Provider Directory Subject Matter Expert Workgroup Meeting #3 April 2, 2014 1.

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Provider Directory Subject Matter Expert Workgroup

Meeting #3

April 2, 2014

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Welcome, March meeting review, agenda review

Karen Hale and Susan Otter

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Agenda Review & March meeting recap Agenda Review

Direct Secure Messaging Federated HPD/Common Credentialing data

presentation Breakout session – Key Provider Directory Uses

(HIE/Analytics/Operations) Group discussion of use cases Wrap up and next steps

March meeting recap Questions or any other updates from group?

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Direct Secure Messaging Presentation

Lisa Parker

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Direct Secure Messaging Overview Direct secure messaging is a secure, encrypted

web-based communication system for healthcare practitioners to share protected health information (PHI)

Allows structured data to be shared from an Electronic Health Record (EHR) (or web portal) that can be ingested directly into an EHR to become part of the patient’s health record data

Allows messages to only be shared between trusted, vetted parties across organizational boundaries and EHR vendors

HIPAA compliant

Direct secure messaging addresses are not readily available

Elements to achieve statewide Direct secure messaging

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1. Organizations must use a Health Information Service Provider (HISP) to communicate with providers outside their organization and/or their specific EHR

2. An organization’s HISP must be a member of a “trust community” to connect with providers participating in a different HISP

3. Direct secure messaging addresses must be known, made available or searchable: • Directories are sometimes a part of a

HISP or “trust community”• currently no statewide directory available

in Oregon; OHA is developing an interim solution

What is a HISP?

Organization 2Organization 1

Health Information Service Provider (HISP)

Organization 3

Organizational Participation Agreement

Standards and Policies

a HISP provides oversight, and sets standards & policies that allow organizations to communicate with providers outside their organization and/or their specific EHR without using interfacesMembers participate in trusted exchange with anyone in the HISP with the knowledge that everyone is held to the same standards and policies, and covered by the same participation agreement.

Prospective members must be vetted :1. All sign Organizational

Participation Agreement2. Adhere to standards and

policies set by the HISPIn vetting process

Organization 4

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What is a “trust community”?A trust community is a group of HISPs electing to follow a common set of standards and policies related to information exchange.

HISP D

HISP BHISP A

Trust Organization

HISP C

Federated Trust AgreementCertification/Accreditation

Standards & Policies

a Trust Organization provides oversight, and sets the policies & procedures to allow organizations within disparate HISPs to exchange without using interfaces

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Trust Communit

y

a HISP joins a “trust community” to allow their participating organizations to exchange beyond the HISP with the knowledge that everyone is held to the same standards & policies, and covered by the same federated trust agreementProspective members must be vetted :1. All HISPs sign a federated

participation agreement in lieu of each of their participating organizations

2. Adhere to standards and policies set by the HISP

DirectTrust’s “trust community”

DirectTrustwww.directtrust.org/accreditation-status/

DirectTrust

Accredited HISP

Accredited HISP

CareAccord

CernerDataMotio

n

MedAllies

SureScripts

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HISP BHISP A

DirectTrust

HISP C

Direct Trust Federation AgreementDirect Trusted Agent

AccreditationGuidelines and Criteria

Candidate HISPIn Direct

Trusted Agent

Accreditation

process

DirectTrust Fully Accredited HISPs

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EHNAC – Electronic Healthcare Network Accreditation CommissionDTAAP – Direct Trusted Agent Accreditation Program as of 4/2/14

DirectTrust Candidates for Accreditation

EHNAC – Electronic Healthcare Network Accreditation CommissionDTAAP – Direct Trusted Agent Accreditation Program as of 4/2/14

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Why does Oregon need a state level provider directory for Direct secure messaging?

