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Family Planning Quality Improvement and Health IT. [email protected]. Background: HHS Office of Population Affairs and the Title X Family Planning Program. Title X Family Planning. A grant making contraceptive service delivery program. - PowerPoint PPT Presentation
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Background:HHS Office of Population Affairs and the Title X Family Planning Program
+Title X Family Planning
Public Health Service Act of 1970 established the Title X Family Planning Program Administered by the HHS Office of Population Affairs (OPA)
Mission: To provide individuals with the information and means to exercise personal choice in determining the number and spacing of their children, including access to a broad range of acceptable and effective family planning methods and services
Within HHS, OPA sits within the Office of the Assistant Secretary for Health However, Title X budget is authorized through HRSA
$286 million in FY14 90% of budget must fund service delivery grantees
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A grant making contraceptive service delivery program
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+Family Planning Encounter A documented, face-to-face contact between an individual and
a FP provider that takes place in a Title X service site. The purpose of a family planning encounter is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies
Services generally include: Contraceptive services to prevent pregnancy Pregnancy testing & counseling Preconception health counseling & services Basic infertility services to achieve pregnancy STD/HIV screening, diagnosis &treatment Related preventive health services
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+
8.6 million encounters annually
4.8 million clients
4189
Service delivery sites in
1138
Sub recipients
50+ States, territories, DC monitored by
93 Grantees monitored by
20 Regional Office Family Planning staff
Supported by
10 Regional Health Administrators
5 National Training Centers
1 HQ
Title X: Diverse and wide network
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* 2012 FPAR service data§ 2013 staffing estimates
The 10 HHS Federal Regions
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+Title X Service Sites
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53%
21%
18%
8%
Health Department (State, County, or Local)
Community Health Center orFQHC
Family Planning Organization
Hospital and Community-based (school, university, correctional, tribal, faith)
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+
Family Planning Annual Report (FPAR)
+Current FPAR = stale, aggregate data
• Collects FPAR data on each Title X client encounter
• Aggregates & submits data to subrecipient or grantee
Site
• Aggregates data from all sites• Submits sub-level aggregate data to
granteeSub
• Aggregates data from all subs• Submits grantee-level aggregate data
annually populating FPAR tablesGrantee
• Contractor aggregates grantees’ data• Validates, analyzes & organizes intoFPAR
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10 Regional
FPAR summarie
s
1 National
FPAR summar
y
January 2012
February 2013
November 201323 months later
+ FPAR 2.0 = encounter-level data
Regional FPAR
system
StateHIE
GranteeData
System
Site B
Site A
Site C
Site D
Site F
Site G
Site J
Site I
Site H
Site E
FPAR 2.0 Repository
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Title X and Electronic Health Record Systems Adoption
+EHR systems & Title X Sites
June 2013 Family Planning National Training Center Training Needs Assessment Results
454 Subrecipients and 1101 Service Sites responded 33% Using EHRs 32% Planning or implementing EHRs 35% No EHR implementation plans
Variation in certification level, vendor, and functionality
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+Next Gen 14%FL Dept of Health Management System 11%Netsmart Insight 9%VistA 9%Greenway (Vitera) 8%eClinicalWorks 5%Custom 5%SuccessEHS 5%Centricity/Logician (GE) 4%Epic 3%Ahlers (FPAR data only) 2%Allscripts/Eclipsys 2%Mitchell & McCormick 1%PatTrac 1%AdvancedMD (ADP) 1% … and others
Reported EHR systems in use
August 2013 | N=3,489 sites
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+Top Commercial EHRs by Service Delivery Type
68%
13%
60%
38%
31%
86%
38%
7%
0.01
0.02
0.13
1%
2%
11%17% 0.13
All other commercial vendors Next Gen FL HMS Netsmart Insight
Greenway VistA
FP group
Other Private Non-Profit
Health Dept
FQHC
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August 2013 | N=3,489 sites
Common tools to
record and exchange
data
Diverse network with specific local needs, multiple reporting structures
Variety of tracking and reporting systems
Understand performance at finer granularities and in real-time
National improvements in electronic data capture and exchange
High individual costs to support infrastructure of data capture and exchange
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The Way Forward: Encounter-level data from Title X service sites used for performance measurement
Operationalize QFP Recommendations
Achieve NQF endorsement
Provide performance feedback
Validate 2.0 elements & measures
