Advancing Health IT Beyond Organizational EHRs Melodie Olsen, Health Care Authority Rick Rubin, OneHealthPort Zosia Stanley, WSHA February 23, 2016
Presenters Melodie Olsen State Health IT Manager Health Care Authority Rick Rubin CEO OneHealthPort Zosia Stanley Policy Director WSHA
A Partnership The Washington State Health Care Authority & OneHealthPort 3
Today s Discussion Background how we arrived here The Link4Health Clinical Data Repository (CDR) Clinical information exchange, the HIE and accessing the CDR Participation requirements Getting started with the CDR 4
Meeting Emerging Needs New organizational arrangements (ACOs) require capabilities outside traditional enterprise HIT resources Needs include repository, analytics, reporting, individual care and population management tools More orgs going at risk for performance, need info/analytics to help manage that risk Sponsor Clinical Data Repository (CDR) Platform Data needs go beyond current claims and ADT, include clinical summaries, care plans, assessments 5
Background: Reaching The Tipping Point 2009 to Now ARRA, HITECH, State appointed HCA and OHP to lead statewide efforts. Electronic Health Records have become the norm for sophisticated delivery systems and hold large volumes of patient clinical data. Federal government has spearheaded important progress on the standards front. We will adhere to national standards. However, one area of HIT has lagged clinical information exchange between authorized providers across regions and organizations. 6
The Strategy: Advance Health IT Beyond Organizational EHR s with a CDR To improve the coordination of care provided and improve health outcomes for Apple Health enrollees - and ultimately all Washingtonians. HCA is initiating Washington Link4Health, a multi-year initiative to advance the statewide electronic exchange of near real time, consolidated clinical records. The Washington Link4Health initiative is part of the State s long-term efforts to improve health care quality, better manage costs and improve health outcomes for all Washingtonians. 7
What is the Clinical Data Repository? A Clinical Data Repository or CDR is a database designed to collect and index clinical content for specific uses. Create a longitudinal view of all care provided on a single patient (patient-centric, point-of-care access for practitioners) Aggregate data that can be used in population analytics Aggregate data for performance reporting to providers across all lives managed by the provider Feeds applications that need clinical information (care management, physician reminders and alerts, etc.) Provides critical information regardless of the geographic region or clinical organization the patient receives care from 8
CDR Features and Benefits Features Leverages standards for sharing clinical summaries Supports clinical data exchange with organizations without similar platforms Offers common place to share information for those participating in different arrangements Aggregates clinical and administrative data into longitudinal patient record Available beyond Medicaid and PEB Benefits May help providers meet ongoing Meaningful Use Objectives and qualify for additional incentive payments Provides the care team a more comprehensive understanding of the patient s medical history. Provides mainstream quality reporting capabilities Enables large data extracts for advanced analytics and population health 9
Staged Implementation- Multi Year Effort Initial services purchased Implementation underway Initial lives committed Apple Health Enrollees assigned to Managed Care (1.4M) More lives over time such as Public Employees, fee for service, other sponsors. Initial data sets Care Summaries from Provider EHR systems Eligibility data and 2 years Claims/Encounter data Ongoing Additional services roll out over time 10
OneHealthPort Who We Are Created by and for the local healthcare community, OneHealthPort solves information exchange and workflow problems shared across healthcare organizations Founded in 2002 by leading NW health care organizations Delivers variety of services, best known for the Single-sign-on (SSO) service Initiated a Health Information Exchange (HIE) in 2009 Serves as the WA state HIE and has independent oversight Diverse transaction offerings, financially stable First HIE phase, an Exchange data transformation, routing Second HIE Phase, 2015 a Clinical Data Repository (CDR) Responding to increasing interest in standardized clinical info exchange 11
