Industry efforts to drive interoperability progress

Transcription

1 Industry efforts to drive interoperability progress Kashif Rathore, VP of Interoperability, Cerner Jitin Asnaani, Executive Director, CommonWell Health Alliance David McCallie, MD, SVP for Medical Informatics, Cerner

2 Interoperability for Seamless Care Kashif Rathore, VP of Interoperability, Cerner

3 536M+ transactions per month 2017 average 275+ connected information systems 80% of connections are to non-cerner EHRs as of February 2018 Connecting health care 506K+ Direct enabled addresses from over 1,650 organizations Five-time Top HIE supplier for hospital networks Source: Black Book State of the Enterprise HIE Industry Report Powering 160+ HIEs as of February 2018 *Report not released in 2013

4 Interoperability is getting the right information to the right place at the right time to enable seamless care for our Veterans and Military Service Members

5 Together, the DoD MHS GENESIS project and the VA Electronic Health Record Modernization program are creating a single, joint, common Electronic Health Record System for Veterans and Servicemembers, shared by VA and DoD

6 Information in the joint VA/DoD EHR system must be shared with community providers EHR systems to enable seamless care for Veterans. Bi-directional health record sharing Community Providers Community providers also need to share information back to VA/DoD. This is called bi-directional sharing and must be possible nationwide.

7 National networks and organizations such as CommonWell, Carequality, ehealth Exchange, DirectTrust, Surescripts and others enable health record sharing between connected providers.

8 What is open? Open is more than SMART on FHIR. Interoperable Interchangeable Multiple attributes are associated with open: Accessible Open Standards- Based Extensible Open Source

9 CommonWell Health Alliance Jitin Asnaani, Executive Director

10 CommonWell Refresher and Update

11 CommonWell Health Alliance is an independent, not-for-profit trade association open to all organizations aligned with Our Vision and Mission.

12 CommonWell has nearly 80 Members across the continuum of care Founding Contributor General 20+ Care Settings including 2/3+ of acute 1/3+ of ambulatory EHRs And leaders in postacute care, imaging, patient portals, emergency services, population health and more Source: KLAS and SK&A, a Cegedim Company 2016 Hospital EMR Market Share, May KLAS Enterprises, LLC. All rights reserved. Physician Office Usage of EHR Software SK&A. February Initial Service Provider

13 Our vision Health data is available to individuals and providers regardless of where care occurs. Access to this data is built-in to HIT at a reasonable cost for use by a broad range of health care providers and the people they serve. Our mission To define and promote a national infrastructure with common standards and policies. To build a vendor-neutral platform that breaks down the technological and process barriers that currently inhibit effective health data exchange.

14 Our network and services are centered around patients CommonWell Services Clinic PCP Community Hospital 1.Person Enrollment creates unique CW record for each individual; de facto national identifier Lab IDN 2.Record Locator creates a virtual table of contents for patient s clinical data across community 3.Patient Matching & Linking enables patient data to be associated or disassociated with unique CW record LTC & Post- Acute Specialist Pharmacy 4.Data Broker facilitates query/retrieve of clinical data on-demand; not a clinical data repository

15 CommonWell is live and expanding across the nation 8,000+ sites live, 25M+ persons enrolled, and 80M+ available records today

16 Going above and beyond for the provider: CommonWell is working with Carequality Collective Success Together, members and participants from both organizations represent: 90% of acute EHR market 60% of ambulatory EHR market Source: KLAS and SK&A, a Cegedim Company 2016 Hospital EMR Market Share, May KLAS Enterprises, LLC. All rights reserved. Physician Office Usage of EHR Software SK&A. February Collaboration CommonWell to implement Carequality Directed Query specification Basic version of CommonWell Record Locator Service (RLS) to be available to Carequality Implementers Sequoia Project and CommonWell to explore collaboration opportunities in the future

17 CommonWell-Carequality integration update (Bi-directional directed query) Design Development Integration testing Pilots Spring 2018 Generally available Summer 2018

18 Looking Forward: TEFCA

19 The Trusted Exchange Framework and Common Agreement (TEFCA) is a repercussion of the 21 st Century Cures Act 21 st Century Cures Act Section 4003(b): The common agreement may include: (I) a common method for authenticating trusted health information network participants; (II) a common set of rules for trusted exchange; (III) organizational and operational policies to enable the exchange of health information among networks, including minimum conditions for such exchange to occur; and (IV) a process for filing and adjudicating noncompliance with the terms of the common agreement.

20 What are the goals of TEFCA? 1. Build on and extend existing work done by industry 2. Provide a single on-ramp to interoperability for all 3. Be scalable to support the nation 4. Build a competitive market allowing all to compete on data services 5. Achieve long-term sustainability

21 One goal seems to stand out 1. Build on and extend existing work done by industry 2. Provide a single on-ramp to interoperability for all 3. Be scalable to support the nation 4. Build a competitive market allowing all to compete on data services 5. Achieve long-term sustainability In order to interoperate, organizations have to join multiple Health Information Networks which do not share data with each other.

22 TEFCA introduces the notion of the RCE and QHIN RCE Recognized Coordinating Entity (RCE) provides oversight and governance. QHIN QHIN QHIN QHIN Qualified Health Information Networks (QHINs) serve as the core for nationwide interoperability. Each QHIN connects to all other QHINs via its Connectivity Broker ( Broker ), which includes an MPI, RLS and Query/Result Aggregation. Participant 1 Participant 2 Participant 3 End-Users Each QHIN connects to a number of different Participants who serve their End Users.

