Time Topic and Lead Action Materials 1:00 pm Welcome, Opening Comments, Approve Minutes Greg Fraser

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1 Office of Health Information Technology Health Information Technology Oversight Council September 4, 2014, 1:00 4:30 pm Oregon State Library, Room 103, 250 Winter Street NE, 1st Floor Salem, OR Meeting Objectives Presentation by OpenNotes Discuss HIT/HIE Community & Organizational Panel (HCOP) Charter Discuss State HIT Dashboard/Report Card OHA HIT Activity Updates Time Topic and Lead Action Materials 1:00 pm Welcome, Opening Comments, Approve Minutes Greg Fraser 1:10 pm Goals and Meeting Overview Susan Otter Information Discussion 1:15 pm OpenNotes Amy Fellows Presentation 1. Agenda 2. March 6, 2014 minutes 3. June 5, 2014 minutes 1:35 pm 2015 HIT Legislation Susan Otter Information Discussion 1:55 pm CCO and Stakeholder Engagement Susan Otter & Marta Makarushka Information Discussion Practice-level EHR/Meaningful Use Technical Assistance Survey preliminary results 2:25 pm HIT/HIE Community & Organizational Panel (HCOP) Susan Otter & Marta Makarushka Draft Charter for Discussion, Approval 3:00 pm BREAK Information Discussion Decision 3:10 pm State HIT Dashboard/Report Card Marta Makarushka Information Discussion 3:30 pm OHA HIT Activity Updates Susan Otter Information Final CMS Rule on Meaningful Use Stage 2 Discussion ONC 10 year interoperability plan and roadmap development Direct secure messaging Flat File Directory Britteny Matero Notifications Update Justin Keller 4. Survey Results 5. HCOP Charter 6. ONC 10 year plan 7. CareAccord Newsletter 8. EDIE August Implementation Report 9. EDIE Business Plan Summary

2 4:15 pm Public Comment Information Discussion 4:25 pm Closing Comments Greg Fraser Information Discussion Other Materials 10. EHR Incentive Program Update Next Meeting: Thursday, December 4, :00 4:30 pm Lincoln Building Portland, OR Vision: HIT-optimized health care: A transformed health system where HIT/HIE efforts ensure that the care Oregonians receive is optimized by HIT. Three Goals of HIT-Optimized Health Care: Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver whole person care. Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention. In turn, policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers.

3 OHA Technical Assistance Needs Assessment Preliminary Practice Survey Response Summary Overview The Oregon Health Authority (OHA) is conducting a study to determine the needs of Medicaid practices for technical assistance with electronic health record (EHR) adoption and optimization, including assistance with Meaningful Use (MU) and health information exchange (HIE). OHA is soliciting responses to two questionnaires designed to obtain input to the design of the technical assistance program from CCOs and provider organizations. This is a preliminary summary of 87 responses to the practice questionnaire received between June 3 and August 3, Prioritized Technical Assistance Needs and Timeframe The practice questionnaire respondents indicated that assistance in the following areas is most needed: Help connecting to an HIE network Training for providers and staff on clinical quality measure (CQM) data collection and reporting Help implementing Direct secure messaging These are also areas of most urgent need, as assistance in these areas was requested as soon as possible or within the next 12 months. Technical Assistance Currently Available 20 respondents indicated that they are receiving Technical Assistance related to EHR implementation and other HIT related areas. OCHIN was the Technical Assistance provider mentioned most frequently. HIE and Direct Secure Messaging Seventeen practices mentioned participation in some form of HIE, with Jefferson HIE being the most frequently cited community HIE network. Twelve of the respondents are using Direct secure messaging, 32 indicated they plan to use Direct secure messaging in the future, and 34 (41.5%) did not know the plan. The Health Information Service Provider (HISP) most frequently mentioned is SureScripts. Discussion Draft 1 August, 2014

4 OHA TA Needs Assessment Summary: Responses to Practice Survey Practices Responding to the Questionnaire 87 practices have responded to date. PRACTICE RESPONSES 1. Number of Practices by Prioritized Areas of Assistance. For each service area, the practices indicated the types of assistance needed. Answer Options Help connecting to an HIE Training on CQM data collection and reporting Help implementing Direct secure messaging Help with optimizing EHR or clinical documentation workflow Help meeting MU 2 measures Help meeting MU 1 measures Help with selecting, adopting or upgrading an EHR 1 - Essential 2 - Important 3 - Helpful 4 - Little Help Needed 5 - No Help Needed N/A Rating Average Response Count Number of Practices by Timeframe for Assistance For each service area, the practices indicated their preferred timeframe for assistance. Answer Options As soon as possible Anticipate need in next 12 months Anticipate need > 12 months N/A Response Count Help connecting to an HIE Help implementing Direct secure messaging Training on CQM data collection and reporting Help meeting MU 2 measures Help meeting MU 1 measures Help with optimizing EHR or clinical documentation workflow Help with selecting, adopting or upgrading an EHR Discussion Draft 2 August, 2014

5 OHA TA Needs Assessment Summary: Responses to Practice Survey 3. Technical Assistance From Other Sources Practices reported whether they are currently receiving EHR or Meaningful Use assistance from another organization. Answer Options Response Count Response Percent Yes % No % Do not know % 4. Organizations Identified as Providing Technical Assistance (19 responses) OCHIN was the most frequently mentioned entity providing help (11 responses). 5. Number of Practices Reporting Ways in Which They are Participating in an HIE (79 responses) Response Answer Options Count Response Percent Unknown % Point-to-point interfaces (e.g. labs, registries, hospitals) % EHR vendor-specific capabilities (e.g. Epic's "CareEverywhere" and "CareElsewhere") % Receiving hospital notifications (e.g. notice of ER visit) % Using Direct secure messaging % Participation in an HIE network % Accessing patient records via a shared instance of an EHR (e.g. an IPA hosted EHR) 4 5.1% 6. Identified Community HIE Networks in Which Practices are Participating (17 responses) Answer Options Response Count Response Percent Jefferson HIE % Unsure which HIE network we participate in % Other % Gorge Health Connect 1 5.9% Central Oregon HIE 1 5.9% CareAccord 1 5.9% Bay Area Community Informatics Agency (Coos Bay) 0 0.0% 7. Practices Plans for Using Direct Secure Messaging Answer Options Response Count Response Percent Yes, we currently utilize Direct secure messaging % Yes, we plan to utilize Direct secure messaging % No, we do not plan to utilize Direct Secure messaging 4 4.9% Unknown % Discussion Draft 3 August, 2014

6 OHA TA Needs Assessment Summary: Responses to Practice Survey 8. Current or Planned HISP for Practice s Use of Direct secure messaging HISPs identified by respondents include: Answer Options Response Count Response Percent SureScripts % Medicity 3 9.1% Gorge Health Connect (Includes Jefferson HIE) 2 6.1% Cerner 2 6.1% Allscripts 2 6.1% NextGen 1 3.0% Relay Health 1 3.0% MedAllies 0 0.0% Truven 0 0.0% CareAccord 0 0.0% We've not yet selected % Don't know % 9. If you do not plan to use Direct secure messaging, please tell us why? Answers included: We have direct secure messaging within our own systems, but not between them. Not sure how to accomplish this, yet. But we do plan to figure it out! Comfort level/ privacy We have Tiger Text Do not think this would be useful. Most of referral networks are on Epic, which can be accessed by Care Everywhere and Care Link, and vice versa for an outside provider reviewing our patients charts. Direct secure messaging is too cumbersome. No EMR Discussion Draft 4 August, 2014

7 Objective Oregon Health Authority Office of Health Information Technology HITOC HIT/HIE Community and Organizational Panel (HCOP) Charter - DRAFT August 2014 The HIT/HIE Community and Organizational Panel (HCOP) is to facilitate communication and coordination among HIOs, CCOs, and other healthcare organizations and provide strategic input to HITOC and OHA regarding ongoing HIT/HIE strategy, policy, and implementation efforts. Panel Sponsor: Susan Otter Members: TBD Staff: Marta Makarushka Justin Keller Scope The HIT/HIE Community and Organizational Panel will be comprised of representatives from a variety of Oregon organizations actively engaged in implementing HIT/HIE initiatives. The goals for this Panel include: Discuss Panel members HIT/HIE implementation efforts to: o Share best practices, o identify common barriers, and o identify opportunities for collaboration o as well as assist the OHA and HITOC in gaining a better understanding of real-world HIT/HIE implementation efforts Identify opportunities for HITOC to consider regarding providing guidance and/or developing policy to address barriers or better support HIT/HIE efforts in Oregon Provide insights to OHA regarding OHA s statewide HIT/HIE initiatives, concerns or implications for implementation, and opportunities for improvement and support Though the Panel will not be responsible for preparing formal recommendations to HITOC or OHA, the Panel s collective input may influence HITOC recommendations or OHA efforts. Duration and Schedule It is anticipated the Panel will convene Fall 2014 and meet quarterly, unless the membership determines a different meeting schedule would better suit the needs and purpose of the group. All meetings will be public meetings. Membership The Panel will be comprised of entities leading community or organizational HIT/HIE implementations or operations such as local HIEs, CCOs, health systems, other partner organizations. Technology vendors are not eligible to participate. Guiding Principles This group is not tasked with creating technical solutions or making policy recommendations. The goal is to discuss direct experiences with HIT/HIE implementation based on which the Panel may put forth suggestions to the HITOC and input to OHA for consideration. Page 1 of 1

8 Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure Overview The U.S. Department of Health and Human Services (HHS) has a critical responsibility to advance the connectivity of electronic health information and interoperability of health information technology (health IT). This is consistent with its mission to protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves. This work has become particularly urgent with the need to address the national priority of better and more affordable health care, leading to better population health. Achieving this goal will only be possible with a strong, flexible health IT ecosystem that can appropriately support transparency and decision-making, reduce redundancy, inform payment reform, and help to transform care into a model that enhances access and truly addresses health beyond the confines of the health care system. Such an infrastructure will support more efficient and effective systems, scientific advancement, and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease. In the past decade, there has been dramatic progress in building the foundation of a health IT infrastructure across the country that is resilient and flexible to accommodate many types of change. Through deliberate policy and programmatic action, the majority of meaningful use 1 eligible hospitals and professionals have adopted and are meaningfully using health IT. This progress has laid a strong base upon which we can build. However, there is much work to do to see that every individual and their care providers can get the health information they need in an electronic format when and how they need it to make care convenient and well-coordinated and allow for improvements in overall health. There is no better time than now to renew our focus on a nationwide, interoperable health IT infrastructure one in which all individuals, their families, and their health care providers have appropriate access to health information that facilitates informed decision-making, supports 1 Formally referred to as the Medicare and Medicaid EHR Incentive Programs 1 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

