EMR Independent Requirements Specification Review Update EMR Vendor Session April 10, 2013
Agenda Every Step Conference Review of Results: First Public Review CORE EMR and EMR OLIS specifications Introduction: Second Public Review EMR Chronic Disease Management EMR - CIHI Data Extract EMR - HRM EMR As A Service Hospital Report Manager Update HCV / EDT Update 2
Every Step Conference Includes Vendor Showcase and Vendor Workshops Communication with all details has been sent Conference is June 11, 2013 Application deadline April 16, 2013 Questions please contact Olivia.Munro@ontariomd.com 3
EMR Specifications Under Development Initial development focuses on restructuring Ontario EMR Specification v4.1a into six individual EMR requirements specifications; EMR Specification 4.1A A: Baseline B: Data Portability C: Chronic Disease Mgmt D: Diabetes Reporting G: CIHI Extract E: OLIS F: Report Manager H: Addt l Requirements Core EMR Spec 4.2 EMR - CDM Spec 4.2 EMR - CIHI Data Extract Spec 4.2 EMR - OLIS Spec 4.2 EMR - HRM Spec 4.2 EMR As A Service Spec 4.2 Each specification will maintain their own individual versions through future development lifecycles. 4
Key Objectives Two key objectives in restructuring each specification and the focus of the public reviews: Update the structure of the individual specifications: Improved introduction, history; Improved organization of requirements; Use case and workflows introduced where applicable; Code Tables and data dictionary to be used across specifications. Apply lessons learned catalogued during the previous Ontario EMR Specification development lifecycle: Clarity has been added from feedback received; Improved consistency in the representation of data and requirements across specifications. 5
First Public Review First Public Review conducted in February 2013 focused on individual requirements specifications for Core EMR and EMR- OLIS. CORE EMR Specification Section 1: Baseline Requirements + Change Log Section 2: Data Sharing + Change Log Section 3: Data Portability + Schema + Change Log EMR OLIS Specification EMR OLIS Specification + Change Log Reference Documents EMR Data dictionary EMR Code Tables 6
First Public Review Responses to feedback received from EMR Vendors will be completed by Friday, April 12 (on a per-vendor basis); Summary of feedback items: Baseline CORE Data Portability Data Sharing OLIS Other Totals Feedback items received 50 23 1 51 1 126 Feedback items resulted in updates 12 1 0 20 0 33 Updates: 33 (further clarifications, grammar, inconsistencies, updated business rules) Change Requests logged: 13 (future updates) Remaining feedback items focused largely on questions 7
First Public Review Updated requirements: During previous validation cycles, some requirements may have been interpreted differently: Some requirements have updated descriptions or guidelines; Clarity has been applied to resolve differences in interpretation; Applying clarity could change a vendors interpretation. Some requirements have been split into multiple requirements. Funding eligibility remains at this time based on EMR Specification 4.1A: As part of the public review process, we want to hear if any of the proposed updates represent significant change to your products; Ongoing improvements are however a necessity that we are all faced with as EMR offerings continue to mature; 8
First Public Review General: Any distinction between Requirement and Guidelines columns Guidelines provide further explanation and clarification to the requirement. The Guidelines form part of the overall Requirement and are mandatory. General: What s the purpose of the Code Table document and relation with the Data Portability specification The Code Table document was extracted from Appendix B Data Portability and evolved to support the suggested codes for Core Baseline Requirements and the mandatory predefined code values for Core Data Portability. It will also serve as a reference for other Specifications. OLIS: Implementing functionality ASP versus Local Unless otherwise specified, functionality must be available to the user (end user or client admin). There should be no difference in the functionality available to an ASP user vs. a Local user. OLIS: Clarification regarding Tests Results duplicate identification/management OLIS publishes and maintains documents that describe how to detect and manage duplicate test results. Please consult with the OLIS team for additional details. Clarification has been added to the OLIS Specification to allow management of duplicate test results regardless of how the test results are received by the EMR (patient query, provider query, preload query). 9
First Public Review OLIS: Functionality of Preview screen for Patient Query and Pre-Load query Clarification has been added to the OLIS Specification to support management of the test results displayed in the preview screens. Data Portability: How to deal with the export of date fields with no values populated in the database (use of Sentinel value) The Core Data Set XML Schema Definition has been updated to allow the export of null data in date fields. A sentinel value should no longer be required. Core Baseline: Preventive Care screening data and recall list/cumulative bonus reporting Clarification and additional details has been added to the Core Baseline Specification to support the preventative care requirements. Core Baseline: Patient Roster vs. Patient Enrolment Clarification has been added to the Core Baseline Specification to distinguish between the concept of rostering and enrolment. 10
Second Public Review Second public review is now underway for four remaining individual EMR requirements specifications. Public review period ends May 3, 2013 EMR Chronic Disease Mgmt EMR CIHI Data Extract EMR Hospital Report Mgr EMR As A Service 11
Chronic Disease Management EMR Chronic Disease Management: Based on requirements represented in Ontario EMR Specification 4.1; Updated the structure of the individual specification; Applied lessons learned catalogued during the previous Ontario EMR Specification development lifecycle; Complements generic care elements leveraged in treatment of chronic disease remain described in the CORE EMR specification (eg: blood pressure, BMI, waist circumference) ; Includes care elements/requirements focused specifically on the treatment of chronic disease; Refer to change log. 12
