himss oregon spring conference - hie

HIMSS OREGON – Spring Conference 2013

Health Data Exchange in What’s Going On?

www.ochin.org

Presented by:

Abby Sears

CEO

Spring Conference 2013

Data Exchange in Oregon: What’s Going On?

www.ochin.org

Presented by:

Abby Sears

CEO

Agenda

• Beyond EHR:

– Who is OCHIN?

– What we do

• An Awakening: Clinical vs. Claims Data

• HIE: Short-term vs. Long-term

Clinical vs. Claims Data

term

Who is OCHIN?

• Our goal is simple: to provide solutions to promote access to quality, affordable health care for all.

• One of the nation’s largest and most successful

Health Information Networks

• Oregon’s Regional Extension Center (REC)

• NEW! Oregon Health Network• NEW! Oregon Health Network

Our goal is simple: to provide solutions to promote access to quality, affordable health care for all.

One of the nation’s largest and most successful

etworks

Oregon’s Regional Extension Center (REC)

NEW! Oregon Health NetworkNEW! Oregon Health Network

What we do

• We are a nonprofit organization that touches 4,500

physicians 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 4,500

Connectivity (Network Services)

Federal and State Program Management

Outreach and Communications

What we do

Connect communities through the advancement and Connect communities through the advancement and adoption of telemedicine and long

study of clinical and operational workflows

Enable providers, staff, and leadership improvement goals and system

study of clinical and operational workflows

Install and optimize a wide range of Health IT products

programs for vulnerable patient populations

adoption of telemedicine and long

programs for vulnerable patient populations

Participate in robust information exchange members, across care regions, and with state and federal

agencies

Implement innovative clinical and health science best practices via practice-based research

Combine data from disparate data systems: GL, clinic,

claims, social

Connect communities through the advancement and Connect communities through the advancement and and long-distance health

study of clinical and operational workflows

Enable providers, staff, and leadership to achieve quality

improvement goals and system optimization through the

study of clinical and operational workflows

a wide range of Health IT products

programs for vulnerable patient populations

and long-distance health

programs for vulnerable patient populations

Participate in robust information exchange among

, across care regions, and with state and federal

Implement innovative clinical and health science best research

from disparate data systems: GL, clinic,

A New Future: High quality care, anywhere

Then (& Now)…

• Core operational

infrastructure systems

operate in siloes

• Decision and

policymakers not focused policymakers not focused

on broader context

• Health IT used only by

those with money &

resources

• Health IT viewed as

optional

A New Future: High quality care, anywhere

The FUTURE of IT

• Core operational

infrastructure systems

are fully integrated

• Decision and policymakers

use clinical data for broader use clinical data for broader

context

• High quality transformative

Health IT and data is

available to all

• Health IT is a core

requirement

If you were to design tomorrow would it look likeIf you were to design tomorrow – what

The Health Neighborhood

• Data Integration

• Technical Integration

• Workflow Integration

• Health Print– Medical

– Behavioral

– Social– Social

• Health Home– Accountability

– Member activation

– Care coordination

The Health Neighborhood

HIT: Short-term (1-3 years)

• There is no one, “out-of-

• What exists

– No EHR solution is perfect and/or incorporates required

mental, 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 to

get HCPs to the next phase of coordinated care

• Beware of vendors that sell “proven”

• Build for the future with trusted

3 years)

-the box” solution

No EHR solution is perfect and/or incorporates required

mental, dental, patient engagement, reporting needs, etc.

What’s needed (at this point-in-time)

Leverage what exists to design an interim HIE solution to Leverage what exists to design an interim HIE solution to

get HCPs to the next phase of coordinated care

Beware of vendors that sell “proven”

solutions

Build for the future with trusted

partnerships

eHealth Exhange

Direct Project

HIT: Short-term (1-3 years)

• What OCHIN is doing

– Piloting “transitional” infrastructure with

and share with others

• EHRs with Mental Health

• Incorporating claims & clinical data into new workflows and

reporting

– Business Intelligence/Analytics: Reporting solutions– Business Intelligence/Analytics: Reporting solutions

– Piloting national HIE approaches that are sustainable

3 years)

Piloting “transitional” infrastructure with CCOs to replicate

Incorporating claims & clinical data into new workflows and

Business Intelligence/Analytics: Reporting solutionsBusiness Intelligence/Analytics: Reporting solutions

Piloting national HIE approaches that are sustainable

HIE: Long-term (3+ years)

• Industry is coming; Get ready to support and plug into 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 regional

term (3+ years)

Industry is coming; Get ready to support and plug into a national HIE/IT infrastructure

What exists/what is under development?

Cloud computing is coming to healthcareCloud computing is coming to healthcare

National broad reaching solutions that are not regional

So Who is OCHIN

We provide solutions to promote access to quality,

affordable health care for all.

Innovatively applying technology

Research to improve health outcomes and deliver costs effective care

Hosted solutions

Professional services

e provide solutions to promote access to quality,

affordable health care for all.