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Title X
Federal partners
Subject matter stakeholders
Technical expert organizations
Title X
Federal partners
Subject matter stakeholders
Technical expert organizations
Study EHR implementation status & systems
Pursue feasibility of data exchange & transition to encounter-level data
Work within SDOs
Standardize & document family planning services
Promote family planning integration in healthcare
Assess EHR Use and Challenges Promote Quality FP Care
Develop Structured FP Data Collaborate with Partners
+Emphasis on Quality Framework17
Gavin, et al. Providing Quality Family Planning Services: Recommendations of CDC and US Office of Population Affairs. MMWR Apr 2014. PMID: 24759690
+Preparing a Path for Success
Activity Type Timeline
JSI Data System & Feasibility Study
Contract 9/13 - 9/15
ChildTrends Pregnancy Intention Study
Research Cooperative Agreement
9/13 - 9/14
Activity Type Timeline
Contraceptive Effectiveness Measure
NQF Proposal 2013 - 2014
S&I Framework Chlamydia Screening CDS /CQM Pilot
ONC Collaboration 4-12/2014
IHE Family Planning Technical Profile
International Collaboration
9/13 - 2015
Title X
U.S. & Beyond
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2014 2015 2016 2017
Go live with 2.0 systemJul 2017Interoperability Showcase
Apr 2015Connectathon
Jan 2015
Public Comment IHE Profile
Jun 2014
Jul 2014 Sep 2017FPAR 1.0 system contract
Jan 2014 Sep 2016OMB approval of current FPAR forms
Apr 2014 Sep 2017Pilot Performance Measures & Targets
Engage OMB on 2.0
Jul 2015 Dec 2015
Jan 2016 Dec 2016OMB review of 2.0
Preg Intentions StudyJan 2014 Sep 2014
Jan 2014 Sep 2015JSI Data System & Feasibility Prep Contract
Jan 2014 Aug 2015RFD and CQF pilot activities
Jan 2014 Apr 2016Market research for 2.0
Fund & solicit 2.0May 2016 Sep 2016
Build & test 2.0 systemOct 2016 Apr 2017
Phase into 2.0 systemJan 2017 Sep 2017
Comprehensive 2.0 Activities Timeline
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+ Query pilot?
+
IHE Family Planning Profile using RFD
Title X EncounterPlease Confirm:
Site:
Visit Date:
SD-3024
6/1/2017
+Reminder of SDC
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+Family Planning Profile at 2015 Connectathon
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Mock Repository& Forms system
1
2
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Send request for FP form Pre-populate
form with mappings, send back
Display form, allow for manual corrections
Send completed Family Planning Document (CDA)
+IHE profiles: SDC vs. FP
The Structured Data Capture (SDC) Content Profile provides specifications to enable an electronic health record system or other application to retrieve a data capture form and submit data from the completed form. The SDC profile utilizes the IHE Retrieve Form for Data Capture (RFD) Profile and an ISO/IEC 19763-13 Meta-model for Framework Interoperability (MFI) form compliance model. This profile also supports optional use IHE Data Element Exchange (DEX) profile for retrieving and submitting forms in a standardized and structured format.
The Family Planning (FP) Profile describes the content and format to be used within the pre-population data part of the Retrieve Form Request transaction from the RFD Integration Profile. It is expected that the Form Filler and Form Manager will implement the RFD transaction as specified in the RFD, and this profile does not include any additional constraints or extensions on the RFD transactions.
+Actor diagrams: SDC vs. FP
Retrieve Form [ITI-34] ↓
Submit Form [ITI-35] ↓
Archive Form [ITI-36] ↓
Retrieve Form [ITI-34] ↓
Submit Form [ITI-35] ↓
Archive Source
Documents [QRPH-36] ↓
Form Filler
Form Processor
Form Archiver
Form Manager
Form Receiver
+Pre-population: SDC vs. FP
Form Filler / Metadata
Consumer
Form Manager / Metadata
Consumer
Form Archiver
Form Receiver
Retrieve form [ITI-34] Request
Retrieve Form[ITI-34] Response
Auto-population
Metadata Source
Retrieve Metadata
[QRPH-44]
Pre-population
Submit Form [ITI-35]
Metadata Source
Retrieve Metadata
[QRPH-44]
Archive Form [ITI-36]
Display Form
Review andComplete Form
+ IHE FP profile aligns FPAR 2.0
Contraceptive Method at ExitDate of Last Pap testHPV Co-test OrderedCT Screen OrderedGC Screen OrderedHIV Screen OrderedHIV Rapid Screen ResultHIV Supplemental ResultReferral Recommended DateReferral Visit Completed DateSystolic blood pressureDiastolic blood pressureHeightWeightSmoking status
Facility identifierClinical Provider identifierPatient identifierVisit DateDate of BirthAdministrative SexPregnancy HistoryLimited Language ProficiencyEthnicityRaceAnnual Household IncomeHousehold SizeVisit PayerCurrent Pregnancy StatusPregnancy IntentionSexual ActivityContraceptive Method at IntakeReason for no contraceptive method (Intake and Exit)
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Next Steps :Public Comment, Vendor Outreach, Testing, Other Pilots
+ASK28
IHE Public Comment Period ends July 5 2014 transparent critique and review by
FP experts, including international stakeholders EHR vendors IT and standards experts
Recruitment of vendors to certify for FP at the January 2015 Connectathon
Scope out another pilot project on query-based model?
