lincoln association of health underwriters · colglazier demmel medical clinic – grant, ne chi...
TRANSCRIPT
2014 NeHII Annual Report Overview
Lincoln Association of Health Underwriters
April 6, 2015
Adoption and increased usage
Sustainability
2014 major projects
NeHII staffing
Preview of the future
Q&A
Contact information
2014 ANNUAL REPORT OVERVIEW
2
ADOPTION AND INCREASED
USAGE3
4
5
6
7
8
NEHII PARTICIPANTS
9
NEHII ADOPTION
10
www.connectnebraska.net 11
Opt out platform
No “Break the Glass” considerations
Special protected data or 42 CFR Part 2 scrubbedfrom the ePHI available
Individual consumer education and consentmanagement processes and support
Privacy/Security Policies address treatment,payment and healthcare operations
NEHII CONSENT MANAGEMENT
12
SUSTAINABILITY13
NEHII’S SUSTAINABILITY STRATEGY
License fee model paid by all participants
Health systems
Providers
Payers
State of NE
Continuum of care providers
14
SUSTAINABILITY PLAN COMPONENTS
Payer participation
State of Nebraska’s financial support
HITECH 90/10 funding
Revised pricing structure with vendor
Expense management
Financing through Mutual of Omaha Bank
15
PAYER PARTICIPATION
BCBS of NE long standing supporter
Implemented ADT alerting services
Coventry now Aetna
Arbor Health Plan
UnitedHealthcare
16
STATE OF NEBRASKA FUNDING SUPPORT
2013 – 2014 $500,000 appropriation to assistproviders and hospitals in meeting MUrequirements
2014 – 2015 $500,000 appropriation to supportMU requirements and $500,000 directly to NeHIIfor operational support
2015 – 2016 requesting annual appropriation of$1 million
NeHII serves as the PDMP for the State
17
HITECH 90/10 FUNDING OPPORTUNITY
Funding request approved by CMS early October tosupport additional HIE adoption activities and allowfor added functionality for eligible providers andhospitals
Available to another 35 CAHs, FQHCs and 6remaining major hospitals to remove HIEimplementation fees
Waive the NeHII implementation fee of $10,000 forthe CAHs, however EHR interface fees remain
Also offers 12 months of free usage of the VHR toproviders
Added functionality includes the Public HealthGateway for syndromic surveillance and expandedADT messaging
Must be implemented by September 30, 2015
18
REVISED VENDOR PRICING STRUCTURE
Re-negotiated master services agreement
Migration to HIE 2.0 will require completely newpricing model based upon # of lives with PHI inthe system and # of feeds
19
FINAL TWO CATEGORIES
Ongoing expense management for operationalsupport
Financing through Mutual of Omaha Bank
Paid down line of credit
20
2014 MAJOR PROJECTS21
ADDED FUNCTIONALITIES PRIORITIZATION
Identified in 2013 Decision Accelerator
Followed by decision scorecard process
HITECH 90/10 funding availability
Input and feedback from various stakeholdersand participants
Recent physician survey
Focus on sustainability and ROI for addedfunctionalities
22
ADDED FUNCTIONALITIES 2014-2015
Single Sign-on Enhanced ADT Messaging to include admitting, working,
discharge diagnosis and allergies Direct Services implementation Public Health Gateway implementation for syndromic
surveillance Optum HIE 2.0 platform migration Open Access to support C-CDA exchange Data analytics using Optum One tools Usage analytics Enhanced PDMP functionality Case management reporting HIE to HIE Gateway Statewide Provider Directory for Direct users Radiologic image exchange Two factor authentication Mobile device alerting
23
EXTERNAL NEHII SECURITY AUDIT
Three year cycle
Performed September 2014 by SHS included onsitevisit of NeHII team members