9 coordinated health management, allows patients to be active partners in their health and care, and improves the overall health of our population. This is not just a technology challenge. Broad adoption of health IT will require that health information can be easily and appropriately shared to support multiple uses. For instance, the national priority of cost-effective care requires information about quality and use of services to be available to consumers, providers, payers, and employers. Further, physicians expect health IT to enable and support patient care. And finally, there is mounting interest by consumers and innovators in creating meaningful opportunities for individuals to partner in their own health care. New technology and market changes have opened the door to creating a more integrated and flexible environment that will not only serve us better in the present day, but will allow for ongoing innovation in the future. This paper is an invitation to health IT stakeholders clinicians, hospitals, public health, technology developers, payers, researchers, policymakers, individuals, and many others to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem (Figure 1). Figure 1. Health IT Ecosystem Vision for the Future An interoperable health IT ecosystem makes the right data available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used by recipients. By 2024, individuals, care providers, communities, and researchers should have an array of interoperable 2 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

10 health IT products and services that allow the health care system to continuously learn and advance the goal of improved health care. This learning health system should also enable lower health care costs, improved population health, truly empower consumers, and drive innovation. For example, all individuals, their families, and care providers should be able to send, receive, find, and use health information in a manner that is appropriate, secure, timely, and reliable. 2 Individuals should be able to securely share electronic health information with care providers and make use of the information to support their own health and wellness through informed shared decision-making. An interoperable health IT ecosystem should support critical public health functions such as real-time disease surveillance and disaster response, and data aggregation for research and value-based payment that rewards higher quality care, not necessarily a higher quantity of care. CONTEXT The nation has made dramatic advancements in digitizing the care delivery system during the past decade: Over one-half of office-based professionals and more than 8 in 10 hospitals are meaningfully using electronic health records (EHRs), which will require them to electronically exchange standardized patient information to support safe care transitions (Figure 2). 3 One-half of hospitals are able to electronically search for patient information from sources beyond their organization or health system (Figure 3). 4 All 50 states have some form of health information exchange services available to support care. 5 Figure 2. Hospitals and Professionals That Have Demonstrated Meaningful Use of Certified EHR Technology 2014 Hospitals Professionals Figure 3. U.S. Hospitals Capability to Electronically Query Patient Health Information from Outside Their Organization or System The term care providers is broadly inclusive of the care continuum, reflecting primary care providers, specialists, nurses, pharmacists, physical therapists and other allied care providers, hospitals, mental health and substance abuse services, long- term and post-acute care facilities, home and community-based services, other support service providers, care managers, and other authorized individuals and institutions Office of the National Coordinator for Health Information Technology. U.S. Hospitals Capability to Electronically Query Patient Health Information from Outside Their Organization and System, Health IT Quick-Stat, no. 25. April Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

11 Through the Blue Button Initiative, more than half of individual consumers and patients are able to access at least some of their own health information electronically via the combined contributions of providers, health plans, pharmacies, and labs. 6 Technological innovations such as wearable devices, remote sensing devices, and telehealth support at-home and virtual care models and new roles for patients. This significant progress has created a growing demand for interoperability that not only supports the care continuum, but supports health generally. Electronic health information needs to be available for appropriate use in solving major challenges such as providing more effective care and informing and accelerating scientific research. Despite significant progress in establishing standards and services to support health information exchange and interoperability, it is not the norm that electronic health information is shared beyond groups of health care providers who subscribe to specific services or organizations. This frequently means that patients electronic health information is not shared across organizational, vendor and geographic boundaries. Electronic health information is also not sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed with vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care. We must learn from the important lessons and local successes 7 of previous and current health information exchange infrastructure to improve interoperability in support of nationwide exchange and use of health information across the public and private sector. Guiding Principles As we work toward this vision for the future interoperable health IT ecosystem, we will plan and execute our work to align with a set of guiding principles: Build upon the existing health IT infrastructure. Significant investments have been made in health IT across the care delivery system and in other relevant sectors that need to exchange information with individuals and care providers. To the extent possible, we will encourage stakeholders to build from existing health IT infrastructure, increasing interoperability and functionality as needed. One size does not fit all. Interoperability requires technical and policy conformance among networks, technical systems and their components. It also requires behavior and culture change on the part of users. We will strive for baseline interoperability across health IT infrastructure, 6 See to learn which data holders are offering electronic access to personal health data by consumers. 7 See for examples of lessons and successes from recent health information exchange efforts. 4 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

12 while allowing innovators and technologists to vary the user experience (the feel and function of tools) in order to best meet the user s needs based on the scenario at hand, technology available, workflow design, personal preferences, and other factors. Empower individuals. Members of the public are rapidly adopting technology to manage numerous aspects of their lives, including health and wellness. However, many of these tools do not yet integrate information from the health care delivery system. Health information from the care delivery system should be easily accessible to individuals and empower them to become more active partners in their health just as other kinds of data are empowering them in other aspects of their lives. Leverage the market. Demand for interoperability from health IT users is a powerful driver to advance our vision. As payment and care delivery reform increase demand for interoperability, we will work with and support these efforts. Simplify. Where possible, simpler solutions should be implemented first, with allowance for more complex methods in the future. Maintain modularity. Complex systems are more resilient to change when they are divided into independent components that can be connected together. Because medicine and technology will change over time, we must preserve systems abilities to evolve and take advantage of the best of technology and health care delivery. Modularity creates flexibility that allows innovation and adoption of new, more efficient approaches over time without overhauling entire systems. Consider the current environment and support multiple levels of advancement. Not every clinical practice will incorporate health information technology into their work in the next 3-10 years, and not every practice will adopt health IT at the same level of sophistication. We must therefore account for a range of capabilities among information sources and information users, including EHR and non-ehr users, as we advance interoperability. Individuals and caregivers have an ongoing need to find, send, receive, and use their own health information both within and outside the care delivery system and interoperable infrastructure should enable this. Focus on value. We will strive to make sure our interoperability efforts yield the greatest value to individuals and care providers; improved health, health care, and lower costs should be measurable over time and at a minimum, offset the resource investment. Protect privacy and security in all aspects of interoperability. It is essential to maintain public trust that health information is safe and secure. To better establish and maintain that trust, we will strive to ensure that appropriate, strong, and effective safeguards for health information are in place as interoperability increases across the industry. We will also support greater transparency for individuals regarding the business practices of entities that use their data, particularly those that are not covered by the HIPAA Privacy and Security Rules. 5 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

13 Three-Year Agenda: Send, Receive, Find, and Use Health Information to Improve Health Care Quality We will develop an interoperability roadmap as articulated in HHS Principles and Strategy for Accelerating Health Information Exchange. Working with all stakeholders, we will fine-tune and use the health IT infrastructure enabled through implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act to support transformation of health care to a more patient-centered, less wasteful, and higher quality system. This near-term priority involves improving the interoperability of existing health information networks, and scaling existing approaches for fluidly exchanging health information across vendor platforms to support a broad array of transitions of care and public health. Ensuring that individuals and care providers send, receive, find, and use a basic set of essential health information 8 across the health care continuum will enhance care coordination and enable health system reform to improve care quality. This means focusing on query-based health information exchange, or the ability to appropriately search for and retrieve health information, in addition to point-to-point information sharing. Through ONC s standards and certification processes, we will work to further standardize the vocabulary and structure of essential information. We will also address critical issues such as data provenance, data quality and reliability, and patient matching to improve the quality of interoperability, and therefore facilitate an increased quantity of information movement. Working with stakeholders, we will operationalize a common framework to enhance trust by addressing key privacy, security, and business policy and practice challenges to advance secure, authorized health information exchange across existing networks. Finally, we will work with federal and state entities to advance payment, policy, and programmatic levers that encourage use of this information in a manner that supports care delivery reform, improves quality, and lowers costs. Figure 4: Example three-year agenda use cases:* Individuals look up their electronic immunization histories when needed. Primary care providers share a basic set of patient information with specialists during referrals; specialists close the information loop by sending updated basic information back to the primary care provider. Hospitals automatically send an electronic notification and care summary to primary care providers when their patients are discharged. *These examples are meant as illustrations and are not meant to provide a comprehensive list. 8 The basic set of essential health information builds from the common meaningful use (MU) data set incorporated into ONC s health IT certification program as part of the 2014 Edition EHR Certification Criteria and currently used to support three MU objectives included in the Medicare and Medicaid EHR Incentive Programs. 6 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

14 Six-Year Agenda: Use Information to Improve Health Care Quality and Lower Cost Over the next six years, the care delivery system will realize enhanced interoperability. Health IT will continue to enable individuals to be active participants in managing their care as an important contributor of information to the health record (e.g., patient experience, selfrated health, and self-generated data). Individuals, care providers, and public health departments will send, receive, find and use an expanded set of health information across the care continuum to support team-based care. Care providers, such as those in schools, ambulances, and prisons will be able to appropriately exchange and use relevant health information. Remote monitoring will be enabled through better interoperability between medical devices, homemonitoring tools, and health information technology, including EHRs. Multi-payer claims databases, clinical data registries, and other data aggregators will incrementally become more integrated as part of an interoperable technology ecosystem. Health care providers will also be able to aggregate and trend information within and across groups of patients based on information from multiple data sources to monitor health disparities and quality improvement opportunities (population health management). As value-based payment gains traction across Medicare, Medicaid, and commercial payers and purchasers, there will be new methods of measuring clinical quality that represent the most important aspects of care delivery and health outcomes. We will work with stakeholders to refine standards, policies, and services to automate the continuous quality improvement process and deliver targeted clinical decision support that fits into a clinician s workflow to close care gaps and improve the quality and efficiency of care. Figure 5: Example six-year agenda use cases:* Individuals regularly contribute information to their electronic health records for use by members of their care team. Individuals integrate data from their health records into apps and tools that enable them to better set and meet their own health goals. Primary care providers and authorized researchers are able to understand how well controlled diabetic patient population s glucose levels (i.e., A1C values) are and how often those patients have been hospitalized based on standardized information from multiple sources. Clinical settings and public health are connected through bi-directional interfaces that enable seamless reporting to public health departments and seamless feedback and decision support from public health to clinical providers. *These examples are meant as illustrations and are not meant to provide a comprehensive list. 7 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

