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"Health Information Exchange in Oregon – Where We Are & Where We Are Going" Moderator: Eric McLaughlin, Project Manager, Cognosante Abigail Sears, Chief Executive Officer, OCHIN Sharon Wentz, RN, Business Development Coordinator, CareAccord Laurie Miller, RHIT, CCS-P, HISP Administrator, Gorge Health Connect Paula Weldon, Project Manager, Jefferson Health Information Exchange
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HIMSS OREGON – Spring Conference 2013
Health Data Exchange in What’s Going On?
www.ochin.org
Presented by:
Abby Sears
CEO
Spring Conference 2013
Data Exchange in Oregon: What’s Going On?
www.ochin.org
Presented by:
Abby Sears
CEO
Agenda
• Beyond EHR:
– Who is OCHIN?
– What we do
• An Awakening: Clinical vs. Claims Data
• HIE: Short-term vs. Long-term
Clinical vs. Claims Data
term
Who is OCHIN?
• Our goal is simple: to provide solutions to promote access to quality, affordable health care for all.
• One of the nation’s largest and most successful
Health Information Networks
• Oregon’s Regional Extension Center (REC)
• NEW! Oregon Health Network• NEW! Oregon Health Network
Our goal is simple: to provide solutions to promote access to quality, affordable health care for all.
One of the nation’s largest and most successful
etworks
Oregon’s Regional Extension Center (REC)
NEW! Oregon Health NetworkNEW! Oregon Health Network
What we do
• We are a nonprofit organization that touches 4,500
physicians with:
• Hosted Services & Solutions
• Connectivity (Network Services)
• Consulting• Consulting
• Research
• Federal and State Program Management
• Outreach and Communications
• Thought Leadership
• Advocacy
• And more…
organization that touches 4,500
Connectivity (Network Services)
Federal and State Program Management
Outreach and Communications
What we do
Connect communities through the advancement and Connect communities through the advancement and adoption of telemedicine and long
study of clinical and operational workflows
Enable providers, staff, and leadership improvement goals and system
study of clinical and operational workflows
Install and optimize a wide range of Health IT products
programs for vulnerable patient populations
adoption of telemedicine and long
programs for vulnerable patient populations
Participate in robust information exchange members, across care regions, and with state and federal
agencies
Implement innovative clinical and health science best practices via practice-based research
Combine data from disparate data systems: GL, clinic,
claims, social
Connect communities through the advancement and Connect communities through the advancement and and long-distance health
study of clinical and operational workflows
Enable providers, staff, and leadership to achieve quality
improvement goals and system optimization through the
study of clinical and operational workflows
a wide range of Health IT products
programs for vulnerable patient populations
and long-distance health
programs for vulnerable patient populations
Participate in robust information exchange among
, across care regions, and with state and federal
Implement innovative clinical and health science best research
from disparate data systems: GL, clinic,
A New Future: High quality care, anywhere
Then (& Now)…
• Core operational
infrastructure systems
operate in siloes
• Decision and
policymakers not focused policymakers not focused
on broader context
• Health IT used only by
those with money &
resources
• Health IT viewed as
optional
A New Future: High quality care, anywhere
The FUTURE of IT
• Core operational
infrastructure systems
are fully integrated
• Decision and policymakers
use clinical data for broader use clinical data for broader
context
• High quality transformative
Health IT and data is
available to all
• Health IT is a core
requirement
If you were to design tomorrow would it look likeIf you were to design tomorrow – what
The Health Neighborhood
• Data Integration
• Technical Integration
• Workflow Integration
• Health Print– Medical
– Behavioral
– Social– Social
• Health Home– Accountability
– Member activation
– Care coordination
The Health Neighborhood
HIT: Short-term (1-3 years)
• There is no one, “out-of-
• What exists
– No EHR solution is perfect and/or incorporates required
mental, dental, patient engagement, reporting needs, etc.
• What’s needed (at this point
– Leverage what exists to design an interim HIE solution to – Leverage what exists to design an interim HIE solution to
get HCPs to the next phase of coordinated care
• Beware of vendors that sell “proven”
• Build for the future with trusted
3 years)
-the box” solution
No EHR solution is perfect and/or incorporates required
mental, dental, patient engagement, reporting needs, etc.
