WSHIMA 2016 Annual Mee1ng

April 29, 2016 Lynnwood, WA

The New Statewide Clinical Data Repository

Session Objec1ves

• Background–howwearrivedhere• TheWALink4HealthClinicalDataRepository(CDR)• ClinicalinformaDonexchange,thestateHIEandaccessingtheCDR• DatasegmentaDon,privacyandsecurity• ParDcipaDonrequirements• TheRoleoftheHIMProfessional• GeMngstartedwiththeCDR

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The Framework for Strategic Ac1on

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“Wewillhavefailedthoseweserveifwedon’tovercometheinteroperabilitychallengesthatmakeitdifficulttodeliverconnectedandcoordinatedcare.”

Mee1ng Emerging Needs

SponsorClinicalDataRepository

(CDR)Pla5orm

Moreorgsgoingatriskforperformance,needinfo/analy>cstohelpmanagethatrisk

Neworganiza>onalarrangements(ACOs)requirecapabili>esoutsidetradi>onalenterpriseHITresources

Needsincluderepository,analy>cs,repor>ng,individualcareandpopula>onmanagementtools

DataneedsgobeyondcurrentclaimsandADT,includeclinicalsummaries,care

plans,assessments

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The Strategy: Advance Health IT Beyond Organiza1onal EHR’s with a CDR

• TheWALink4HealthiniDaDveispartoftheState’slong-termeffortstoimprovehealthcarequality,beVermanagecostsandimprovehealthoutcomesforallWashingtonians.• HCAisiniDaDngWashingtonLink4Health,amulD-yeariniDaDvetoadvancethestatewideelectronicexchangeofnearrealDme,consolidatedclinicalrecords.

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Staged Implementa1on- Mul1 Year Effort

• IniDalservicespurchased– Clinicalportal– ReporDngportal

• ImplementaDonunderway• IniDallivescommiVed

– AppleHealthEnrolleesassignedtoManagedCare(1.4M)– MorelivesoverDmesuchasPublicEmployees,feeforservice,othersponsors.

• IniDaldatasets– CareSummariesfromProviderEHRsystems– Eligibilitydata– Claims/Encounterdata(6mthinclinicalportal&2yearsinreporDngportal)

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What is the Clinical Data Repository? • AClinicalDataRepositoryorCDRisadatabasedesignedtocollectandindexclinicalcontentforspecificuses.– CreatealongitudinalviewofallcareprovidedonasinglepaDent(paDent-centric,point-of-careaccessforpracDDoners)

– ClinicalPortal– AggregatedatathatcanbeusedinpopulaDonanalyDcs– AggregatedataforperformancereporDngtoprovidersacrossalllivesmanagedbytheprovider

– ReporDngPortal

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Par1cipa1on in Link4Health Helps Meets Stage 2 MU Requirements

• DriveadopDonofclinicaldatasharingviatheStateHIEthroughpurchasingeffortsandMeaningfulUse.• ReducetheneedtobuildexpensivepointtopointinterfaceswithmulDpletradingpartnersoutsideyourorganizaDon.• EnableeligibleprofessionalsandhospitalstomeetMUrequirementsandtapintoremainingincenDves.

Note:HCAisworkingwithCMStoensurecontribuEngdata(CCDA)totheCDRmeetsMUrequirementsforexchangingsummariesofcareacrossvendorplaMorms.

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CDR Features and Benefits

•  Leveragesstandardsforsharingclinicalsummaries•  SupportsclinicaldataexchangewithorganizaDonswithoutsimilarplaborms•  OfferscommonplacetoshareinformaDonforthoseparDcipaDngindifferentarrangements•  AggregatesclinicalandadministraDvedataintolongitudinalpaDentrecord•  AvailablebeyondMedicaidandPEB

•  MayhelpprovidersmeetongoingMeaningfulUseObjecDvesandqualifyforaddiDonalincenDvepayments•  ProvidesthecareteamamorecomprehensiveunderstandingofthepaDent’smedicalhistory.•  ProvidesmainstreamqualityreporDngcapabiliDes•  EnableslargedataextractsforadvancedanalyDcsandpopulaDonhealth

