NC HIE Hospital Onboarding Strategy

Transcription

1 NC HIE Hospital Onboarding Strategy April 2014

2 I. Purpose of Document This document presents a comprehensive plan for onboarding the North Carolina hospitals that bill Medicaid for services to the North Carolina Health Information Exchange (NC HIE) to enable compliance by NC HIE, the North Carolina Department of Health and Human Services (NC DHHS or The Department ) and hospitals with the North Carolina Health Care Cost Reduction and Transparency Act of 2013 (N.C. Session Law , s. 14.1). The following sections describe the legal requirement and NC HIE s proposed approach to compliance for all parties by October 31, II. Background NC HIE was established to plan, implement, and operate the statewide health information exchange infrastructure (the HIE Network) that allows the secure electronic sharing of a patient s personal health information with other healthcare entities that have a relationship with that patient. Initial and ongoing funding for NC HIE has been made available to NC HIE through a program managed by the Division of Medical Assistance with funding from the State and the Centers for Medicare and Medicaid Services (CMS). By executing the DHHS-NC HIE Master Services Agreement, the Department recognized NC HIE as a strategic partner to further the Department s goals and objectives related to improving the quality and coordination of care provided to beneficiaries of DHHS programs and initiatives across health systems through timely access to claims and clinical data. With the enactment of the North Carolina Health Care Cost Reduction and Transparency Act of 2013 (N.C. Session Law , s. 14.1), the strategic partnership between the Department and NC HIE will increase significantly to enable the Department to have timely access to clinical information from hospitals concerning Medicaid and HealthChoice beneficiaries. Such access will enable the Department to use this information to enhance its ability to (i) implement and evaluate Medicaid reform strategies designed to control health care costs and improve the fiscal oversight of the Medicaid program; (ii) perform comparative and population-based research and evaluation designed to increase quality, enable more effective population health management and reduce duplication of Medicaid services; and (iii) identify fraud and abuse within the Medicaid program. The submission of patient demographic and clinical data from the hospitals across North Carolina is critical to improving the timeliness and safety of health care services provided to some of NC s most vulnerable citizens. The submission of hospital data across the State will also enhance interoperability between healthcare systems allowing for the treatment of the whole patient and improvement in many services including public health surveillance and disease management. NC HIE Hospital Onboarding Strategy 1

3 III. Scope of Work According to Statement of Work Number 5 to the NC DHHS-NC HIE Master Service Agreement and pursuant to House Bill 834, NC HIE shall connect all hospitals that bill Medicaid for services to the HIE Network such that the following data elements for all patient encounters are made available in the HIE Network on a real-time or near-real-time basis: i. Demographic; ii. Payer(s); iii. Encounter Purpose/Diagnosis; iv. Problems; v. Procedures; vi. Medications; vii. Immunizations; viii. Allergies; ix. Laboratory Results; x. Vital Signs; xi. *Family History; xii. *Social History; xiii. *Advance Directives; xiv. *Medical Equipment; xv. *Functional Stats; and xvi. *Plans of Care. *Note that these data elements may not be available from all hospitals upon initial connectivity. NC HIE shall accomplish the former through two main interfaces required for all hospitals: Admission, Discharge, Transfer (ADT), and Continuity of Care Document (CCD), part of the Consolidated Clinical Document Architecture (CCDA) standard promoted by the Office of the National Coordinator of Health Information Technology (ONC), the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) and other federal agencies promoting the standardized sharing of health data across health care providers and enterprises. NC HIE Hospital Onboarding Strategy 2