What’s needed (at this point-in-time)
Leverage what exists to design an interim HIE solution to Leverage what exists to design an interim HIE solution to
get HCPs to the next phase of coordinated care
Beware of vendors that sell “proven”
solutions
Build for the future with trusted
partnerships
eHealth Exhange
Direct Project
HIT: Short-term (1-3 years)
• What OCHIN is doing
– Piloting “transitional” infrastructure with
and share with others
• EHRs with Mental Health
• Incorporating claims & clinical data into new workflows and
reporting
– Business Intelligence/Analytics: Reporting solutions– Business Intelligence/Analytics: Reporting solutions
– Piloting national HIE approaches that are sustainable
3 years)
Piloting “transitional” infrastructure with CCOs to replicate
Incorporating claims & clinical data into new workflows and
Business Intelligence/Analytics: Reporting solutionsBusiness Intelligence/Analytics: Reporting solutions
Piloting national HIE approaches that are sustainable
HIE: Long-term (3+ years)
• Industry is coming; Get ready to support and plug into a national HIE/IT infrastructure
– What exists/what is under development?
– What’s really needed?
– How to prepare» Cloud computing is coming to healthcare» Cloud computing is coming to healthcare
» National broad reaching solutions that are not regional
term (3+ years)
Industry is coming; Get ready to support and plug into a national HIE/IT infrastructure
What exists/what is under development?
Cloud computing is coming to healthcareCloud computing is coming to healthcare
National broad reaching solutions that are not regional
So Who is OCHIN
We provide solutions to promote access to quality,
affordable health care for all.
Innovatively applying technology
Research to improve health outcomes and deliver costs effective care
Hosted solutions
Professional services
e provide solutions to promote access to quality,
affordable health care for all.
Innovatively applying technology
Research to improve health outcomes and deliver costs effective care
Summary/Re-Cap – Cont’d.
We don’t know what we don’t know
Cont’d.
We don’t know what we don’t know
www.ochin.orgwww.ochin.org
Sharon Wentz, RN
Business Development Coordinator
Office of Health Information Technology
04/22/13
Where We Are & Where We Are Going
Organization Types Participating in CareAccord
Direct Secure Messaging
Acute Care Acute Care
Hospitals
Ambulatory
Laboratories
Other
●No-cost Direct Secure Messaging services through 2013 ●No-cost Direct Secure Messaging services through 2013
● Registration Process enhanced with a “Bulk upload” capability for individual and delegate accounts
● 2.0 Deployment anticipated → Provider Directory Admin Privileges
Health Information Service Provider (HISP)
Beta Accreditation
www.directtrust.org
www.ehnac.org
Pilot to Production
Vision: Scalable Trust and Policy
Wsctrust.org
● 8 Core states, 7 satellite states
● Creating policies and procedures that lay groundwork
for safe interstate transfer of health information
● Pilot work: Oregon, California, Alaska
Vision: Scalable Trust and Policy
Framework that eliminates barriers to HIE
HIMSS/ONC Interoperability Showcase March 2013 Coordinating Care Across State Lines
Creating trusted HISP communities
Managing community membership
Distributed Provider Directories
Connecting with Disparate Technologies
“In 2007, the Oregon Legislature passed
POLST (Physician Orders for Life-Sustaining Treatment)
Registry: Form submission to the Registry
“In 2007, the Oregon Legislature passed
Senate Bill 329 (State Health Fund Board), and
in 2009 passed HB 2009 as part of Oregon's
health care reform efforts, enabling Oregon to
launch the nation's first 24-hour electronic
POLST Registry on December 3, 2009. First
responders and providers are able to call the
registry from the field and be informed of a
patient's POLST orders.”
“Embrace a model of information symmetry, in
which the patient and the clinician are partners,
collaborating around the patient’s health.”
“Information is freely exchanged because
hoarding information bestows no power and runs
counter to the common goal.”
“How can patients be expected to take care of
themselves if they don’t have access to their own
health information?”
“In the U.S., patient have been guaranteed
access to their medical records since the HIPAA
Privacy Rule became effective in 2003, although
not always without friction and burdensome
costs.”
