Health Information Sharing Maturity Model

Transcription

1 Health Information Sharing Maturity Model G. Hamilton T. Novak March 8, 2018 The MITRE Corporation operates the Centers for Medicare & Medicaid Services (CMS) Alliance to Modernize Healthcare (CAMH), a federally funded research and development center (FFRDC) dedicated to strengthening the nation s health care system. MITRE operates CAMH in partnership with CMS and the Department of Health and Human Services.

2 2 What is Health Information Sharing (HIS) The sharing of health and healthcare information (HIS) Electronically across key participants and stakeholders to Improve health and healthcare practices Ensures health information is available at the right place at the right time for the right person Lowers burden on healthcare providers and patients Improves efficiency of healthcare system and lowers costs Best of all, IMPROVES HEALTH OUTCOMES!

3 Enabling Health Information Sharing: The HIS Maturity Model (HISMM) 3 A maturity model will enable Health Information Sharing by: Providing states with a mechanism to assess the maturity of health information exchange within a state s healthcare Enterprise. Ensuring the most effective use of scarce resources, leveraging common efforts, both public and private Ensuring that best practices and lessons learned, such as increased modularity, are incorporated Improving reuse of solutions across states HIS Maturity Model benefits Helps prioritize areas that may require technology supports/enhancements Reveals the mitigations and workarounds needed to support a program Helps you understand gaps, where you may need to make more Health Information Technology (HIT) investments Demonstrates how to mature a capability based on cost/benefit analysis and resource Helps with overall HIT planning Helps identify gaps and determine steps to incrementally improve the capability Provides the steps to use in building the roadmap to improve the capability

4 4 Why Do We Care About Maturity Levels Low Maturity HIS capabilities that: share inaccurate information require manual entry have inefficient workflows Results in: medical errors provider burden need for additional staffing High Maturity HIS capabilities that: share accurate information enable automation have efficient workflows Results in: better care coordination for patients less burden on providers reductions in admin staff and contractors Overall, a capability with a high maturity can achieve delivery system reform goals

5 5 Proposed HIS Capabilities to Include in Maturity Model Admission, Discharge and Transfer (ADT) Events/Encounter Alerting Advanced Directives Analytics Reporting Care Plans Claims Information Sharing/ All-Payer Claims Databases Death Reporting Disease and Public Health Registry Information Electronic Prescribing Eligibility and Benefits Information EMS Integration Financial Information Health Record Image Sharing Immunization Registry Lab Orders Lab Results Patient Consent Patient Education Patient-Generated Data Patient Identifier Patient Portal Information Patient Record Locator Population Health Information Prescription Monitoring Provider Attribution Provider Directory Quality Reporting Referral Management Risk Assessment Social Determinants of Health Only select the ones that support your program goals

6 6 HIS Maturity Model Components Programs: The Why (Goal) Provides understanding of what capabilities are needed to achieve a State Medicaid Agency goal Example: Behavioral Health Integration Capabilities: The What The functionality you are exploring Example: Provider Directory Dimensions: The How The tool/mechanism that supports a specific functionality Example: Measure the level of Usability

7 7 HIS Maturity Model Components: Program Sheets Purpose: To layout what is needed to attain program goals. Used to Identify Main objectives Outcomes Stakeholders Relevant capabilities How to use: To review capabilities and identify priorities Refer to relevant Capability sheet to help estimate maturity level and target level To identify additional stakeholders and outcomes As a communication tool to socialize needs with stakeholders Example: Behavioral Health Integration Program

8 8 HIS Maturity Model Components: Capability Sheets Purpose: Provides a capability definition and example of maturity levels to help communication/understanding Identify Programs Stakeholders Low, medium, high, maturity level summary Provides a common mechanism for communication How to use: Review capability description Identify additional stakeholders Capability Example: ADT Events Review maturity level descriptions to estimate as is and target maturity state

9 9 HIS Maturity Model Dimensions: Criteria for Assessment Technical Dimensions People & Process Dimensions Governance Dimensions Information Quality Transport Security Transaction/Query Usability/Workflow Alignment/Duplication Participation Consent/Privacy Data Governance Stakeholder Governance Sustainability Is the data being shared, timely, usable, high quality, complete and relevant? What is the maturity of the data transport mechanisms used? Push/Pull What mechanisms are in place to ensure data is shared securely? What is the level of adoption of the Application Programming Interface (API) used? How easy is the information to consume? Is the information incorporated into the workflow? How many different mechanisms are available? Can all possible participant types (providers, patients, payers,...) for the capability, participate, and how many are actually participating? Can patients control (provide consent) who has access to data about them to a granularity appropriate to the capability? How mature are the processes to govern data involved in exchanges? How mature is the organizational structure and associated processes to govern exchanges for this capability? What are the resources available to sustain efforts for any capability; people, funds, skills, leadership?

