Health Information Exchange

Transcription

1 Health Information Exchange A collaboration of regional providers Tracy Crawford, Program Director ClinicalConnect Health Information Exchange May 23 rd, 2012

2 The Road to ClinicalConnect Six (6) Community Hospitals began discussions around the commonality of performing Open Heart Surgery The Federal Government enacts the Health Information Technology for Economic and Clinical Health Act (HITECH) to establish the meaningful use of interoperable EHRs. Community Hospitals joined Altoona Regional, Armstrong Memorial and UPMC to explore forming a Health Information Exchange (HIE). A consulting firm was engaged to study how a HIE could be formed and run by this group. Two models were proposed

3 The Road to ClinicalConnect Model 1 Rich Model: Independent, non-profit RHIO operating an HIE. Requires accounting, marketing, legal services, liability insurance, benefits, overhead, marketing, outreach, and business development Model 2 - Lean Model: Leverage the strength of UPMC and their in-kind services to implement quickly at a reasonable cost to each member Technology to leverage capabilities of members; dbmotion offers semantic interoperability and centralized repository of aggregated normalized data. A outside law firm was engaged to construct the bylaws, agreements, and model for the Clinical Connect Health Information Exchange (CCHIE) established. 3

4 Creation of ClinicalConnect HIE 503c Non-Profit Board of Directors was created; first meeting occurred on September 1, 2011 Each Participant shall designate three (3) Board Representatives Chief Information Officer Senior Executive Physician Leader Officers of the Board include Chair Vice Chair Executive Director Treasurer Secretary 4

5 Creation of ClinicalConnect HIE Subcommittees of the Board were established for: Privacy and Security - Responsible for the development of a Data Exchange Agreement and a HIPAA Business Associate Agreement Membership and Finance - Responsible for financial matters, including those related to the addition of new members and participants Quality Committee - Comprised of the Physician leadership to work on establishing and tracking quality indicators and benchmarks 5

6 ClinicalConnect HIE Governance Board-approved Workgroups were established for: Operations and Oversight Comprised of the participant CIOs and others Responsible for operational oversight of ClinicalConnect HIE 6

7 ClinicalConnect HIE Founding Partners UPMC Altoona Regional Health System ACMH Hospital The Washington Hospital Butler Health System St. Clair Hospital Excela Health Jefferson Regional Medical Center Heritage Valley Health System 7

8 ClinicalConnect HIE Charter Mission To develop and operate a sustainable network to securely exchange health information in western Pennsylvania. Vision To securely provide information to care providers, where they need it, when they need it and how they need it, in a consistent and reliable manner. 8

9 Expected Benefits from ClinicalConnect Making complete, accurate and searchable health information available at the point of care Enhancing the quality, reliability and continuity of health care delivery not waiting for the exchange of paper records Reducing adverse events/medication errors Eliminating duplicate tests Improving efficiency 9

10 ClinicalConnect HIE Guiding Principles Enhance the coordination of care through a provider driven and patient centered model Facilitate just in time access to data across the care continuum, minimizing delays and allowing clinicians to focus on patient care Build on existing facility investments and leverage vendor relationships Implement incrementally (start with continuity of care document [CCD]) Achieve and maximize Meaningful Use incentives 10

11 Meaningful Use - Proposed Rule Office of National Coordinator for Health IT has released its proposed rule for Meaningful Use Stage 2 Comment period ended May 7 th, 2012 Proposed start date will be October 1, 2013/January 1, 2014 New Proposed rule as it relates to exchange of information: Eliminates the previous Stage 1 objective of Exchange of key clinical information Proposes a more robust health information exchange for Stage 2 Transition of care objective 11

12 Key Meaningful Use Stage 2 areas to be addressed by ClinicalConnect HIE Communication Standards Transition of Care Public Health Measures 12

13 Communication Standards Proposed ONC EHR certification criteria requires a single standard to communicate information Exchange requirements will become more rigorous in Stage 2 of Meaningful Use Clinical Document Architecture (CDA) for the summary of care record based on components of the Continuity of Care Document (CCD) standard formats The Nationwide Health Information Network (NwHIN) Direct Exchange Project provides a simple, secure, standardized way to send encrypted health information to trusted recipients over the Internet 13