23 TEFCA flows down minimum required terms QHIN RCE QHIN QHIN QHIN Recognized Coordinating Entity (RCE) provides oversight and governance. Qualified Health Information Networks (QHINs) serve as the core for nationwide interoperability. Each QHIN connects to all other QHINs via its Connectivity Broker ( Broker ), which includes an MPI, RLS and Query/Result Aggregation. F L O W D O W N S Participant 1 Participant 2 Participant 3 End-Users Each QHIN connects to a number of different Participants who serve their End Users.

24 CommonWell fits into the TEFCA vision QHIN RCE QHIN QHIN QHIN Recognized Coordinating Entity (RCE) provides oversight and governance. Qualified Health Information Networks (QHINs) serve as the core for nationwide interoperability. Each QHIN connects to all other QHINs via its Connectivity Broker ( Broker ), which includes an MPI, RLS and Query/Result Aggregation. F L O W D O W N S Participant 1 Participant 3 Providers End-Users Each QHIN connects to a number of different Participants who serve their End Users.

25 CommonWell fits into the TEFCA vision QHIN RCE QHIN QHIN? QHIN Recognized Coordinating Entity (RCE) provides oversight and governance. Qualified Health Information Networks (QHINs) serve as the core for nationwide interoperability. Each QHIN connects to all other QHINs via its Connectivity Broker ( Broker ), which includes an MPI, RLS and Query/Result Aggregation. F L O W D O W N S Participant 1 Participant 3 Providers End-Users Each QHIN connects to a number of different Participants who serve their End Users.

26 TEFCA is expected to be finalized in late 2018

27 So what did CommonWell say? 1. About the TEFCA vision: CommonWell Health Alliance is supportive, as it can ensure that the data follows the patient as per our own vision. It raises the minimum bar on interoperability from point-to-point connectivity to person-centered data exchange nationwide, eliminating data blind spots. TEFCA s federated query model builds on the approach that CommonWell is delivering nationwide. We hope that this regulation becomes less voluntary.

28 So what did CommonWell say? 2. About Qualified Health Information Networks (QHINs): CommonWell Health Alliance intends to become a QHIN. Operational feedback: Starting with permitted purposes and patterns of exchange that we are more familiar with (e.g., reciprocal treatment), and working toward the less-understood uses (federated population health queries) Consumer-facing experiences that can be fulfilled by partners/members instead of by the network itself A less restrictive approach to business sustainability models Feedback on references to standards, including content (USCDI)

29 So what did CommonWell say? 3. About the Recognized Coordinating Entity (RCE): RCE should have balanced stakeholder representation, including a representative cross-section of QHINs, Participants and End-Users. RCE should have assiduous neutrality. No appropriate body exists today to play the role of RCE. CommonWell intends to play an active role in the finalization of the RCE.

30 Evolution of CommonWell Services

31 We built a person-centered network, starting with EHRs. EHR EHR EMPI RLS Linking Data Broker EHR

32 We expanded across the continuum into post-acute and patient-driven exchange. EHR EHR PHR EMPI RLS Linking Data Broker FHIR Broker EHR

33 Now we are expanding our reach by connecting to other Health Information Networks (HINs). HIEs, interface engines, proprietary clinical networks, Carequality First steps to connectivity initially more limited. EHR EHR PHR EMPI RLS Linking Data Broker FHIR Broker Notifications EHR

34 TEFCA will facilitate connectivity at a richer level both to HINs internally as well as to other QHINs. Inter-network brokered query EHR EHR PHR EMPI RLS Linking Data Broker FHIR Broker Notifications EHR

35 The Health Data Sharing Landscape David McCallie, MD, SVP for Medical Informatics, Cerner

36 We have entered the API Era Surprisingly rapid emergence of standardsbased APIs for Health IT 21st Century Cures (2016) Comprehensive APIs TEFCA / DaVinci / all data JASON Task Force (Oct 2014) Provide standards-based API for core data services and core data profiles JASON Report (Apr 2014) EHRs should expose public APIs EHR Certification Rule (2015) Requires API for access to MU data elements Argonaut Project (Dec 2014) Coalition to agree on API core data services and profiles

37 Multi-vendor SMART/FHIR Apps are now a reality Mobile Apps Web Apps OAuth 2.0 FHIR Data Profiles Supporting Health IT Systems HSPC Healthcare Services Platform Consortium

38 SMART+FHIR for decision support Extend vendor s CDS tools using SMART and FHIR Vendor triggers the hook using built-in CDS (e.g., Discern) Hook can provide: Information Alternative choice Launch a full app

39 Use SMART Apps to integrate care across EHRs Population Health / ACO / Clinical Services Cerner SMART HTML Epic SMART HTML athena SMART HTML SMART App Care Plan SMART App Care Plan SMART App Care Plan FHIR FHIR FHIR Local Data Local Data Local Data CommonWell / Carequality then TEFCA

40 Functionality Interoperability: an evolving landscape Advanced Clinical Services CDR Simple Services Pop Health and ACOs (Private)?? New QHINs State and Regional HIEs erx, PDMP, Claims, etc. TEFCA Network of Networks Data Pipes Custom HL7 Peer to Peer ADT, etc. Vendor HIEs & Networks?? CommonWell as + QHIN HINs Direct Local Regional National Geographic Reach

41 Interoperability s New Challenge: Too Much Data Outside Data (TEFCA / iphones) Our Data (ACO / Pop Health) My Data (EHR) Challenges Automatic reconciliation Labs, vitals, documents - OK Allergies / Problems? Care plans? Automatic de-duplication Provenance is missing! Limited time and attention Show me what s new" Show me what I need to see Help me find things