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Update on Health Information Exchange Better Health Conference Allan Hackney June 6, 2019
Update on Health Information ExchangeBetter Health Conference
Allan Hackney June 6, 2019
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Today’s Topics…
1. HIE entity
2. HIE governance model
3. Trust Framework
4. Use Cases
5. Timeline and next steps
Health Information Exchange (HIE) Entity
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Statewide stakeholder engagement identified the need for trust:
• “Neutral” – no participant in the services is advantaged over any other
• “Trusted” – the services are overseen by representatives reflective of the participants
Incorporating a non-governmental entity to ensure stakeholder buy-in:
• Non-profit, public good entity• Will deliver the core services to manage
identity and facilitate health data exchange• Adapting a trust framework that sets forth
stakeholder engagement
Establishing a Delivery Vehicle
HIEEntity
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HIE Governance and Trust Framework
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Entity Management
Entity Operation Advisory
Committee
Entity Board
BYLAWS
Data Stewardship& Governance
Issue Remediation Privacy
Technical, Operations, Cybersecurity
Use Case
(Role = Fiduciary)
(Role = Self-Regulation)
The HIE Trust Framework establishes the Operations Advisory Committees:
• Created in the spirit of “Neutral and Trusted”
Qualified Trusted Data Sharing Organizations may designate members of the HIE’s Operations Advisory Committees
Entity Management will rely upon the Operations Advisory Committees to guide priorities and address concerns
HIE Board has ultimate fiduciary governance authority
• Control is held by non-state board members
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Trust Framework – Legally Connecting to the HIE
Step Two: Execute Use Case Exhibits (UCEs) to share information
Step One:Execute one of the following agreements to join the network:
(1) Qualified Data Sharing Organization Agreement (QDSOA) or(2) Simple Data Sharing Organization Agreement (SDSOA)
Legally Connecting is a Two-step Process…
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HIE Organization AgreementsHIE Organization Agreements createTrusted Data Sharing Organizations
Both agreements spell out basic business and HIPAA Business Associate terms:
• Note: no data is shared by executing these agreements!
Difference between Simple and Qualified agreements:• SDSOA and QDSOA cover all the same terms, but…• QDSOA can be modified to unique issues, e.g.:
• Cyber liability limits• Statutory constraints
• QDSOA participants may designate individuals to participate in HIE operational governance
Trust Framework creates a highly-modular method toparticipate in the HIE!
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A Use Case in general is the interaction between a system and the users of that system to produce results of value
HIE Will Operate Based on Use Cases
Defines the reason for the Use Case
Diagrams the flow of data
Explicitly defines the data content and transaction rules
Lays out explicit permissible uses of
the data
Defines service level expectations for the
Use Case
Spells out responsibilities for both senders and
receivers
Technical specifications are
referenced
Unique requirements are explicitly defined
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HIE’s can facilitate many types of use cases…
• Public health reporting• Genomics / precision medicine• Research / clinical trials• Quality measurement (clinical and
cost)• Identity and Care Mapping• Disability determination• Life insurance• Lab orders / results• Image exchange• Opioid monitoring
• Encounter Alerts• Immunizations• Referral Management• Transitions of Care• Clinical encounter notifications• Medication Reconciliation• Chronic Care Management• Advance Directives• POLST/MOLST• Consumer-mediated exchange• Emergency super-utilizers
Green = CT high priority
Health Information Exchange (HIE) Entity?
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HIE Timeline
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Key Takeaways…
1. HIE Entity and Trust Framework guiding principle: “Neutral and Trusted”
2. Trust Framework is highly modular…organizations can choose (and change) the extent of their participation according to their needs
3. The HIE will be organized around Use Cases
4. Data is only shared by signing on to one or more Use Cases
5. Qualified Trusted Data Sharing Organizations may participate in the operational governance of the HIE
We are seeking early adopters to participate in the initialOperations Advisory Committees!
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Health Information Technology Office:Allan Hackney, [email protected]
Health IT Office Website:https://portal.ct.gov/OHS/Services/Health-Information-Technology
Health Information Alliance, Inc. (pending):Sabina Sitaru, [email protected]
Health Information Alliance Website:Coming Soon!
