– 6:00 pm ET - CURRENTLY ON HOLD HL7 Structured Documents WG Meetings Thursdays from 10:00 – 12:00pm Eastern • WebEx: https://iatric.webex.com/iatric/j.php?ED=211779172&UID=0&RT=MiMxMQ%3D%3D • Dial In: 770-657-9270; Access Code: 310940 • Focus on block voting of HL7 C-CDA R2 Ballot comments • ALL 1013 comments have been reconciled. Ballot reconciliation package was voted on 4/10. • Draft version of final CCDA R2.0 specification has been distributed to the SDWG list serv.

HL7 Patient Care WG Meeting Reminders Coordination of Care Services Specification Project • Voting for the HL7 May 2014 Ballot Cycle closed on April 28th • Ballot reconciliation is underway • Provide SOA capabilities/models to support coordination of patient care across the continuum • Current working documents found here: http://wiki.hl7.org/index.php?title=Coordination_of_Care_Services_Specification_Project • Meetings every Tuesday 5:00 – 6:00pm ET • Meeting Information: • Web Meeting URL: https://meetings.webex.com/collabs/meetings/join?uuid=M55ZKYUA35CE2U3J4SV41XMZR3-3MNZ • Meeting Number: 193 323 052 • Phone: 770-657-9270, Participant Code: 071582

HL7 Patient Care WG Meeting Reminders, cont’d... Care Plan Project • Completed ballot reconciliation • Submitted updated Care Plan Storyboards and Domain Analysis Model for the HL7 May 2014 ballot Cycle • Ballot reconciliation is underway • Current working documents found here: http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012 • Meetings every other Wednesday from 4:00 – 5:30pm ET • Next meeting is TBD • Meeting Information: • Web Meeting URL: nehta.rbweb.com.au • Phone: 770-657-9270, Participant Code: 943377

HL7 Patient Care WG Meeting Reminders, cont’d... Health Concern Topic • Developing user stories highlighting the following: What is a Health Concern Observation; How Health Concern Tracker is Used; How Health Concern is different from Problem Concern • Current working documents found here: http://wiki.hl7.org/index.php?title=Health_Concern • Meetings every other Thursday from 4:00 – 5:00pm ET • Next meeting scheduled for May 22nd • Meeting Information: • Web URL: https://meetings.webex.com/collabs/#/meetings/joinbynumber • Meeting Number: 236424669 • Phone: 770-657-9270, Participant Code: 943377

AHIMA 2014 LTPAC Health IT Summit WHAT: Provides thought-provoking, interactive sessions aimed at advancing HIT Priorities; showcases implementation successes; and puts the spotlight on LTPAC technologies WHEN: June 22nd to June 24th, 2014 WHERE: Hyatt Regency Baltimore on the Inner Harbor Register at: http://www.ahima.org/events/2014june-ltpac For further information, contact Exhibits Manager: sarah.lawler@ahima.org

LTPAC/BH Listening Session (HealthIT.gov) The Certification and Adoption Workgroup of the Health Information Technology Policy Committee has been exploring the health IT needs of LTPAC and BH settings and how those needs could be supported through ONC Voluntary EHR Certification. The Workgroup has developed a proposed set of certification criteria focused on interoperability, privacy and security, and modularity and is now seeking public comment in two ways. • Participate in a listening session on Thursday, May 22th. There is limited time for this session, please register early. • During the week of May 12th, the full list of the proposed recommendations and an opportunity to provide written comments on those recommendations will be provided. Click here to sign up for May 22nd listening session

FACA Meeting Reminders (see end of deck for updates) HIT Policy Committee Certification and Adoption WG Next meeting scheduled for May 13thfrom 9:00am – 11:00am ET http://www.healthit.gov/FACAS/calendar/2014/05/13/policy-certificationadoption-workgroup HIT Policy Committee Meaningful Use WG Next meeting scheduled for May 20th from 10:00am – 12:00pm ET http://www.healthit.gov/facas/calendar/2014/05/20/policy-meaningful-use-workgroup HIT Policy Accountable Care WG Next meeting scheduled for May 20th from 2:30pm – 4:00pm ET http://www.healthit.gov/FACAS/calendar/2014/05/20/policy-accountable-care-workgroup HIT Standards Committee Next meeting scheduled for May 21stfrom 9:00am – 3:00pm ET http://www.healthit.gov/facas/calendar/2014/05/21/hit-standards-committee HIT Quality Measures Vendor Tiger Team Next meeting scheduled for May 22ndfrom 11am – 12:30 pm ET http://www.healthit.gov/FACAS/calendar/2014/05/22/policy-quality-measures-vendor-tiger-team HIT Policy Committee Next meeting scheduled for June 10thfrom 9:30am – 3:00pm ET http://www.healthit.gov/FACAS/calendar/2014/06/10/hit-policy-committee