10 10 HIS Maturity Model Assessment Steps Identify Program Identify the State program goal that will drive the needed Information Technology (IT) capabilities Identify Capabilities & Stakeholders Use the program sheets to determine and prioritize the required capabilities and identify all stakeholders that will be involved in the assessment Review Capability Sheets Use capability sheets to determine expectations for the capability maturity level Use Dimensions Assess current maturity for each capability against each dimension. Target Maturity Level and Identify Gaps Determine target maturity for each capability against each dimension. Use dimension sheet to identify gaps to achieve desired level. Identify Steps to Address Identify incremental steps to address the gaps. Use these identified steps to inform a roadmap to improve capability.

11 HIS Maturity Model on Centers for Medicare & Medicaid Services (CMS) zone 11 HISMM available for review on zone Maturity Model Executive Summary Presentation Spreadsheet model Information/Capability sheets Behavioral Health ADT Events Health Record Information Discussion Forum Leave comments, ask questions! Instructions available for access

12 12 For More Information To learn more or provide feedback on the HIS Maturity Model, please contact Tom Novak

13 13 Follow up To download a copy of this presentation, visit: Data Interoperability to Reduce Clinician Burden Follow us on social

14 Reference Slides 14

15 15 How a Maturity Model is Used to Improve a Capability A maturity model shows how a capability can be improved step by step Each level lays out critical success factors for the capability Expectations are made clear As objectives to improve the capability to get to the next level are clear this enables: Incremental Improvement: Helps identify gaps and determine steps to incrementally improve the capability Roadmap Development: Provides the steps one can use to build the roadmap for improving the capability Identify realistic target Can determine which level is achievable for the capability based on cost/benefit analysis and resources