15 10-Year Agenda: The Learning Health System By year 10, the nation s health IT infrastructure will support better health for all through a more connected health care system and active individual health management. Information sharing will be improved at all levels of public health, and research will better generate evidence that is delivered to the point of care. Advanced, more functional technical tools will enable innovation and broader uses of health information to further support health research and public health. The evolution of standards, policies, and data infrastructure over the next 10 years will enable more standardized data collection, sharing, and aggregation for patient-centered outcomes research. Continuous learning and improvement will be feasible through analysis of aggregated data from a variety of sources. Health IT systems will enable both analysis of aggregated data and use of local data at the point of care through targeted clinical decision support (CDS). CDS will improve care by taking into account information such as an individual s genetic profile, local trends in disease prevalence, antibiotic resistance, occupational hazards, and other factors. The process of clinical trial recruitment, data collection, and analysis will be accelerated and automated. Retrospective analyses will allow for rapid inquiry around many aspects of public health, health care quality, outcomes, and efficiency. Public health surveillance will be dramatically improved through better outbreak detection and disease incidence and prevalence monitoring. Interoperable health IT will also help contain outbreaks and manage public health threats and disasters. The nation s health IT infrastructure will facilitate health improvement through active individual health management, Figure 6: Example 10-year agenda use cases:* Individuals manage information from their own electronic devices and share that information seamlessly across multiple electronic platforms as appropriate (health care providers, social service providers, consumer-facing apps and tools, etc). Primary care providers can select effective medications for patients with certain conditions based on their genetic profiles and results of comparative effectiveness research. Individuals, care providers, public health and researchers contribute information and learn from information shared across the health IT ecosystem, with rapid advancement in methods for deriving meaning from data without sharing PHI. *These examples are meant as illustrations and are not meant to provide a comprehensive list. improved information sharing with public health, and the ability for research to generate evidence that is delivered to the point of care. 8 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

16 How will we get there? It will take a strategic and focused effort by the federal government, in collaboration with state, tribal, and local governments and the private sector. We will aim to develop a shared agenda that focuses on five critical building blocks for a nationwide interoperable health information infrastructure: 1. Core technical standards and functions 2. Certification to support adoption and optimization of health IT products and services 3. Privacy and security protections for health information 4. Supportive business, clinical, cultural, and regulatory environments 5. Rules of engagement and governance These building blocks are interdependent and progress must be incremental across all of them over the next decade to realize this vision. We will develop a more comprehensive set of use cases and goals for three, six and ten-year timeframes that will guide work in each of the building blocks, including alignment and coordination of prioritized federal, state, tribal, local, and private sector actions. BUILDING BLOCK #1: CORE TECHNICAL STANDARDS AND FUNCTIONS Through our Standards & Interoperability (S&I) Framework, ONC will continue to work with industry stakeholders and federal and state governments to advance core technical standards for terminology and vocabulary, content and format, transport, and security. These standards will enable, at a minimum, the following essential services for interoperability: 1. Methods to accurately match individuals, providers and their information across data sources 2. Directories of the technical and human readable end points for data sources so they and the respective data are discoverable 3. Methods for authorizing users to access data from the data sources 4. Methods for authenticating users when they want to access data from data sources 5. Methods for securing the data when it is stored or maintained in the data sources and in transit, i.e., when it moves between source and user 6. Methods for representing data at a granular level to enable reuse 7. Methods for handling information from varied information sources in both structured and unstructured formats ONC will also work toward flexible and dynamic technical tools to support interoperability for primary and secondary use of health information, such as the architecture described in the JASON report prepared for the Agency for Healthcare Research and Quality, A Robust Health Data Infrastructure. 9 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

17 BUILDING BLOCK #2: CERTIFICATION TO SUPPORT ADOPTION AND OPTIMIZATION OF HEALTH IT PRODUCTS AND SERVICES ONC will leverage the ONC Health IT Certification Program to ensure that a broad spectrum of health IT conforms to the technical standards necessary for capturing and exchanging data to support care delivery. Certification will be used to test that health IT conforms to standards, and also to certify that the technology has the ability to interoperate with other data sources so that users can exchange and use information from other systems. To increase flexibility in our regulatory structure, ONC has proposed that content and transport functions of technology be tested for certification separately. ONC has also been responsive to a demand for expansion of the certification program s scope to include health IT used in a broader set of health care settings, such as long-term and post-acute care and behavioral health. Ensuring consistent adoption of standards and policies for health IT applications used across all settings of care will support interoperability and health information exchange. BUILDING BLOCK #3: PRIVACY AND SECURITY PROTECTIONS FOR HEALTH INFORMATION ONC will strive to ensure that privacy and security-related policies, practices, and technology keep pace with the expanded electronic exchange of information for health system reform. We will continue to assess evolving models of health information exchange to identify and, with stakeholder input, develop solutions to address weaknesses and gaps in privacy protections. We will encourage the development and use of policy and technology and workflow practices to advance patients rights to access, amend, and make informed choices about the disclosure of their electronic health information. We recognize that there are certain state and federal laws under which some patients must give affirmative consent to the disclosure of their health information (often related to a sensitive health condition such as behavioral health or genetic information), a privacy protection that is more stringent than the HIPAA Privacy Rule. ONC will endeavor to ensure that these patients will not be left on the wrong side of the digital divide. We will work to improve standards, technology, and workflow that enable the electronic collection and management of consent as well as the electronic exchange of related information within existing legal requirements (including notice of redisclosure restrictions). We will also invest in methods and approaches that support distributed analytics and open evidence sharing without sharing PHI. Continued coordination across federal and state governments is needed to develop, implement, and evolve appropriate privacy and security policies for various types of health information exchange. Expanding interoperability and exchange may also pose new security challenges. We will work with the National Institute of Standards and Technology (NIST) and other stakeholders to expand the options for ensuring, at an appropriate level of certainty, that those who access health information electronically are who they represent themselves to be. We will continue to assess and improve policies and standards that help ensure health information is only accessed by authorized people 10 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

18 and is used in reasonable and transparent ways. We will also work with the private sector to address emerging cyber threats. Given our support for electronic access by individuals to their own health information, we will also be mindful of the privacy and security risks created when information exits the realm of HIPAA covered entities. We will support developers creating health tools for consumers to encourage responsible privacy and security practices and greater transparency about how they use personal health information. In addition, we will collaborate with the Office for Civil Rights and other agencies to encourage greater consumer education about the benefits of health information exchange and the steps they can take to safeguard their own data. As we expand health information exchange, it is important that all stakeholders (the government, health care providers and plans, vendors, developers, patients and their caregivers) recognize their responsibility in protecting health information. We intend to continue our outreach and technical assistance to help everyone reach this goal. BUILDING BLOCK #4: SUPPORTIVE BUSINESS, CLINICAL, CULTURAL, AND REGULATORY ENVIRONMENT While the Medicare and Medicaid EHR Incentive Programs have been a primary motivator for the adoption and use of certified EHR technology, these programs alone are insufficient to overcome barriers to our vision of information sharing and interoperability as outlined above. Current policies and financial incentives often prevent such exchange, even when it is technically feasible. To ensure that individuals and care providers send, receive, find, and use a basic set of essential health information across the care continuum over the next three years, we need to migrate policy and funding levers to create the business and clinical imperative for interoperability and electronic health information exchange. In collaboration with employers, federal agencies, and private payers, ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange. Incremental steps to accelerate health information exchange will initially stem from Affordable Care Act (ACA) delivery reform programs and Medicare payment regulations. HHS will consider ways in which the adoption and use of ONC-certified health IT products can be aligned with and encouraged by Medicare and Medicaid payment policy, and other HHS programs funding health care delivery so that care delivery transformation and interoperability evolve in tandem. With regard to individual access to health information and the engagement it enables, a significant barrier is a lack of knowledge among members of the public that access to health information is becoming increasingly available, and a cultural bias against taking advantage of it. Many patients are intimidated or embarrassed to ask for copies of their records or to ask health-related questions of their providers. To address these cultural barriers, we will encourage providers to proactively offer 11 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

19 access to health information for their own patients, and using consistent marketing and messaging via the Blue Button Initiative, encourage diverse stakeholders including data holders and consumer advocacy organizations to educate individuals about their rights and the benefits of access to and use of health information. We will also work with states, employers, consumers, providers, technology developers, payers, and others to support efforts driving appropriate health information exchange for improvements in care and to see that any regulatory and business barriers preventing data flow are reduced and/or removed. BUILDING BLOCK #5: RULES OF ENGAGEMENT AND GOVERNANCE OF HEALTH INFORMATION EXCHANGE The HITECH Act charged ONC with establishing a governance mechanism for the nationwide health information network. We view the nationwide health information network as a continually expanding ecosystem of electronic exchange activities and network service providers across the nation that rely on a set of standards, policies, and services to meet electronic exchange needs including the privacy, security, and appropriate use of the information exchanged. This market includes many forms of electronic exchange and network service providers, ranging from simple forms (such as direct electronic exchange of health information between two known providers) to more sophisticated forms (such as query and response techniques). Governance will facilitate trust and interoperability across all the diverse entities and networks that provide exchange services so that health information follows individuals regardless of where and when they access care. Looking forward In 2014, ONC will build on our existing governance framework and principles to ensure individual access, privacy, transparency, responsible financial and business practices, and use of federal standards to support health information exchange. As needed, ONC will identify the rules of the road necessary for information to flow efficiently across networks and will transition to a governance approach for health information exchange that will likely involve both policy and collaboration across industry, government, and consumer representatives. Experience has demonstrated that while trust can be established among specific, known groups of health information trading partners (providers, public health departments, payers, etc.) through local governance, data use agreements, and other contractual arrangements (constituting a trust community), scaling trust across communities requires assurance that each adheres to a minimum set of common security and business practices. Our governance approach must consider 12 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