Participation on S&I CQF Chlamydia Use Case and pilot
+Contact Information
@OPAHIT
http://opahit.sites.usa.gov/
+
More Details
+Common reporting burden among Title X sites
0.4
0.28
0.21
0.11
Medicaid
Other Fed & State
Title X
Private & fees
FundersReported Revenue Sources 2012
FPAR
Quality & Performance
BPHC-UDS
HAB-CAREWare
PCMH
Organizational
Public Health reporting
Immunizations, cancer registry, chronic
disease registries, notifiable diseases,
syndromic surveillence,
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+Difficult to finding meaning across siloes and reporting hierarchies
HIV Family Planning
Primary Care32
Patient
Provider
Practice
Community
Quality
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+Draft Performance Measures
Measure Source Aligns with
Proportion of sites that dispense or provide on-site a full range of contraceptive methods
AGI clinic survey, PIMS
Clinic survey, HP2020
Proportion of female users at risk of unintended pregnancy who adopt or continue use of the most effective or moderately effective FDA-approved method of contraception.
PIMS NQF proposal, HP2020
Proportion of female users ≤ 24 years who were identified as sexually active and who had at least one test for Chlamydia during the measurement year
PART, PIMS
HEDIS, HP2020
Proportion of users ≥18 years of age who had their BMI documented during the measurement year.
QFP HEDIS, HP2020
Proportion of users who were screened for hypertension during the measurement year.
QFP HP2020
Proportion of users who were screened for tobacco use during the measurement year.
QFP HP2020, Meaningful use
Proportion of users who stated clear childbearing intentions. IOM, PIMS
*TBD*
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+Proposed NQF Performance Measures for Contraceptive ServicesProportion of female clients aged 15-44 years who received contraceptive services in the past 12 months, that adopt or continue use of FDA-approved methods of contraception that are:
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1. Most effective
OR
• male or female sterilization • implants• intrauterine devices (IUDs)
moderately effective • injectables• oral pills, patch, ring• diaphragm
2. Long-acting reversible methods of contraception (LARC)
• implants• intrauterine devices (IUDs)
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Updated Proposal
Data System & Feasibility StudyExpert
Working Group
Proposal for New Data Elements
Customization Guide
Survey Possible
Participants
Evaluate for final selection
- N clients- N sub sites- Current data systems- Location- Interest & capacity
9 Grantees
- Compare proposal to current system- Estimate burden to change- Qualitative interview about processes and data systems
Survey ? sites
Rate each data element:- Clarity- Ability to collect- Modifications needed
to systems- Report @ encounter-
level
+ Subject Matter Stakeholders
Current national partners:
New national & international partners we’re reaching out to:
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+Beyond Title X
All interoperable solutions should be designed to have broad applicability outside Title X providers Primary Care, Health Centers, Health Departments Emergency Departments International settings
Common data elements and their definitions will satisfy evidence-based performance measurements and other benchmarks Input is welcome on data elements, definitions, and quality metrics
HIT Infrastructure developments sponsored by OPA will pave the way for other providers to adopt these tools in their own systems
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+ HIT Success Stories in Title X
HRSA BPHC Health Center Controlled Network (HCCN)East Providence, RI NCQA PCMH L3, HCCN, & Title XEHR system: NextGen
NFPRHA Case Study of group EHR purchasingIndiana Family Health CouncilEHR system: iSalus
HHS ONC Case Study of EHR implementationPortland, ORFQHC & Title XEHR system: Epic
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Timeline for IHE Connectathon Ask
2014 Apr May Jun Jul Aug Sep Oct Nov Dec Jan2015 2015
Connectathon to Certify FP Profile
Jan 26
Ask Vendors to Review FP ProfileApril
2014 June 2014
May 2014 August 2014Follow-up with Vendor contacts
Vendors Comment on FP ProfileJune 2014 July 2014
Ask Vendors to ConnectathonJuly 2014 September 2014
October 2014Vendor Engagement
Vendor Development January 2015September 2014
August 2014
+Vendor Outreach
Seeking CDA technical input
Support to develop and test
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