16 How a Maturity Model is Used to Improve a Capability (Continued) 16 technical people and process governance level Information Quality transport Security Transaction/Query Alignment/Duplication Usability/ Workflow participation consent/ privacy data governance stakeholder governance sustainability Dimension Is the information timely, of high quality, complete Is the mechanism used to What mechanisms are in place to What is the level of How many different How easy is the data to Can all possible participant Can patients control How mature are the How mature are the What are the resources and relevant? exchange the data ensure data is shared securely? adoption of the APIs used? mechanisms for this consume? Is the data types (providers, patients, (provide consent) who has processes to govern data organizational structure available to sustain efforts standardized, capability are in use by incorporated into the payers...) for the capability access to data about them involved in exchanges? and associated processes for any capability; people, documented, and proven? end users? workflow participate, and how many to a granularity Are common agreements to govern exchanges for funds, skills, leadership? Ensure that the protocol actual participants are appropriate to the in place, in use, and this capability? supports required participating? capability? enforced between communication between participants? participants (e.g., request and response). Average across exchanges for the capability maturity level. Transport maturity levels for the capability maturity level. 0 No exchanges occurring for information in this capability area 1 Information available in external systems. All protocols custom and Baseline CIA policies have been Using DIRECT (to push Multiple efforts that Information available in less than 25% of the all or nothing general some exchanges of the no governance Uncertainty in funding Some Information is non-human readable private and not defined but implementation is ad information) duplicate capability, with separate system potential participant types consent only same type of data for the organizational structure in over the next year. Mainly unstructured, little structured meta data, documented hoc and manual no effort to reconcile Information is available (as defined by capability) capability do not have place Funding is unstable across multiple systems Separation of duties mainly admin but not readily accessible. and not all participants of governance agreements in Inconsistent leadership No metrics defined for information quality. defined those types exchanging place support. Systems meet all required Federal and state security policies CIA needs defined 2 Measurable metrics defined for information quality documented non-standard Some automation to meet CIA Undocumented API (to Multiple efforts that Information available in less than 25% of the all or nothing consent to all exchanges of the same governance organizational Uncertainty in funding Measurable metrics defined for information protocols baseline policies. These processes query information)- duplicate capability, same system but not potential participant types data access for specific type of data have structure in place but does over the next 5 years completeness are repeatable require no manual proprietary Identification of areas of integrated. (as defined by capability) providers but no other governance agreements in not include representation Funding source is unstable Some (not all) information from less than 50% of input. overlap Requires extensive manual but all participants of participant types place but not from a from all stakeholders Inconsistent leadership external systems Identification of all policies that effort to reconcile, or those types exchanging common basis (participant types that support. Searchable: Results mainly unstructured, ad-hoc could be automated. duplicate data entry participate in capability) formats or PDF with key meta-data structured Commitment to tracking policy Areas identified for and defined governance Human readable conformance is in place. automation and processes exist Identification of process improvement Ongoing efforts to further automate. improvement. Baseline requirements met, threats identified and plan to mitigate defined 3 Information searchable within workflow At least one documented Full automation to enforce need to Using proven standards Multiple efforts that Information available in at least 50% of the consent to access specific all exchanges of the data governance organizational Certainty of funding over Some information are from less than 50% of standard protocol in use. know, separation of duties and least (XDS-b, API standardized) overlap capability, with same system, can be potential participant types classes of data for specific for the capability are structure in place the next 3 years available external systems And used consistently privilege policies. for query business case specific reconciled into workflow (as defined by capability) providers but other governed by a common including representation Funding source is unstable Data mainly structured across the organization. Tracking is in place to track variations identified with minimal manual exchanging but not all participant types governance agreement from all stakeholders, and Consistent leadership Human readable. Metrics collected on APIs. conformance with policies, and effort. participants used by all exchanges defined governance support. Measurement of information quality against identify areas for further Metrics identified for processes exist defined metrics ad-hoc automation. tracking Usability Measurement of information completeness against CIA requirements monitored. Some automated control, defined metrics ad-hoc Plan to address threats to CIA areas identified for further Use cases for relevance determined. With some implemented automation. metrics identified. 4 Information searchable within workflow Mostly documented Full automation to enforce of Using 1 or more Multiple efforts that have Information in same at least 50% of the consent to access specific data exchange governance governance organizational Certainty of funding over Some information are from more than 50% of standards-based specified policies to meet need to documented, published, minimal overlap of system, reconciled into potential participant types classes of data in specific has quantitative structure in place the next 3 years available external systems protocols. Used know, separation of duties and least and standards-based API(s) capability and ongoing workflow, with quality (as defined by capability) ways (e.g., viewing, measurement in place to including representation Funding source is stable Available same day consistently internally and privilege policies and CIA. efforts to reduce control exchanging with at least annotating, adding, assess process from all stakeholders and Leadership is engaging and Human readable externally within the Metrics for improvement are defined duplicated capabilities Usability metrics captures 75% of possible updating) for specific defined governance providing direction. Information quality enforcement with repeatable organization. for policies. areas identified for participants of those types providers but no other processes have process CIA requirements enforced, threat improvement exchanging participant types quantitative measurement Process to track and enforce information mitigation in place. Majority of capability in place to assess process completeness automated, requiring minimal input 5 All information from more than 70% of available Only use of approved Full automation to enforce need to Use only documented, Single common Real time information at least 95% of potential consent to access specific based on quantitative governance organizational Certainty of funding over systems standards-based protocols know, separation of duties and least published, and standardsbased API (based on capability. same system, reconciled potential participant types ways (e.g., viewing, data governance, the including representation Funding source is stable mechanism used per available on demand in participants of all classes of data in specific metrics collected about structure in place the next 5 years Process to incorporate data from remaining systems privilege policies, and CIA in place Metrics for security policies are recommended standard Process in place to ensure into workflow, with (as defined by capability) annotating, adding, governance agreements from all stakeholders, and Leadership is providing Mostly real time, or on-demand tracked, enforced and improved e.g., those documented in no further duplication quality control. are exchanging updating) for specific and process are defined governance direction, incorporating as Incorporable at a computable level (semantic and CIA enforced ONC Interoperability Process fully automated, participants of any type continuously improved. processes have part of mission. syntactic interoperability CIA Threat mitigation monitored Standards Advisory) manual input only for quantitative measurement Information quality improvement process in place with continual improvement human decision making and are continuously Information completeness improvement process in Process for Continual improved based on place improvement of usability measurements Human readable in place Sustainability Stakeholder Consent / ADT Events : Current State Participation Information ADT Events Transport Usability/ Security Transaction/Q MITA similarities: Number of dimensions: TA Integration & Utility: Utility TA Intermediary and Interface 11 TA Access & Delivery: Security & Privacy TA Integration & Utility: Utility TA Integration & Utility: Utility TA Integration & Utility: Utility BA Utility or Value to Stakeholders TA Access & Delivery: Security & Privacy IA Data Management Strategy BA Standards Management: Manage Business Relationship Information BA Utility or Value to Stakeholders

17 How a Maturity Model is Used to Improve a Capability (Concluded) 17 The HIT Modular Functions Stack identifies the foundational components, core infrastructure, and health IT functionality needed for multiple use cases required to enable Alternative Payment Models (APMs).