20 a common framework for privacy, security, technology, data, and business practices, provide assurance to trust communities that each abides by that framework (including a process for dispute resolution and reconciliation), and maintain minimum technical tools where needed to make scaling trust easy. We will seek input and collaboration with federal agencies to inform governance implementation and ensure broad participation across existing operating health information networks, including those focused at the vendor, enterprise, regional, and state levels. We seek to promote competition among network service providers in a way that avoids providers or individuals being locked in to one mechanism to exchange health information, limiting their ability to share health information and coordinate care efficiently. It will take time to build a fully interoperable infrastructure of coordinated care and communication across health care providers, patients, and public health entities that improves health care quality, lowers health care costs, and improves population health. HHS is fully committed to ensuring ubiquitous, standards-based interoperability of health information across all care settings through a multi-year approach that is consistent, incremental, yet comprehensive. No one person, organization, or government agency alone can realize this vision of an interconnected health system. But together, we can achieve the promise and potential of health information technology to improve the health of all. 13 Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure

21 CareAccord Quarterly Newsletter August 25, 2014 Volume 1, Issue 1 A New Service is Available for Improving the Electronic Exchange of Health Information The Oregon Health Authority Office of Health Information Technology is pleased to announce that a new Directory of health care professionals is available in CareAccord s Provider Directory. The Flat File Directory enables CareAccord users to find the Direct secure messaging addresses for health care professionals beyond the community of CareAccord subscribers. This service will expand the discovery of health care professionals addresses for Direct secure messaging to improve the electronic exchange of health information. The Directory includes more than 2,700 users with Direct secure messaging Our goal is to support providers and care coordination team members ability to access meaningful, timely, relevant and actionable patient information at the point of care. addresses for health care professionals at: Oregon Health & Science University (**CDA required for messaging) Legacy Health Systems (**CDA required for messaging) Tuality Healthcare CareAccord Log into CareAccord, gain access to the Flat File Directory and begin connecting through Direct secure messaging with professionals located throughout Oregon who are part of the Direct Trust community. The Flat File Directory is located as an extended search within the CareAccord Provider Directory. As the Flat File Directory expands, you will receive updated information about who is participating. For more information, visit the CareAccord website at See Page 3 for other important information. Connect today! News Links: Advancing HIT in Oregon With a New Approach Progress on Adoption of EHR and Meaningful Use 2 Extension Oregon Participates in Consumer Engagement Pilot Special Points of Interest: The Flat File Directory is now available. Viewable documents within CareAccord. The CareAccord Quick User Guide is online. An update from Susan Otter, Director of Health Information Technology. 1

22 Additional Types of Documents Will Soon Be Viewable Within CareAccord Until now, some electronic attachments (such as Transitions of Care) generated out of an Electronic Health Record (EHR) and sent to a CareAccord user have been unreadable when opened within the CareAccord web browser. At the end of September, CareAccord subscribers will have the new ability to open, view and print electronic attachments in their web browser from the following formats: CDA, C-CDA, CCD, C32, and C-CCD. Look for the ability to easily receive and read Transitions of Care from your Direct EHR partners soon! Please welcome the newest members to the CareAccord Trust Community: Southern Oregon Regional Brokerage Partners In Care James A Dutro, DMD Saint Alphonsus Medical Group Tuality Physicians Click here to access a complete list of CareAccord Trust Community members The CareAccord Quick User Guide is Available Online Learn today how you can: Place a CareAccord icon on your desktop for simplified workflow. Recover a password. Find your username. Establish personal settings unique to your needs. The Quick User Guide will help you configure CareAccord to fit your needs. With CareAccord, it is now easier than ever to make Direct secure messaging part of your daily work flow. Access the Quick User Guide, online at CareAccord Connects you to the Following HISPs Users of accredited Health Information Service Providers (HISPs) are now able to exchange Direct secure messages. As an accredited HISP CareAccord performs regular testing to prove interoperability with other accredited HISPs. CareAccord users are able to connect with health care professionals who have Direct addresses through one of the following HISPs: Axesson, Cerner, EMR Direct, Health Companion, HealtheConnections RHIO of CNY, IOD, MaxMD, Medicity, MHIN, MRO, NextGen Share, Orion, San Diego Health Connect, Surescripts and Updox 2

23 Lessons Learned from Flat File Directory Pilot We want to share with you some lessons learned from the recent pilot for the new Flat File Directory. Flat File Directory pilot participants had to meet criteria for participation, including using a 2014 Certified EHR Technology, having a fully accredited Health Information Service Provider (HISP), and having assigned Direct addresses. Through our pilot, the CareAccord team discovered some valuable information we think may be useful to you as a Direct secure message user. Lessons Learned: Often there are additional steps organizations must take between their EHR and HISP vendors in order for Direct secure messaging to function outside the organization. A message delivery notification may be received, verifying that the HISP serving the EHR received the message, even if the Direct message was not be received within the EHR itself. Different EHR vendors have developed their product capabilities around Direct secure message sending and receiving in various ways. Here are two primary examples: Some EHRs will only send and receive messages with an attached CDA (transition of care document, lab, etc.). Depending on the EHR, Direct addresses may only be assigned to health care providers with National Provider Identifiers (NPIs). Our Suggestions: CareAccord will help you connect Find out if the organization you want to exchange with has any EHR restrictions (Ex. OHSU & Legacy can only send and receive Direct messages with an attached CDA). Call and verify that your initial message with a Flat File Directory/DirectTrust participant (not served by CareAccord) reached its destination. After verifying once, you should be good to go. Call us today and find out how we can better serve you. CareAccord: Be patient. Ask questions. Don t give up. The healthcare industry is moving more and more towards using Direct for health information exchange. You are leading the way as a CareAccord Direct user. 3

24 Direction of HIT/HIE in Oregon: A Note from Susan Otter, Director, Office of Health Information Technology Last fall, the Oregon Health Authority engaged a Health IT Task Force to synthesize stakeholder input and develop a plan to advance Health Information Technology (HIT) and Health Information Exchange (HIE) in the state. This process led to a vision for Oregon of a transformed health system in which HIT/HIE efforts ensure that the care Oregonians receive is optimized by HIT. HIT-optimized health care is more than just the replacement of paper with electronic or mobile technology. It includes changes in workflow to assure providers fully benefit from timely access to clinical and other data that will allow them to provide individual and familycentric care. In an HIT-optimized health care system: Providers have access to meaningful, timely, relevant, actionable patient information to coordinate and deliver whole person care. With the State, health plans, CCOs, community and organizational HIEs, health systems, providers and individuals all working together, Oregon can achieve a transformed health care system optimized by HIT. Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and for incentivizing health and prevention. Policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers. The stakeholder process also helped the State define it s role for Health IT in Oregon. This role includes: Coordinating and supporting community and organizational HIT efforts. Establishing compatibility, interoperability, privacy and security standards for participants in new state-level services. Providing technologies for transformation to enhance state-level information sharing. The completed Business Plan Framework, and OHA s vision for HIT-optimized health care, is a significant milestone in the state s ongoing approach for a transformed health system that achieves better care, better health and lower costs for Oregonians. To learn more about the direction of HIT/HIE in Oregon, I invite you to read Oregon s Business Plan Framework for HIT and HIE at: Advancing-HIT-in-Oregon.aspx CareAccord Summer Street NE E-52 Salem OR [email protected] 4

25 EDIE Hospital Adoption Update This document summarizes where each Oregon hospital is in the implementation of EDIE. Currently: 86% of hospitals have completed the legal review and have signed agreements with CMT. 70% of hospitals have completed the IT process, and CMT has live feeds with 75% of hospitals. 58% of hospitals are receiving Notifications. Another 6 hospitals are expected to be receiving Notifications by September. In the table below, the colors indicate progress as follows: Green = Complete, Yellow = In Progress, Red = Not Begun Hospital Health System Legal IT ED Notifications Feed Type Adventist Medical Center Adventist Health - Fax ED Only Asante Ashland Community Hospital Asante IP ED + Inpatient Asante Rogue Regional Medical Center Asante IP ED + Inpatient Asante Three Rivers Medical Center Asante IP ED + Inpatient Bay Area Hospital - Print ED Only Blue Mountain Hospital IP ED + Inpatient Columbia Memorial Hospital - Fax ED + Inpatient Coquille Valley Hospital Cottage Grove Community Hospital PeaceHealth - Print ED Only Curry General Hospital IP Good Shepherd Medical Center IP IP ED + Inpatient Grande Ronde Hospital - Fax ED Only Harney District Hospital - Fax ED + Inpatient Kaiser Sunnyside Medical Center Kaiser IP IP Kaiser Westside Medical Center Kaiser IP IP Lake District Hospital - EMR ED + Inpatient Legacy Emanuel Medical Center Legacy IP ED Only Legacy Good Samaritan Medical Center Legacy IP ED Only Legacy Meridian Park Medical Center Legacy IP ED Only Legacy Mount Hood Medical Center Legacy IP ED Only Lower Umpqua Hospital McKenzie Willamette Medical Center Catholic Health Systems IP Mercy Medical Center Catholic Health Initiatives IP Mid Columbia Medical Center IP ED Only Oregon Health & Science University OHSU - EMR ED Only Peace Harbor Hospital PeaceHealth - Print ED Only Pioneer Memorial Hospital Heppner IP ED + Inpatient Pioneer Memorial Hospital Prineville St. Charles - Print ED + Inpatient Providence Hood River Memorial Hospital Providence - EMR ED Only Providence Medford Medical Center Providence - EMR ED Only Providence Milwaukie Medical Center Providence - EMR ED Only Providence Newberg Medical Center Providence - EMR ED Only Providence Portland Medical Center Providence - EMR ED Only Providence Seaside Hospital Providence - EMR ED Only Providence St. Vincent Medical Center Providence - EMR ED Only Providence Willamette Falls Medical Center Providence - EMR ED Only Sacred Heart Medical Center at RiverBend PeaceHealth - Print ED Only Sacred Heart Medical Center University District PeaceHealth - Print ED Only Salem Hospital Salem Health IP Samaritan Albany General Hospital Samaritan - Fax ED + Inpatient Samaritan Lebanon Community Hospital Samaritan - Fax ED + Inpatient Samaritan North Lincoln Hospital Samaritan - Fax ED + Inpatient Samaritan Pacific Communities Hospital Samaritan - Fax ED + Inpatient Samaritan Regional Medical Center Samaritan - Fax ED + Inpatient Santiam Memorial Hospital - Fax ED + Inpatient Silverton Hospital - Print ED + Inpatient Sky Lakes Medical Center - Print ED + Inpatient Southern Coos Hospital & Health Center St. Alphonsus Medical Center Baker City Trinity Health St. Alphonsus Medical Center Ontario Trinity Health St. Anthony Hospital Catholic Health Initiatives IP St. Charles Medical Center Bend St. Charles - Print ED + Inpatient St. Charles Medical Center Madras St. Charles - Print ED + Inpatient St. Charles Medical Center Redmond St. Charles - Fax ED + Inpatient Tillamook Regional Medical Center Adventist Health - Fax ED Only Tuality Forest Grove Hospital Tuality - Fax ED + Inpatient Tuality Healthcare Tuality - Fax ED + Inpatient Wallowa Memorial Hospital IP ED + Inpatient West Valley Hospital Salem Health IP Willamette Valley Medical Center Capella - Fax ED + Inpatient