14 Previous Meaningful Use Stage 2 and 3 Requirements Stage 2: Connect to at least three external providers in primary referral network (but outside delivery system that uses the same EHR) or establish an ongoing bi-directional connection to at least one health information exchange Stage 3: Connect to at least 30% of external providers in primary referral network or establish an ongoing bidirectional connection to at least one health information exchange 14

15 Proposed Meaningful Use Stage 2 Measures related to Transition of Care More robust health information exchange for Stage 2 The eligible provider or eligible hospital that transitions or refers their patient to another setting of care or provider of care must provide a summary of care record for more than 65 percent of transitions of care and referrals The eligible provider or eligible hospital that transitions or refers their patient to another setting of care or provider of care must electronically transmit a summary of care record using Certified EHR Technology to a recipient with no organizational affiliation and using a different Certified EHR Technology vendor than the sender for more than 10 percent of transitions of care and referrals Proposed content of Transition of Care Document has been defined 15

16 Public Health Measures Stage 2 will require providers and public health agencies to identify an electronic process for the ongoing submission of data such as immunizations ONC is recommending that HIE infrastructure serve as an efficient and lower-cost mechanism for thousands of providers to interact with a smaller number of lower-budget public health entities 16

17 ClinicalConnect HIE 17

18 What does ClinicalConnect look like to a clinician? Clinician logs into participant EHR and selects patient record Clinician clicks a link to access the HIE data Patient is displayed in context in dbmotion HIE node with data from the HIE participants and the UPMC data integrated into a single view * QD = Queries Dialogue appears on EHR desktop

19 dbmotion Summary Clinical View 19

20 ClinicalConnect HIE Privacy and Security Overview All participants must sign a standard Data Exchange Agreement, which includes a standard HIPAA Business Associate Agreement, Notice of Privacy Practices Addendum CCHIE would be a Business Associate to each participant CCHIE has a staff member dedicated to ensuring Privacy, Security and Compliance policies exist and are monitored 20

21 Data Exchange Agreement Includes a standard HIPAA Business Associate Agreement, Notice of Privacy Practices Addendum, and policies Developed based on input from the HIE s Privacy Workgroup Approved by the HIE s Board of Directors Reviewed by outside counsel 21

22 Data Exchange Agreement outlines Consent Model Establishes standards for the exchange of information though the HIE Based on an opt-out approach (i.e. the data will be exchanged, unless the patient requests that his/her information is not exchanged) Describes the HIE s and each Participant s rights and obligations 22

23 Data Exchange Agreement Permits exchange for treatment, payment, healthcare operations, public health and the reporting of clinical quality measures (including measures to demonstrate meaningful use ) Requires board approval for various other uses, such as benchmarking & comparative purposes, population management and preventative care by the HIE or Provider 23

24 Challenges of Consent Challenge of collecting patient consent using the Lean Model No customer service center at this stage of CCHIE; therefore, each participant s registration system collects patient consent CCHIE MPI tracks all consent responses CCHIE honors the last consent received 24

25 ClinicalConnect HIE Implementation Phases Phase 1 - June 2012 Heritage Valley Health System (HVHS) will serve as the pilot and will send health information to the HIE via a Continuity of Care Document (CCD). HVHS and UPMC health information will be integrated into a normalized HIE view. During month of June 2012, four (4) of the eight (8) Founding Partners will be connected to CCHIE for viewing capabilities. Planning in process of remaining Founding Partners to view by September

26 Proposed Data to Exchange via CCD in Phase 1 Encounters Medications Allergies Problems Immunizations Lab Results Documents such as Discharge Summary, Radiology reports and Pathology Reports 26

27 Future of ClinicalConnect HIE Assess the remaining Founding Partners to submit their health information via a CCD Assess the ability and pilot an outbound CCD Add additional hospital systems and healthcare providers such as other physician groups, long term care or rehab facilities, home health agencies, and ancillary providers Identify how ClinicalConnect can better serve members via the Direct Project Connect to other HIEs or NwHIN Public health reporting of immunizations Support members in achieving MU2 through the timely transfer of transition of care documents 27

28 Future State of Health Information Exchange ClinicalConnect HIE will most likely be connected to both the State and Federal exchanges, in addition to other Health Information Exchanges. ClinicalConnect HIE PA ehealth Collaborative Community Shared Services (CSS) Other HIEs Federal NwHIN Provider Organizations Depending on scope of services offered by CSS, CCHIE may connect to other regional HIEs and the NwHIN independently or via CSS. 28