november 1, 2011 - caehc.orgcaehc.org/wp-content/uploads/caehc-webinar-nov-1-2011.pdf · november...

November 1, 2011

Copyright 2011 under a Creative Commons 3.0 Non-commercial Attribution Share-alike License. Some rights reserved.

!"

November 1, 2011

1.  Lori Hack, Update on CAeHC

2.  Laura Landry, Interim CEO Cal eConnect

#"

$%"&'%()*+",-"%&+-",-*")-./01)(+"2%'03"2%'"+45+,/67",.8()8+1")-"9,/)2%'-),"67,6":)//"*')(+"67+"*+(+/%&3+-6"%2"1+.0'+",..+11"6%"./)-).,//;4'+/+(,-6")-2%'3,8%-",6"67+"&%)-6"%2".,'+<"

CAeHC’s Mission

="

9>+59"?)1)%-"

@"

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

9>+59"A'%B+.61"

o 9%-8-0+"C*0.,8%-,/"D+11)%-1",-*"E+F)-,'1"o 9%%'*)-,6+"A')(,.;",-*"D+.0')6;">1&+.6"%2"67+"D9>GGCH"I',-6"

o  J-.0F,6+"9>H+5JG"%&&%'60-)6;"2%'"&'%()*+'1"o D0&&%'6"9$G"$+/+3+*).)-+">&&/).,8%-1"o A'%3%6+"C*0.,8%-,/"9%-2+'+-.+1"

K"

o  LM<=N">5HO"I',-6"6%"P9DQ",-*")61"&,'6-+'1"6%"+-,F/+"-+,'"'+,/483+".%3&,',8(+"+R+.8(+-+11"'+1+,'.7",-*"&'%1&+.8(+",-,/;1)1"%2"*,6,".%//+.6+*"2'%3"./)-).,/"*,6,F,1+1<"

o  A,'6-+'1"J-./0*+S"–  "T')U7,3",-*"E%3+-’1"5%1&)6,/"–  97,'/+1"Q'+:"P-)(+'1)6;"%2"N+*).)-+"–  H,-*",-*"H+1)/)+-6"G+6:%'V"D;16+31"–  D,-"W',-.)1.%"D6,6+"X9>+59Y"–  ?,-*+'F)/6"P-)(+'1)6;",-*"N+*).,/"9+-6+'"

Z"http://scanner.ucsd.edu/collaborators

CAeHC 2011 Webinar Series Upcoming Webinars:

o  November 15: Kiki Nocella, PhD, CEO of Believe Health -

EKCITA

o  November 29: Michael Marchant, HIE Director – California, ACS, a Xerox Company

["

Health Information Exchanges

M"

OCPRHIO

Cal eConnect

NAMMcal (CHIEF)

(26) (13)

HealthShare Bay Area

Next Webinar: November 15, 2011 1:00 PM PST

Kiki Nocella, PhD

President & CEO, Believe Health

\"

Thank you for attending the CAeHC Webinar!

Established February 2009

!]"

www.caleconnect.org

© 2010 Cal eCONNECT. All rights reserved. 1

2012 -- Focused on Providing Solutions CAeHC Webinar

Laura Landry Interim CEO

November 1, 2011

2 © 2011 Cal eCONNECT. All rights reserved.

Cal eConnect

Mission To establish policies, services, and innovations collaboratively

that make possible the appropriate, secure, and efficient exchange of health information for the purpose of improving health and healthcare safety, quality, access, and efficiency for all Californians.

Vision Healthcare built on a solid foundation of health information

exchange that provides safe and secure patient and provider access to personal and population health information, dramatically improving the health and wellbeing, safety, efficiency, and quality of care for all Californians.

3 © 2011 Cal eCONNECT. All rights reserved.

Background: Cal eConnect

Where we were !  Provider Directory & Exchange Services

primary goal

!  Business plan development focused on provider directory

!  Managing grants ( executing $35 million )

Where we are !  Managing grants (refined focus)

– Near-term ONC Program Information Notes (PIN) alignment -- address and enable three HIE capabilities – e-prescribing, receipt of structured lab results, and sharing patient care summaries across unaffiliated organizations.

– Establishing statewide environmental baseline of HIE efforts

!  Developing/refining business requirements

!  Continuous improvement – Checking with stakeholders to ensure provided value

Where we are going !  Become recognized thought leader for

HIE. Accomplish by: –  Executing flawlessly on grant work

–  Developing/securing expert resources in technology, workflow, processes, etc.

–  Establishing, refining, and communicating policy that affects health information exchange

–  Address liability and strive to balance concerns with practical solutions

–  Openly address approaches that establish acceptable consent models

4 © 2011 Cal eCONNECT. All rights reserved.

Strategic & Operational Framework

! Policy, Leadership, & Barrier Removal " Expert support to select or develop solutions to problems # Conserving scarce resources and making big impacts

Coordination!

ONC & CHHS Priorities !  Establish Trust

Environment !  Robust Support for

Ancillary Services –  Public Health –  Community Pharmacies

–  Community Diagnostic Laboratories

!  Coordinate, Monitor, & Report on HIE Landscape

Sustainable HIE in California

5 © 2011 Cal eCONNECT. All rights reserved.