Features Benefits

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CDR Portals

• Clinical:ViewindividualpaDenthealthinformaDonforcaredecisionsandcoordinaDon.– Buildscomprehensivemedicalrecordincludingdiagnoses,meds&allergies.– EnablesdatasharingregardlessoftheEHRvendorsystem.– ProvidesasinglesourcetoviewfullpaDentprofileandmedicalrecord– ResultsinloweradministraDvecostsandimprovedpaDentsafetybyloweringthefrequencymedicaDonerrors

• Repor>ng:Viewaggregatede-idenDfieddataforclinicalqualityreporDngandpopulaDonmanagement.– Receive,parseandsortclinicalandadministraDveinformaDonfromavarietyofsourcesandinvariousformsandformats.

– Usea“digitalenvelope”toinformclinicians,providingreal-DmereporDngonpaDentqualityatthepointofcare.

– Storedisintegrateddatasothatphysicianscanaccessdatatheyneedtodeliverevidenced-basedmedicineandhighqualitycaremanagement.

– Develop,interpretandreportonstandardCMSandstatespecificqualitymeasures.

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High Level Timeline and Gates

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What Does Provider Par1cipa1on Look Like?

• January2016MCOssentHCA’s“ProviderPar>cipa>onLeQer”totheirprovidernetworks:

hVp://www.hca.wa.gov/HealthIT/Documents/Provider%20Requirements%20LeVer%202015%2012%2021.pdf

LeQerContained:

1.IntroducDontotheCDRtotheprovidercommunity2.ListofthethreecriteriadefiningwhoisrequiredatthisEme -ContractwithMCOtocareforAppleHealthenrollees

-Haveanelectronichealthrecord-Havea2014cerEfiedEHR3.ClarificaDonforprovidersthattheyneedtobegingeMngreadysooninpreparaDonfortheFebruaryof2017deadlinetobecontribuDngdata4.Linkto“howtogetstarted”tools

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C-CDA=(ConsolidatedClinicalDocumentArchitecture)–modular

Na>onalstandardforclinicalinfoexchange

Cer>fiedEHRsdesignedtoexportandingestC-CDA

Earlyinthegame–aworkinprogress

C-CDA – Clinical Document Standard

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CDR Business Model

• SponsorpaysforCDRcosts• TradingPartnersmustbecomeHIEParDcipants– Mosthospitals,somepracDcesalreadyparDcipateinHIE

– HIEParDcipantsexecuteacommoncontractualframework

• HIEParDcipantspayasingleannualsubscripDonfee– Coversallservices,notransacDonfees

• HIEParDcipantannualsubscripDonfeesderivedfrommatrixbelow

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AnnualOrganizationRevenue AnnualSubscriptionFee $0–$10Million $600

$10Million–$100Million $6,000

$100Million–$500Million $12,000

$500Million–$1Billion $24,000

$1BillionPlus $48,000

EHR Vendor Role VendorsplayacriDcalroleinsupporDngproviders’abilitytomeetC-CDAdatacontribuDonrequirements

EnsureC-CDAmeetsfileformatconformanceagainstna>onalstandardWorkwithprovidertoclassifydataasN,RorVSet-upconstraintsforC-CDAmessageheaderAllowparameterstobesetbyprovidertotriggerdatasubmissionperSponsorspecifica>ons

AutomateC-CDAdatasubmissionprocesstotheCDR

OneHealthPortEngagedwithEHRVendors

• OHPworkingwithEHRvendorstoaddresstechnicalrequirements• WhatyourEHRvendorhastodotosubmitaC-CDAtoCDRwilldependonwheretheyaretoday• OHPschedulingwebcastsforEHRvendors/technicalITstaffandotherpracDcestaff• CDRTechnicalWebcastsign-uplinkhVps://onehealthport.formstack.com/forms/cdr_technical_webcast_registraDon

•  CDRProviderStaffWebcastsign-uplink:hVps://onehealthport.formstack.com/forms/cdr_clinical_webcast_registraDon

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Access Controls and Data Classifica1on

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•  AuthenDcateconnecDons

•  UseProviderDirectorytoroutemessages

•  Facilitateexchangeofstandarddata

•  HostAPI/webservices•  APIDirectory•  StandardsPropagaDon

C-CDAResponsetoAPIQueryfrom/toEHR

HospitalEHRspushC-CDAtoCDRapereachMedicaidencounter.AperacriDcalmassofdataisreached,hospitalscandrawC-CDAfromCDRintotheirEHRthroughtheHIE,orviewCDRthroughsecureportal.