Contacts
Journey on the Path to Building a Medication Reconciliation Use Case
Thomas P. Agresta M.D., MBI
6/6/2019
Objectives• Define Medication Reconciliation
• Describe the Office of Health Strategy (OHS) & UConn Health’s Medication Reconciliation (Med Rec) work
• Describe findings and next steps for CT Med Rec work & HIE Use Case Development
Why Medication Reconciliation?To Avoid MED WRECK
• Medication Errors are Harmful and Expensive– Continuing to take medications discontinued– Taking two similar medications (blood pressure, diabetes)– Not starting or continuing a medication– Using over the counter medications and supplements
• Many are related to incorrect med lists– Multiple Clinical and Pharmacy providers with different HIT systems– Interoperability between systems is problematic– Patients and families with different formats to track current meds
(electronic, handwritten, APPS etc..)
Why HIE for Med Rec?• Getting A Correct Medication List is Complicated
– Technology helps and hurts• > 80% of Providers use an EHR – But they are not fully interoperable• ePrescribing – the norm in CT, including most controlled substances
– No more handwritten prescriptions– Introduces unintended errors, difficulty with de-prescribing
• Health Information Exchange– Tools to consolidate medication lists from several sources– Yet interoperability between systems is limited– Information & Cognitive Overload
• New Interoperability guidance from CMS and Office of National Coordinator– Emerging standards for interoperability– Vendors and Standards agencies working on improving electronic data sharing
• Connecticut has a perfect eco-system to try and introduce innovation– Small state with no legacy HIE infrastructure to deal with
What is Medication Reconciliation “Med Rec”
Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions (Joint Commission)
• This process comprises five steps: • (1) develop a list of current medications• (2) develop a list of medications to be prescribed• (3) compare the medications on the two lists• (4) make clinical decisions based on the comparison• (5) communicate the new list to appropriate caregivers and patientBarnsteiner JH. Medication Reconciliation. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 38. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2648/
Background/Timeline
Summer2017
12/2017 –9/2018
OHS MRP
Workgroup
CT HIE: Office of Health Strategy (OHS)
CancelRx Workgroup
2/2019
CancelRx Report
Med Rec Hackathon
5/20186/2019
4/2019
OHS MRP Report
6/2019
Develop HIE Use Case
6/2019-9/2021
Help Us
Engagement• CancelRx Workgroup
– ~ 50 participants– electronic deprescribing
• Medication Reconciliation Hackathon = 84
• OHS MRP Workgroup– 22 Members, many other
participants
Stakeholders & Workgroups
CancelRx Workgroup 15+ Orgs:
Yale, Trinity, UConn, St Joseph, Hartford Health, CVS, Surescripts, NCPCP, CT Pharm Association, CT VNA, State agencies, EHR and Pharmacy Vendors
Diverse group CMIO CIO PharmD MD Students
OHS MRP Workgroup Experts in Polypharmacy Experts in Medication Reconciliation Representative of DCP Pharmacists Prescribing Practitioner Health IT Advisory Council
representative –Consumer Advocate CancelRx expert Legal expert LTPAC representative Payer representative Pharmaceutical representative Hospital representative State Representation- DSS & DHMAS
Preliminary MRP WG Findings• 1. Best Possible Medications History (BPMH)
• Incremental approach, increasing use of technology as able• 2. Patient Engagement
• Patient-centered, evidence-based, usable tools and education• 3. Medication Reconciliation Process Improvements
• Enable best practices from Joint Commission• 4. Team Approach
• Solutions should permit teams to share data / responsibilities• 5. Deprescribing
• Tools, processes and policies should facilitate appropriate deprescribing• 6. Implementation and Adoption of CancelRx
• Facilitate the ability to electronically cancel prescriptions
*Please note these are still under review and require final approval of the group
Preliminary MRP WG Findings• 7. Technology
• Incremental approach, leverage emerging technology appropriately add analytics and decision support
• 8. SUPPORT Act Funding Planning & Design• Leverage opioid reduction funding and planning
• 9. Aligned Policy• Ensure payment reform, medication safety quality measures, privacy
and security policies are aligned• 10. IAPD Funding - Planning/Design Process
• Secure funding for design and implementation of MRP recommendations as part of HIE funding from CMS
• 11. Continuation of the MRP Work Group• Review construction, process of workgroup to align with outcomes
*Please note these are still under review and require final approval of the group
Next Steps• Publish a MRP White Paper and finalize
recommendations to legislature
• Begin Creation of Med Rec Use Case for HIE
• Develop Business, Functional and Policy Requirements for Medication Management Service
• Structure the set of recommendations to facilitate the design of technical infrastructure for HIE
Contact
UConn Health Center for Quantitative Medicine
Thomas P. Agresta, MD, MBI Clinical and Informatics Advisor to the HITO
