HIMSS Oregon Spring Conference - HIE

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"Health Information Exchange in Oregon – Where We Are & Where We Are Going" …

"Health Information Exchange in Oregon – Where We Are & Where We Are Going"

Moderator: Eric McLaughlin, Project Manager, Cognosante
Abigail Sears, Chief Executive Officer, OCHIN
Sharon Wentz, RN, Business Development Coordinator, CareAccord
Laurie Miller, RHIT, CCS-P, HISP Administrator, Gorge Health Connect
Paula Weldon, Project Manager, Jefferson Health Information Exchange

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  • 1. HIMSS OREGON – Spring Conference 2013Health Data Exchange inWhat’s Going On?www.ochin.orgPresented by:Abby SearsCEOSpring Conference 2013Data Exchange in Oregon:What’s Going On?www.ochin.orgPresented by:Abby SearsCEO
  • 2. Agenda• Beyond EHR:– Who is OCHIN?– What we do• An Awakening: Clinical vs. Claims Data• HIE: Short-term vs. Long-termClinical vs. Claims Dataterm
  • 3. Who is OCHIN?• Our goal is simple: to provide solutions to promoteaccess to quality, affordable health care for all.• One of the nation’s largest and most successfulHealth Information Networks• Oregon’s Regional Extension Center (REC)• NEW! Oregon Health Network• NEW! Oregon Health NetworkOur goal is simple: to provide solutions to promoteaccess to quality, affordable health care for all.One of the nation’s largest and most successfuletworksOregon’s Regional Extension Center (REC)NEW! Oregon Health NetworkNEW! Oregon Health Network
  • 4. What we do• We are a nonprofit organization that touches 4,500physicians with:• Hosted Services & Solutions• Connectivity (Network Services)• Consulting• Consulting• Research• Federal and State Program Management• Outreach and Communications• Thought Leadership• Advocacy• And more…organization that touches 4,500Connectivity (Network Services)Federal and State Program ManagementOutreach and Communications
  • 5. What we doConnect communities through the advancement andConnect communities through the advancement andadoption of telemedicine and longstudy of clinical and operational workflowsEnable providers, staff, and leadershipimprovement goals and systemstudy of clinical and operational workflowsInstall and optimize a wide range of Health IT productsprograms for vulnerable patient populationsadoption of telemedicine and longprograms for vulnerable patient populationsParticipate in robust information exchangemembers, across care regions, and with state and federalagenciesImplement innovative clinical and health science bestpractices via practice-based researchCombine data from disparate data systems: GL, clinic,claims, socialConnect communities through the advancement andConnect communities through the advancement andand long-distance healthstudy of clinical and operational workflowsEnable providers, staff, and leadership to achieve qualityimprovement goals and system optimization through thestudy of clinical and operational workflowsa wide range of Health IT productsprograms for vulnerable patient populationsand long-distance healthprograms for vulnerable patient populationsParticipate in robust information exchange among, across care regions, and with state and federalImplement innovative clinical and health science bestresearchfrom disparate data systems: GL, clinic,
  • 6. A New Future: High quality care, anywhereThen (& Now)…• Core operationalinfrastructure systemsoperate in siloes• Decision andpolicymakers not focusedpolicymakers not focusedon broader context• Health IT used only bythose with money &resources• Health IT viewed asoptionalA New Future: High quality care, anywhereThe FUTURE of IT• Core operationalinfrastructure systemsare fully integrated• Decision and policymakersuse clinical data for broaderuse clinical data for broadercontext• High quality transformativeHealth IT and data isavailable to all• Health IT is a corerequirement
  • 7. If you were to design tomorrowwould it look likeIf you were to design tomorrow – what
  • 8. The Health Neighborhood• Data Integration• Technical Integration• Workflow Integration• Health Print– Medical– Behavioral– Social– Social• Health Home– Accountability– Member activation– Care coordinationThe Health Neighborhood
