(60 min) California State Updates

Transcription

1 (60 min) California State Updates Presenters: 30 min Speranza Avram, CEO, CalHIPSO: EHR status & uptake in CA 20 min David A. Minch, President & COO, HealthShare Bay Area: HIE status 10 min Questions 1

2 Trust is the Foundation for Health Data Exchange Patients must trust the Providers to hold their data securely, and only share it when they find it necessary. Providers must trust other Providers to share relevant and accurate patient data. Providers and Patients must trust Plans in utilizing health information appropriately. Providers and Patients must trust Government entities to collect and hold only that data needed for population safety and health. Etc In short, all parties in the exchange must trust the other parties, or none of this works. 2

3 HIE / HIO the ONC Definitions National Alliance for Health Information Technology, April, 2008: [amended by ONC]: HIE: HIO: The electronic movement of healthrelated information among unrelated organizations according to nationally recognized standards in an authorized and secure manner. An organization that oversees HIE (abridged definition). 3

4 What does it mean? The electronic movement of health-related information among unrelated organizations according to nationally recognized standards in an authorized and secure manner. Can include pushing data or pulling data. Information does not have to be clinical. Any organizations can participate doesn t have to be just medical providers. Must use nationally recognized standards. Must be authorized, and must be secured. 4

5 Three Basic Architectures for HIE NwHIN Direct A specifically engineered -like capability which uses Public Key Infrastructure (PKI) to encrypt, sign, and securely send messages [push] ehealth Exchange (formerly NHIN / NwHIN) A specifically engineered set of layered protocols and services used to query for information [pull] Use the services of an HIO Create a Private Exchange for your enterprise Participate in a Community Exchange [link and aggregate] 5

6 NwHIN Architectures The ONC has worked on two initiatives for sending messages from point A to point B: Direct (push) and Exchange (Pull). Direct HIE EHR Exchange HIE 6

7 Basic Function of an HIE Data exchange scenarios requiring aggregation of clinical data can only be accomplished through the use of an HIE which has the ability to link data together by patient from many sources and provide analysis and display of the aggregated data. Community Repository EHRs EHRs EHRs Labs Labs Labs Imaging Imaging Imaging Hospitals Hospitals Hospitals Health Information Exchange Organization 7

8 Types of HIOs in California Public HIO: Typically a diverse stakeholder group Membership & services through a collaborative governance model Funding sources vary: private sources, government grants, service offering revenue, and participant fee-for-service Public / private non-profit with government involvement Private HIO: Private, centralized ownership & governance Owner manages cost and determines operations, services and membership Examples: Enterprise or IDNs, dominant regional hospital, payers, medical service or disease specific, vendors, etc. 8

9 Known California HIOs Today 9

10 Known HIOs Public HIOs Brown & Toland x Adventist 10

11 Western States Consortium (WSC) New name: National Association for Trusted Exchange (NATE) States sharing common goal of creating policies and procedures that lay the groundwork for enhancing safe interstate transfer of electronic health information. Address legal, policy and technical barriers between entities within a state and across states; Collaborate to develop required solutions and pilot in the real-world

12 ehealth Exchange: an Evolving Landscape Evolved from federal initiative to sustainable public-private model Dramatic growth, particularly in private sector, driven by: Maturation of HIE capabilities Financial incentives Recognized value in commoditizing basic connectivity Robust HIE certification program for products and participants Work ahead: Expand the network Improve identity matching Enhance data content validation Develop strategic road map Foster continued collaboration around HIE implementation

13 EHR/HIE Interoperability Workgroup Members 19 States: represent approximately 52% of US population 42 vendors: EHR and HIE market leaders 13

14 Introducing: California Association of Health Information Exchanges CAHIE is a statewide group of community and enterprise health information organization leaders working together to advance safe and secure HIE throughout California. 14

15 CAHIE Vision CAHIE s vision is to create a California trust framework that is based on national standards and protocols for trusted exchange and to create pathways to ensure that all providers can connect to and use Direct and HealtheWay s ehealth Exchange (formerly NwHIN). In short, the CAHIE wants to functionally eliminate the interoperability white space in California. 15

16 Facilitating Interoperability in California California Addendum to the DURSA / CA Version of the DURSA 16

17 CAHIE Trust Levels DURSA+ would further specify the DURSA re: permitted uses, audit/oversight, content targets between CA Participants, etc. plus additional exchange patterns. CA ehealth Exchange DURSA+ Participants H1 H2 H3 ehealth Exchange Fully Onboarded ehealth Exchange Participants H4 H5 H CA ehealth Exchange MMPA V1: HIO / Participants CA Health Systems and HIOs Agrmt. MMPA2? H7 Pa Pb Pc 2 H8 H9 2 Nothing we are doing would change the present environment of HIO-HIO bilateral agreements between any 2 parties. Separate Data Sharing Agreement, perhaps leveraging MMPA work, will need to include DURSA flow down requirements 17

18 Preparing for Data Exchange Your EHR MUST be tooled to participate in Direct: Act as a Direct sender Act as a Direct receiver Access to a directory of healthcare provider addresses Your EHR SHOULD be tooled to participate in Exchange: Be capable of posting an inquiry for a patient Be capable of responding to an inquiry 18

19 Preparing for Data Exchange Your EHR MUST utilize the HealtheWay/IWG specifications for the Continutiy of Care Document (CCD or C32): Your EHR vendor MUST be preparing for the Transition of Care requirements for MU3 which includes transition to use of the Clinical Document Architecture data structures including Plan of Care and Past Medical History. Your EHR MUST be capable of creating and consuming HL7 2.5 messages (or HL7 3.1 XML-based) for the basic capabilities called out in the California HIE Ready specification: 19

20 For more information: Speranza Avram, CEO, CalHIPSO; David A. Minch, President & Chief Operating Officer, HealthShare Bay Area; 20

21 CAHIE Mission CAHIE s mission is to establish a light-weight self-governance function for trusted exchange in California, which relies on the National Coordinating Committee for national governance, but fills in the gaps with those additional functions its members require to achieve a trusted exchange relationship with each other. CAHIE will cooperate with, support, contribute to, and learn from other national HIE initiatives such as the National Association of Trusted Exchange (formerly Western States Consortium), the DirectTrust framework, the Interoperability Workgroup, and the National ehealth Collaborative. 21

22 HIE Common Technical Elements HIE Foundational Services Community Master Patient Index (CMPI or EMPI) Record Locator Service (RLS) Master Provider Index (MPrI) Entity Directory (Hospitals, Med Groups, etc.) User Directory Other Directories (Clinics, Public Services, Registries, non-participant message destinations, etc.) Authentication / Authorization Methods ATNA-compliant Transaction and Use Logs 22

23 Walkthrough of Message Routing Logic EHR MED MPrI Message Destination Processing HL7 2.5 Message Message Parsing and Normalization Patient Matching Add if not in the CMPI Message Buss Data Provider HIE CMPI RLS CDR Edge EHR 23 Data Receiver

24 Common HIE Services Transaction Services (Hospital & Ambulatory): Inbound Interfaces: EHR HIE Outbound Interfaces: HIE EHR Interoperability Services Application Services Premium Services EHR-type services PHR-type services Data Warehouse and Analytics 24

25 Workflow Considerations Workflow is likely the most important consideration for an HIE next to privacy and security it may even trump cost. Notifications must be delivered to the provider s in-box or EHR-based worklist Clinical data reconciliation is a key service to promote physician adoption and use of the HIE Value is realized when difficult tasks are simplified Physicians need to be able to readily manage their patients within the context of their EHR 25