4 IV. Implementation/Electronic Health Record Landscape Implementing a statewide integration plan for our health care environment can be a tedious process due to multiple variables in the electronic health record (EHR) environment. In the state of North Carolina, there are more than 20 different EHR vendors scattered throughout our hospitals. Within EHRs there is the potential to have multiple products and versions, creating alternate paths to integration. There will be opportunities to explore efficiencies in connectivity as more hospitals are onboarded. The State of North Carolina has larger integrated delivery networks (IDNs) that share EHR systems, so the potential to integrate with a single source of data can encompass multiple individual hospitals. There are also EHR vendors that are prevalent within the State where integration methods may be reused according to the likeness of those systems. V. Standard Integration Process The standard integration process for hospitals at NC HIE consists of the following eight phases. Please note that the timeframe provided here estimated at an average of 12 weeks per hospital is an approximation based on recent experience with integrations and can vary depending upon multiple factors including EMR vendors and hospital resource levels. 1. Initiation: Involves hospital receipt and completion of the NC HIE Business Requirements Form, Implementation Planning Questionnaire and VPN Connectivity Form, and provision of the hospital s EHR specifications to NC HIE. Forms are received and reviewed by NC HIE for accuracy, followed by a technical discovery call with all parties to clarify details necessary for the planning and preliminary groundwork for development and testing. The timeframe for this phase is 1-2 weeks. 2. Planning: Involves identification and documentation of the complete scope of integration; creating an integration project schedule for NC HIE, hospital and its EHR vendor; creation of Test Plan; agreement on high-level milestones; and finally the project kick-off call. The timeframe for this phase is 1-2 weeks. 3. Design: Involves facility list build, design, and data mapping analysis of all the interfaces in scope. The timeframe for this phase is 2-3 weeks. 4. Build and Execution: Involves establishing connection, mostly through VPN, and in certain cases through web services. Once the connectivity is established, the hospital will send test messages for validation, after which development and unit testing for each interface occur. This is the most time consuming phase and should typically last 5-6 weeks. NC HIE Hospital Onboarding Strategy 3

5 5. User Acceptance Testing: Involves NC HIE s creation and hospital review of user acceptance test scripts, code promotion to the Test Environment, and testing. Once complete, the hospital reviews the results, orders more testing is necessary or provides final sign-off. This phase can last 1-2 weeks. 6. Production Implementation: Involves review of the go-live schedule and migration plan developed by NC HIE and the hospital and promotion of the code to the Production Environment. Final production implementation testing then occurs. This phase lasts for 1 week. 7. Training: Provided in recorded or live webinar format for participants through the NC HIE website, or when required onsite, due to the extent of integration and the number of facilities involved. 8. Closeout: Involves sign-off via the customer acceptance form, which establishes mutual agreement on a successful roll-out of code into production and completion of implementation testing. The flowchart on the following page depicts the above eight-step standard integration process for onboarding one hospital. NC HIE Hospital Onboarding Strategy 4

6 NC HIE Hospital Onboarding Strategy 1

7 VI. Hospitals in Scope and Roll-Out Schedule The following schedule represents an estimated roll-out of hospital onboarding for all hospitals covered under the legislative requirement over 18 months from the anticipated April 2014 agreement between NC DHHS and NC HIE, or from May 1, 2014 October 31, Hospitals Currently Under Contract with NC HIE Twenty-seven (27) hospitals are currently under contract with NC HIE. These hospitals, contracted on or before April 1, 2014, are listed in the table below with estimated go-live dates based on current implementation projects. Go-live is defined in the below table to mean the date when ADT and CCD information for that hospital is available in the HIE Network. Current Hospital Participants of NC HIE (Contracted prior to April 1, 2014) EHR System Estimated Go-Live 1. Morehead Memorial Hospital Meditech 15-May Carteret General Hospital Meditech 15-May Granville Health System Meditech 15-May Lenoir Memorial Hospital Meditech 15-May Halifax Regional Medical Center Meditech 15-May UNC Chatham Hospital 31-May Rex Healthcare 31-May University of North Carolina Hospitals 31-May Wilson Medical Center Meditech 15-Jun Maria Parham Medical Center Paragon 15-Jun Person Memorial Hospital Meditech 15-Jun Hugh Chatham Memorial Hospital CPSI 30-Jun Our Community Hospital HMS 30-Jun High Point Regional Hospital (UNC Health Care) McKesson 30-Jun UNC Caldwell Memorial Hospital Siemans 30-Jun UNC Pardee Hospital Meditech 30-Jun UNC Wakebrook (?) 30-Jun Johnston Medical Center (UNC Health Care) Meditech 30-Jun-14 NC HIE Hospital Onboarding Strategy 2