Push

EHRpushesC-CDAtoCDR

ViewonlyuseoftheCDRusingPortal

Accessing the CDR Sponsorbulk

loadsclaimsandeligibilitydata

SponsorandotherauthorizedparDescanaccessreports

and/ordata

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Data contributed to the CDR is classified to provide confiden1ality, data integrity and user

accountability

Data Classifica1on conforms to HL7 na1onal rules.

Organiza1ons contribu1ng data are responsible

for classifying the data prior to submiang to the CDR

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Data Classifica1on • CDRdatasubmissionsmustbeclassified– DataclassificaDonperHL7specificaDons– ClassificaDonprovidesconfidenDality,dataintegrity,anduseraccountability

• OrganizaDonscontribuDngdataareresponsibleforclassifyingthedatapriortosubmiMngtotheCDR

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CDR Access Levels • AccesscontrolisdelegatedtotheproviderenDty• LeveragetheOHPSingleSign-Onservice• Sevenaccessrolesareestablishedforthefirststage• AppropriateaccessguidedbytwokeyquesDons:

– WhatlevelofpersonallyidenDfiableclinicaldatadoesthisuserneed?

– WhatneeddoesthisuserhaveforpopulaDon-levelreports?

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Repor1ng • Reportsbasedonaggregatedclinicalandclaimsdata– Clinicalsummarydatacontributedbyprovidersaperencounter– 2yearsofhistoricalclaimsplusmonthlyupdates

• IndividualProvider,Team/Dept.,OrganizaDonandSponsorviewsofdataavailable• DimensionsreportsmaptotheQualityMeasuresthatSponsorshaveelected:– Financial(e.g.,highcostpaDents,providers,PMPM)– ACOReports– PQRSReports– HEDISStarMeasures– WashingtonStatePerformanceMeasureSet

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Safeguarding Privacy and Confiden1ality

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• HCAiscommiQedtopa>entprivacyandaccuracyofpa>entrecords• CurrentEffortswithinter-agencyprivacyworkgroup:– OpennessandTransparencyprinciples– Datacollec>on,useanddisclosureprinciples

– Safeguardprinciples(administra>ve,technical,physical,etc)

The Role of Health Informa1on Management

• ReinforceinformaDonregardingthepurposeandbenefitsoftheCDR

• CollaboratewithITandclinicalleadershiponreadinessacDviDes(role-basedaccessandbusinessprocessanalysis)

• ProvideanyguidanceneededregardingtheclassificaDonofdatafordataexchange

• ReinforcewhatdataexchangeisallowableunderHIPAA• Contributecomments/feedbacktoSAMSHAregarding42.2CFRproposedrule-making

• ReinforceneedforstafftocompleteCDRtraining

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Geang Started With the CDR

CDRStartPageprovidesallthestepsneededforproviderstoonboard,testandcontributedatafortheWashingtonLink4HealthCDRiniDaDve

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Next Steps/Ques1ons • HCAandOneHealthPortwelcomeopportuni>estoexpandontoday’ssummaryoverview• Generalques>onsaboutCDRpar>cipa>onemailourHCAHealthITteamatHealthIT@hca.wa.gov

(Put“CDR”inthesubjectline)• ForQues>onsaboutyourMCOcontract:contacttheproviderrepresentaDvefortheMCO• Visitourwebsite:www.HealthIT.wa.gov

– Shortinforma>onalwebinars– FAQandDecisionTreeregardingCDRpar>cipa>on– Otherhelpfulreferencematerials

• Generalques>onsaboutpar>cipa>ngintheHIEorconnec>ngtotheCDR:hVp://www.onehealthport.com/HCA_CDR

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