February 10, 2016

Common Credentialing Advisory Group Meeting

• CCAG Membership and Charter Update• Procurement Update and Harris Introduction• Programmatic Details• Upcoming Work

– Convening the RAC– Fee Development

• Public Testimony

Agenda

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CCAG Membership• Final candidates to represent:

– Hospitals– Health Plans – Independent Physician Associations (IPAs)

• Appointments to be approved by OHA Director• Renewal of expiring memberships• Revisit at the April CCAG meeting

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Charter Update• CCAG Charter updated to reflect current work• Highlighting the Legislative Requirements

– SB 604: program, database, convene CCAG, develop rules, issue RFI, report to Legislature

– SB 594: establish implementation date with six months notice, report to Legislature

• High-level timeline through implementation• Feedback and comment by February 19th

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Procurement Update

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HARRIS INTRODUCTION AND HIT PORTFOLIO UPDATE

GEORGE WEBBER: PROJECT MANAGERLEW PEARSON: TECHNICAL LEAD

Harris Overview• Leading technology innovator, solving

mission-critical challenges through advanced, technology-based solutions for government & commercial customers

Harris in Healthcare• Entered domain in 2006 with vision of bringing data processing

technologies used in defense areas to help solve challenges of health care, including:– Increasing interoperability – Making clinical and administrative workflow more efficient– Strengthening collaboration across the continuum of care

• Founded in 1895• More than 22,000 employees,

including 9,000 scientists and engineers

Systems & Network Integratio

n

Cyber Security & Information Assurance

Managed Services

Health Records Sharing

Secure Infrastruc

ture

Interoperability

Clinical Research Support

• Harris became the prime contractor for the Oregon HIE (Health Information Exchange), branded as CareAccord– CareAccord went live in May 2012– Offers statewide portal accounts for Direct Secure Messaging

and its Provider Directory

Areas of Expertise:

HIT Portfolio Project OverviewAs the HIT Portfolio System Integrator (SI), Harris will provide Health Information Technology (HIT) Solutions and Services, including: • Accountability for delivering HIT Portfolio Solutions• Project and risk management• Technical requirements, architectural roadmap and implementation design for

the integration of HIT Solutions• Systems integration ensuring interoperability of the HIT Solutions while

maintaining privacy and security• Prime contractor for best-vendor solutions (subs) and ongoing operations

support• Successful adoption of each HIT Solution (including outreach, change

management and end user training)• Integration of three new individual HIT Solutions:

1. Common Credentialing 2. Provider Directory 3. Clinical Quality Metrics Registry

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HIT Portfolio Project Overview – cont.

Approach includes two distinct phases - Planning and Design - Implementation

First Contract Amendment – Planning and Design Phase• Conducting the planning and design phase for Common Credentialing and Systems

Integration requirements • Tasks include:

– product evaluations– securing a COTS product subcontractor for the CC solution– procurement– contracting– interface and integration solutions – common access solutions– data management – project management service

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Critical Success FactorsOverall critical success factors that OHA will use to measure the success of the HIT Portfolio and each of the implementation phases: • Stakeholder engagement in HIT Solution selection process;• HIT Solutions are implemented successfully on time and within

budget;• Project Deliverables meet or exceed the stated expectations of

stakeholders as evidenced by system adoption;• A Common Access Solution minimizes the effort for users to

access solutions as evidenced by positive user feedback and reviews; and

• System interoperability Deliverables are met, as evidenced by efficiencies in data sharing and reductions in redundant data collection between and among State agencies and external stakeholders.