26 Emergency Department and Inpatient Admission/Discharge Notification Across the State of Oregon Business Plan Summary Version July 3, 2014 This plan describes the formation of a state-level utility, including the scope, financing plan, governance, and other key elements. The EDIE Plus Utility will enable a common service or utility of patient hospital event information from across the state. The Utility builds off the initiative to bring the Emergency Department Information Exchange (EDIE) to all hospitals in Oregon in 2014, and expands EDIE to include inpatient and discharge information. The utility will provide financial sustainability for EDIE for at least three years ( ), ensuring that EDIE continues to provide real-time notification to emergency department (ED) providers for high utilizers of EDs, as well as notifying of patients admitted with recent inpatient activity. EDIE Plus provides a foundation for providing hospital event notifications to plans, Coordinated Care Organizations (CCOs) serving Oregon s Medicaid population, local health information exchanges, and providers through a second service, PreManage, also offered by Collective Medical Technologies (CMT), the EDIE vendor. The desired result is that through improved communication and information sharing, hospitals and eventually other providers and health plans will be empowered to provide higher quality care to patients, identify patients at risk for hospital readmission, reduce burdensome duplication of tests, and ultimately reduce reliance on costly EDs through better coordination of care. Value Proposition Emergency Department (ED) visits, with their high overhead costs and reliance on advanced technology, are a main driver of health care costs in Oregon. Due to low reimbursement rates by Medicare and Medicaid, and residually uninsured/charity care patients, hospitals are required to shift costs to commercial patients. Approximately 19% of every dollar billed by hospitals is cost shifting to compensate for these underinsured/uninsured patients. 1 EDIE provides a critical tool that once established, can be used to identify patients that over utilize EDs and manage the care of these patients to avoid further ED visits by coordinating the care these patients with their primary care provider. This in turn, will allow for cost savings for health plans and hospitals across the state. 1 Milliman 2007 Oregon Cost Shift Report, Oregon Hospital and Physician Cost Shift: Payment Level Comparison of Medicare, Medicaid and Commercial Payers, EDIE Plus/PreManage Business Plan Summary 1

27 Considering the high cost of hospital care, adding this critical information can reduce unnecessary test and procedures, allow hospital providers to make more informed treatment decisions, and connect the dots for complex patients, including connecting to their care team. As hospitals enter risk-sharing arrangements with health plans and CCOs, ensuring that hospital care is well-informed will add value to all parties. Even without risk-sharing arrangements, there is indirect benefit to payers, plans, CCOs and providers when ensuring better, more efficient hospital care. In addition, the EDIE Plus Utility provides the foundation to support PreManage, by notifying outpatient care providers and health plans of ED and inpatient/discharge activity of their patients/members for improved care transitions. EDIE Plus will benefit all Oregon patients by reducing the fragmentation and costs of our healthcare system via real-time notifications to hospitals, and through PreManage, notifications to care teams and case managers resulting in improved communications and coordination of care. Goals of EDIE Plus Utility Recently published results of CCO transformation efforts in Oregon show that emergency department visits by people served by CCOs have decreased 17% since 2011 baseline data. In 2012, the State of Washington began the implementation of emergency department best practices (EDIE is a best practice). A March, 2014 report from the Washington Health Authority to the Washington State Legislature stated that emergency department visits declined by 9.9% for the Medicaid population and the rate of visits by frequent Medicaid clients (who visited five or more times annually) decreased by 10.7%. Given these results in Oregon and Washington, the following goals were developed for the EDIE Plus Utility: Goal Timeframe ED visits avoided since 2013 Projected Savings Reduced ED utilization overall by 1% End of ,547 $12.16 million statewide Reduced ED utilization overall by 6.3% End of ,046 $76.6 million (match 2011 Washington state ED rate) Oregon Health Plan Goal Meet OHA goals for CCOs in reducing ED visits (current target is 44.6 admissions/1,000 member months) End of ,255 $15.9 million The goals represent a broader effort beyond the EDIE technology which includes emergency departments, health plans, CCOs and providers working collaboratively within their communities to improve care coordination focusing on patients who have a pattern of high inappropriate ED usage. EDIE Plus/PreManage Business Plan Summary 2

28 PreManage PreManage represents the natural evolution from supporting ED and hospital care to supporting care coordination and care teams, using the data collected by the EDIE Plus Utility. While EDIE Plus provides hospital event information for communication among emergency departments and limited, identified care givers, PreManage maximizes the use of this data and allows for population management, care coordination, and follow-up by pushing hospital event data to health plan, CCO and provider groups on a real time basis for their specified member or patient populations. The PreManage subscription is a contractual relationship between CMT and the organization receiving the notifications. Negotiation of functionalities and pricing of PreManage is solely the responsibility of the purchaser. CMT has identified three use packages where PreManage might be helpful. Though not limited to these three specific uses, they describe the needs expressed through communication with our stakeholders. CMT has agreed to make these three use packages available in Oregon and has set a price for the most basic functionality for each use package (ranging from $0.04 to $0.06 PMPM). All health plans and CCOs that contribute to the EDIE Plus Utility will be eligible for discounted PreManage package pricing. The Provider Direct package pricing is available to any medical group or clinic. In all three models there is nothing that restricts parties from sharing financing arrangements to achieve economies of scale or simplify single source PreManage functionality. For example, multiple health plans /CCOs that work with the same provider group may want to combine their respective membership so the provider group has single means to improve care management for all health plans. In this example, CMT takes responsibility for negotiating pricing based on total membership with the collective parties. EDIE/PreManage Product Suite Product Data Included Timeline Payment Model Who Has Access EDIE Emergency Department ADT (Admit Discharge Transfer) Feed (date, location, diagnosis, meds, etc.); care guidelines Implemented statewide by Nov Funded by OHA (SIM grant), OHLC and OHLC member plans. Hospitals incurred technology Hospitals EDIE Plus PreManage Adds inpatient ADT including discharge notes Leverages EDIE Plus data to make hospital event data available to plans, CCOs, providers, care team for their members or patients Begins 2015, implemented statewide by end of 2015 Rolling implementation starting in 2015 implementation costs. Utility Model (hospitals and health plans/cco split costs) Subscription fee (negotiated between CMT and purchaser) Hospitals HIE Health Plans CCOs Providers EDIE Plus/PreManage Business Plan Summary 3

29 Financial Plan for EDIE Plus Utility The total cost for funding EDIE and EDIE Plus for the entire state is $750,000/year. The following table outlines the annual operating expenses for the EDIE Plus Utility. Note that this budget does not include the following incurred costs: OHLC, OHA and other stakeholder donated staff time, analytics, and training costs. Expense Cost Collective Medical Technologies EDIE (live emergency department data) $383,690 EDIE Plus (live inpatient and discharge data) $250,000 Subtotal $633,690 Implementation Subsidies $30,000 Administrative/Contingency Costs $86,310 TOTAL $750,000 Funding will begin in 2015 based on a tiered structure of financing partners, 50% funded by the hospitals, tiered based on revenue, and 50% by the health plans and CCOs, tiered based on membership size. The following tables represent the tiers. Kaiser and Providence are discounted 25% for both Hospital and Health Plan due to fact that they are counted in both health plan membership and hospital. Overall they will both pay higher total rates. Hospital Tiers: Based on Revenue $1.5 BB and above $60,000 $1 BB to $1.5 BB $45,000 $500 MM to $1 BB $27,000 $200 MM to $500 MM $12,000 $100 MM to $200 MM $5,900 $50MM to $100 MM $2,750 $20 to $50 MM $1,250 $0 to $20 MM $500 Health Plan/CCO Tiers: Based on Enrollment Over 300,000 members $55,000 Over 250,000 members $43,000 Over 150,000 members $31,000 Over 100,000 members $19,000 Over 75,000 members $14,000 Self-Insured Plans $11,000 Over 30,000 members $8,250 Over 15,000 members $3,000 Under 15,000 members $1,000 For CCOs, OHA is currently seeking approval from the Centers for Medicare & Medicaid Services to use federal and state funds to cover the CCO s EDIE Plus Utility contribution, thus covering their dues. Implementation Plan EDIE Plus is an expansion of EDIE and will require additional data sources and filtering to the IT interfaces established for EDIE. IT resource requirement estimates to accomplish the additional requirements for EDIE Plus are approximately hours of interface development and hours of testing. EDIE Plus/PreManage Business Plan Summary 4

30 OHLC and its partners will facilitate implementation efforts, including hospital participation across Oregon working with CMT to develop a schedule to expand their existing EDIE interfaces to accommodate EDIE Plus. The new EDIE Governance Board will ask for a three-year commitment from all hospitals in the state for EDIE Plus in order to see a return on investment. This commitment will be captured in a Memorandum of Understanding (MOU) committing to the parameters of this business plan. MOU should be completed by October 1, Implementation Subsidy for Independent Critical Access Hospitals The EDIE governance committee has proposed eligibility criteria for hospitals to received partial subsidies for their EHR implementation costs for implementing EDIE Plus: 1) The hospital must be a critical access hospital (CAH); and 2) The hospital must use a third-party vendor for IT; and 3) The hospital must be independent. Rollout and Billing The first year s costs for implementing EDIE have been covered by an OHA grant and OHLC and its member plans contribution. The original plan for the billing cycle for EDIE was to initiate one-year EDIE licenses for each participating hospital when they are both contributing and receiving data to EDIE ( go live ). To ensure administrative simplification moving forward, it is proposed that billing for EDIE Plus for all participants in the second year will be pushed to December 1, 2014, with payment due by January 31, This billing cycle will continue for years 3-4. Hospital licenses for EDIE (EDIE Plus going forward) will be renewed annually based on the go-live date for that hospital, but billing for participation in the EDIE Plus Utility will remain on the calendar year schedule. OHLC, as administrative support to the EDIE Plus Utility Board, will invoice participants and will receive payments, and pay CMT. Each entity participating in the utility will sign an MOU with the EDIE Plus Utility Governing Board/OHLC, committing to the parameters of this business plan, including delegating governing decisions to the Governance Board, and committing to financial participation for the full three years. Implementation Year Year 1 - EDIE (2014) Year 2-4 EDIE Plus Utility ( ) Billing Cycle Deadline EDIE costs are covered by OHA grant, OHLC and its member plans contribution, hospitals incur technical integration/interface costs December 1 invoice date, Payment due by January 31 Other logistical decisions, (i.e., revision of agreements to accommodate for EDIE Plus data, etc.) will be made and overseen by the EDIE Governance Board moving forward. EDIE Plus/PreManage Business Plan Summary 5

