eHealth Advisory Committee Interoperability Plan ...•Revise system-wide information governance to reflect new organizational structure and facilitate compliance with applicable policies.

eHealth Advisory Committee Interoperability Plan Workgroups Update

HHSC eHealth Advisory Committee

September 29, 2017

Interoperability Report Background

• Required by House Bill 2641, Regular Session, 84th

Legislature

• The report should address measurable progress in

ensuring that relevant information systems are

interoperable with one another and meet the

appropriate standards.

• The report must include an assessment of the progress

made in achieving commission goals related to the

exchange of health information, including facilitating

care coordination among the agencies, ensuring quality

improvement, and realizing cost savings.

9/29/2017 e-Health Advisory Committee Meeting 2

Interoperability Report Status

• Initial report submitted 2016

• Established a planning framework

• eHealth advisory committee input• Recommended projects• Measures

• Workgroups established• Business and Technology Operations• Communications• Governance• Infrastructure• Policy and Practice


Potential Interoperability Technologies Descriptive Information

• How is governance addressed?• What functions is the system responsible for?• Stakeholders/Communications plan• System creation date?• System End-of-Life projection date?• What clinical data is included?• With whom is data exchanged?

• Other HHS agencies• Between HHS and health care providers• Research (academic)

• What exchange currently occurs?• Does system currently use accredited standards (some/all

transactions)?• Are accredited standards available? (some/all transactions)• Does system use Health Services Gateway?


Workgroup Reports

• Business and Technology Operations

• Communications

• Governance

• Infrastructure

• Policy and Practice


Business and Technology Operations

• Dr. Ogechika Alozi (Chair)

• A.J. Patel

• Will Rodriguez

• Dr. Gijs Van Oort

Staff: Steve Eichner, Leo Achembong, Peggy Hines

6

Business and Technology Operations - Discussion

• Overview of business services supported through

HHS Interoperability

• Information standards/adoption process used by

HHS agencies

• Data use agreements

• Data sharing

• Use of Health Services Gateway

• Pharmacy systems- ability to track adherence


Potential Interoperability Measures-System Performance

System (Example

s)

Numberof

Clients Served

by System

Numberof Clients Served in

Time Period

Number of

Providers Served

by System

Numberof

Providers Served in

Time Period

DollarValue

(where applicable)

Number ofTransactions

per Time Period Data Volume

Medicaid Claims

(Number of clients in Medicaid?)

X X X X X ?

ImmTrac X X X X X ?

MEHIS(Breakdown?)

X X X X X ?

StateHospital EHR

X X ? ? X ?

Lab Orders

X X X X ? X ?

9/29/2017e-Health Advisory Committee Meeting

8

Measure Notes

• Not all measures are appropriate for each system.

• Comparing information across systems must be done carefully, if at all- units of measure may be similar, however eligible patients, number of providers, what constitutes a transaction, and volume of data may all be different.

• Volume measures need system-specific descriptions to best understand value.

• Start with simple measures; expand as necessary.


Sample Care Coordination Questions/Possible Measures

• Does system have capacity to identify/track shared clients?

• What approach is currently used?

• Are reports (individual/system) currently available?

• What format of data is appropriate for care coordination?


Discussion

11

Communications

• Dr. Gerald Nissley (Lead)

• Sarah Mills (Recorder)

• Rebecca Moreau (Reporter)

• Dr. Salil Deshpande

• Staff: Hope Morgan

12

Communications Challenges Impacting Interoperability

• Limited information about the effectiveness of HHS’ communications

• No measures of behavioral impacts

• Health Plans

• Limited member contact information provided by HHS

• Limited electronic communications with members

• Provider

• Information overload

• Messages received are unclear regarding significance

• Communications to rural providers

• Cultural Factors

• Members

• Varying attitudes to government messaging across the state

• Public perception of government extends to managed care

• Communications to rural members

• Cultural Factors

Bo


Potential Interoperability Measures- Communications

• Conduct Market Research- look at using survey technology to get a snapshot and feedback from web users

• Changes in behaviors of clients

• Changes in behaviors of providers

• Changes in behaviors of health plans

• Recognize the different modalities of communication that are effective for different stakeholders and explore “nudge” communications


Potential Interoperability Measures -System Performance

System (Examples) Members Providers Health Plans

General Population

Medicaid Website Website,Email

Paper, Email WebsiteSocial Media

Public Health WebsiteSocial Media

Website

Access and Eligibility Services

WebsiteSocial MediaTextEmail

WebsiteSocial Media

Long Term Care Website

Public Health Reporting

WebsitePublic Service Announcements

WebsiteSocial MediaNewslettersEmail

WebsitePublic Service Announcements


Sample Communications Questions/Possible Measures

• How effective is targeted messaging based on cultural factors ?

• Providers

• Health Plans

• Members

• General Population

• How responsive are providers to new interoperability capabilities implemented at HHS?

