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This webinar discusses the connection between HIE/HIO and the Direct Protocol in the implementation of Meaningful Use Stage 2. Panelists explore interoperability, trust, security, and best practices for information exchange.
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December 18, 2013 A Closer Look at HIE/HIO & the Direct Protocol: Exploring the Connection to Meaningful Use Stage 2 Implementation & Information Exchange Facilitator: Lee Barrett, Executive Director, EHNAC Panelists Catherine Costello JD, Project Manager Ohio Health Information Partnership David Kibbe MD, MBA President/CEO DirectTrust Alex Kontur, Research Analyst, eHealth Initiative (eHi) Lee Stevens, Director, State HIE Policy, ONC Andrea Perry MPA, Privacy Officer, Ohio Health Information Partnership Andrew VanZee, Director Healthcare Strategies & Technology Indiana Family & Social Services Admin. For National eHealth Collaborative (NeHC) Mariann Yeager, Executive Director HealtheWay
Agenda • L. Barrett: Panel Intro. & Setting the Stage • L. Stevens: ONC Nationwide HIE Strategy • A. Kontur: eHi 2013 HIE survey and Summit key topics • A. VanZee: NeHC Workgroup Certification/Accreditation Inventory initiative • M. Yeager: HealtheWay Exchange Connectivity • D. Kibbe: The role of DirectTrust and the Direct Protocol • C. Costello/A. Perry: OHIP Case Study • Q&A
Webinar Objectives • Explore how organizations can assure interoperability and scalable trust; • Explain the significant differences between EHR technology software certification and security/trust accreditation for HISPs, CAs and RAs who partner with EHRs; • Provide best practice examples of how to facilitate security, interoperability and trust among exchange participants, fostering public confidence, and promoting the adoption and success of allexchange stakeholders;
Webinar Objectives cont. • Describe ways to reduce PHI exposure risks through the demonstration of comprehensive risk management programs; and • Outline how to prepare your exchange for implementation of secure communications in support of Meaningful Use requirements by the ONC.
Challenges • Understanding the role of the various industry organizations • What are the various exchange models in use today • Stakeholder Trust • Managing Risk & Risk Mitigation • Privacy and security issues
Nationwide HIE Strategy Lee Stevens Director State Health Information Exchange Policy Office ONC
Information Securely Follows Patients Whenever and Wherever They Seek Care QUERY-BASED EXCHANGE MULTIPLE MODELS DIRECTED From Health Affairs, March 5, 2012 CONSUMER-MEDIATED EXCHANGE
HIE Market Reality • HIE facilitated by a variety of organizations/sources including: • HIOs • HISPs • EHR vendors • National services providers • Hospitals • ACOs • Health Center Controlled Networks • Others
ONC’s Approach • HIE is a journey, not a destination • Leverage government to create conditions of exchange • Health information exchange is not one-size-fits-all • Multiple approaches will exist side-by-side • Build in incremental steps – “don’t let the perfect be the enemy of the good”
ONC’s Role Reduce Cost and Increase Trust and Value To Mobilize Exchange ONC
The State HIE Program (data as of Q2 2013) Directed Exchange Color Legend Directed exchange mechanisms broadly available NH VT ME WA Directed exchange mechanisms available in regions ND MT MN MA OR NY WI ID SD MI RI CT WY Directed exchange mechanisms being piloted PA NJ IA DE NE OH MD IN NV IL Directed exchange mechanisms not available WV UT VA CO CA KS MO KY NC Query-Based Exchange Pattern Legend TN SC OK AZ AR NM GA Query-based exchange mechanisms broadly available MS AL FL LA TX Other states and territories Query-based exchange mechanisms available in regions AK HI • Only 3 territories do not have operational exchange options available for providers today • Most states now offer both directed and query exchange options to providers CNMI AS PR DC USVI GU
Focus on Exchange in the Stage 2 Meaningful Use Criteria • E-prescribing • Transition of Care summary exchange: • Create & transmit from EHR • Receive & incorporate into EHR • Lab tests & results from inpatient to outpatient • Public health reporting – transmission to: • Immunization Registries • Syndromic surveillance • Reportable lab results • Cancer Registries • Patient View, Download and Transmit to 3rd Party