  • 9. HIT: Short-term (1-3 years)• There is no one, “out-of-• What exists– No EHR solution is perfect and/or incorporates requiredmental, dental, patient engagement, reporting needs, etc.• What’s needed (at this point– Leverage what exists to design an interim HIE solution to– Leverage what exists to design an interim HIE solution toget HCPs to the next phase of coordinated care• Beware of vendors that sell “proven”• Build for the future with trusted3 years)-the box” solutionNo EHR solution is perfect and/or incorporates requiredmental, dental, patient engagement, reporting needs, etc.What’s needed (at this point-in-time)Leverage what exists to design an interim HIE solution toLeverage what exists to design an interim HIE solution toget HCPs to the next phase of coordinated careBeware of vendors that sell “proven”solutionsBuild for the future with trustedpartnerships
  • 10. eHealth Exhange
  • 11. Direct Project
  • 12. HIT: Short-term (1-3 years)• What OCHIN is doing– Piloting “transitional” infrastructure withand share with others• EHRs with Mental Health• Incorporating claims & clinical data into new workflows andreporting– Business Intelligence/Analytics: Reporting solutions– Business Intelligence/Analytics: Reporting solutions– Piloting national HIE approaches that are sustainable3 years)Piloting “transitional” infrastructure with CCOs to replicateIncorporating claims & clinical data into new workflows andBusiness Intelligence/Analytics: Reporting solutionsBusiness Intelligence/Analytics: Reporting solutionsPiloting national HIE approaches that are sustainable
  • 13. HIE: Long-term (3+ years)• Industry is coming; Get ready to support and pluginto a national HIE/IT infrastructure– What exists/what is under development?– What’s really needed?– How to prepare» Cloud computing is coming to healthcare» Cloud computing is coming to healthcare» National broad reaching solutions that are not regionalterm (3+ years)Industry is coming; Get ready to support and pluginto a national HIE/IT infrastructureWhat exists/what is under development?Cloud computing is coming to healthcareCloud computing is coming to healthcareNational broad reaching solutions that are not regional
  • 14. So Who is OCHINWe provide solutions to promote access to quality,affordable health care for all.Innovatively applying technologyResearch to improve health outcomes and deliver costs effective careHosted solutionsProfessional servicese provide solutions to promote access to quality,affordable health care for all.Innovatively applying technologyResearch to improve health outcomes and deliver costs effective care
  • 15. Summary/Re-Cap – Cont’d.We don’t know what we don’t knowCont’d.We don’t know what we don’t know
  • 16. www.ochin.orgwww.ochin.org
  • 17. SharonWentz, RNBusiness Development CoordinatorOffice of Health InformationTechnology04/22/13WhereWe Are &WhereWe Are Going
  • 18. OrganizationTypes Participating in CareAccordDirect Secure MessagingAcute CareAcute CareHospitalsAmbulatoryLaboratoriesOther
  • 19. ● No-cost Direct Secure Messaging services through 2013● No-cost Direct Secure Messaging services through 2013● Registration Process enhanced with a “Bulk upload” capability forindividual and delegate accounts● 2.0 Deployment anticipated → Provider Directory Admin Privileges
  • 20. Health Information Service Provider (HISP)Beta Accreditationwww.directtrust.orgwww.ehnac.org
  • 21. Pilot to Production
  • 22. Vision: ScalableTrust and PolicyWsctrust.org● 8 Core states, 7 satellite states● Creating policies and procedures that lay groundworkfor safe interstate transfer of health information● Pilot work: Oregon, California, AlaskaVision: ScalableTrust and PolicyFramework that eliminates barriers to HIE
  • 23. HIMSS/ONC Interoperability Showcase March 2013Coordinating Care Across State LinesCreating trusted HISP communitiesManaging community membershipDistributed Provider Directories
  • 24. Connecting with DisparateTechnologies
  • 25. “In 2007, the Oregon Legislature passedPOLST (Physician Orders for Life-SustainingTreatment)Registry: Form submission to the Registry“In 2007, the Oregon Legislature passedSenate Bill 329 (State Health Fund Board), andin 2009 passed HB 2009 as part of Oregonshealth care reform efforts, enabling Oregon tolaunch the nations first 24-hour electronicPOLST Registry on December 3, 2009. Firstresponders and providers are able to call theregistry from the field and be informed of apatients POLST orders.”
  • 26. “Embrace a model of information symmetry, inwhich the patient and the clinician are partners,collaborating around the patient’s health.”“Information is freely exchanged becausehoarding information bestows no power and runscounter to the common goal.”“How can patients be expected to take care ofthemselves if they don’t have access to their ownhealth information?”“In the U.S., patient have been guaranteedaccess to their medical records since the HIPAAPrivacy Rule became effective in 2003, althoughnot always without friction and burdensomecosts.”