Personal
StoriesStories
What if………………
Andrew John Wentz
Erin June Yarber
Gorge Health Connect, Inc.(GHC)
http://www.gorgehealthconnect.org
GHC has Board representation from:
• Columbia Gorge Community College
• Providence Hood River Hospital
• Mid-Columbia Medical Center
• One Community Health (La Clinica Del Carino)• One Community Health (La Clinica Del Carino)
• Mid-Columbia Surgical Specialists
• Mid-Columbia Center for Living
• North Central Public Health District (Wasco, Sherman, Gilliam Counties)
• Hood River County Public Health Department
Health Resources and Services
Administration - 2009
• Network Development Grant
• GHC intends to use this planning year to
establish the governance structure of the
network in greater detail through a strategic network in greater detail through a strategic
planning process which includes refining a
mission statement and identifying key
strategic goals for group.
Grouped Resources - 2010
• GovernanceBy-laws and officers
• HRSA Technical Assistance
Member expectationsMember expectations
Deliverables
ID Stakeholders
• Community Needs Assessment
EHR utilization
Workforce training
Connectivity
Grouped Resources - 2011
• Electronic Health Records: A Tutorial
– Dr. Michal Kirshner, DDS, MPH - Oregon Tech
• Crucial Conversations- Board Retreat
– Vital Smarts: Crucial Conversations 2-day training – Vital Smarts: Crucial Conversations 2-day training workshop
• Non-Profit Status
– Organized as a 501(c)(3)
• ONC and Oregon HITOC
– Workgroup and Panel Positions
• The Direct Trust- Original Seating Board position
Direct Trust
• Non-profit, competitively neutral, self-regulatory entity created by and for Direct community participants.
• Establishing and maintaining a national Security and Trust Framework (the “Trust Framework”) in support of Directed exchange.
– A set of technical, legal, and business standards for Directed exchange
– Expressed as policies and best practices recommendations, which members of – Expressed as policies and best practices recommendations, which members of DirectTrust agree to follow, uphold, and enforce.
• Leveraging the Trust Framework for a Direct Trusted Agent Accreditation Program, DTAAP, with EHNAC, for HISPs, CAs, and RAs, as well as their clients.
• Complementary and subject to, as well as supportive of, the governance rules, regulations, and best practices for the Direct Project and the NwHIN, promulgated by HHS and ONC, and the mandates of the HITECH act.
Direct Project Pilot - 2011
• Demonstrated one of the 1st Direct Project pilots
• Pilot used Medicity HISP services to demonstrate
these use cases:
– summary care records and results between PCP and – summary care records and results between PCP and
specialists
– transmitting PCP referrals and summary care records to
hospitals
– sending discharge information from hospitals back to
referring PCPs
• http://www.gorgehealthconnect.org/directproject/
Grouped Resources – 2012
• The Dalles Google Data Centers Grants Fund of Tides Foundation to introduce participants to HER. 77% pursue HIT Information/Training
– HIT Workforce Development Curriculum
– OpenEMR
– My HealtheVet- Blue Button
• Oregon Connections Telecommunications Conference
• iNexx Deployment
Here today! The Developing Three-Party Approach:
Federated Identity Management
Identity (Verification)
Relying
Relying Party
ATM Example
10
Identity Provider Relying
Party
Subject
(Bank A)
(ATM Card) (ATM Card)
(Bank B)
Relying Party
(Bank C)
(Bank D)
GHC -Federated Model
• Participating organizations in a Federated HIE
retain control of their healthcare information
and responds to queries when information is
requested, likewise sent.requested, likewise sent.
• A Centralized HIE collects information from
participating organizations and stores the
information in a centralized place to provide
access.
• Resilient awarded 12 month, $2M
grant to pilot innovative solutions for
both healthcare and education
National Strategy for Trusted Identities in
Cyberspace
National Strategy for Trusted Identities in
Cyberspace
• Signed by the President in 2011
• Create new Identity Ecosystems
to assure security and privacy
Identity Ecosystems
both healthcare and education
• Trust Network will connect over
15 nationally recognized leaders for
identity, policy and online content
• Goal is to commercialize solutions
and capabilities for rapid adoption by
public / private sectors
• Pilot grants and an adoption
requirement for .Gov websites
Goals of the NSTIC Pilot
Healthcare: Patient-Centered Coordination of Care (PCC)
� Enable trust for sensitive healthcare transactions on the Internet
� Provide secure, multifactor, on-demand identity proofing and authentication
across multiple sectors, at national scale
� Implement an identity ecosystem encompassing patients, physicians and
staff which facilitates coordinated care through secure, HIPAA-compliant
access to:access to:
� Electronic referral and transfer of care messaging
� Advanced, on-demand decision support service
� Commercialize solutions and underlying capabilities, beyond Year 1
� EXCHANGE PARTNERS
� La Clinica del Carino and San Diego Beacon Community
Healthcare: Patient-Centered Coordination of Care
Highlights of Pilot
• Populations of seasonal agricultural
workers from SD work and received
care in Oregon too
• Identity matching and policy
enforcement enables coordination
• Enable NwHIN Direct messaging
across HIE platforms and state lines
• Novel, cloud-based decision support
available to doctors in both states
Pilot Sites & HIE Software:
Decision Support Partners:
• On-demand, privacy-preserving
authentication and authorization
• Commercialized identity matching,
secure messaging & cloud-based
decision support can scale rapidly
Identity & Attribute Providers:
Advisors on Governance / Protocols / Policy: Principal Investigator
Dr. David Hartzband, D.Sc.