C-CDA Clinical Document Standard C-CDA = (Consolidated Clinical Document Architecture) modular National standard for clinical info exchange Certified EHRs designed to export and ingest C-CDA Early in the game a work in progress 12
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CDR Roles & Responsibilities Sponsor Trading Partner HIE/CDR Operator Pays for the cost of lives in the CDR Controls access to CDR data HCA is the first sponsor, MCOs are subsponsors Sends data to the CDR, draws data from the CDR Must be a Participant in the OneHealthPort HIE Hospitals, practices and other providers Manages the HIE and CDR based on policies defined in contractual framework and promulgated by Sponsor OneHealthPort 14
CDR Business Model Sponsor pays CDR costs Trading Partners must become HIE Participants Most hospitals already participate in HIE HIE Participants sign common contractual framework HIE Participants pay an annual subscription fee Covers all services, no transaction fees Annual HIE subscription fee derived from matrix below Annual Organization Revenue Annual Subscription Fee $0 $10 Million $600 $10 Million $100 Million $6,000 $100 Million $500 Million $12,000 $500 Million $1 Billion $24,000 $ 1 Billion Plus $48,000 15
Accessing the CDR EHR pushes C- CDA to CDR Push Authenticate connections Use Provider Directory to route messages Facilitate exchange of standard data Host API/web services API Directory Standards Propagation Sponsor bulk loads claims and eligibility data View only use of the CDR using Portal C-CDA Response to API Query from/to EHR Hospital EHRs push C-CDA to CDR after each Medicaid encounter. After a critical mass of data is reached, hospitals can draw C-CDA from CDR into their EHR through the HIE, or view CDR through secure portal. Sponsor and other authorized parties can access reports and/or data 16
Clinical Portal Access Levels Delegating portal access control to the provider Trading Partner Consistent with common practice Leverages the OHP Single-Sign- On digital ID that s pervasive in WA 17
Clinical Portal View of Patient DRAFT SAMPLE 18
Reporting Reports based on aggregated clinical and claims data Clinical data contributed by providers after encounter 2 years of historical claims plus monthly updates from Sponsor Different views of data available various levels of aggregation Reports map to quality measures Sponsors elected: Financial (e.g., high cost patients, providers, PMPM) ACO Reports PQRS Reports HEDIS Star Measures Washington State Performance Measure Set 19
Sample DRAFT Reports Provider Utilization ACO Dashboard HEDIS STAR Reporting 20
What Does Provider Participation Look Like? January 2016 MCOs sent HCA s Provider Participation Letter to their provider networks: http://www.hca.wa.gov/healthit/documents/provider%20requirements%20letter %202015%2012%2021.pdf What s in the Letter: 1. Introduces the CDR to the provider community 2. Lists the three criteria defining what is required at this time 3. Informs providers that they need to begin getting ready soon in preparation for the February of 2017 deadline to be contributing data 4. Provides link to how to get started tool: 21
Decision Tree: Data Submission Requirement No CDR Participation required at this time NO NO Provider is contracted to MCO for Apple Health Patients YES Provider uses EHR that s 2014-certified by Federal ONC for Meaningful Use YES Provider must submit data to CDR no later than 02/01/17
What Do I Do Next? Decision tree tool developed to help providers determine who the requirement pertains to at this time: http://www.hca.wa.gov/healthit/documents/decisiontree.pdf Use decision tree tool to determine participation requirements. (Even if you are not required, we invite you to participate) Go to the Getting Started guide provided by OneHealthPort: http://www.onehealthport.com/hca_cdr 23
Getting Started With the CDR CDR Start Page provides all the steps needed for providers to onboard, test and contribute data for the Washington Link4Health CDR initiative 24
Contact Information for Follow Up HCA and OneHealthPort welcome opportunities to expand on today s summary overview General questions about CDR participation email HCA Health IT team at HealthIT@hca.wa.gov (Put CDR in the subject line) For Questions about your MCO contract: contact the provider representative for the MCO Visit HCA website: www.healthit.wa.gov General questions about participating in the HIE or connecting to the CDR: http://www.onehealthport.com/hca_cdr 25
Questions? 26
Thank You 27
Contact Information Zosia Stanley Policy Director, WSHA ZosiaS@wsha.org (206) 216-2511 28