31 Governance and Management The current EDIE governance committee will transition to a more permanent governance board for the EDIE Plus Utility. The current governance committee will accept nominations from each of following stakeholder groups / participants to serve staggered three year terms, with the following distribution of nominated positions: o Hospitals / Health Systems: 4 positions, all voting o Health Plans 2 positions, all voting o CCOs 2 positions, all voting o OHLC physician member 1 position, voting o OCEP physician member 1 position, voting o CCO physician member 1 position, voting o OAHHS (ex-officio) 1 position, voting o OHA (ex-officio) 1 position, non-voting o At-large community member 1 position, voting Responsibilities Provide oversight to management of EDIE Plus contractual relationships among stakeholders, CMT, and management, including oversight/coordination of data analysis. Accountable for Financial, Operations, Data Use and Communication policies and procedures among stakeholders. Management Structure OHLC Board accepts management responsibility for providing management services to EDIE Plus project through contractual agreement with OHA, CCOs represented by OHA and other OHLC stakeholders for three year implementation period or until EDIE Plus Governance Board recommends alternative structure. OHLC Management staff will continue management support for EDIE Plus utility project as directed by OHLC Board Specific management functions of the management agreement will include Financing, Operations, Data Use and Communications and others as specified by the EDIE Plus Board. Measurement The EDIE Plus Utility provides the technology for providers across systems and organizations to improve care coordination on behalf of their patients. The workflows and communication required to coordinate patient care, once the patient has been identified by EDIE, will necessitate collaboration among hospitals, health plans, CCOs and providers within communities. These community collaboratives will require common metrics across ED s to assess areas of opportunity and progress toward improvement. The CMT agreement with hospitals, that determines the use of the data, will need a revision to allow CMT to report patient de-identified and aggregated data to the EDIE Governance Board for the purpose of reporting aggregate measures and hospital de-identified data. A basic data EDIE Plus/PreManage Business Plan Summary 6

32 set has been identified which CMT will obtain permission to share with the EDIE Governance Board monthly. Basic Reporting Apprise, a subsidiary of the OAHHS, will compile complementary basic monthly reports including the number of ED visits, number of high utilizers, and the number of patients who have been treated 3 or more times in an ED in 60 days. These include Hospital level reports and aggregate statewide stakeholder reports showing these basic de-identified metrics. Data Analytics and Advanced/Custom Reporting The EDIE Governance Board will determine any additional analytics or reporting of the aggregated de-identified EDIE data set provided by CMT, subject to the CMT-hospital data use agreement, beyond the basic reporting provided by Apprise. The purpose of aggregating and analyzing de-identified data is to enable cross organizational quality improvement initiatives and to evaluate the impact of the investment in the Utility on utilization outcomes and cost. EDIE Plus/PreManage Business Plan Summary 7

33 EHR Incentive Programs Update National EHR Incentive Program Payments As of June 2014, $24.1 billion in total payments paid out from the Medicare and Medicaid EHR Incentive Programs across states More than $15.9 billion in Medicare EHR Incentive Program payments have been made between May 2011 and June More than $8.2 billion in Medicaid EHR Incentive Program payments have been made between January 2011 (when the first set of states launched their programs) and June Oregon EHR Incentive Program Payments Total Medicaid EHR incentives paid in Oregon as of August 12, 2014: $103.5 million 2 Total Medicare EHR incentives paid in Oregon as of June 2014: $185.4 million 3 Total paid to Oregon providers: $288.9 million Oregon EHR Incentive Program Payments to Hospitals # Hospitals #Payments Total amount paid Medicare $89,026,629 Medicaid* $54,034,026 Medicaid/Medicare** $143,060,655 * Estimate 58 out of 59 hospitals will be eligible for the Medicaid EHR Incentive Program. **Two hospitals paid in Medicare only 1 is eligible for the Medicaid EHR Incentive Program Hospital Meaningful Use Status for 2014 based on current participation Not Started Stage 1 Stage Medicaid EHR Incentive Program data dated 8/12/ June Payments by States by Program & Provider 1

34 EHR Incentive Programs Update Hospital Medicaid EHR Incentive Program Participation Status % total # Completed # participated in 2 # participated in 3 participants that participation Medicaid consecutive years consecutive years have achieved EHR Incentive Program MU % Oregon EHR Incentive Program Payments to eligible professionals # Payments Amount paid # Unique # MU Medicare $96,400, Medicaid $49,481, Total $145,881, Payments by provider type Provider Type Number Meaningful Users % meeting Meaningful Use Physician % Nurse Practitioner % Certified Nurse Midwife % Dentist % Physician Assistant % Pediatrician* % Total % *Providers qualifying under reduced Medicaid patient volume (at least 20%) available only to Pediatricians. Pediatricians qualifying at the full patient volume (at least 30%) are included with Physicians. 4 Medicare data: Guidance/Legislation/EHRIncentivePrograms/DataAndReports.html; June 2014 State Registrations and Payments; Unique Count of Providers by State January 2011 June Medicaid data: Oregon s Medicaid EHR Incentive Program, August

35 EHR Incentive Programs Update Payment analysis by adoption stage Payment year AIU MU - Stage 1-1st year MU - Stage 1-2nd year MU - Stage 2-1st year Totals Totals Meaningful Use Status for 2014 Stage 1 Stage AIU estimates for eligible professionals is not available Medicaid EHR Incentive Program Participation Status # participated in 2 # participated in 3 # achieved MU out % participants that consecutive years consecutive years of all participants have achieved MU (2012/2013) (2011, 2012, 2013) % 3

36 Initial Framework for HIT/HIE Dashboard Goal 1: Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver whole person care. Objective 1: Increase access to patient information to achieve statewide interoperable, secure information exchange. Objective 1.1: Increase adoption and Meaningful Use of certified EHR technology. Sample Metrics: (1) EHR adoption/mu rates for EP/EHs, (2) technical assistance output to Medicaid providers Objective 1.2: Increase providers ability to coordinate care by increasing adoption of Direct secure messaging and other health information technologies by behavioral health, dental care, long-term care, etc. Sample Metrics: (1) EHR adoption/mu rates for EP/EHs, (2) CareAccord subscriber rates by organization type including behavioral health, long-term care, dental care, etc. Objective 1.3: Increase adoption and use of Direct secure messaging that is interoperable across EHR/HISP vendors. Sample Metrics: (1) number of community HIEs and (2) number of OR s health systems/providers connected to CareAccord for interoperable Direct secure messages Objective 1.4: Increase use of CareAccord Direct secure messaging services targeted to Medicaid entities, particularly those without access to EHRs and/or HISP services. Sample Metric: Analysis of CareAccord subscriber data and Medicaid affiliation Objective 1.5: Improve and accelerate sharing of patient information across community and organizational HIT efforts. Sample Metrics: (1) EDIE participation data, (2) hospital notifications program utilization data, (3) number of community HIEs connected to CareAccord for interoperable Direct secure messaging Goal 2: Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention. In turn, policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. Objective 2: Improve the use of aggregated clinical data for Medicaid and other State programs, CCOs, health plans, and other health system partners. Sample Metrics: (1) number of Medicaid EPs receiving incentive payments who submitted individual-level CQM data to OR s CQM registry, (2) number of Medicaid providers submitting individual-level CQM data for the CCO CQMs to OR s CQM registry Goal 3: Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers. Objective 3: Improve individual/family access to their meaningful health information. Sample Metric: Number of OR s EPs and EHs achieving Meaningful Use Stage 2 (requires the provision of online access to health information for more than 50% of patients, with more than 5% actually accessing)

37 Health Information Technology Oversight Council September 4,

38 Agenda 1:00- Welcome, Opening, Minutes Greg Fraser 1:10- Goals & Meeting Overview Susan Otter 1:15- OpenNotes Amy Fellows 1: Legislation Susan Otter 1:55- CCO and Stakeholder Engagement Susan Otter & Marta Makarushka 2:25- HIT/HIE Community & Organizational Panel Susan Otter & Marta Makarushka 3:00- Break 3:10- State HIT Dashboard Marta Makarushka 3:30- OHA HIT Activity Updates Susan Otter 4:15- Public Comment 4:25- Closing Comments 2

39 Meeting Objectives Presentation by OpenNotes Discuss HIT/HIE Community & Organizational Panel (HCOP) and Charter Discuss State HIT Dashboard OHA HIT Activity Updates 3

40 Goals of HIT-Optimized Health Care 1. Providers & Care Team 2. Systems & Policy 3. Individuals & Families Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver whole person care. Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention. In turn, policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers. 4

41 HITOC s Role in Achieving HIT- Optimized Health Care Provide guidance, input and recommendations for OHA s HIT strategy, policy and planning efforts to support the 3 goals of an HIT-Optimized health care system Assessing the changing state and federal HIT/HIE landscape, including convening HIO Executive Panel Recommendations and input on legislation, policy, refining priorities, removing barriers Special focus on: Promoting EHR adoption, Meaningful Use, and leveraging national standards and federal incentives Promoting statewide Direct secure messaging Providing guidance, information, assistance to support our overarching goals 5

42 OpenNotes Presentation September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 6

43 OpenNotes Health Information Technology Oversight Council September 4, 2014 Amy Fellows, MPH

44 What is OpenNotes? Patients invited to review their doctors visit notes through secure patient portals Each patient notified automatically via secure message when a note has been signed and reminded to review it before their next scheduled visit Research and demonstration project that started in the summer of 2010, involving more than 100 PCPs and 20,000 patients in Boston (BIDMC), rural Pennsylvania (Geisinger), and the Seattle inner city (Harborview) Supported primarily by the Robert Wood Johnson Foundation

45 3 Overall Questions Does OpenNotes help patients become more engaged in their care? Is OpenNotes the straw that breaks the doctor s back? After living with this transparency, do patients and doctors want to continue?