LCC Pilot WG Timeline: Aug 2013 – Sept 2014 LCC Pilot Proposal Review LCC Pilot Monitoring & Evaluation LCC Pilot WG LCC Pilot Wrap-Up HL7 Ballot & Reconciliation HL7 Ballot HL7 C-CDA IG Revisions LCC Pilot WG Launch Revisions for HL7 CCDA IG Complete HL7 Ballot Publication HL7 Fall Ballot Close IMPACT Go-Live LCC Pilots Close LCC Pilot Test Spec. Complete Milestones GSI Health Go-Live NY Care Coordination Go-Live

GSI Health Pilots Update • Vince Lewis • Vincent.Lewis@gsihealth.com

Next Steps • Homework Assignments: • Complete Pilot Survey • Sign up as an LCC Committed Member • Submit Pilot Documentation Proposals • Available on the LCC Pilot SWG Wiki: http://wiki.siframework.org/LCC+Pilots+WG • Email to Lynette Elliott (Lynette.elliott@esacinc.com)

LCC Initiative: Contact Information • LCC Leads • Dr. Larry Garber (Lawrence.Garber@reliantmedicalgroup.org) • Dr. Terry O’Malley (tomalley@partners.org) • Dr. Bill Russell (drbruss@gmail.com) • Sue Mitchell (suemitchell@hotmail.com) • LCC/HL7 Coordination Lead • Dr. Russ Leftwich (Russell.Leftwich@tn.gov) • Federal Partner Lead • Jennie Harvell (jennie.harvell@hhs.gov) • Initiative Coordinator • Evelyn Gallego (evelyn.gallego@siframework.org) • Project Management • Pilots Lead: Lynette Elliott (lynette.elliott@esacinc.com) • Use Case Lead: Becky Angeles (becky.angeles@esacinc.com) LCC Wiki Site: http://wiki.siframework.org/Longitudinal+Coordination+of+Care

FACA Updates • As of 05/12/2014

FACA Updates: HIT Standards Committee Meeting 04/24/14 Summary of recommendations regarding Transitions of Care: • EHRs will not be able to distinguish between a 2014 and 2015 CCDA, although the 2015 Edition EHR technology must be able to receive both types • EHR technology certified to the 2014 Edition will not be able to receive and process a ToC using CCDA 2.0 • There should be asynchronous bilateral upgrades • The Direct Edge Protocol Implementation Guide (IG) is too ambiguous and not sufficiently constrained • Although it would be good to have a performance standard, it is difficult to understand how it could be tested for certification • It would seem minimally that a library of derivative CCDAs would have to be available or a testing tool capable of generating the same would need to be available for vendors to prepare with

FACA Updates: HIT Standards Committee Meeting 04/24/14, cont’d… Comments on the Transitions of Care recommendations: • It was suggested that if certification testing were sufficiently rigorous, it would not be necessary to consume large bodies of CCDAs • A discussion took place regarding the possibility of changing from conformance testing to outcome testing • The definition of interoperability, rather than testing, is the issue, and thinking about changing the definition of success to interoperability is recommended • It was suggested and discussed that reduction of optionality should occur at the front end • It was suggested that Edge protocol should be highly constrained and specific • A recommendation was made to fix the trust issue first

FACA Updates: HIT Policy Committee – Certification & Adoption WG 05/06/14 Workgroup comments on LTPAC/BH Voluntary EHR Certification (specifically regarding Transitions of Care): • Alignment of standards and certification criteria across all heath providers is essential for transitions of care (TOC). • Refinements to the TOC and care planning standards in the Fall HL7 2013 CCDA ballot will support care coordination for LTPAC, BH and other health care providers across the care continuum. • Operational experience with emerging standards is needed before inclusion in certification. • ONC should assess emerging standards maturity • Standards development cycles may vary (e.g., standards that have never been collected versus vocabularies in use by a sector, but newly added to the CCDA)