NeHII “has developed and implemented strongsecurity controls throughout the institution and isexceptionally compliant with its own policy”
Reviewed 288 items of which 263 or 91% foundcompliant
Resulting security action plan addressed primarilypolicy revisions and included the implementation ofemployee background checks and drug testingprocedures
Detailed plan not made public for protective reasons24
SECONDARY USE OF DE-IDENTIFIED DATA
POLICY
To support research efforts using de-identifieddata
Utilizes IRB review and approval
Complete “Access to and Use and Disclosure ofInformation Policy” Found in Exhibit E
Approved December 2014 by Privacy & SecurityCommittee and NeHII Board
25
CYBER SECURITY EDUCATIONAL EFFORTS
Annual NeHII staff training
Cyber security workshops
Cyber security newsletter
Partnership with outside vendors
26
ADT Alerting/Notification Service
For payers, providers and hospitals
Notification admits for inpatient stays
Notification of Emergency Department visits
Notification of discharges
Thirty Day Readmittance
Notification when a patient is admitted to ahospital within 30 days of discharge
Patient consent considerations
POPULATION MANAGEMENT
SERVICES/SPECIAL PROJECTS
27
Produce comprehensive daily census reports onadmissions, discharges and ED visits
Improve care transitions/case management
Improve efficiency
Avoid unnecessary service
Streamline utilization management obligationsto payers
Beginning population health strategy support
Future support public health alerting
PURPOSE OF
ALERTING/NOTIFICATION SERVICES
28
What is Direct messaging?
Trusted secure encrypted email service that supportselectronic communication between healthcare providers andpatients
Privacy, security, and trust-in-identity controls of Directexchange are VERY important!
Consider HIPAA and the new penalties for breach of privacy
Supports Stage 2 MU objectives related to Transitions ofCare and Patient Engagement
DIRECT MESSAGING SERVICES
29
DATA EXCHANGE TO PROMOTE
COORDINATION OF CARE
StandardizedContinuity of
Care Document
HospitalLTCRehab Facility
Primary CareSpecialty CareHome HealthReferral Hospital
“Transition of Care” – The movement of a patient from one setting of care(hospital, ambulatory primary care practice, ambulatory specialty carepractice, long-term care, home health, rehabilitation facility) to another.
30
Direct is a push-based transport
Direct addresses are used to route Direct messages
Digital certificates are used to protect Direct messagesin transit and to express trust relationships
SMTP is used to transport Direct messages
Security/Trust Agents (STAs) such as HealthInformation Service Providers (HISPs) are responsiblefor providing the services necessary for exchange usingDirect
Trust communities, e.g. DirectTrust facilitate theexchange of Direct messages
KEY CONCEPTS IN DIRECT
31
DIRECT – IN SUMMARY
Privacy, security, and trust-in-identity controls ofDirect exchange are VERY important!
Consider HIPAA and the new penalties forbreach of privacy
HISPs are Business Associates and “trustedagents”of Direct users. CAs/RAs aresubcontractors.
EHRs have 3 options for enabling Directexchange:
1. EHR can be a HISP for its customers (and patients?)2. EHR can partner with a single full service HISP.3. EHR can configure connections (SOAP XDR) to
allow customers to choose a HISP, in which case anEHR vendor might have relationships with multipleHISPs.
In all three options, it is ultimately the provider’sresponsibility that privacy is protected andidentity is assured!