46 Reports from Patients Among patients with notes (visits): 82% of patients opened at least one of their notes 1-8% of patients across the 3 sites reported that the notes caused confusion, worry, or offense 20-42% shared notes with others

47 Reports from Patients 70-72% taking better care of themselves 77-85% better understanding of their medical conditions 76-84% remembering the plan for their care better 69-80% better prepared for visits 77-87% more in control of their care 60-78% doing better with taking my medications as prescribed.

48 Principal Concerns of 105 Participating PCPs Impact on workflow Visits significantly longer More time addressing patient questions outside of visits More time writing/editing/ dictating notes Expectations (%) Postintervention (%) and, compared to the year preceding the intervention, the volume of electronic messages from patients did not change

49 For PCPs: The Bottom Line When offered the option of turning off open notes not one doctor asked to do so. For Patients:

50 3 Overall Questions Does OpenNotes help patients become more engaged in their care? YES Is OpenNotes the straw that breaks the doctor s back? NO After living with this transparency, do patients and doctors want to continue? YES, virtually 100%

51 The Bottom Line for Institutions All 3 sites decided to expand OpenNotes Geisinger and Harborview: doctors in most ambulatory practices BIDMC: all clinicians who sign notes Also MD Anderson Cancer Center, Mayo Clinic, Veterans Administration, Group Health, Cleveland Clinic More coming: toward a new standard of care

52 Who Is Sharing Notes?

53 HIPAA Says

54

55 NW OpenNotes Consortium* February 2013: WCDB annual meeting--decides to adopt OpenNotes as a major initiative June 2013: WCDB convenes meeting of Oregon s health systems, consumer groups, and policy makers Monthly: meetings involving major health systems September 2013: Agreement to form a consortium of health systems to collaborate together to implement OpenNotes as a community * Support from: Cambia Health Foundation, RWJ Foundation, Consumer Reports

56 NW Consortium Clinical Participants Kaiser Permanente Northwest Legacy Health System (Oregon/SW Washington) OCHIN, Inc. (80+ clinics, 17 states) Oregon Health & Science University The Portland Clinic Portland VA Medical Center Providence Medical Group (Oregon/SW Washington) Salem Health The Vancouver Clinic PeaceHealth (Oregon/Washington) Others

57 Portland VA All Veterans, entire EHR since Jan 2013 Kaiser NW 500K patients on April 8, 2014 OCHIN 78 clinics, 18 states, all doctors can opt in, April 2014 OHSU All family practice patients since May 2014 Portland Clinic Clinic wide adoption August 2014 Vancouver Clinic Early Adopters Clinic wide adoption August 2014

58 Right Behind Legacy Health System 2 Clinics piloting spring 2014 PeaceHealth Oregon clinics to adopt fall 2014/2015 Providence Implementing 2015 Salem Health 1 Clinic pilot Spring 2015 Reaching out to other health systems in Oregon... 22

59 Kaiser early information on implementation Traffic to portal to review visit information up 400% MD traffic flat Rare concerns from patients about care ¼ of 1% of notes are hidden by MDs Mental health providers excluded Adolescents (13-18) excluded 7,000 notes per day now available to patients.

60 KPNW Patient Advisory Council Having the KP.org notification that I can view my doctor s notes on myself reminded me to have my labs drawn. It is a new schedule for lab draws that I had forgotten. I have a serious condition and this will help me do what my doctor wants me to do. Reviewing the notes I see why I need to lose weight. I cut the notes out of KP.org and posted in my kitchen. I DO NOT WANT TO BE A DIABETIC and this is in my face. It feels like my doctor really cares about my health, I never knew that." For me, the chart notes are like Paul Harvey states ' THE REST OF THE STORY " I told my doctor I ran every day and now I think he knows I REALLY DON'T. This may hold me more accountable to myself and my doctor I wanted my doctor to treat my mind, body and spirit. I am convinced that is happening based on reading the notes. The total picture of my health will help me heal

61 Vendors identified through Acumentra IPA Consortium

62 From Medscape Survey (18,000 Physicians)

63 The note becomes part of the treatment (Kahn, et al, JAMA, 2014)

64 Summary OpenNotes: A national initiative working to give patients access to the visit notes written by their clinicians Proven benefits: Patient engagement Minimal physician impact Cost/Benefit NW OpenNotes Consortium First to embrace OpenNotes as a community Monthly meetings open to all health systems

65 So be brave! Join the OpenNotes Movement!

66 2015 HIT Legislation September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 30

67 Legislative Concepts 2015 Health IT legislative concept: The authority to provide statewide HIT programs beyond Medicaid/OHA programs, including charging fees to users The authority to participate in partnerships or collaboratives that operate statewide HIT services Updating and refining the role of HITOC 31

68 Statewide HIT Programs OHA has clear authority to provide HIT services that serve OHA program purposes such as Medicaid, and is implementing new services now for Medicaid including Provider Directory To support HIT-optimized health care, statewide HIT services must support the care that all Oregonians receive, legislation would ensure OHA has explicit authority to provide HIT services statewide expanding beyond Medicaid ability to charge fees to ensure sustainability of HIT services 32

69 Statewide HIT Programs Collaboratives and Partnerships to Deliver Statewide HIT Services: Legislation would allow OHA the option of entering into new or existing partnerships or collaboratives: OHA can act formally (e.g., vote on a governance board) or participate financially in such a partnership or collaborative. OHA can leverage federal investment to support statewide HIT/HIE initiatives. OHA can elect to transition state-operated HIT services to a partnership or collaborative if needed 33

70 Updating HITOC s Role Much of the current HITOC statute (ORS ) has been superseded by state and federal policies (including the 2009 ARRA/HITECH Act) Implications for HITOC in the pending legislation: HITOC would report to the Oregon Health Policy Board, membership would be set by the Board Reset HITOC duties: Make recommendations to the Board on HIT efforts needed to achieve goals of health system transformation Monitor progress of state and local HIT efforts in achieving goals; regularly report to Board on progress in Oregon of adopting/using HIT Advise Board on federal law/policy changes affecting HIT 34

71 Next Steps on Legislation Drafting of final bill language Finalizing strategy/approach to introducing bill Maintain current HITOC meetings while anticipating passage of the legislation, including working with the Governor s Office on filling HITOC seats in the interim 35

72 CCO & Stakeholder Engagement September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 36

73 Deeper Dive Meetings with CCOs Objectives: Identify opportunities for increasing alignment of HIT/HIE development among OHA, CCOs, and other key stakeholders Assess opportunities for TA to CCOs Produce CCO HIT Profiles 2-3 hour on-site meetings with each CCO Half are completed; rest scheduled through Oct 1 st 37

74 Deeper Dive Meeting Components Overview of OHA s Phase 1.5 HIT/HIE Development Strategy Discussion of CCO s HIT/HIE Development Strategy Demonstrations of HIT/HIE solutions TA Survey Findings and Discussion Gauge Interest in HIT/HIE Community and Organizational Panel 38

75 Preliminary Overview of Main Themes Emerging From Deeper Dive meetings CCO profiles and HIT landscape Varies by community; e.g., size, member population, stage of development, HIT/HIE resource availability CCOs continue making investments in HIT/HIE EHR adoption not the most salient barrier, rather Connecting to an HIE Direct secure messaging access/capability Clinical Quality Measure collection and reporting Connecting to behavioral health is a ubiquitous challenge 39

76 Preliminary Overview of Main Themes Emerging From Deeper Dive meetings Consent management is a challenge CCO HIT/HIE investments include: health information exchange, care/case management, population management and analytics, practice management Some plan to: rely largely on state Phase 1.5 services, others will leverage regional initiatives or develop their own infrastructure 40

77 Preliminary Overview of Main Themes Emerging From Deeper Dive meetings 6 of 9 CCOs interviewed so far are leveraging regional HIEs for services including: Direct secure messaging, p-to-p referral system, clinical alerts, patient search CQM reporting Key driver for CCOs with respect to HIT efforts Regional HIEs are considering filling this role Difficulty getting clinical data is a common theme 41

78 Preliminary Overview of Main Themes Emerging From Deeper Dive meetings Final summary of gaps and opportunities across CCOs to be included in the next HITOC meeting Most CCOs inquired about how they compare (e.g., investments, challenges, successes) highlighting a potential role for sharing information across communities (HCOP) 42

79 Technical Assistance Needs Assessments Objective: Assess TA needs among Medicaid Providers Identify priority TA areas and target practices Will be basis for contractor work plans OHA distributed two questionnaires CCO Questionnaire received 12 Practice Questionnaire received 86 Data collection ongoing 43

80 Summary of Practice-level TA Surveys Top areas of needs Connecting to an HIE Training on CQM data collection and reporting Help implementing Direct secure messaging Assistance in these areas requested as soon as possible or within the next 12 months 23% reported obtaining TA from other sources (mostly from OCHIN) 44

81 Summary of Practice-level TA Surveys Ways practices are participating in an HIE: 33% Point-to-point interfaces (e.g., hospitals) 29% EHR vendor-specific capabilities (e.g., Epic s CareEverywhere) 24% Receiving hospital notifications 20% Using Direct secure messaging 17% participating in an HIE network 45

82 HIT/HIE Community & Organizational Panel (HCOP) September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 46

83 Objective: HIT/HIE Community and Organizational Panel (HCOP) to facilitate communication and coordination among HIOs, CCOs, and other healthcare organizations provide strategic input to HITOC and OHA regarding ongoing HIT/HIE strategy, policy, and implementation efforts 47

84 HIT/HIE Community and Organizational Panel (HCOP) Goals include: Identify and share best practices. Identify common barriers to HIT/HIE implementation progress. Identify opportunities for collaboration amongst entities implementing and operating HIT/HIE. Coordinate and communicate across organizations. Identify risks and challenges. 48

