DHIN Infection Implementation in Delaware

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1 Delaware Health Information Network Town Hall Wednesday, March 12, :00 a.m. 11:00 a.m. Conference Room 107 Wolf Creek Boulevard Suite 2 Dover, DE Meeting Minutes Purpose To keep our public informed. Agenda What we are doing What we will be doing What should we be doing (public feedback?)? I. CURRENT Activities Update DHIN has successfully certified another EMR for a results delivery interface. The significance is that one interface from the EMR to DHIN allows all of the result types from DHINs eighteen data senders to be incorporated directly into the users EMR; a tremendous savings over the cost of interfacing to multiple data senders and an important convenience and improved work flow. All Meds is now certified which brings us to a total of twenty EMRs that have certified results delivery into DHIN. This represents close to three-quarters of all of DHIN practices that use an EMR. The practices make the decision whether to implement the interface and some choose not to implement. One of our concerns is that there are approximately forty smaller EMRs left that are being used by one or two practices in the state of Delaware; and with the smaller EMRs, we cannot work with all of the vendors on developing an interface. DHIN does not want to walk away from those users who have an EMR that is not one of the most popular in the state. Therefore, we have recently executed a contract with Halfpenny and they will work on our behalf with some of the smaller EMRs. Halfpenny has already done integration work with these EMRs in other settings and we are hopeful that this will give us an avenue to continue to provide an important service where it would be difficult to get the attention of those vendors without additional help.

2 Public Health DHIN expects to go into production with Public Health Lab as our newest data sender by tomorrow morning. We are happy to see results coming through DHIN and want to stress that at our initial Go-Live we will not be including sensitive data such as STD/HIV testing results. At this time, we do not have the tools to filter out or limit any sensitive and confidential data. DHINs next software upgrade will have the tools to allow us to have a more granular consenting. DHIN will eventually include all Public Health Labs with a limitation on the data transmitted into DHIN. Newborn Screening We continue to work with Public Health to incorporate newborn screening results into DHIN. Newborn screening involves a component of a hearing test and a metabolic screening test which will be combined into one report. DHIN will then deliver the NBS report to the ordering providers and a copy in the community health record will be available for query. DHIN anticipates an early May production date. Beebe DHIN has been working with Beebe on a number of initiatives. Beebe is currently going through a massive EHR integration change. Radiology and transcribed reports interfaces were completed first since these are existing interfaces. These went into production on March 9 th ; however, due to post production issues, these have not been turned on for the end users. The next interface scheduled is cardiology, and DHIN is targeting to Go-Live within the next two weeks. In early April, DHIN and Beebe will begin planning the lab interface upgrade. The lab Go-Live date will occur during DHIN s blackout period, so we will try to have this completed before the freeze. ADT Messages DHINs enrichment of ADT messages for Nemours, Nanticoke and Atlantic General Hospital have completed the process which was done for all other hospitals. More of an internal process, but we now are able to enrich all of the ORU messages for the hospitals with ADT information. Software Upgrade DHIN has completed a minor software upgrade with a series of small fixes; one being an upgrade to ProAccess on Medication History. Medication History has not been widely adopted partially due to many of our users having other tools/services available which they are receiving the information from. DHIN has received confirmation from the using practices that the upgrade has solved any issues or concerns regarding the performance of Medication History.

3 Event Notification System For several months, DHIN has been providing notifications to the Medicaid Managed Care Organizations of discharges from participating emergency room hospitals. DHIN continues to follow up to confirm that the information they are getting is what is needed and useable. We are also working on metrics that will allow us to get meaningful assessments of the value of the service. DHIN continues to work with Aetna and Highmark on behalf of the State Employee Benefits Program. DHIN has received the member roster from Highmark and is in the process of validating the information and configuring the ENS service. DHIN also continues working on MOAs with the qualified health plans listed on the Market Place. One of the requirements in Delaware for a plan to be listed on the Market Place is participation in DHINs data exchange services. Between the Medicaid expansion and those who have signed up on the Market Place, at the end of February, providers of the 9000 additional covered lives will be participating in the ENS with DHIN. DHIN is in beta testing with three practices throughout the state to validate that the same functionality can be applied at the practice level. CMS has approved two new billing codes for transitional care management. These codes apply to Medicare patients and allow the practices to follow up within two days of discharge from a hospital setting. The key is having some form of contact with the patient within 48 hours of discharge, whether it is face-to-face, voice, etc. On a practical level, the Event Notification System will enable practices to receive immediate notification when one of their patients has been discharged from an inpatient/emergency department setting. This information then allows the provider to take action and obtain reimbursement from CMS. One reimbursement a month will come very close to covering the cost of subscribing to the service. Care coordination is going to be a valuable service as patients transition from one care setting to another, making certain the right people are informed of that transition and are able to take appropriate actions. DHIN has successfully tested with all three beta practices and all three have received notifications. We now have a plan on how to implement this service at practice level and are now ready to market broadly throughout the state. For those interested in signing up for the Event Notification System there is a landing page on the DHIN web-site ( and complete information regarding ENS. Providers can log on to the link for onboarding, complete the form and you will be contacted by our staff within 24 hours to finalize the onboarding experience.

4 Electronic Lab Reporting DHIN continues to work with Nanticoke and Public Health on Electronic Lab Reporting of notifiable conditions. We are now at the level of content validation and need to ensure that Public Health is getting the content needed. Though the work is in progress, CCHS is not yet reporting their notifiable labs to Public Health. CCHS has run into time restraints as all data sending organizations are involved with ICD -10, which is consuming the attention of the IT staff in all healthcare organizations. Immunization Reporting Immunization Reporting is a work in progress as we continue to onboard practices. We currently have 106 different organizations sending their immunization updates to Public Health electronically through to DHIN and this number will continue to grow as the organizations that are in testing move into production. Immunization Reporting is one of DHINs newer services and a Meaningful Use requirement. CCDs Continuity of Care Document exchange with ambulatory practices is a requirement under Meaningful Use Stage 2. At each transition of care, a summary of care needs to be provided to the receiving care setting and a certain percentage must be provided electronically. DHIN will deliver the content where it needs to go and a copy will also be kept in the community health records where it will be available for query. DHIN currently has five vendors and an additional number of organizations that have expressed an interest to work with us on CCD Exchange. CCD Exchange is a new data type and is also necessary for Meaningful Use State 2. However, it is also important and valuable, for those involved in patient centered medical homes or those thinking about accountable care organizations. Clearly, the ability to track patients and know where they are is important and to provide appropriate information, to the appropriate parties, at the appropriate times is critical for everything to work. DHIN has the opportunity to be relevant and to be the one place to go for clinical information about patients. By the end of 2014 fiscal year, our goal is to have 30 practices providing CCDs into DHIN. Department of Corrections DHIN also continues in discussions with Department of Corrections. DOC contracts with a company to provide medical services for their residents and will be changing their vendor in July. DOC is one of the largest users of the DHIN system. We met with representatives from DOC yesterday to discuss a broader need in the future. They are also very interested in CCDs. Most of their residents leave the DOC system and transition into Medicaid. Since DHIN works with Medicaid MCOs, it is a good tie in to helping to facilitate the transition of care.

5 II. PLANNED Activities Update DHIN is preparing a major software/data base conversion upgrade. We anticipate significant changes and improvements in the basic technology platform that Medicity is providing. However, there will be an incredible amount of testing before anything goes into production. We will be partnering with all of our data senders to validate the integrity of the data before going live and out to the public. During the time of testing, there will be a blackout period where we will not be able to move additional projects into production. We will continue to do back end work on projects, but will not be able to move them into production during this time. DHIN is working closely with all the data sending organizations to ensure they understand the timeline and the window of opportunity to move projects into production is before we start the upgrade in early May. Any projects that have not gone into production by early May will not go into production until the software upgrade has been completed in September. This is a significant time period and we will continue to work on current projects and do the preliminary work for future projects, but will not be able to go into production with any new projects until September. DHIN is working with DMMA on a project to incorporate Clinical Quality Measure Reporting directly into the MAPIR systems. Providers who are participating in the EHR Incentive Program through Medicaid rather than Medicare are required under Meaningful Use Stage 2 to ensure those quality measures are entered into the mapping system. We have received 90/10 funding from CMS to initiate this project which is to automate passing of the numerator and denominator information from the practice s EHR into the MAPIR system without the end user having to manually enter the information. This should result in efficiency for practices and faster movement of the information. The grant timeline is April 1, 2014 to September 30, 2015 which gives us just over a year to complete the project. We are currently working on the necessary contracts with vendors and work should start in the near future. The utility of this project is to assist in making the Meaningful Use attestation process easier for the provider. The end result would be that by using this Meaningful Use assistance application, we would have a more comprehensive way of looking at the numerator and denominator of the measures that have been reported and begin analysis of the measures as they are reported by Medicaid providers. SIM Grant The state of Delaware has applied for and received a grant from the Medicare/Medicaid Centers for Innovation to develop a model design for New Systems of Care Delivery and Payment. The final deliverable under this grant was submitted to CMMI in December 2013.

6 The opportunity to apply for the testing grant should be announced shortly. One of the factors that will play into whether we receive the testing grant is evidence that work has already begun to take action on the plan. Though this is a state grant, DHIN has been identified as a key partner for any components of the model design that pertains to Health IT. There will be shared resources across the state involving IT resources and we are meeting on a weekly basis with McKinsey, the consulting company that the state has retained to work on the project. We are currently looking at: What are the technology requirements? What is the minimum required at launch? What is the broader vision of the desired end state? What could we have in place by first quarter of calendar year 2015? What is going to take longer to acquire and build out? We are still gathering requirements and need to understand what the business requirements are before we can provide a technical solution. Public Comments No questions or comments. Next Town Hall meeting will be held on Wednesday, April 9, 2014.