Innovatively applying technology

Research to improve health outcomes and deliver costs effective care

Summary/Re-Cap – Cont’d.

We don’t know what we don’t know

Cont’d.

We don’t know what we don’t know

www.ochin.orgwww.ochin.org

Sharon Wentz, RN

Business Development Coordinator

Office of Health Information Technology

04/22/13

Where We Are & Where We Are Going

Organization Types Participating in CareAccord

Direct Secure Messaging

Acute Care Acute Care

Hospitals

Ambulatory

Laboratories

Other

●No-cost Direct Secure Messaging services through 2013 ●No-cost Direct Secure Messaging services through 2013

● Registration Process enhanced with a “Bulk upload” capability for individual and delegate accounts

● 2.0 Deployment anticipated → Provider Directory Admin Privileges

Health Information Service Provider (HISP)

Beta Accreditation

www.directtrust.org

www.ehnac.org

Pilot to Production

Vision: Scalable Trust and Policy

Wsctrust.org

● 8 Core states, 7 satellite states

● Creating policies and procedures that lay groundwork

for safe interstate transfer of health information

● Pilot work: Oregon, California, Alaska

Vision: Scalable Trust and Policy

Framework that eliminates barriers to HIE

HIMSS/ONC Interoperability Showcase March 2013 Coordinating Care Across State Lines

Creating trusted HISP communities

Managing community membership

Distributed Provider Directories

Connecting with Disparate Technologies

“In 2007, the Oregon Legislature passed

POLST (Physician Orders for Life-Sustaining Treatment)

Registry: Form submission to the Registry

“In 2007, the Oregon Legislature passed

Senate Bill 329 (State Health Fund Board), and

in 2009 passed HB 2009 as part of Oregon's

health care reform efforts, enabling Oregon to

launch the nation's first 24-hour electronic

POLST Registry on December 3, 2009. First

responders and providers are able to call the

registry from the field and be informed of a

patient's POLST orders.”

“Embrace a model of information symmetry, in

which the patient and the clinician are partners,

collaborating around the patient’s health.”

“Information is freely exchanged because

hoarding information bestows no power and runs

counter to the common goal.”

“How can patients be expected to take care of

themselves if they don’t have access to their own

health information?”

“In the U.S., patient have been guaranteed

access to their medical records since the HIPAA

Privacy Rule became effective in 2003, although

not always without friction and burdensome

costs.”

Personal

StoriesStories

What if………………

Andrew John Wentz

Erin June Yarber

Contact information:

www.careaccord.orgwww.careaccord.org

Sharon.l.wentz@state.or.us

Cell: 503-983-8290

Gorge Health Connect, Inc.(GHC)

http://www.gorgehealthconnect.org

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

Health Resources and Services

Administration - 2009

• Network Development Grant

• GHC intends to use this planning year to

establish the governance structure of the

network in greater detail through a strategic network in greater detail through a strategic

planning process which includes refining a

mission statement and identifying key

strategic goals for group.

Grouped Resources - 2010

• GovernanceBy-laws and officers

• HRSA Technical Assistance

Member expectationsMember expectations

Deliverables

ID Stakeholders

• Community Needs Assessment

EHR utilization

Workforce training

Connectivity

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 training workshop

• Non-Profit Status

– Organized as a 501(c)(3)

• ONC and Oregon HITOC

– Workgroup and Panel Positions

• The Direct Trust- Original Seating Board position

Direct Trust

• Non-profit, competitively neutral, self-regulatory entity created by and for Direct 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 of DirectTrust agree to follow, uphold, and enforce.

• Leveraging the Trust Framework for a Direct Trusted Agent Accreditation Program, DTAAP, with EHNAC, for HISPs, CAs, and RAs, as well as their clients.

• Complementary and subject to, as well as supportive of, the governance rules, regulations, and best practices for the Direct Project and the NwHIN, promulgated by HHS and ONC, and the mandates of the HITECH act.

Direct Project Pilot - 2011

• Demonstrated one of the 1st Direct Project pilots

• Pilot used Medicity HISP services to demonstrate

these use cases:

– summary care records and results between PCP and – summary care records and results between PCP and

specialists

– transmitting PCP referrals and summary care records to

hospitals

– sending discharge information from hospitals back to

referring PCPs

• http://www.gorgehealthconnect.org/directproject/

Grouped Resources – 2012

• The Dalles Google Data Centers Grants Fund of Tides Foundation to introduce participants to HER. 77% pursue HIT Information/Training

– HIT Workforce Development Curriculum

– OpenEMR

– My HealtheVet- Blue Button

• Oregon Connections Telecommunications Conference

• iNexx Deployment

Here today! The Developing Three-Party Approach:

Federated Identity Management

Identity (Verification)

Relying

Relying Party

ATM Example

10

Identity Provider Relying

Party

Subject

(Bank A)

(ATM Card) (ATM Card)

(Bank B)

Relying Party

(Bank C)

(Bank D)

GHC -Federated Model

• Participating organizations in a Federated HIE

retain control of their healthcare information

and responds to queries when information is

requested, likewise sent.requested, likewise sent.