85 HIT/HIE Community and Organizational Panel (HCOP) Goals include Identify opportunities for HITOC to consider regarding: Providing guidance Developing policy Monitoring the environment Provide feedback to OHA Insights regarding the current status of HIT/HIE initiatives Barriers to implementation Opportunities for support 49

86 HIT/HIE Community and Organizational Panel (HCOP) Discussion points Membership: open or limited via nominations? HCOP to present HITOC with opportunities to consider or specific recommendations? HCOP to discuss HITOC-identified topics? 50

87 Next Steps HIT/HIE Community and Organizational Panel (HCOP) Recruitment for panel Timing of first meeting Vote on approval of charter (pending requested changes) Schedule interim meeting to further discuss 51

88 52 Break

89 State HIT Dashboard/Report Card September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 53

90 HIT/HIE Dashboard Use available data and information to help HITOC and stakeholders understand Oregon s progress toward the state s three goals for HIT-optimized healthcare 54

91 Overview of Dashboard Planning Status In preliminary planning phase Framed within the 3 goals of HIT-optimized healthcare Using objectives/sub-objectives outlined for CMS Outline intended to initiate discussion regarding data of interest what would be helpful 55

92 Goal 1. Providers & Care Team Providers have access to meaningful, timely, relevant and actionable patient information to coordinate and deliver whole person care. Support & facilitate adoption and Meaningful Use of certified EHRs Support the goal that providers have a means to access key patient information Support the protection, privacy and security of shared patient information 56

93 Objective 1: Increase access to patient information to achieve statewide interoperable, secure information exchange Objective 1.1: Increase adoption and Meaningful Use of certified EHR technology Medicaid EP/EH adoption/mu rates Rates over time AIU MU MU for multiple years (continuous participation) Extent of TA to Medicaid providers 57

94 Objective 1: Increase information access Objective 1.2: Increase providers ability to coordinate care by increasing: adoption of Direct secure messaging access to other health information technologies by behavioral health, dental, long-term care Medicaid EP/EH adoption/mu rates CareAccord subscriber rates by organization type including BH, Dental, LTC 58

95 Objective 1: Increase information access Objective 1.3: Increase adoption and use of Direct secure messaging that is interoperable across EHR/HISP vendors. # of community HIEs # of Oregon s health systems/providers connected to CareAccord for interoperable Direct secure messaging 59

96 Objective 1: Increase information access Objective 1.4: Increase use of CareAccord Direct secure messaging services targeted to Medicaid entities, particularly those without access to EHRs and/or HISP services: Analysis of CareAccord subscriber data and Medicaid affiliation 60

97 Objective 1: Increase information access Objective 1.5: Improve and accelerate sharing of patient information across community and organizational HIT efforts. EDIE participation data Hospital notifications program utilization data # of community HIEs connected to CareAccord for interoperable Direct secure messaging 61

98 Goal 2. Systems & Policy Systems (health systems, CCOs, health plans) effectively and efficiently collect and use aggregated clinical data for quality improvement, population management and incentivizing health and prevention. In turn, policymakers use aggregated data and metrics to provide transparency into the health and quality of care in the state, and to inform policy development. 62

99 Objective 2: Improve the use of aggregated clinical data For Medicaid and other State programs, CCOs, health plans, and other health system partners # of Medicaid EPs receiving incentive payments who submitted individual-level CQM data to Oregon s CQM registry # of Medicaid providers submitting individuallevel CQM data for the CCO CQMs to Oregon s CQM registry 63

100 Goal 3. Individuals & Families Individuals and their families access their clinical information and use it as a tool to improve their health and engage with their providers. Objective 3: Improve individual/family access to their meaningful health information Number of Oregon EPs and EHs achieving Meaningful Use Stage 2 (requires provision of online access to health information for > 50%, with >5% actually accessing) 64

101 Additional data sources Profiles of promising pilots PCPCHs meeting tier 3 requirements related to EHRs/MU Use of HIE Ability to aggregate/display data CCO data on EHR and MU related metrics CCO technology efforts as reported to OHA 65

102 HIT/HIE Dashboard Discussion Questions HIT/HIE data you would like to see incorporated into the dashboard Preference for dashboard format Frequency of dashboard reports View some annually, some quarterly Acceptable frequency? 66

103 OHA HIT Activity Updates September 4,

104 Changes to the EHR Incentive Program in 2014 Final Rule On August 29, 2014 CMS and ONC released the final rule that gives flexibility to providers who could not implement 2014 Edition Certified EHR Technology (CEHRT) due to delays in availability Allows providers to receive meaningful use payments in program year 2014 using 2011 CEHRT Requires 2014 CEHRT to successfully demonstrate meaningful use in program year 2015 Formalizes the delay of stage 3 until 2017 Does NOT affect payments for Adopt, Implement, or Upgrade (AIU) which still requires 2014 CEHRT and does NOT change the EHR reporting periods 68

105 ONC 10-Year Interoperability Plan September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 69

106 CareAccord Flat File Directory Exchange and Direct at the National Level 1. Providers & Care Team 2. Systems & Policy 3. Individuals & Families 70

107 Flat File Directory Service OHA OHIT began offering a Directory service, via flat file, of Direct addresses on July Goals for flat file directory: 1. Expand discovery of health care professionals Direct addresses for improved care coordination 2. Support Meaningful Use (MU) attestation around Direct secure messaging and summaries of care 71

108 Flat File Directory Participation o The Flat File Directory had 4 organizations participate in the first exchange: Oregon Health & Science University (OHSU) Legacy Health Systems Tuality Healthcare CareAccord o More than 2,700 Direct secure messaging addresses were included in the Flat File Directory exchange. o As of the end of August, all participant organizations are able to send and receive Direct secure messages with each other. 72

109 Lessons Learned Efforts to upload the Flat File Directory varied among participants. o Some EHR directories require a National Provider Identifier (NPI) in order to be included. Several challenges were identified when Legacy and OHSU went to exchange DSM with CareAccord and Tuality: 1. Additional steps were needed between the EHR and HISP configurations before the HISP could process DSM. 2. It was discovered that certain EHRs will only send and receive messages with an attached, version-approved CDA (transition of care document, lab, etc.). 73

110 Lessons Learned Continued Confusion occurred around send/receipt notifications when CareAccord sent Direct secure messages to Legacy and OHSU. Process Notifications were received by CareAccord, but messages without a valid CDA were not received. In Summary: All lessons learned (and challenges revealed!) as a result of the Flat File Directory exchange are valuable. Continued dialogue is needed between all involved: EHRs, HISPs, and health care organizations and professionals. 74

111 Next Steps for Flat File Directory o OHIT & CareAccord continue to engage Flat File participants to resolve barriers and discuss future of statewide (and national) Direct secure messaging. o CareAccord is reaching out to all Oregon hospitals to participate in the Flat File Directory. o CareAccord is testing sending/receiving Direct secure messages with those whose HISPs are in candidate status. 75

112 Direct at the National Level o Other states are seeing similar challenges with Direct resulting from: MU Stage 2 EHR certification requirements versus real-world expectations. Choices by some vendors to implement the minimal functionality necessary to achieve MU Stage 2 certification. o The ecosystem as a whole is working to resolve challenges being seen in the field and to advance HIE. ONC is proposing new EHR certification criteria and testing procedures. The Interoperability and Health Information Exchange Subcommittee for the Health IT Policy Committee has been holding hearings for public testimony regarding the governance of health information exchange. o Direct secure messaging continues to expand across the nation. Direct Trust now has 36 HISPs accredited or in the process of accreditation. 76

113 Notifications Update September 4, Providers & Care Team 2. Systems & Policy 3. Individuals & Families 77

114 Product Data Included Timeline Payment Model Who Has Access EDIE Emergency Department data from Implemented statewide by Funded by OHA (SIM grant), OHLC Hospitals ADT (Admit Discharge Transfer) Feed (date, location, diagnosis, meds, etc.); Nov and OHLC member plans. Hospitals incurred technology care guidelines implementation EDIE Plus PreManage EDIE, EDIE Plus, PreManage Adds inpatient data (ADT) including discharge notes Leverages EDIE Plus data to make hospital event data available to plans, CCOs, providers, care team for their members or patients Begins 2015, implemented statewide by end of 2015 *OHA to pursue federal funding for CCO share costs. Utility Model: costs split between: hospitals health plans/ccos* Hospitals 2015 Subscription fee Local HIEs Health Plans CCOs Providers

115 EDIE Implementation Status As of August 15, 2014: 41 hospitals have established live feeds with EDIE (69% implemented) 35 hospitals are receiving notifications (59% implemented) 25 hospitals are sending both ED and inpatient data to EDIE (42%) 79

116 EDIE Utility Business Plan On July 10, 2014, the Oregon Health Leadership Council approved the EDIE Plus/PreManage Business plan: The EDIE Plus utility and associated tiered financing structure The governance structure Locked in pricing for basic PreManage use cases OHA/CCO participation: OHA is sponsor for EDIE Plus, provides staff support for planning process CCO HIT Advisory Group provided input on Business Plan concepts In July, CCO CEOs agreed that OHA should use Transformation funds and seek federal funding for EDIE Plus financing (CCO share) OHA is also interested in seeking federal funding for a Medicaid subscription to PreManage and will be working with each CCO to identify their interest 80

117 EDIE Utility Governance Board The current governance committee will accept nominations from each of following stakeholder groups / participants to serve staggered three year terms, with the following distribution of nominated positions: Hospitals / Health Systems 4 positions, all voting Health Plans 2 positions, all voting CCOs 2 positions, all voting CCO physician member 1 position, voting OHLC physician member 1 position, voting OCEP physician member 1 position, voting OAHHS (ex-officio) 1 position, voting OHA (ex-officio) 1 position, non-voting At-large community member 1 position, voting 81

118 Purchasing Options for PreManage Discussions with stakeholders to look at group or community purchasing of PreManage subscriptions Avoid paying twice for same patients under plan and provider subscriptions Coordinate provider subscriptions across payers so they can sign up for their entire panel if desired, which will support integrating notifications into their workflow These conversations will be important in helping OHA understand: Interest in PreManage among CCOs and Medicaid providers; Options for a state-level Medicaid PreManage subscription if this were to be approved by CMS 82

119 Concluding Discussion Feedback on OHA HIT Activities? Feedback on HITOC meetings Feedback on HITOC Monthly Updates? Any other suggestions? 83

120 Public Comment September 4,