Care and Payment Reform Activities • Inter-professional Education & Inter-collaboratory Practice Models • Patient Centered Medical Home (PCMH) • Pay for Performance (P4P) • Programs to pay for value; not for volume (outcome; not services) • Accountable Care Organizations (ACO) • Shared Savings Program (SSP) • Advanced Payment ACO Model • Pioneer ACO Model • Center for Medicare & Medicaid Innovation Programs (CMMI) • State Innovation Models Initiative (SIM) • Comprehensive Primary Care Initiative (CPC) • Bundled Payments for Care Improvement Program (BPCI) • Community-based Care Transitions Program (CCTP)
Strategies to Advance Nationwide Exchange • Enable a governance infrastructure, including a trust framework, that reduces barriers to exchange • Coordinate across federal government partners on HIE funding, innovations and implementations • Create shared learning opportunities to identify best practices and lessons learned to advance exchange • Coordinate between real world implementers and the S&I Framework to test standards and develop implementation guidance • Convene implementers to develop and implement “solution packages” to thorny and important exchange challenges to drive towards nationwide adoption
Strategies to Advance Nationwide Exchange • Support HIE as an important element of meaningful use of EHRs • Help vendor community (EHR and HIE) understand meaningful use requirements and options • Help identify and resolve technical and policy issues • Better understand vendor needs and challenges and help coordinate practical solutions
Strategies to Advance Nationwide Exchange • Support state-level and community HIT-enabled care transformation • Work with CMS and vanguard states to develop models for developing and deploying HIT infrastructure at the state level to support payment reform and care transformation • Support states in using policy, contracting, regulatory and convening levers to build a stronger business case for exchange and address the exchange needs of payment reform • Convene state policy leaders, federal partners and other leaders to tackle and resolve specific issues confronting on the ground implementers who are using HIT to support state-level care transformation including quality reporting, analytics, care coordination and patient engagement.
Conclusion • Nationwide HIE will include directed, query and consumer based exchange • There will be a variety of sources for exchange • Exchange will develop incrementally • MU and payment reform are important policy levers for exchange • Governance is required to develop the trust that will enable data to flow between unaffiliated organizations • Adherence to nationwide standards and certifications will remove the “stove pipes” • States will continue to be a key strategic partner as HIE supports payment reform and state health goals
Stay Connected • Browse the ONC website at: healthIT.gov • Contact us at: onc.request@hhs.gov • Follow our blog: http://www.healthit.gov/buzz-blog/ • Ask a question: BlueButton@hhs.gov • Subscribe, watch, and share: • @ONC_HealthIT • http://www.youtube.com/user/HHSONC • HealthIT and Electronic Health Records • http://www.scribd.com/HealthIT/ • http://www.flickr.com/photos/healthit
About eHealth Initiative • Since 2001, eHealth Initiative is the only national, non-partisan group that represents all the stakeholders in healthcare. Represents over 15 different stakeholder groups and 39 states across the nation. • Mission to promote use of information and technology in healthcare to improve quality, safety and efficiency. • Last year, over 4500 individuals attended our events and 500+ individuals participated in our national councils and workgroups • eHealth Initiative focuses its research, education and advocacy efforts in four areas: • Data and Analytics • IT Infrastructure to Support Accountable Care • Technology for Patients with Chronic Disease • Data Exchange & Interoperability
About the 2013 Survey • 10th annual survey • Comprehensive survey to determine the state of the field; covers governance, sustainability, operations, stakeholder participation, privacy policies, and more • 199 of 315 identified organizations completed the survey • 90 community HIEs, 45 SDEs/state HIEs, 50 healthcare delivery organizations, others include public health, payers
What We’ve Learned • 84 have reached stage 5 (operational) or higher • Who provides HIEs with data? • Hospitals (160), ambulatory care providers (142), independent labs (85), community and/or public health clinics (82) • Who accesses data? • Ambulatory care providers (159), hospitals (145), community/public health clinics (105), behavioral or mental health (90)