• A Centralized HIE collects information from

participating organizations and stores the

information in a centralized place to provide

access.

• Resilient awarded 12 month, $2M

grant to pilot innovative solutions for

both healthcare and education

National Strategy for Trusted Identities in

Cyberspace

National Strategy for Trusted Identities in

Cyberspace

• Signed by the President in 2011

• Create new Identity Ecosystems

to assure security and privacy

Identity Ecosystems

both healthcare and education

• Trust Network will connect over

15 nationally recognized leaders for

identity, policy and online content

• Goal is to commercialize solutions

and capabilities for rapid adoption by

public / private sectors

• Pilot grants and an adoption

requirement for .Gov websites

Goals of the NSTIC Pilot

Healthcare: Patient-Centered Coordination of Care (PCC)

� Enable trust for sensitive healthcare transactions on the Internet

� Provide secure, multifactor, on-demand identity proofing and authentication

across multiple sectors, at national scale

� Implement an identity ecosystem encompassing patients, physicians and

staff which facilitates coordinated care through secure, HIPAA-compliant

access to:access to:

� Electronic referral and transfer of care messaging

� Advanced, on-demand decision support service

� Commercialize solutions and underlying capabilities, beyond Year 1

� EXCHANGE PARTNERS

� La Clinica del Carino and San Diego Beacon Community

Healthcare: Patient-Centered Coordination of Care

Highlights of Pilot

• Populations of seasonal agricultural

workers from SD work and received

care in Oregon too

• Identity matching and policy

enforcement enables coordination

• Enable NwHIN Direct messaging

across HIE platforms and state lines

• Novel, cloud-based decision support

available to doctors in both states

Pilot Sites & HIE Software:

Decision Support Partners:

• On-demand, privacy-preserving

authentication and authorization

• Commercialized identity matching,

secure messaging & cloud-based

decision support can scale rapidly

Identity & Attribute Providers:

Advisors on Governance / Protocols / Policy: Principal Investigator

Dr. David Hartzband, D.Sc.

CTO, Resilient Network

Systems

Pilot Implementation Overview

Two Key Questions We’re Trying to Address

For Online Transactions

• “Who are you?” (Identification)– Assigning attributes to individuals (or companies, or

devices)• 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 credential

16

– 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 previously

identified– Correlate a person to a credential (drivers license, UserID,

etc.) via an authenticator (e.g., picture, password, etc.)

Moving Forward

Connected 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

GHC- Accreditation Forerunner

The Electronic Healthcare Network Accreditation

Commission (EHNAC), a non-profit standards

development organization and accrediting body, has development organization and accrediting body, has

partnered with Direct Trust to create a national

accreditation program for:

• Health information “trusted agent” service providers,

• Health information service providers (HISPs),

• Certificate authorities (CAs) and

• Registration authorities (RAs)

Connecting Southern OregonConnecting Southern Oregon

HIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceApril 22, April 22, April 22, April 22, 2013201320132013

Paula Weldon Project Manager, JHIE

To create an environment where patients get the highest quality health care at the lowest cost because everyone involved in because everyone involved in

their care is connected through a secure, user-friendly and

efficient source of information that follows the patient.

Payers

Hospitals First Responders

Providers

Diagnostics

Registries

Clinics

Pharmacies

Home Care

� Asante Health System◦ Three Rivers Community Hospital (Grants Pass)

◦ Rogue Regional Medical Center (Medford)

� Sky Lakes Medical Center (Klamath Falls)

� Providence Health and Services� Providence Health and Services◦ Providence Medford Medical Center (Medford)

� Mid-Rogue IPA (MRIPA)

� Primary Care and Specialty Clinics in Medford, Grants Pass and Klamath Falls

Phase III Considerations◦ Data de-identification

◦ Reporting parameters

◦ Acceptable use of aggregate data

� State of the Art technology to protect patient data

� Federal and State compliant policies and procedures that protect patient rights and control access to information based on need control access to information based on need to know

� User training to reinforce appropriate use

� Monitoring usage to ensure patient privacy

� Sanctions for misuse

� Non-Profit Corporation

� Multi-Stakeholder Decision-Making◦ Hospitals

◦ Physicians & Independent Physician Associations� Primary Care and Specialists

◦ Health Plans and CCOs◦ Health Plans and CCOs

◦ Community Health Agencies & Clinics

◦ Community Organizations & Patient Advocates

� Board and Committees◦ Providers◦ Patients◦ Governance and Policy

o Financeo Technology

� Ensuring that all participants have representation in the decision-making process, including: ◦ Definition of services and functions◦ Definition of policies governing data use

� Equitable participation in the cost to implement and maintain the HIEand maintain the HIE◦ Move to next phase only when adequate revenue to support

� Focus on workflow change to support use

� Focus on growing data sources◦ Hospitals and health care facilities◦ Physicians and other health care providers

Thank You! Contact:

Email: Info@jhie.org

855-290-5443 toll free

www.jhie.orgwww.jhie.org