Direct secure messaging addresses must be known, made available or searchable • directories are sometimes a part of a HISP or “trust

community”• currently no statewide directory available in Oregon• OHA is developing an interim solution

• Piloting flat file solution for 2014 for Oregon entities with a DirectTrust accredited HISP

Value of Direct secure messaging supported with provider directory• Care coordination across organizational boundaries• Interoperability of information (exchange without interfaces)• Electronic exchange of structured clinical information

Policy Levers• Federal: Support Stage 2 Meaningful Use requirements• State: Statewide goal to promote Direct secure messaging;

State contracts promoting HIT/HIE; Oregon’s Patient-Centered Primary Care Home

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Federated HPD and Common Credentialing Data Crosswalk

John Hall

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The Big Picture – Where we end up in 2015 Federal Healthcare Provider directory (HPD) standards are

in place that place criteria on how these data are stored and shared in EHRs

Common credentialing database is beginning to capture credentialing data (fully functional in January 2016)

Stand-alone healthcare directories are connected via federated provider directory services Web Portal Orchestrator “Hub” Centralized database for some components

Those with HPD capabilities can connect to the network of Oregon directories and Interstate Directories

Those without HPD capabilities can interact via flat-file exchange with the centralized components of the directory

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Provider Directory - Big Picture

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Leveraging state and federal efforts

Emerging Federated HPD standard for

provider directories

Common credentialing efforts

underway that ensure data accuracy

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Background on OPCA Oregon Practitioner Credentialing Application

Practitioner demographics Medical specialty Practice information

Primary/Additional practices Hospital/Healthcare affiliations

Starting point for implementing the Oregon Common Credentialing Solution Analysis of RFI responses completed Rules to be effective June 2014 RFP to be issued by June 2014

Decision point for possible data elements included in the OCCS

Award contract by October 2014

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Background on Federated HPD Federated Healthcare Provider Directory (HPD) is a

technology standard for how to “talk” to healthcare directories and describes a minimum set of data supported by those directories Emerging version of HPD Builds upon HPD Plus v1.1 protocol and data model Adds capabilities supporting federated directory networks

ONC and Integrating the Healthcare Enterprise (IHE) are collaborating to advance Federated HPD, with the final specification to be published in 2014

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National Adoption of Federated HPD Adoption of Federated HPD is anticipated to be

widespread Federated HPD seen as the strongest contender enabling

a nationwide directory infrastructure Some vendors are already building to (draft) Federated

HPD – Federated HPD Demonstration at HIMSS 2014 conference included Surescripts, Verizon, and other directory vendors

Products supporting Federated HPD could be available as early as 2014, but broad support more likely will be 2015 to early 2016 based on typical vendor product development cycles.

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Federated HPD Data Model

• Information about where a provider is credentialed (includes credentialed date and expiration)

• Can also represent professional qualifications (e.g., degrees, certifications)

Credentials

• Indicates affiliations between individuals and organizations• Includes contact and Services information for the individual specific to

the affiliation

Memberships

• Represents organizational entities• Includes identifying information such as name, legal address, and

contact, plus items such as languages supported pointers to Services

Organizations

• Represents individual healthcare professionals• Includes identifying information such as name, profession,

specialization, addresses (legal, billing, postal), and contact information, plus items such as status (primary, other, inactive)

Providers

• Contains health information exchange information for an individual or organization, including Direct address and query endpoint

Services

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Expressing OPCA data in Federated HPD Initial analysis indicates most of the OPCA data

can be expressed using the Federated HPD data model.

Some gaps appear to be indicated, but analysis continues.

Any indicated gaps do not necessarily mean particular data cannot be stored in the statewide Provider Directory Services. More on this after the next slide…

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Element

Common Credentiali

ng

Federated HPD Potential “Gaps”

Identifying/Practitioner Address Information

X XIn Common Credentialing, not HPD:

• Birth date and place, SSN, Citizenship, VISA

• Additional status types (full time, part time, telemedicine, etc.)

• Other professional actives (administration, research, teaching, retired)

• Department name (hospitals)

• Federal Tax ID, SSN• Professional liability carrier

In HPD, not Common Credentialing:

• Direct Address

Not in either:

• Historic practice or work history data

• Historic affiliations• Office hours

Practice Information/Practice Call Coverage

X X

Specialty Information X X

Board Certification/Recertification/Other Certifications

X X

Education/Residencies/Fellowships X X

Health Care Licensure, Registrations, Certificates

X X

Hospital and Health Care Facility Affiliations

X X

Professional Practice/Work History X X

Peer References X

CME X

Professional Liability Insurance X

Attestation Questions/Professional Liability Actions

X

Direct Address X

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Operations and Limitations for Federated HPD Querying for and accessing data beyond the standard data model

using Federated HPD may pose challenges. Products used to access directories via Federated HPD may not have the

necessary capabilities enabling its users to query for data outside the standard data model.