  • 27. PersonalStoriesStoriesWhat if………………
  • 28. Andrew JohnWentz
  • 29. Erin JuneYarber
  • 30. Contact information:www.careaccord.orgwww.careaccord.orgSharon.l.wentz@state.or.usCell: 503-983-8290
  • 31. Gorge Health Connect, Inc.(GHC)http://www.gorgehealthconnect.org
  • 32. GHC has Board representation from:• Columbia Gorge Community College• Providence Hood River Hospital• Mid-Columbia Medical Center• One Community Health (La Clinica Del Carino)• One Community Health (La Clinica Del Carino)• Mid-Columbia Surgical Specialists• Mid-Columbia Center for Living• North Central Public Health District (Wasco,Sherman, Gilliam Counties)• Hood River County Public Health Department
  • 33. Health Resources and ServicesAdministration - 2009• Network Development Grant• GHC intends to use this planning year toestablish the governance structure of thenetwork in greater detail through a strategicnetwork in greater detail through a strategicplanning process which includes refining amission statement and identifying keystrategic goals for group.
  • 34. Grouped Resources - 2010• GovernanceBy-laws and officers• HRSA Technical AssistanceMember expectationsMember expectationsDeliverablesID Stakeholders• Community Needs AssessmentEHR utilizationWorkforce trainingConnectivity
  • 35. Grouped Resources - 2011• Electronic Health Records: A Tutorial– Dr. Michal Kirshner, DDS, MPH - Oregon Tech• Crucial Conversations- Board Retreat– Vital Smarts: Crucial Conversations 2-day training– Vital Smarts: Crucial Conversations 2-day trainingworkshop• Non-Profit Status– Organized as a 501(c)(3)• ONC and Oregon HITOC– Workgroup and Panel Positions• The Direct Trust- Original Seating Board position
  • 36. Direct Trust• Non-profit, competitively neutral, self-regulatory entity created by and forDirect community participants.• Establishing and maintaining a national Security and Trust Framework (the“Trust Framework”) in support of Directed exchange.– A set of technical, legal, and business standards for Directed exchange– Expressed as policies and best practices recommendations, which members of– Expressed as policies and best practices recommendations, which members ofDirectTrust agree to follow, uphold, and enforce.• Leveraging the Trust Framework for a Direct Trusted Agent AccreditationProgram, DTAAP, with EHNAC, for HISPs, CAs, and RAs, as well as theirclients.• Complementary and subject to, as well as supportive of, the governancerules, regulations, and best practices for the Direct Project and the NwHIN,promulgated by HHS and ONC, and the mandates of the HITECH act.
  • 37. Direct Project Pilot - 2011• Demonstrated one of the 1st Direct Project pilots• Pilot used Medicity HISP services to demonstratethese use cases:– summary care records and results between PCP and– summary care records and results between PCP andspecialists– transmitting PCP referrals and summary care records tohospitals– sending discharge information from hospitals back toreferring PCPs• http://www.gorgehealthconnect.org/directproject/
  • 38. Grouped Resources – 2012• The Dalles Google Data Centers Grants Fundof Tides Foundation to introduce participantsto HER. 77% pursue HIT Information/Training– HIT Workforce Development Curriculum– OpenEMR– My HealtheVet- Blue Button• Oregon Connections TelecommunicationsConference• iNexx Deployment
  • 39. Here today! The Developing Three-Party Approach:Federated Identity ManagementIdentity(Verification)RelyingRelyingPartyATM Example10IdentityProvider RelyingPartySubject(Bank A)(ATM Card) (ATM Card)(Bank B)RelyingParty(Bank C)(Bank D)
  • 40. GHC -Federated Model• Participating organizations in a Federated HIEretain control of their healthcare informationand responds to queries when information isrequested, likewise sent.requested, likewise sent.• A Centralized HIE collects information fromparticipating organizations and stores theinformation in a centralized place to provideaccess.