Some of the Challenges All HIEs face great challenges in the coming months. Examples:

•  Connecting communities •  Support providers who want to meet advanced Meaningful Use •  Connect as many constituents as possible •  Keep information flowing securely throughout the state •  Ensure and monitor appropriate access to health information •  Meet requirements of ONC, HITECH Act, and more. •  Create the right governance models •  Make exchanges attractive to all, including employers •  Balance regulatory authority •  Develop sustainable business model for HIE infrastructure •  Support consumers to be empowered by their health information

6 © 2011 Cal eCONNECT. All rights reserved.

Core Assumptions

!  $38M not enough to establish “statewide HIE” –  Back of the envelope estimated $>1B –  Even if were wrong by 80% = $200M –  Therefore, we must be innovative and flexible –  Leverage existing prebuilt infrastructure (hospital, private HIE’s)

!  Cal eConnect does not have statutory or regulatory authority –  For now, all processes must be given “market permission” (i.e., the

market needs something and is willing to work together to solve it under CeC’s leadership)

!  HIE Solutions must be clearly vetted as “short-term” or “long-term” sustainable –  CeC and other HIEs may invest in short-term solutions to meet

requirements –  Need to be focused on driving toward long-term CA sustainability of HIE

7 © 2011 Cal eCONNECT. All rights reserved.

High Priority: Making the Business Case for HIE

!  Determine ways to measure/trend the following: –  Streamlined access to patient histories –  Improve the consistency and completeness of documentation

–  Administrative savings (hospital & payer)

–  Improved care (rapid access to test results, and enable data access outside clinical settings)

–  Quicker and improved access to medical records (hospital)

–  Reductions in admission times and improvements in care delivery and efficiency

!  Refine business case for health information exchange. Examples: –  Part of the legislation: Tax credits, Deductability

–  Consideration of “bounce back” for specific hospital DRG

–  On liability issues: Many precedents for “If you do it this way, you are in a safe harbor”

8 © 2011 Cal eCONNECT. All rights reserved.

Measuring Progress -- Groundwork

! Existing –  Many HIE environmental scans (eHI, CapSite, etc.)

–  Medi-Cal environment scan (in progress)

–  Stakeholder analysis – request for governance and technical assistance

! Missing (but planned, and required by grant) –  Current baseline – how much exchange is ACTUALLY

occurring now? •  Which data sets? Between whom? What’s stored? Where?

•  National stakeholders (laboratories, Rx) -- what’s available?

•  Predominant vendors

•  Unique requirements

•  Required by ONC and CHHS

9 © 2011 Cal eCONNECT. All rights reserved.

Sample -- Managing priorities, timelines, work plans and resources

10 © 2011 Cal eCONNECT. All rights reserved.

Underlying Approach to Technical Solutions Where we are going !  Identifying/capturing technical gaps !  Targeting requirements

–  Foundational –  Business analysis –  Feasibility –  Technical

!  New RFP(s) only when we have –  Defined business need

•  Requirements established •  Supported by market permission

•  Financial support model is accepted

•  Evidence-based support (letters of commitment/support, etc.)

11 © 2011 Cal eCONNECT. All rights reserved.

Focus is on Action: Examples Policy Outcomes (by June 30, 2012)

!  Complete the survey of applicable law and regulations –  Fill any outstanding gaps from CalPSAB and Privacy Steering Team

!  FAQs (post consensus definitions and create clarity)

!  HIE data participation agreements –  Challenges: Liability, Permitted Uses (e.g. Public Health), etc.

!  HIE to HIE agreements

!  Policies (minimum acceptable requirements)

!  Standards

!  Statutory and regulatory changes documented for use by the State and others (to create a receptive HIE environment while protecting patient confidentiality) –  Cal eConnect believes the State will need to agree on delegated authority

(use ONC Certification as a model)

–  Propose exemption/safe harbor •  Potential -- if you conform with these requirements, then you are in an “exemption/safe harbor”

12 © 2011 Cal eCONNECT. All rights reserved.

Focus is on Action: Examples Technology Outcomes (by June 30, 2012)

!  Create a HIE Marketplace (HISPs, HIE ASP models, shared services etc.) –  Defined:

•  Develop common terms and conditions and leverage model contracts

•  Negotiated discounts and favorable terms (leverage aggregated view)

•  Offer technical assistance to large/small, established/un-established stakeholders

•  Available to any Provider in the State –  How do we know the stakeholders will follow our lead?

•  Requests for this type of leadership from interviewees •  Vendors/partners supporting our vision •  Other states of similar complexity using this successfully

13 © 2011 Cal eCONNECT. All rights reserved.

Focus is on Action: Examples Technology Outcomes (cont’d)

!  Design, test value, and establish technical solutions that support statewide organizations participation and regional / “private label” HIEs –  Brainstorm “Routing hub” concept/approach

•  One data feed, multiple end points

•  Lab Hub

–  Possible data providers •  Medi-Cal FFS, Commercial health plans

•  Hospitals

–  Possible data recipients •  Regional HIEs, “Private Label” HIEs, EHR ASP models

!  Brainstorm Provider Directory morphing to HISP “active directory” Overlay Certificate Authority if possible.

www.caleconnect.org

© 2010 Cal eCONNECT. All rights reserved. 14

Q & A / Thank You!

Laura Landry eMail – llandry@caleconnect.org Voice – 510-978-4830

Visit our Web site: www.caleconnect.org

For more information. contact: