Deloitte PowerPoint template - Digital Bridge · 2016-12-19 · care systems. Emerging. Acute • Trust, education, collaboration, and partnership • Does not end with report, i.e

Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab | Executive Summary4

Reflections• Our vision: we will work together to improve the

health of our nation by creating a bi-directional exchange of health information between public health and healthcare

• While the group identified many challenges, there was overall optimism that the vision can be accomplished

• This is not a technical challenge, it is a matter of governance, will, and resources

• The process will move forward with active, timely and broad stakeholder engagement

• Our governance body will include representatives from public health, providers, and vendors. It will be enhanced and refined as we move forward

• The first phase, testing implementation, will be complete by July 1, 2017 with a range of jurisdictions, vendors and delivery systems

• Both the governance and technical solution will be built to evolve

• Definitive commitments were made by participants that will move the ball forward

• We will start with notifiable disease data

• Our work will build on work already done by others

• We have a high level work plan to guide our efforts

• This is an historic convening of all three stakeholder groups that will result in a sustained effort over time

Building the Bridge: The Digital Intersection of Healthcare and Public Health Lab | Executive Summary

Statement of Purpose Key stakeholders in the digital health care and public health community came together for a 2-day immersive experience to collaborate on a vision for digital health data exchange and a proof-of-concept for Electronic Case Reporting to improve the health, well-being and security of the nation.

Envisioning the Bridge

Welcome and set the stage

Build a shared understanding around the facts and constraints

Shape an understanding through 3 user stories

Laying a Foundation for Success – eCR Proof of Concept

Affirm for the need and purpose of an eCR proof of concept by further defining the proof of concept

Further define the proof of concept approach

Charting the Path Forward

Create the notional timeline

Reflections

Select a tool and closing thoughts

ACT I

ACT II

ACT III

AGENDA

LAB PARTICIPANTS

Participant Organization Participant Organization

Chris Alban Epic John Lumpkin RWJF

Scott Becker APHL Bill Mac Kenzie CDC

Jason Bonander CDC Tushar Malhotra eClinicals Works

Geoff Caplea AllScripts Lori Melichar RWJF

Brian Carter Cerner Sharon Moffatt ASTHO

Benson Chang Deloitte Patrick O'Carroll OASH

Jim Daniel ONC Richard Paskach HealthPartners

Art Davidson NACCHO Dan Pollock CDC

Jim Doyle Epic Indu Ramachandran Kaiser

Brian Edlin CDC Dave Ross PHII

Jeff Engel CSTE Mark Rupp Nebraska Medical Center

David Friedman Deloitte Vivian Singletary PHII

Kirsten Hagemann Cerner John Stinn Deloitte

Hilary Heishman RWJF Ben Stratton Deloitte

Steve Hinrichs APHL Kathy Turner CSTE

Michael Iademarco CDC Jagan Vaithilingam eClinical Works

Kevin Isbell Kaiser Joe Wall Meditech

Jim Jellison PHII Andy Wiesenthal Deloitte

Andrew Karson Partners Larry Wolk ASTHO

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ACT IAct I Envisioning the BridgeJohn Lumpkin from the Robert Wood Johnson Foundation kicked off the Lab by introducing the eCR vision. All participants were then asked to demonstrate their alignment to the vision and execution thereof by positioning themselves on the spectrum between “storm clouds” and “sunny skies.” While the majority of participants landed on “sunny skies” for both, several shared realistic skepticism and concerns with the group.

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That we work together to improve the health of our nation for creating bi-directional exchange of health information between public health and healthcare.

An interview with John Lumpkin

Data can be a liability; requires

security and adds risk of

litigation

Variation drives up cost, drives up

risk and compromises quality for all

parties.

CDC does not have direct control over

state/local jurisdictions and does

not get the data directly.


ACT IAct I Envisioning the BridgeTo continue building a shared understanding, participants were asked to explore constraints and considerations through the eyes of each stakeholder group. They then used three different case studies as a means to understand current pain points and articulate future aspirations.

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Multiple competing

priorities. Hitch our wagon to

Zika!

Articulate the fiscal

opportunities in changing care systems

Emerging Acute• Trust, education,

collaboration, and partnership

• Does not end with report, i.e. after providers report event, they receive real time information that is useful to them, for example: a picture of what is going on in the jurisdiction or information telling them if this is part of something bigger

Chronic• Establish a purpose

indicators data sources triggers

• Passive data collection• Understand intervention

options and tailor stakeholders, data, flows, trigger

• Automation lowers risk and failures

• Systemized• Flexible• Sensitive to

workflow• If/Then/Else

Architecture• Existing pipeline• Triggers &

standards exist for pulling data out of EAR

• Public Health can consume & act on data electronically

* For complete exercise outputs, see Appendix.


In the afternoon of Day 1, participants began to define critical success factors for the eCR proof of concept (POC). Participants agreed that, in order to be successful…..

ACT IIAct II Laying a Foundation for Success – eCR Proof of Concept

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An eCR proof-of-concept will:Allow as many groups as possible to “see” themselves in it; i.e. it will include meaningful diversity, such as geography, technological capabilities, urban vs rural, resourcing levels and jurisdictional model (city/county/state)

Include multiple vendors

Include multiple types of care systems

Prove that we can send and receive data

Test automatic trigger codes (not updates)

Prove that we can partner

Include content and formatting of case reports that is standardized, automated, passive, accurate,

useful and timely, and evaluate conformance in measurable ways to each of those parameters

Demonstrate that we won’t lose the ability to share information beyond notifiable requirements

Be sustainable


ACT IIAct II Laying a Foundation for Success – eCR Proof of Concept

9

To close out Day 1, and kick off Day 2, participants discussed and defined the fundamental requirements for the POC governance structure, roles and responsibilities/operating model and core technical approach.