8 19. Nash Hospitals 30-Jun Wake Forest Baptist Hospital 30-Jun Davie Medical Center (Wake Forest Baptist Health) 30-Jun Lexington Medical Center (Wake Forest Baptist Health) 30-Jun CaroMont Regional Medical Center McKesson 30-Jun Ashe Memorial Hospital Meditech/Iatric 30-Jun Watauga Medical Center Allscripts Sunrise 30-Jun Blowing Rock Hospital Allscripts Sunrise 30-Jun Charles A. Cannon Memorial Hospital Allscripts Sunrise 30-Jun-14 Hospitals Not Currently Under Contract with NC HIE One-hundred and nine (109) hospitals under the legislation (estimated based on general/acute care hospitals, long-term care, behavioral health hospitals, other specialty hospitals and stateoperated hospitals that bill Medicaid per 2014 GAP/MRI Plan; B1-B2 Inpatient Test Tab data provided by the Division of Medical Assistance and available data on the North Carolina Hospital Association website) are not under contract with NC HIE as of April 1, These hospitals are listed in the table below along with EHR vendor, if known. If all hospitals execute an agreement with NC HIE by July 31, 2014 (project assumption), per an expected agreement and announcement by NC HIE and NC DHHS in late April 2014, the current integration project timeline will allow for an average of hospitals to complete implementation efforts and go live on the HIE Network quarterly, completing all work by the target date of October 31, The queuing of these systems will be based on when hospitals enter into contract as well as readiness. Future Hospital Participants of NC HIE (Contracted after April 1, 2014) Alamance Regional Medical Center Albemarle Hospital Alleghany Memorial Hospital Angel Medical Center Annie Penn Hospital Anson Community Hospital Asheville Specialty Hospital Betsy Johnson Hospital EHR System Meditech CPSI NC HIE Hospital Onboarding Strategy 3

9 Blue Ridge Regional Hospital Bladen County Hospital Broughton Hospital Brynn Marr Behavioral Healthcare Cape Fear Valley Medical Center Care Partners Rehabilitation Hospital CarolinaEast Medical Center Carolinas Medical Center-Northeast Carolinas Medical Center Carolinas Medical Center-University Carolinas Medical Center-Mercy Carolinas Medical Center-Pineville Carolinas Medical Center-Lincoln Carolinas Specialty Hospital Catawba Valley Medical Center Central Carolina Hospital Central Harnett Hospital Central Regional Hospital Charlotte Institute of Rehabilitation Cherokee Indian Hospital Cherry Hospital Cleveland Regional Medical Center Columbus Regional Healthcare System Crawley Memorial Hospital Davis Regional Medical Center Dosher Memorial Hospital Duke Raleigh Hospital Duke Regional Hospital Duke University Hospital FirstHealth- Montgomery Memorial Hospital FirstHealth- Moore Regional Hospital FirstHealth- Richmond Memorial Hospital Frye Regional Medical Center Grace Hospital Inc. Highlands-Cashiers Hospital Highsmith-Rainey Memorial Hospital Holly Hill Hospital Iredell Memorial Hospital Resource & Pt. Mgmt. System CPSI CPSI NC HIE Hospital Onboarding Strategy 4

10 Julian F Keith ADATC Kindred Hospital- Greensboro Kings Mountain Hospital Lake Norman Regional Medical Center Lifecare Hospital of North Carolina Martin General Hospital MedWest Harris Regional Hospital MedWest Haywood Regional Medical Center MedWest Swain County Hospital Missions Hospitals, Inc Moses Cone Memorial Hospital Murphy Medical Center New Hanover Regional Medical Center Northern Hospital of Surry County Novant Health Brunswick Medical Center Novant Health Charlotte Orthopedic Hospital Novant Health Clemmons Medical Center Novant Health Forsyth Medical Center Novant Health Franklin Medical Center Novant Health Huntersville Medical Center Novant Health Kernersville Medical Center Novant Health Matthews Medical Center Novant Health Medical Park Hospital Novant Health Presbyterian Medical Center Novant Health Rowan Medical Center Novant Health Thomasville Medical Center Old Vineyard Hospital- Keystone Onslow Memorial Hospital Park Ridge (Fletcher) Hospital Pender Memorial Hospital Pioneer Community Hospital of Stokes Randolph Hospital Inc. Rutherford Hospital Sampson Regional Medical Center Sandhills Regional Medical Center Select Specialty Hospital- Durham Select Specialty Hospital- Greensboro Select Specialty Hospital- Winston-Salem CPSI Meditech Meditech NC HIE Hospital Onboarding Strategy 5