FACA Updates: HIT Policy Committee – Certification & Adoption WG 05/06/14, cont’d…

FACA Updates: HIT Policy Committee – Certification & Adoption WG 05/06/14, cont’d… Recommendations for LTPAC and BH EHR Certification Criteria – Transitions of Care (for all Providers)

FACA Updates: HIT Policy Committee – Certification & Adoption WG 05/06/14, cont’d… Recommendations for LTPAC and BH EHR Certification Criteria – Privacy and Security (for all Providers)

FACA Updates: HIT Policy Committee Certification & Adoption WG 05/06/14, cont’d… Summary of 2015 Edition NPRM Comments • Overarching comments: • The WG is supportive of ONC’s intention to ease the burden of regulations and have a more incremental process. However, many of the proposals do not seem to achieve that goal. • Overall, the WG did not think certification was the appropriate avenue to explore innovations. • The WG stated that certification is often prescriptive and overly burdensome. • In order to support and stimulate development of HIT, ONC could, for example, provide a roadmap, continue its efforts with the S&I Framework, support pilot programs and build on innovations in the marketplace. • When considering costs, ONC should include software development and certification costs; Provider implementation, training and rollout costs; ongoing use, maintenance, support and service/subscription costs • The WG urges ONC to use the 5 Factor Framework

FACA Updates: HIT Policy Committee Certification & Adoption WG 05/06/14, cont’d… Incremental Rulemaking Comments: • CAWG supported ONC’s goals of providing clear signals and incremental changes to increase opportunities for innovation and updates to standards. • The WG did not support ONC’s model of incremental rule making, and did not believe incremental rules would achieve the stated goals. The WG cited the following issues: • As regulatory process, certification involves long time periods and significant testing costs. • Certification should not use “Version 1” of standards or new functionalities. Before certification is proposed, significant operational usage should be required—not just “pilots” and not just “balloting”. • “Mandated” standards can interfere with consensus-driven stakeholder standards development • Frequency of regulatory update makes it difficult for vendors and providers to keep up.

FACA Updates: HIT Policy Committee Certification & Adoption WG 05/06/14, cont’d… Incremental Rulemaking Comments, cont’d: • If ONC chooses to pursue incremental rule making, the CAWG believes it should only make: • Incremental certification program updates • Minor technical updates and fixes , including minor updates to referenced standards, vocabularies and data definitions • Error corrections • For all other items, an RFI or ANPRM is better suited to solicit early feedback. The WG did not achieve consensus regarding discontinuation of the Complete EHR definition. The CAWG did not support the proposal around “Certification Packages.” Regarding the ONC Certification Mark, the WG understands this to be primarily an issue between ONC and the Authorized Certification Bodies. ONC wants a single Certification Mark rather than having each ACB issue its own mark.

FACA Updates: HIT Policy Committee Certification & Adoption WG 05/06/14, cont’d… Non-MU Certification Comments • Overall, the WG could not determine the impact of having non-MU certification on the market and the vendor community. • The WG supported taking a step forward to support non-MU adoption of EHR technology. However, the WG believes the proposal creates a binary certification program. Instead, the WG supports conceptualizing the expansion as multi-factor, with many other programs and needs for CEHRT arising. Non-MU HIT Certification Comments • The WG sees value in voluntary certification program for other types of HIT. • The WG encourages ONC to work with other agencies to collaboratively develop programs and funding specific to the needs of the partner agency before certification criteria are created.

FACA Updates: HIT Policy Committee Certification & Adoption WG 05/06/14, cont’d… Additional Patient Data Collection Comments • Overall, the WG agreed that there was value in collecting disability, sexual orientation and gender identity, occupational, and military data about patients. • The reasons for collecting each of these data elements differed, and are likely not a good fit for a demographics criterion. • The collection of these additional data elements raised privacy, implementation, and workflow concerns. • If this information is collected, it is important to focus on the capture of data, and not how it is collected or where it is stored. • The collection of this data could be valuable for assessing health disparities. • In addition, the WG believes the information needs to be coordinated with CCDA requirements and coded in accordance with the CCDA.

Longitudinal Coordination of Care Pilots WG