* For complete exercise outputs, see Appendix.


In the final module, participants identified critical milestones and dependencies that will guide the eCR POC implementation effort between today and January 1, 2018.

ACT IIIAct III Charting the Path Forward

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IMMEDIATELY Q3 2016 Q4 2016 Q1 & Q2 2017 Q3 & Q4 2017

It could be even more urgent

Broad stakeholder engagement for all of the above

HL7 eCR Implementation guide publishedCDC, CSTE

Current pilot lessons learned gathered and analyzed to inform POC

Council votes on eCR policy statementCSTE

Launch recruitment of participants for the POCCDC

Review & analysis of current PH Governance Group ASHTO

Secretariat and neutral convener formedPHII, RWJF

Funding Plan identified for POC

Funding proposal (RFP, response, implementation)

Review and analysis of current pilot. Get in part from vendors, providers, PH

CSTE

Draft press release

First trigger codesCDC, APHL, CSTE

PH Informatics Conference8/24/16

Document eCR business requestsCERN, PHII, CSTE

Establish tech WGCDC, APHL, Epic

Define communications planCDC, PHII, ASTHO

RCKMS on AIMSCSTE, CDC, APHL

POC sites & participants selected

Establish tech working group & requirements group

Governance body defined and recruitedRWJF, CDC, PHII, EHRA, ASTHO

Define measurable metrics for success CPC, CSTE, ASTHO, HPartners, Epic

Privacy & Security Policy

Data use agreement –POC definedASTHO

Develop eCR readiness toolkit for PH agenciesCSTE

POC startedCSTE, ASTHO

POC tech solutions defined

PH expansion plan beyond POC identifiedASTHO

Report on measurable success metrics

What have we learned that may refine standards

External Communications happeningPHII

POC eval completeCTSE & ASTHO

PH Agencies report readiness

Sustainability plan and scalability planASTHO

Recruit next implementation sitesCSTE

Governance Entity launchedCDC, EHRA,, ASTHO

Define messaging

8/1

January 2018

CSTE, CDC, ECW, APHL, EHRA, Epic,

Cern, meditect, AllScripts, HPartners

CSTE, Epic, AllScripts,Partners, Health Partners,

NPAL/UNMC,

Challenges and Opportunities


To close the Lab, participants were asked to work within their stakeholder group to select a tool from the tool box that represented the role they will play in ongoing planning, implementation and maintenance efforts for the initial eCR POC. Further, many participants offered specific commitments* to support and contribute to the effort.

ACT IIIAct III Charting the Path Forward

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*In many cases, these commitments were pending approval from their organization’s leadership.

Public HealthWe will measure

what we do

VendorsTest connections,

technical “how do we make things work?”

ProvidersWe are on the front lines, measuring the impact, efficiency,

etc.

Appendix

City Hall Gallery WalkNot-for-profit systems have community benefit requirement

Not-for-profit systems have community benefit requirement

There is a lot of information gathered by software

Data can be a liability:• Requires security• Chance of

litigation, e.g. Apple v FBI

How will we leverage Community Board Assessment Regulations (?)

How to quantify the Return on Investment for public health reporting

Stewards of the patient/doctor relationship

City Hall Gallery Walk

Most conditions are vastly underreported

Multiple, competing priorities. Hitch our wagon to Zika!

“Golden Rule” Centers - plural

National healthcare surveys

Epidemiologists want to inform the public – they are the bosses


Example of cooperation? Do exist (sic)

Does the vendor community speak with one voice?

Vendors have a lot of specific regulations to comply with

Spend time on low value activities

Public health doesn’t know how to engage vendors

Managing a product means vendors cannot afford to satisfy all requests

AND providers have implementation cycles


Workforce developments and evolution

How does the next generation of MDs, RNs and public health want to do business?

Articulate the fiscal opportunities in changing care system

Public Comments – What does success look like?

* Synthesized on Slide 17

Public Comments – What does success look like?

* Synthesized on Slide 17

User Stories – Emerging Conditions

User Story #1: Public Health Surveillance of Currently Non-Reportable Conditions, like Elizabethkingia

Today: Outbreaks of emerging diseases occur and cases of novel manifestations of common diseases occur. Some public health jurisdictions are mandated to monitor the new disease as a reportable condition, and want the disease to be electronically reportable. Public Health Agencies are unable to monitor and provide accurate guidance on outbreaks and physicians do not have a sufficiently broad view of the events to identify anomalous events until they are full blown epidemics.





User Stories – Acute Illness

User Story #2: Electronic Case Reporting of Standard Reportable Events, like influenza

Today: A patient comes into the physician’s office in <Local Jurisdiction> with certain symptoms. The physician decides on a diagnosis. According to applicable regulations, the event is reportable. The physician is aware that the case is reportable, but lacks the form and the time. The physician instructs his staff to report it, but they also lack the form and the time. The case is not reported.





User Stories – Chronic Diseases

User Story #3: Public Health Surveillance of Chronic Diseases, like diabetes

Today: A public health diabetes control officer is monitoring all of the diabetics in their jurisdiction. They would like to know when the patients become insulin dependent. Currently there is no straightforward way to do this in the current environment. They make an arrangement with the office nurse of a busy practice to periodically report how many patients have had new insulin prescriptions.





Core Technical Approach



Governance

Governance

Roles & Responsibilities



eCR POC Definition

Your Greenhouse Facilitation Team44

Sarah Minor-MassyChristine Nelson

Leigh OteyJeanne StrepackiSaagar Thakkar

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Deloitte PowerPoint template - Digital Bridge · 2016-12-19 · care systems. Emerging. Acute • Trust, education, collaboration, and partnership • Does not end with report, i.e