Blue: Planning PhasesBrown: Implementation Phases

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Jan 2016

Feb 2016

Mar 2016

Apr 2016

May 2016

Jun 2016

Jul 2016 - - - - - Dec

2016Jan2017 - - - - - Dec

2017

                       

                       

CC Solution

                       

Planning & Design Phase (6 Months)

Architecture Design

Common Credentialing Project Summary

Implementation Phase (TBD Months)

Vendor Selection

Requirements Definition

Vendor Product Selection Process

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Technical Analysis - Introduction

• Enterprise Architect Modeling Tool– World class modeling tool incorporating requirements, use case, workflow, and

data modeling– Modeling goals

• Incorporate all CC, SI (System Integration) requirements into the Model• Map all requirements to Use Cases• Sequence Use Cases into Workflows• Generate Deliverables

• Technical Outputs– Analysis is providing input for Requirements Traceability Matrix, Integration

Requirements Specification, and Current & Future State Business and Technical Workflow Process

– These will be inputs for the Request For Proposal and Vendor Selection Process

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Technical Analysis – Progress

Progress– All CC and SI requirements are in the model– Use Cases: 84 defined Use Cases, requirements being mapped– Workflows: 11 defined Workflows, Use Cases being mapped

• 20+ Workflows to be entered into the Model

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Requirements Analysis

• Requirements Analysis = Role + Use Case + Data

• Roles (users, systems, organizations) are determined by interviewing staff/SMEs and by analyzing requirements

• Each Role can “execute” different Use Cases

Workflow Analysis

• Determine the interaction and conditional flow between Use Cases

• Determine the interaction, flow and responsibility between different Roles

Modeling Methodology

Sample Use Case Diagram

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Sample Workflow Diagram

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Provider Data Alignment • OHA engaged stakeholders such as the Advisory

Committee on Physician Credentialing, credentialing subject matter experts, and the Provider Directory Advisory Group

• Agreed on value of adding data elements to the common credentialing solution with some considerations:– A handful of elements okay; but too many is not– Do not add much in complexity or cost– Minimizing provider burdens is important– Could be a separate, but connected solution

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OHA’s Intent to Proceed• Intend to explore cost and feasibility of including

some of the additional data types via the RFP:– Office hours/provider availability (per clinic affiliation)– Accepting new patients (general and Medicare/Medicaid)– Foreign languages (indication of written, spoken, or both)

• Assess vendor capabilities, cost, complexity• Engage stakeholders on findings/recommendations• In line with stakeholder advice/concern:

– Data are important, BUT…– Additional delay or extreme cost should be avoided

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Delegation Agreements

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• Existing process to create efficiencies • Involves 3rd party information sharing • DAs could impact the viability of the common credentialing

solution and play a part in fee fluctuations• Department of Justice Opinion:

– DAs not purposefully excluded from legislation– Should allow practitioner credentialing information to be

shared with delegating entities only if the practitioner allows it– Rules should clarify instances in which entities which can

enter into DAs to be consistent with telemedicine DA rules• Subject matter expert opinions:

– Practitioners should know where their information may shared

– Third party sharing not necessary with OCCP– Necessary to eliminate transactional fees

Credentialing Decision

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• Informs practitioners of where they are credentialed• Directs notifications to right credentialing organizations• Department of Justice Opinion:

– Continued access to credentialing information after denial or termination violates confidentiality

– Application could indicate permission for release continues until such time as practitioner revokes authorization or identifies different entities as authorized recipients of the information

• Subject matter expert opinions:– Must have a way for practitioners and credentialing

organizations to discontinue relationships; not to be shared– Record pull can indicate start of relationship– Should create rule that practitioners and credentialing

organizations must report discontinuances

Stakeholder Informed OptionsDelegation Agreement Options:

1. Do not track2. Track delegation agreements, but not delegated practitioners

3. Track delegation agreements and workflow

Credentialing Decision Options:1. Track credentialing decisions

2. Allow the discontinuance of relationships

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Intent to Proceed• Delegation Agreements:

– Allow delegation agreements to extent efficient (roster scenario, quality control purposes)

– Third party information sharing not necessary– Require reporting of delegation relationships, not delegated

practitioners – Add disclaimers that information may be shared via delegation

arrangements as practitioner approved• Credentialing Decision:

– Do not track decisions– Allow discontinuances by practitioners and credentialing

organizations• Fee Structure: Replace transactional with annual subscription

22Rules must be developed to these intentions

Upcoming Work• Convening the Rulemaking Advisory Committee• Continued Fee Structure Development• Marketing and Outreach Strategy Development• Procurement activities (demonstrations)

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Public Testimony

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More information can be found at:www.oregon.gov/oha/OHPR/occp

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