  • 41. • Resilient awarded 12 month, $2Mgrant to pilot innovative solutions forboth healthcare and educationNational Strategy for Trusted Identities inCyberspaceNational Strategy for Trusted Identities inCyberspace• Signed by the President in 2011• Create new Identity Ecosystemsto assure security and privacyIdentity Ecosystemsboth healthcare and education• Trust Network will connect over15 nationally recognized leaders foridentity, policy and online content• Goal is to commercialize solutionsand capabilities for rapid adoption bypublic / private sectors• Pilot grants and an adoptionrequirement for .Gov websites
  • 42. Goals of the NSTIC PilotHealthcare: Patient-Centered Coordination of Care (PCC)Enable trust for sensitive healthcare transactions on the InternetProvide secure, multifactor, on-demand identity proofing and authenticationacross multiple sectors, at national scaleImplement an identity ecosystem encompassing patients, physicians andstaff which facilitates coordinated care through secure, HIPAA-compliantaccess to:access to:Electronic referral and transfer of care messagingAdvanced, on-demand decision support serviceCommercialize solutions and underlying capabilities, beyond Year 1EXCHANGE PARTNERSLa Clinica del Carino and San Diego Beacon Community
  • 43. Healthcare: Patient-Centered Coordination of CareHighlights of Pilot• Populations of seasonal agriculturalworkers from SD work and receivedcare in Oregon too• Identity matching and policyenforcement enables coordination• Enable NwHIN Direct messagingacross HIE platforms and state lines• Novel, cloud-based decision supportavailable to doctors in both statesPilot Sites & HIE Software:Decision Support Partners:• On-demand, privacy-preservingauthentication and authorization• Commercialized identity matching,secure messaging & cloud-baseddecision support can scale rapidlyIdentity & Attribute Providers:Advisors on Governance / Protocols / Policy: Principal InvestigatorDr. David Hartzband, D.Sc.CTO, Resilient NetworkSystems
  • 44. Pilot Implementation Overview
  • 45. Two Key Questions We’re Trying to AddressFor Online Transactions• “Who are you?” (Identification)– Assigning attributes to individuals (or companies, ordevices)• Name, address, age, status (e.g., student or faculty), company, authority, credit rating, gender,model number, serial number, etc.• A one-time (offline or online) process called “identity proofing”– Issuing a credential16– Issuing a credential• Drivers license, passport, ATM card, UserID, digital certificate, smart card, etc.– Typically a one-time event• “How can you prove it?” (Authentication)– Verifying that the person online is the person previouslyidentified– Correlate a person to a credential (drivers license, UserID,etc.) via an authenticator (e.g., picture, password, etc.)
  • 46. Moving ForwardConnected at the HISP• Connected with Jefferson HIE• NSTIC connect with San Diego Beacon• NSTIC connect with San Diego Beacon• Working to connect with Care Accord• Provider needs– Workforce training – workflow• Explore network needs and infrastructure
  • 47. GHC- Accreditation ForerunnerThe Electronic Healthcare Network AccreditationCommission (EHNAC), a non-profit standardsdevelopment organization and accrediting body, hasdevelopment organization and accrediting body, haspartnered with Direct Trust to create a nationalaccreditation program for:• Health information “trusted agent” service providers,• Health information service providers (HISPs),• Certificate authorities (CAs) and• Registration authorities (RAs)
  • 48. Connecting Southern OregonConnecting Southern OregonHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceApril 22,April 22,April 22,April 22, 2013201320132013Paula WeldonProject Manager, JHIE
  • 49. To create an environment wherepatients get the highest qualityhealth care at the lowest costbecause everyone involved inbecause everyone involved intheir care is connected througha secure, user-friendly andefficient source of informationthat follows the patient.
  • 50. PayersHospitals First RespondersProvidersDiagnosticsRegistriesClinicsPharmaciesHome Care
  • 51. Asante Health System◦ Three Rivers Community Hospital (Grants Pass)◦ Rogue Regional Medical Center (Medford)Sky Lakes Medical Center (Klamath Falls)Providence Health and ServicesProvidence Health and Services◦ Providence Medford Medical Center (Medford)Mid-Rogue IPA (MRIPA)Primary Care and Specialty Clinics in Medford,Grants Pass and Klamath Falls
  • 52. Phase III Considerations◦ Data de-identification◦ Reporting parameters◦ Acceptable use of aggregate data
  • 53. State of the Art technology to protect patientdataFederal and State compliant policies andprocedures that protect patient rights andcontrol access to information based on needcontrol access to information based on needto knowUser training to reinforce appropriate useMonitoring usage to ensure patient privacySanctions for misuse
  • 54. Non-Profit CorporationMulti-Stakeholder Decision-Making◦ Hospitals◦ Physicians & Independent Physician AssociationsPrimary Care and Specialists◦ Health Plans and CCOs◦ Health Plans and CCOs◦ Community Health Agencies & Clinics◦ Community Organizations & Patient AdvocatesBoard and Committees◦ Providers◦ Patients◦ Governance and Policyo Financeo Technology
  • 55. Ensuring that all participants have representation inthe decision-making process, including:◦ Definition of services and functions◦ Definition of policies governing data useEquitable participation in the cost to implementand maintain the HIEand maintain the HIE◦ Move to next phase only when adequate revenue to supportFocus on workflow change to support useFocus on growing data sources◦ Hospitals and health care facilities◦ Physicians and other health care providers
  • 56. ThankYou! Contact:Email: Info@jhie.org855-290-5443 toll freewww.jhie.orgwww.jhie.org