• Measure number of Meaningful User providers connected to HIEs

• Measure the number of health plans connected to HIEs


Other Areas For Communications To Explore

• Public Health

• Clinical Information available to providers

• Long Term Care

• Assisted Living

• Community Based Care

• State Supported Living Centers

• State Hospitals

• Nursing Homes


Governance

• Adam Chesler, PharmD (Lead)

• Nora Belcher

• Thomas Wheat

• George Gooch

Staff: Adriana Rhames, Hope Morgan

18

Update on Data Standards Survey

Governance Workgroup

HHSC e-Health Advisory Committee

September 29, 2017

Background on Governance Workgroup

Strategies for governance:

• Revise system-wide information governance to reflect new

organizational structure and facilitate compliance with

applicable policies.

• Implement a process to coordinate standards utilization.

• Work to address the incorporation of Texas’s needs into

national standards.


Data Standards Survey Questions

• Question 1: Does your organization participate in any national standards development work?

• Question 2: Are you aware of any situations where national standards may not have met the needs of the state of Texas? If so, please provide specific examples.

• Question 3: Please review these national standards (www.healthit.gov/standards-advisory). Are there any additional standards which would be useful for Texas but are not included on this list? Any that need to be removed from the list?


http://www.healthit.gov/standards-advisory

Survey Question Response Data

Question# of

Responses Response Details Outliers

Participate in standardsdevelopment?

10 5 yes; 4 no; 1 unclear.

Organization examples include State Board of Nursing, ONC Advisory Committees, IEH USA, NQF telehealth framework, NCPDP, CMS data standards.

1 response may have been to the incorrect question. Overall, responses seem to be clearly yes or no.

Any standards that do not work for Texas?

10 9 no; 1 provided other feedback.

1 pharmacy representative mentioned crossover between workers comp issues and NCPDP telecommunications standards

Additional standards that would be useful? Need to remove any standards?

10 9 no (for adding or deleting); 1 provided other feedback.

1 pharmacy representative cautioned against incorporating HL7 standards into pharmacy.


Questions?


Infrastructure

• Steve Eichner (Lead)

• George Gooch

• Elizabeth Adamson

• Pamela McNutt

Staff: Leo Achembong

24

Steve Eichner

George Gooch

Elizabeth Adamson

Pamela McNutt

Steve Eichner

George Gooch

Elizabeth Adamson

Pamela McNutt

Infrastructure Workgroup Areas Discussed

• Opportunities for Interoperability• Extend connectivity for

clinical data exchange for SSLCs and State Hospitals

• Electronic Case Reporting• Ask on Order Entry• Extend interoperability for

information on Medicaid clients

• Blood lead reporting• Advancing informatics in

public health

• Health Services Gateway• Support for programs across HHS• Moved into State Data Center

• New Service Capacities• Exchange of clinical data for Local

Mental Health Authorities/State Hospitals

• Public Health reporting through HIEs (in progress)

• ImmTrac2-Bi-directional exchange• (in progress)• Transition to new EHR in State

Supported Living Centers (SSLCs)• Replace Vital Statistics system

(2019)• Updates to communicable disease

system- tuberculosis• Conversion to Unified Helpdesk



System (Example

s)

Numberof

Clients Served

by System


Time Period

Number of

Providers Served

by System

Numberof

Providers Served in

Time Period

DollarValue

(where applicable)



Medicaid Claims


X X X X X ?

ImmTrac X X X X X ?

MEHIS(Breakdown?)

X X X X X ?

StateHospital EHR

X X ? ? X ?

Lab Orders

X X X X ? X ?


Measure Notes












Discussion

29

Policy and Practice

• Leo Achembong (Lead)

• Kristi Henderson

• Dr. Stacey Cropley

• Erin McManus

• Scott M. Freshour

Staff: Steve Eichner

30

Policy and Practice Workgroup Areas Discussed

• Establishing and maintaining reporting

requirements and standards, including public

health reporting

• Privacy and security of HHS information

• Developments in interoperability within the HHS

• Internal audit activity

• Support for Federal Programs – MIPS and

Meaningful Use

• Use of Health Services Gateway for efficiency

• Benefits realization by both HHS and partners



System (Example

s)

Numberof

Clients Served

by System


Time Period

Number of

Providers Served

by System

Numberof

Providers Served in

Time Period

DollarValue

(where applicable)



Medicaid Claims


X X X X X ?

ImmTrac X X X X X ?

MEHIS(Breakdown?)

X X X X X ?

StateHospital EHR

X X ? ? X ?

Lab Orders

X X X X ? X ?


Measure Notes












Discussion

35

Thank you


Steve Eichner

HIT Policy Director, DSHS

[email protected]

eHealth Advisory Committee Interoperability Plan ...•Revise system-wide information governance to reflect new organizational structure and facilitate compliance with applicable policies.

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