CTO, Resilient Network
Systems
Pilot Implementation Overview
Two Key Questions We’re Trying to Address
For Online Transactions
• “Who are you?” (Identification)– Assigning attributes to individuals (or companies, or
devices)• Name, address, age, status (e.g., student or faculty), company, authority, credit rating, gender,
model number, serial number, etc. • A one-time (offline or online) process called “identity proofing”
– Issuing a credential
16
– Issuing a credential• Drivers license, passport, ATM card, UserID, digital certificate, smart card, etc.
– Typically a one-time event
• “How can you prove it?” (Authentication)– Verifying that the person online is the person previously
identified– Correlate a person to a credential (drivers license, UserID,
etc.) via an authenticator (e.g., picture, password, etc.)
Moving Forward
Connected at the HISP
• Connected with Jefferson HIE
• NSTIC connect with San Diego Beacon• NSTIC connect with San Diego Beacon
• Working to connect with Care Accord
• Provider needs
– Workforce training – workflow
• Explore network needs and infrastructure
GHC- Accreditation Forerunner
The Electronic Healthcare Network Accreditation
Commission (EHNAC), a non-profit standards
development organization and accrediting body, has development organization and accrediting body, has
partnered with Direct Trust to create a national
accreditation program for:
• Health information “trusted agent” service providers,
• Health information service providers (HISPs),
• Certificate authorities (CAs) and
• Registration authorities (RAs)
Connecting Southern OregonConnecting Southern Oregon
HIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceHIMSS Oregon 2013 Spring ConferenceApril 22, April 22, April 22, April 22, 2013201320132013
Paula Weldon Project Manager, JHIE
To create an environment where patients get the highest quality health care at the lowest cost because everyone involved in because everyone involved in
their care is connected through a secure, user-friendly and
efficient source of information that follows the patient.
Payers
Hospitals First Responders
Providers
Diagnostics
Registries
Clinics
Pharmacies
Home Care
� Asante Health System◦ Three Rivers Community Hospital (Grants Pass)
◦ Rogue Regional Medical Center (Medford)
� Sky Lakes Medical Center (Klamath Falls)
� Providence Health and Services� Providence Health and Services◦ Providence Medford Medical Center (Medford)
� Mid-Rogue IPA (MRIPA)
� Primary Care and Specialty Clinics in Medford, Grants Pass and Klamath Falls
Phase III Considerations◦ Data de-identification
◦ Reporting parameters
◦ Acceptable use of aggregate data
� State of the Art technology to protect patient data
� Federal and State compliant policies and procedures that protect patient rights and control access to information based on need control access to information based on need to know
� User training to reinforce appropriate use
� Monitoring usage to ensure patient privacy
� Sanctions for misuse
� Non-Profit Corporation
� Multi-Stakeholder Decision-Making◦ Hospitals
◦ Physicians & Independent Physician Associations� Primary Care and Specialists
◦ Health Plans and CCOs◦ Health Plans and CCOs
◦ Community Health Agencies & Clinics
◦ Community Organizations & Patient Advocates
� Board and Committees◦ Providers◦ Patients◦ Governance and Policy
o Financeo Technology
� Ensuring that all participants have representation in the decision-making process, including: ◦ Definition of services and functions◦ Definition of policies governing data use
� Equitable participation in the cost to implement and maintain the HIEand maintain the HIE◦ Move to next phase only when adequate revenue to support
� Focus on workflow change to support use
� Focus on growing data sources◦ Hospitals and health care facilities◦ Physicians and other health care providers
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