TEXAS COUNCIL OF COMMUNITY CENTERS:DATA WORK GROUPMARCH 14, 2013

Healthcare Intelligence Partners, LLC

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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Overview of the Day/Approach

Conceptual Model Review national efforts Agreement on an approach for resolving

major challenges: Identify key areas for greater exploration Identify areas of specific focus in Texas

Key goals for the workgroup Meeting operations:

Group Charter Meeting schedule

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Major Issues

Data Standards/Implementation Specifications

Patient Consent Measurement

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Conceptual Model

Functional Domains: Interoperability Privacy/Security

(Consent) Measurement

Infrastructure EHRs HIEs

Legal

Techno-

logically

Possible

Operationally Feasible

Clinically

Relevant

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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National Landscape

Functional Domains: Interoperability Privacy/Security (Consent Management) Measurement

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National Landscape

HIE Models: Push/Direct Model

A referring provider “pushes” data to another provider.

Requires a provider directory Standards developed nationally

Pull/Patient Record Locator HIEs are notified when a patient record has new

information. Providers must query HIE regarding a specific

patient to find out of there are other patient records available.

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National Landscape

Interoperability Terms: Standards Specifications

Message Components: Message content Message ‘envelope’

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National Landscape

Interoperability Health Level 7 (HL7): Behavioral Health CCD

Project Behavioral Health CCD implementation guide (BH

CCD), which will constrain the C32 profile required for Meaningful Use Stage 1.

Currently being ‘balloted’ and tested. Center for Integrated Health Solutions (CIHS)

SAMHSA/HRSA Center for Integrated Health Solutions – Health Information Exchange (HIE) of Behavioral Health and Physical Health Care Data

5 state HIE Initiative (IL, KY, ME, OK, RI)

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National Landscape

Interoperability Behavioral Health Data Exchange

Consortium Managed by RTI’s State Health Policy

Consortium. Projects are expected to be completed by 3/31/13.

Florida, Michigan, Kentucky, Alabama and New Mexico have joined together to develop a common set of data exchange procedures for inter-state Direct exchange.

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National Landscape

Interoperability Workgroup (IWG) A project of the New York eHealth Collaborative

(NYeC) Vendors, States, and Providers Includes Texas

Not clear how information is devolving to HIEs in Texas.

Intended to create “plug and play” standards for HIE and EHR vendors.

States are supposed to use policy levers to promote the use of products that use these specifications.

Use market forces to drive interoperability.

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Privacy and Security

Patient Consent Identity Management/Trusted Entities

Authentication Authorization Certificate Management SAML Assertion

Data Use and Reciprocal Support Agreement (DURSA) Framework for allowing participating organizations to

share data. Supported by ONC and HHS; referenced in THSA

documentation.

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Privacy and Security

S&I Framework (http://wiki.siframework.org) The S&I Framework is a collaborative community of participants

from the public and private sectors who are focused on providing the tools, services and guidance to facilitate the functional exchange of health information. Each S&I Initiative tackles a critical interoperability challenge through a rigorous process that typically includes Development of clinically-oriented user stories and robust use cases Harmonization of interoperability specifications and implementation

guidance Provision of real-world experience and implementer support through

new initiatives, workgroups and pilot projects Mechanisms for feedback and testing of implementations, often in

conjunction with ONC partners such as NIST Data Segmentation for Privacy (DS4P) (handout)

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Measurement

ONC-SAMHSA Behavioral Health Technical Expert Panel (TEP)

The purpose is to: Recommend BH measures for widespread

adoption and utilization for future stages of the Medicare and Medicaid EHR Incentive Programs

Recommend future measure development needs by evaluating available clinical research

Provide private sector input regarding measure implementation feasibility

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TEP Endorsed Measures

MEASURE CONCEPT SUBGROUP

Recommended

PrioritySETTI

NGNQF

#STEWA

RDBipolar Disorder (BD and Major Depression (MD): Appraisal for alcohol or chemical substance use Alcohol 1 EP 110 CQAIMH

BBD and MD: Assessment for Manic or hypomanic behaviors Depression 1 EP 109 CQAIMH

BD: Suicide Risk Assessment Suicide 1 EP 111 CQAIMH

Maternal Depression Screening Depression 2 EP 1401 NCQA

Follow-up after Hospitalization for Mental Illness Depression 1 EP 576 NCQARisky behavior assessment or counseling by age 13 – Alcohol, Tobacco, Substance Abuse, Sexual Activity

Substance Use Disorder (SUD) 1 EP 1406 NCQA

Risky behavior assessment or counseling by age 18– Alcohol, Tobacco, Substance Abuse, Sexual Activity (SUD) 1 EP 1507 NCQA

Alcohol Screening Alcohol 1 EH 1661 TJC

Alcohol Brief Intervention Alcohol 1 EH 1663 TJC

Bipolar antimanic agent Depression 2 EP 580 RHI

From: http://www.healthit.gov/policy-researchers-implementers/behavioral-health-expert-panel (3/12/2013)

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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Texas Landscape

THSA and the Federated HIE model Update on conversations with THSA

Collaboration Council Pilot implementation with one HIE

Getting started on getting information

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Conceptual Model

Functional Domains: Interoperability Privacy/Security

(Consent) Measurement

Infrastructure EHRs HIEs

Legal

Techno-

logically

Possible

Operationally Feasible

Clinically

Relevant

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Technological Capability

Functional Domains: Interoperability Privacy/Security (Consent) Measurement

Infrastructure EHRs HIEs

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Technological Capability

Will the interfaces across EHRs in use by TCCC members and local HIEs support your legal, clinical, and operational goals? Consider the different requirements across

HIEs. Can they be modified to support your

legal, clinical and operational goals?

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Operational Feasibility

Functional Domains: Interoperability Privacy/Security (Consent) Measurement

Infrastructure EHRs HIEs

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Operational Feasibility

EHRs Eg. Anasazi and Topaz: Supported CCD

standards? Others?

HIEs: How many? Similarities/differences? Supported CCD standards? Patient consent management approaches? Data segmentation?

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Legality

Functional Domains: Interoperability Privacy/Security (Consent) Measurement

Infrastructure EHRs HIEs

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Legality

IL Document (Handout) How do Texas privacy laws differ from

federal privacy laws?

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Clinically Relevant

Functional Domains: Interoperability Privacy/Security (Consent) Measurement

Infrastructure EHRs HIEs

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Clinically Relevant

Can you send clinically relevant content with appropriate care partners?

Do you receive clinically relevant content from care partners?

Do you have enough data to develop/use clinical quality measures?

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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Group Charter

Name Goals Objectives In-Scope/Out of Scope Deliverables Roles Meeting frequency/duration

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Content Sharing/Decision-Making Setting meeting agendas? When do you have enough information

to make a decision? How will decisions get made?

In-scope/out-of-scope? Strategies? Technical Issues?

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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Next Steps

Next Meeting Topic Explore speakers?

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Agenda

Welcome and Introductions Overview of the Day/Approach National Landscape Texas Landscape Initiate Development of Group Charter Next Steps Meeting Schedule/Wrap-up

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Meeting Schedule/Wrap-up

Meeting date Meeting duration

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Smarter Strategies for Better Healthcare

David BergmanFounder

(207) 650-0357dbergman@hcipartners.com

Healthcare Intelligence Partners