32
CURRENT DIRECT PARTICIPANTS
Wayne Family Medicine (part of Faith RegionalPhysician Services
Colglazier Demmel Medical Clinic – Grant, NE CHI Health
Good Samaritan Hospital – Kearney, NE Nebraska Heart Hospital – Lincoln, NE St. Francis Medical Center – Grand Island, NE St. Elizabeth Regional Medical Center – Lincoln, NE
Pathology Services, P.C. – North Platte, NE NeHII, Inc. 3 skilled nursing and rehabilitation facilities
Linden Court – North Platte, NE Hilltop Estates – Gothenburg, NE Heritage Estates – Gering, NE
Total Direct users to date: 6133
DIRECT USE CASES UNDER DISCUSSION
Need for Statewide Provider Directory of Directaddresses
VA – care coordination
BCBSNE – claims & case management
Additional nursing home referrals
Interstate Direct message exchange Successful tests performed with:
IDPH – Iowa Department of Public Health
KHIN – Kansas Health Information Network
MHC – Missouri Health Connection
CORHIO – Colorado Regional Health InformationOrganization:
South Dakota Health Link 34
PDMP ENHANCEMENTS REQUESTED BY
NMA
Mandated consumer participation
Reporting of all controlled substances to thesystem
Free access for physicians across the State
Secure grant funding to accomplish the goals
LB471 introduced January 2015
35
2014 ANNUAL MEETING Held August 7, 2014 at CHI’s McAuley Center in
Omaha, NE Sponsored by CHI Health, BCBS of NE, Baird Holm
Law and SHS More than 120 attendees Keynote speakers included Jim Hetherington,
Manager of HIE Applications for CHI; Scott Afzal,Program Director for CRISP; and Nicholas Blake,Client Services Manager with Briljent
Ken Lawonn, Sr. VP and CIO of Sharp Healthcarerecognized with the Visionary Leader of HIE Award
NeHII Council and Committee reporting Meeting presentation available at www.nehii.org,
Downloads/Forms & Documents/2014 NeHII AnnualMeeting Presentation
36
LEGISLATIVE ADVOCACY EFFORTS
BCBS lobbyist team
Raise the awareness of State Senators
Secure annual funding from the State
Received $500,000 to support NeHII’s operations
Revised LB237 so that NeHII could secure grantfunding to enable PDMP enhancements
37
NEHII STAFFING38
OPERATIONAL EXPENSE MANAGEMENT
Annual budget $2.6 million
Virtual workplace with 6 FTEs and contracted PT servicesas needed CEO Project Managers – 2 Data Analyst – 1 Physician Trainer – 1 Administrative - 1
Delicate balance between increased adoption and addedservices/new projects while maintaining current users
Outsourced contracted roles CFO Legal Counsel Privacy Officer
Met 2014 goal of 100 new providers/quarter39
PREVIEW OF THE FUTURE40
MEET ADOPTION AND ADDED
FUNCTIONALITIES PROVIDED BY HITECH90/10 FUNDING
Support sustainability and MU requirements
Hospital and provider adoption activities
Added functionalities:
Expanded ADT messaging to include admitting,working and discharge diagnosis and allergies
Advance Directives
Public Health Gateway for syndromic surveillance
Ability to create and exchange CCD not availableuntil HIE 2.0 (Open Access)
41
CAPITAL EXPENDITURES BUDGET
Functionalities not included in HITECH 90/10funding
HIE 2.0 platform migration
Single Sign-on
Usage and data analytics
Statewide Provider Directory for Directaddresses
Additional care coordination and casemanagement services
42
Added flexibility, cloud based Oracle solution
Planned to begin March 2015
Project plan for migration completion – sixmonths
No data migration costs from Optum
New pricing model
Currently collecting OIDs from NeHIIparticipants
43
MIGRATION TO HIE 2.0 PLATFORM
34
EXHIBITS44
2014 ANNUAL REPORT EXHIBITS:
A: Growth of NeHII Users
B: Future Functionalities in Optum HIE 2.0
C: Sample NeHII Project Proposal
D: NeHII 2014 Financial Statements
E: NeHII Secondary Use of Data Policy
F: Direct Participants Listing
G: NeHII State Senator One Page Overview
H: NeHII Project & Operational Responsibilities
I: NeHII 2015 Projected Projects
45
IN CONCLUSION46
Q & AThank you for joining us today!47
Dr. Michael Westcott – President, NeHII Board of Directors
Deb Bass - Chief Executive Officer, NeHII
Lianne Stevens – Security Officer/Project Manager, NeHII
NeHII, Inc.
P.O. Box 27842
Omaha, NE 68127
Deb’s Cell: 402.981.7664
Lianne’s Cell: 402.290.7029
www.nehii.org 48
NeHII CONTACT INFORMATION