What We’ve Learned • Interoperability is a major concern • 142 respondents cited interoperability as a pressing challenge • 151 organizations have had to build interfaces with disparate systems (68 have had to build 10 or more; 32 have had to build 5 or more) • 65 participate in an ACO; 65 plan to do so in the future • 90 currently use Direct • Transitions of care is the most common use case (65) • 30 are NOT planning to use Direct
What We’ve Learned • What services do HIEs offer? • Connectivity to EHRs (125), exchange of health summaries (115), master patient index (114), results delivery (104), provider directory (84) • What data types are available? • Results (131), admission/discharge summaries (125), care summaries (125), diagnoses (115), CCDs (113), allergy info (113), patient histories (111), medication data/prescriptions (109)
What We’ve Learned • Who is funding HIE? • Hospitals (79), state or federal funding (64), ambulatory providers (38), private payers (23), Medicaid (15) • How? • Memberships fees (71), assessment fees (66), fees for specific services (48), state funds (39) federal funds (34) • Are they sustainable? • About half (52) receive sufficient revenue from participants to cover operational expenses
What We’ve Learned • Opt-out is the most common consent model (115) • 109 organizations do not offer patients granular consent controls • controls for sensitive information are most common (43) • Limited patient access • 31 organizations offer patients access to their data • 102 plan to offer access in the future • 56 have no plans to do so
Looking Forward • Evolving sustainability plans • Private payers • less emphasis on public sources • shift to service fee model • HIEs are turning the corner • Interoperability is now a more pressing concern than sustainability
Looking Forward • Health reform has helped create the business case for HIE, and service offerings will reflect this • HIEs anticipate offering provider alerts (83), patient access (78), analytics (74), reporting to disease registries (66)
Thank You! Contact info: Alex Kontur 202.624.3280 akontur@ehidc.org
Andrew VanZee: NeHC Workgroup Certification/Accreditation Inventory Initiative
Definitions*As determined by the Accreditation & Certification workgroup Accreditation • A process in which certification of competency, authority, or credibility is presented • The accreditation process ensures that their policies and practices are acceptable, that organizations behave ethically and employ suitable quality assurance and, if appropriate, that they are competent to test and certify third parties Certification • The process of certifying that a certain product has passed performance tests and quality assurance tests, and meets qualification criteria stipulated in contracts, regulations, or specifications
Forum HIE Accreditation and Certification Workgroup Workgroup Charge • Develop an inventory of national, regional, and state accreditation and certification programs, providing a landscape of these efforts including their purpose, scope and source of authority Workgroup Purpose • This landscape will provide stakeholders with an understanding of the categories of programs, where and why they are emerging, and what they are intended to address
Accrediting and Certifying Organizations Data Request • Key accreditation and certifying bodies, including state designated entities, were invited to share information to provide understanding of the HIE accreditation and certification landscape • Purpose of Accreditation/Certification program: • Who is this accreditation/certification relevant to? Who is the target audience? • What is the scope (technical, policy, etc.)? • What are the issues that are addressed? • What are the types of assurances that are gained? • What is the source of the authority; i.e. state, regional, national organization? • Is the program voluntary or required? • Is it an evaluation or a registry? • Are there any standards that are being used as a baseline for their certification or accreditation? • Are you aware of any overlap in the industry regarding HIE accreditation and certification? If yes, please provide details on overlap. • What are the gaps in current HIE accreditation or certification activities; i.e. what other matters would be best served by receiving an accreditation or certification by a third party? • What type of entity is best suited to perform this additional verification?