If a product does allow queries for non-standard data, users may not be aware that such data exists to be queried in the first place or how to use their product to make such queries.

No guarantees that products will be able to display (properly or at all) data received that falls outside the standard Federated HPD data model.

Oregon could advocate and work through the Federated HPD standards process to extend the potential of the standard data model. In the meantime, however, other options supporting query and access of such data include: Web portal of the statewide Provider Directory Services Extracts for data subscribers Integration with data subscribers

Use cases will determine which options make sense and when.

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A word on historical data... Directories are data repositories for “point in time” data As such, no applicable standards or data models support

versioning of information or provide time indicators delimiting applicability of data (i.e., no directory standards enable queries for relationships in place or data values that were “good” at a given time or time period)

Oregon’s statewide Provider Directory Services could still support queries for historical data via one or more options: Periodic repository snapshots Parallel “read only” directories containing data and relationships

as they were at defined times Better understanding of use cases in this area will help

target the right approach(es).

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Data mechanisms

Common Credentiali

ng

HPD• EHR or

HIE/HIOOther

Credentialed healthcare providers

only

All participants in an EHR or HIE

TBD

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Provider Directory Uses

Karen Hale, Susan Otter, and Group

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Key use elements for “HIE”, Analytics, Operations

Users and Sources

ProvidersGroups

Clinics/Clinic SitesHospital

Health SystemState programs

Plans/CCOsLocal HIEs

Value

Meet meaningful use

Care coordination

Administrative simplification

Data available for research and

analytics

Required Data

Demographics, contact

information Licensing information

State program participation

Vital stats

Affiliations

HIE Addresses

Parameters

Assumptions

Challenges

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Provider Directory Key Services WorksheetItem: Information that’s needed:

Description of use High level description of the use case in question

Value What is the value or desired outcome?

Function (uses) What are the functions or uses? Prioritization by uses?

Users Who are the users that would be affected or touched by the use case? Prioritization by users?

Parameters How does it have to work to be useful and what must it have to be useful?

Assumptions What are standards and external systems expected to be in place? What is the context?

Data (attributes) by mechanism if possible and priority level for each

List data accepted in common credentialing solution/same for HPD. Are there gaps?

Challenges to consider What are obstacles or barriers? Are there potential risks and ways to mitigate?

Other considerations What are other areas and advice to offer?

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Provider Directory Key Use examplesOperations Analytics “HIE” (Referrals, Care

Coordination, HIPAA compliant communication)

PCPCH program needs to verify eligibility for clinics/providers

OHA analytics department needs to assess quality outcomes for providers/ clinics/ groups by CCO

Medicaid EHR Incentive Program in OHA needs to correspond with non-CareAccord users

Clinic needs to track whether a practitioner is accepting new patients by plan

Plan needs to analyzing quality metrics by clinic or practice

Primary care doctor needs to refer patient to specialist. The specialist is not in the primary care doctor’s clinic or health system

Other use - Other use - Other use -

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Gaps to discuss in breakout sessions

• Birth date and place, Citizenship, VISA• SSN

Practitioner Information

• Additional status types (full time, part time, telemedicine, etc.)• Other professional actives (administration, research, teaching,

retired)

Specialty Information

• Department name (hospitals)• Federal Tax ID, SSN

Practice Information/Practice Call Coverage

• Professional liability carrier• Historic practice or work history data

Professional Practice/Work History

• Hours of operation• PCPCH• Historic information

Other

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Group Breakout Session

• Gina, Erick, Bob, Hongcheng

“HIE”

• Jessica, Stephanie, Christopher, Ray

Analytics

• Mary Kaye, Tina, Rebecca, Liz

Operations

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Group Discussion of Use Cases

Karen Hale, Susan Otter, and Group

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Wrap up and next steps

Karen Hale & Susan Otter

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Next Meeting

Date Location

April 23rd Salem – State Library250 Winter Street NE, Conference Room 103

May 14th Portland – State Office Building800 NE Oregon Street, Conference Room 1C