Health Information Exchange Ad Hoc Workgroup Public Meeting Notes. May 25, 2010

Transcription

1 Health Information Exchange Ad Hoc Workgroup Public Meeting Notes May 25, 2010 Attendees: John Halamka, MD, BIDMC and NEHEN Phil Poley, COO, Medicaid Tim Andrews, High Pine Associates Kate Berry, SVP, Surescripts Claudia Boldman, Commonwealth of MA, Info Tech Division Jim Daniel, CIO, DPH Del Dixon, CIO South Shore Hospital John Kelly, HPHC Steve McDonald, VP of Sales for Hospital and HIE, MedPlus Micky Tripathi, MAeHC Phone: Barbara Ferrer, City of Boston Steve Fox, BCBSMA Larry Garber, MD, Safe Health and Fallon Clinic Martha Hayward, Partnership for Healthcare David Smith, Massachusetts Hospital Association Todd Rothenhaus, CIO, Caritas Christi Others: MTC Staff Bert Ng (Healthcare Finance Committee) Nag Kodali (Pelham Healthcare Associates) Brian Malone (Magnet Health / Healthcare Heartbeat Rita Cramer (Ingenix) Judy Silvia Bethany Gilboard Angelia Lewis Carole Rodenstein Kris Cyr HIE Ad Hoc Meeting Notes Every plan should begin with a functional and geographical inventory and gap analysis of the 6 MU transactions. Then fill the gaps. Issue RFPs to ensure that most clinicians can do 6 MU transactions. When done with 2011 we can then look beyond to 2013, Good idea to initiate listening sessions to create greater awareness of our process. 1

2 Likely have one in Boston area and one in Central MA. Should focus on the capabilities we don t have and take advantage of what we have. Don t waste time and energy on what exists. We don t anticipate having a closed marketplace. Focus on minimal connectivity for MU requirements. MMIS stopped supporting paper and only a handful asked for a waiver. Heatmap of the different pulses in each region. Visually capture the depiction of current infrastructure. Look to MTC to understand broadband map. Vendor community are they going to push connectivity to sell products. Having trouble getting back surveys on connectivity from health providers Berkshire is having some connectivity issues, but software/ architectural issues to overcome. Could look at a way to address cost/ maintenance of office installations Have the REC group look at this. eprescribe: Tried to tap into SureScripts work. NEHEN is fully in compliance. Not aware of emerging products. Merging of standalone vendors into EHR. MA is extremely well positioned in state. #1 in eprescribe, but not 100%, expect to hear more up to date info soon. Some standards may be considered limiting: rxnorm. Feel good about this. Transmission mechanism is used across US. NEHEN connects. We re well positioned. Clear standard and clear approach. Can have intermediary if needed. Eligibility: More work. Not as straight forward. Very mature in the state. Many solutions. Even vendors that have self-built solutions are in good shape. Gets to question of what is the role of HIE. Need to have consent framework. Common identifiers, data store, demographics, etc. Going to be a lot of competition in this space. More work to do on some of the barriers. Can largely leverage NEHEN work. Promote standards at the vendor level would be helpful. 2

3 Have 0 marginal costs on eligibility. Would help to settle on operating rules. From to be vision perspective would be to expand and settle on rules. Between vendor-based solutions and NEHEN. Use case that looks at public health. Div Health Fin Policy They will require claims data to data repository. Echo the claim through HIE mechanism to ensure that no additional burden. Clinical Exchange: 80% response rate from HIEs IDNs IPAs. Surprised to see over a dozen vendors doing HIE. Many with CCD capabilities. Many homegrown with CCD. No detail on vocabulary and compliance. Barriers: waiting for some finality on MA approach. Interest in Master Patient Index. Alignment of incentives. Look to what is going on federally. Policy driving policy HIT policy, NHIN, Standards. All three closed down. Single team meeting 3 hours/ week. NHIN Direct is happening in 2 months. Need to match services to policies. Are advanced directives included? Likely IFR will include specificity. Clinical exchange is not a one-size fit all. How do HIEs and IDNs connect to each other. Directory Services. MPI. RLS. One service must grapple with this. Is convergence of PKI at HUB level. DEA prescribing allows for digital certificates. Looking at standing up community-wide PKI. Public Health: Immunization is well-defined. Syndromic Surveillance: Diagnosis one Hoping to move to HL7 gateway. Message content stays the same, but web-service end point would. Lab Data: Submitted through HL7 to Diagnosis one. Want to move to HL7 gateway. LOINC and SNOWMED are not used in MA. Have a resource issue around certification process. BIDMC has 80% SNOWMED. Local health departments that have reg authority. Also run their own syndromic. MA is anomaly b/c we don t have county health departments. IFR is clear on what standards need to used. Most orgs don t collect in a way to do this. Labs could be a huge win if MA can get policy and standard in place. Deal with quest and others. Hub of LOINC encoded data with a single connection is ideal. Through EHR, Surescripts, etc. A lot of requirements from PH not included in MU. Syndromic state doesn t have a system for ambulatory care. DPH isn t collecting. EMHI indicates this might be a community goal. 3

4 Patient Engagement: Patient gets electronic copy of CCR or CCD. Ambulatory summary CCR or CCD available online. CCR or CCD that follows from one point of care to the next. What is the role of the HIE? Policy, enablers. Will be downloadable. Quality: How documented: Admin sources. Quality sources. IDNs creating repositories. A lot of local solutions. Have been issues in the past to harmonize quality data. NQF s definition. Tough to get at. Fun challenge to figure out. Process redesign. Contractual issues. Would like to sit on Quality task force. Spend fortune on getting data. Transparency agenda is important. Not looking at this as competitive advantage. State levers to say this is the core set of measures. Board of registration publishes those. Where does GIC sit. Should have someone from GIC in workgroups HIE Services Breakdown: Transmission: o NHIN/ NHIN Direct smtp o Surescripts SOAP REST Packaging o General format CCD HL72.x X12 NCDCP DICOM Directories o Provider include end-point; people; organization o Patient MPI, Surescript o Record Locator o Payer Security and Privacy: o Authentication identity management o Community-wide PKI o Consent consistent/ transportable 4

5 o Deidentification o Disclosure Logging o Auditing Vocabulary services: o RxNorm o SNOWMED o LOINC o ICD9/ 10 o Mappings Population health and Registries: o Aggregation (public health, quality) o Transformation Knowledge Services: o Example: License up to date o HIE as public utility o Common service that vends rules o Financial models, help with sustainability MU may not meet our business needs. Sustainability. Look at sweeteners to get orgs on board. NY Basic infrastructure and then services. Hard to get to what should be a shared service. Looking at where contracts are. Validating against business case. Medicaid very significant requirements. 5