11 Scotland Memorial Hospital Southeastern Regional Medical Center St. Luke's Hospital Stanly Regional Medical Center The McDowell Hospital, Inc The Outer Banks Hospital, Inc (Vidant) Transylvania Regional Hospital Union Memorial Regional Medical Center Valdese Hospital Vidant Beaufort Hospital Vidant Bertie Hospital Vidant Chowan Hospital Vidant Duplin Hospital Vidant Edgecombe Hospital Vidant Medical Center Vidant Roanoke-Chowan Hospital WakeMed Cary Hospital WakeMed Hospital Walter B Jones ADATC Washington County Hospital Wayne Memorial Hospital Wesley Long Community Hospital Wilkes Regional Medical Center Wilmington Treatment Center Yadkin Valley Community Hospital McKesson Meditech NextGen VII. Cost to Hospitals NC HIE s pricing structure was configured to spread the operating costs of the HIE Network evenly among North Carolina Hospitals. The current costs to hospitals for initial connectivity and ongoing subscription fees are represented in the below table. NC HIE Hospital Onboarding Strategy 6

12 Participant Category Hospitals/IDNs (includes access for all hospital-based providers) CORE Services Subscription Fee (Annual Fee) $250 per licensed bed $50 per licensed bed for skilled nursing or long-term care beds Estimated Integration Fees (One-time Charge) Core interfaces to be included: - ADT (Admission, Discharge, Transfer) - CCD (Continuity of Care Document; bi-directional) Core interfaces: $7,000 Public Health interfaces to be included: 1. NC Immunization Registry interfaces: - VXU (Vaccination Update Message) - QBP (Query By Parameter) - RSP (Response Message) 2. NC Electronic Lab Reporting interface: - ORU (Observation Result Message) Public Health interfaces: $11,000 DSM Direct EMR Integration (optional): $10,000 VIII. Project Assumptions The following assumptions have been made to ensure adherence to the project schedule: 1. All hospitals will be under contract with NC HIE by July 31, No discounted annual pricing will be available to hospitals for contracts signed after May 1, The following are completed no later than 2 weeks from contract execution between the hospital and NC HIE: a. Pre-technical documentation by the hospital, including completion of NC HIE s Business Requirements Form, Implementation Planning Questionnaire, VPN Connectivity Form and other requested documentation; and b. Resource allocation is done at all three ends: NC HIE, Hospital and EHR Vendor. 4. Hospital system readiness is confirmed during the initiation phase. IX. Conclusion In conclusion, the Onboarding Strategy herein is an aggressive but feasible approach to connect all hospitals in the State to NC HIE pursuant to the North Carolina Health Care Cost Reduction and Transparency Act of 2013 (N.C. Session Law , s. 14.1). The connectivity established will allow for data sharing between the hospitals, other healthcare providers and trading partners and the Department of Health and Human Services (DHHS) to (i) implement and evaluate Medicaid reform strategies designed to control health care costs and improve the fiscal oversight of the Medicaid program; and (ii) perform comparative and population-based research NC HIE Hospital Onboarding Strategy 7

13 and evaluation designed to increase quality, enable more effective population health management and reduce duplication of Medicaid services. The availability of statewide clinical data will allow healthcare providers to be more efficient in the treatment of patients and to streamline care coordination efforts amongst multiple providers, improving the quality of care administered and reducing rising healthcare costs. X. Appendices The following documents are appended to this Onboarding Strategy document to provide further context for its contents: A. North Carolina Health Care Cost Reduction and Transparency Act of 2013 (N.C. Session Law , s. 14.1) B. DHHS-NC HIE Master Services Agreement C. DHHS-NC HIE Master Services Agreement, Scope of Work #5 D. NC HIE Technical Specifications NC HIE Hospital Onboarding Strategy 8