781-890-7446 Health Delivery Services May 29, 20090 Eastern Massachusetts Healthcare Initiative Policy Work Group Session 2 May 29, 2009.

781-890-7446 Health Delivery Services May 29, 2009 1

Eastern Massachusetts Healthcare Initiative

Policy Work GroupSession 2

May 29, 2009


Agenda

• Progress and Remaining Activities

• Resolution of Previous Issues

• New Questions and Issues

• Policy Framework Document

• Next Steps


Policy Group Work Session Plan

Period Agenda Preparation

Thru May 8Complete

• Obtain agreement on approach, schedule, and work group membership

• Obtain agreement on scope• Review general principles• Review policy document outline• Review example policies• Review open questions/issues

• Request existing policies from work group members and other groups

• Research policies from NEHEN/MA-SHARE and other sources

• Document principles• Develop policy document outline• Develop example policies• Document open questions/issues

May 29 • Hold Policy Work Group Meeting:• Review draft policies• Review open questions and issues• Assign follow-up responsibilities

• Develop additional policies

June 5 • Distribute interim work products to Advisory Group

• Prepare presentation outlining framework, content, open questions/issues

June 12 • Send policy framework to other EMHI members for review

• Update framework• Prepare summary presentation

June 19 • Hold Policy Work Group Meeting:• Review final framework/policies• Review open questions and issues• Assign follow-up responsibilities

• Develop/update policies• Finalize policy document• Draft plan for maintaining policies• Draft communication plan

June 26 • Present framework to Advisory Group • Prepare presentation outlining framework, content, open questions/issues


Policy Guiding Principles

• General– Decisions Based on Guiding Principles

– Openness and Transparency

– Patients’ Rights

– Patient Access and Participation

– Data Collection and Use Limitation

– Privacy and Security Policy Compliance

– Coordinated Decentralization

– Broad Adoptability

– Anticipation of Change

• Technical– Open Standards

– Federated Data Architecture

– Flexibility and Agility

– No Rip and Replace

– Multiple Implementation Models


Definitions

• Participant: A Provider Organization, Payer Organization, or Other Organization that has directly entered into a Data Sharing Agreement with NEHEN, accesses Protected Health Information via NEHEN, and actively participates in the exchange of electronic healthcare data via NEHEN.

• Sending Participant: A Participant engaged in sending clinical data to another Participant via NEHEN.

• Receiving Participant: A Participant engaged in receiving clinical data from another Participant via NEHEN.

• Sending User: A person who is associated with a NEHEN Participant and sends clinical data via that association.

• Receiving User: A person who is associated with a NEHEN Participant and receives clinical data via that association.


Policy Questions and Issues:Resolutions for Review

• What is NEHEN’s responsibility as regards Participant compliance with data sharing agreements and policies? Assume compliance or audit for compliance?

– Resolution: Create a "statement of compliance" and require a legal signatory of the Participant to sign on an annual basis. The statement should include the right to make unannounced audits regarding privacy at any time.

• Should all disclosures be reported to a patient upon patient request, or just selected disclosures?

– Resolution: Report on all disclosures based on available data. Provide capabilities for Participants to use local NEHEN audit logs in their disclosure reporting work flows.

• What should be the baseline for privacy and security protection—meeting minimum legal requirements or developing/meeting community best practices?

– Resolution: Meet minimum legal requirements. Review Participant practices, and consider common practices for “best practice” implementation.


Policy Questions and Issues for Discussion:Responsibilities of the Exchange

• Do we need to define the purpose of the exchange to address the issue of the Receiving Participant/User’s liability (e.g., lab results received by a physician other than the physician who ordered the test)?

– Examples:• The intent of the exchange is to support “live care”

• The intent of the exchange is to support “better care management”

• Must NEHEN restrict participation in order to comply with legal requirements, including state laws?

– Examples:• May individuals and organizations operating in/licensed in New England states other than

Massachusetts be users of the clinical data exchange? Must NEHEN policies address requirements for those states (e.g., sensitive information requirements)?

• Can an organization operating in/licensed in another state be made responsible for compliance with that state’s laws?

• May an individual operating in/licensed in another state be a user of the exchange?


Policy Questions and Issues for Discussion:Responsibilities of the Exchange

• Are NEHEN and/or Participants responsible for :– Attempting to influence legislation?

– Educating the public about the exchange of clinical data?

– Informing users of the potential for increased liability due to increased availability of information?

– Informing or training Users on appropriate use of the exchange?


Policy Questions and Issues for Discussion:Responsibilities of Persons/Organizations Receiving Messages

• Must a Receiving Participant/User view a message received from an external source?

– Examples:• May a receiver “turn off” receipt of some or all messages?

• May a receiver “reject” a message that has been appropriately addressed?

• May a receiver discard a message without viewing it?

• What are a Receiving Participant/User’s responsibilities for acknowledging a message?

– Examples:• Notify the sender that the message was received.

• Notify the sender that the message was delivered to its final destination.

• Notify the sender that the message could not be delivered (i.e., “addressee unknown”)

• Notify the sender that the message was addressed to the wrong recipient (i.e., “not me”)

• Must a Receiving Participant/User retain a message received from an external source?

• May a Receiving Participant/User specify preferences for how/when they receive messages regardless of message type (e.g., “as soon as available”, “bundled” at end of day)?


Policy Questions and Issues for Discussion:Responsibilities of Persons/Organizations Sending Messages

• May/must a Sending Participant/User include in a message information that was received from an external source (i.e., not originally collected by the sender)?

– If so, should it be identified as having come from an external source?

• Must a Sending Participant/User resolve ambiguous destinations for a Receiving User (e.g., a physician who practices in multiple organizations or physical locations)

– May/must a Receiving User identify a “preferred address” for cases where the ambiguity is not resolved?

• May a Sending Participant/User specify preferences for how and when messages will be delivered (e.g., specify urgency or method of delivery)?


Policy Questions and Issues for Discussion:Provider Registration/Addressing

• May a message be addressed to an organization rather than an individual (e.g., a clinic or a CHC)?

• May a message be addressed to a Receiving Practitioner who is other than a licensed care provider?

• May a message be addressed to a Receiving Participant who acts as an intermediary for practitioners (e.g., a vendor offering portal access)?

• Must a Receiving Practitioner be affiliated with a Receiving Participant organization for the purpose of authentication, authorization, and routing?

– Examples:• California pediatrician refers patients to Children’s and wishes to be “added” as a Children’s user.

• MMS or a vendor wishes to offer portal access.

• NEHEN wishes to make access available via the NEHEN Portal.

• Must NEHEN or the Participant organization obtain a provider’s consent to register the provider in the community directory?


Next Steps

• Distribute update to Advisory Committee week of June 1

• Incorporate today’s decisions and redistribute draft for Policy Group review week of June 1

• Distribute draft document and summary presentation to EMHI members not represented on Policy Group week of June 1 or June 8

781-890-7446 Health Delivery Services May 29, 20090 Eastern Massachusetts Healthcare Initiative Policy Work Group Session 2 May 29, 2009.

Documents

nehen participant

policy questions

review draft policies

review example policies

policy document outline

clinical data

health delivery services

policy document draft