Initial Conclusions from Information Gathered from Accrediting and Certifying Organizations • A continuing theme around these efforts is that to increase trust and interoperability. • Much of the target audience consists of HISPS, HIOs, providers, vendors, or HIEs. • The scope of the accreditation & certifications center around: • Technology • Policy/Legal including trust agreements • Security • Financial Sustainability including fee structures • Approximately half are required and half are voluntary with some – Texas – being voluntary unless you would like to be listed as a trusted entity. • The majority of accreditation & certifications are evaluations • Many states are using national sources like EHNAC, DirectTrust, Healtheway, and CCHIT as a basis for their accreditation and certification efforts but some – Vermont, Indiana mostly, and Pennsylvania – pull from other sources as well.
Potential Gaps • What are the gaps in current HIE accreditation or certification activities; i.e. what other matters would be best served by receiving an accreditation or certification by a third party? • We do not yet have a reliable and comprehensive testing and certification service unique for HISP/STAs. These entities may be partially tested and certified when using specific EHR vendor modules as “relied upon software” within the context of the 2014 Edition Certificate Criteria. However, not all HISPs have these partnerships.
Additional Verification • What type of entity is best suited to perform this additional verification? • Initially at this early stage, state programs are adequate; however ultimately a public/private non-profit should be responsible • Verification standards and other criteria should be set by a community entity or government • Verification against criteria should be performed by an independent third party
Data Request of Non-Accrediting and Certifying Organizations • Invited non-certifying bodies to provide information about accreditation and certification programs they are subject to. • Organization Name: • What HIE accreditation and certifications are you required to comply with? • What voluntary HIE accreditation and certifications do you currently comply with? • Are they evaluation or registries? • Are you aware of any overlap in the industry regarding accreditation and certification requirements? • What are the gaps in current HIE accreditation or certification activities; i.e. what other components would be best served by receiving an accreditation or certification by a third party? • What type of entity is best suited to perform needed accreditation or certification?
Non-Accrediting and Certifying Organizations Who Provided Information • Great Lakes HIE (GLHIE) • Brooklyn Health Information Exchange (BHIX) • Rhode Island Quality Institute (RIQI) • Oregon Health Authority/CareAccord (OR HIE) • ConnectHealthcare • Advanced Answers on Demand, Inc.
Initial Conclusions from Non-Accrediting and Certifying Organizations • The majority of respondents are not required to comply with any accreditation or certification programs although states (OR, NY) are slowly developing these programs that may be required in the future. • Many are voluntarily certified and accredited with EHNAC and CCHIT. • Many did not understand the question about registries vs. evaluations so we did not receive a good sense of their answer. • Most were not aware of any overlap in the current requirements. • Meaningful Use and HIE was cited by two respondents as a potential gap that could be filled by a third party. • Two respondents cited an “independent” organization as the best one to administer the needed certification and/or accreditation. Some cited EHNAC or CCHIT. One suggested a government agency or accreditation commission. One suggested an entity who was fluent in the laws of the specific state.
Entities to Perform Needed Programs • What type of entity is best suited to perform needed accreditation or certification? • An entity best suited to perform accreditation or certification of Qualified Entities in New York State would be one that comprehends the complexity of the HIE environment from many perspectives, including but not limited to technical applications, policy and privacy concerns, overall operations as well as the business community. The entity would also need to be well versed in Federal Law, New York State Law as well as emerging New York State Policy Guidance which governs health information exchange. • We believe the current ATCB process with entities like CCHIT are the best.
Suggested Next Steps • Continue to inform and educate the community on the types of accreditation and certification programs, status, and progress. • Raise awareness of the value proposition and business case for accreditation and certification. • Identify a neutral, credible third-party organization and encourage them to keep track of current accreditation and certification programs for community reference. • Encourage above organization to build on current landscape work and collaboratively identify gaps and consider how best to fill them.
Mariann Yeager: eHealth Exchange Enabling Care Coordination and Transitions of Care
eHealth Exchange • Establishes framework that community of exchange partners use to interconnect directly with each other based upon a common set of rules of the road • Technical requirements verified through technical testing • Common expectations regarding privacy and security and other exchange obligations • Compliance with rules of the road enforced by contract • Participants can exchange for multiple use cases and different work flows under this common framework • Push of clinical documents • Query / retrieval of information for treatment, transitions of care, care coordination, Social Security disability benefits, etc.