CIHI Data Extract EMR - CIHI Data Extract Based on requirements represented in Ontario EMR Specification 4.1; Updated the structure of the individual specification; Applied lessons learned catalogued during the previous Ontario EMR Specification development lifecycle; Remains largely unchanged; Refer to change log. 13
Hospital Report Manager EMR Hospital Report Manager: Based on requirements represented in Ontario EMR Specification 4.1; Includes amendments introduced in 4.1A; Updated the structure of the individual specification; Applied lessons learned catalogued during the previous Ontario EMR Specification development lifecycle. Refer to change log. 14
EMR As A Service EMR As A Service Based on requirements represented in Ontario EMR Specification 4.1 (Appendix H); Includes amendments introduced in 4.1A; Updated the structure of the individual specification; Applied lessons learned catalogued during the previous Ontario EMR Specification development lifecycle; Remains largely unchanged; Refer to change log. 15
Funding Eligibility Funding Eligible EMR Offerings are NOT being re-validated against these individual EMR Specifications at this time and remain based on Ontario EMR Specification 4.1A; No new EMR offerings will be validated at this time; Individual EMR Specifications however represent a foundation for future enhancements and additional EMR Specifications; In the future, funding eligibility will be based on a set of individual EMR requirements specifications packaged together in an EMR Release. 16
Vendor Engagement Thank you! EMR Vendor engagement is an important and valued step in the EMR Specification development process; Every item of feedback is reviewed and addressed Help us continue to improve our public review process: Are the communication and vendor sessions helpful? Would you suggest any changes to the communication approach? Is the feedback process easy to use? Is there sufficient lead time to allow you to participate in the public review? Does the 4 week period allow for enough time to conduct your review and capture feedback? If you DID NOT provide feedback, please explain why. We welcome your thoughts to emr@ontariomd.com 17
Hospital Report Manager Update HRM General Deployment: 1,560 clinicians by March 2014 Phased approach with hospitals & practices Concurrent Streams: Out-of-scope LHINs continue, transition in the future SPIRE hospitals will be migrated at later date Begin working with practices aligned with first hospitals Committed to working closely with all stakeholders Regular engagement with LHINs EMR Vendors engaged early to support sufficient planning time and have information require HRM Pilot to Production Deployment: Have been some delays in installing HRM at the Guelph Data Center Working to complete HRM environment testing In near term: Begin detailed migration planning for Pilots Begin testing with selected hospitals Begin working with vendors to select reference sites HRM Deployment Team will work closely with the LHINS to initiate testing activities with scheduled hospitals 18
Hospital Report Manager HRM will deliver great value for hospitals and physicians; and has high demand and support from physicians. Physicians are anxious to use HRM HRM presents a great opportunity in the market for vendors 1400 slots are available in the funding program Offer value add services related to HRM installation and maintenance 19
EMR Spec 4.1 A - Final Published as Final effective March 11, 2013 Req. 3.6 b) became weighted in response to vendor concerns 3.6 b) Supports addition of Medical Practice confidentiality statement on printed binary reports. EMR Spec 4.1A now forms part of the current set of requirements for Funding Eligibility EMR Spec 4.1A Conformance testing of HRM (Spec 4.1A) conducted at Reference Site Leverage Reference Site with test environment for this purpose Validation of HRM at Reference Site will include EMR Spec 4.1A Approval of HRM is a prerequisite to funded physicians participating in the provincial rollout of HRM 20
HRM Reference Site Phases HRM Go Live HRM Approval Phases HRM Test Conformance HRM Prod Go Live & Normalization HRM Reference Site Phase HRM Expansion UAT Environment At EMR Spec 4.1A Test conformance Prod Environment At EMR Spec 4.1A Prod verification Normalization Clinical Use period Prod Environment At EMR Spec 4.1A Reference Site Validation Final Decision * HRM Test environment will be available for Vendor internal development and conformance 21
HRM Reference Site Deliverables & Dependencies by Phase Dependencies HRM Test Conformance: OMD HRM Test Env Ready (EMR Spec 4.1A) Vendor has completed internal development and conformance EMR Vendor submit connectivity request Deliverables HRM Connectivity established HRM Test Conformance Note: Offering is at Spec 4.1A HRM Prod Go Live &: Normalization: HRM Reference Site Phase: Offering obtained HRM Test Conformance Approval HRM Agreements (subscription* & user) complete *as required Offering obtained HRM Prod Conformance Approval Complete 4 weeks clinical use No defects or fixes pending based on Go Live testing HRM (EMR Spec 4.1A )Go Live HRM Connectivity established HRM Verification Check HRM training (Admin & End User) conducted Reference Site clinical use period Identify and Resolve Issues with OMD Complete Pre-Reference Site Actions Conduct HRM Reference Site Validation OMD identify corrective actions** Vendor fix and successfully demonstrate* Vendor Offering Approved for HRM clinical use * as required 22
Vendor Engagement: Continue to share program level information and updates through: EMR Vendor Sessions EMR Vendor Bulletin Will begin to share and collaborate at deeper level with vendors through individual sessions: Planning Meeting for HRM & Kick Off (next couple weeks) Session 1: Planning focus Session 2: Operational focus Ongoing Monthly Status Checkpoint 23
Health Card Validation / Claims Submission The Ministry of Health and Long-Term Care is updating its electronic Business Services (ebs) with web services versions of Health Card Validation (HCV) and Electronic Data Transfer (EDT); EMRs are being targeted as the first wave of consumers; Technical Specifications are available at : http://www.health.gov.on.ca/en/pro/publications/ohip/ See: Technical Specifications for Health Card Validation (HCV) via Electronic Business Services (EBS) and, Technical Specifications for Medical Claims EDT (MCEDT) via Electronic Business Services (EBS) Test/conformance environments are now available with MOHLTC; ehealth Ontario and OntarioMD will be working with MOHLTC to develop an EMR specification for HCV (full, OBEC) and MCEDT (claims). 24
Questions? 25