Health Homes Novel Prototype

PowerPoint Presentation

System Stack Element 2 (HIE)Secure Record SharingHIE+A DIRECT HIE is:A Directory of Participating Care Provider Addresses (ex [email protected]) Compatible with EHRs, email, and PHRs

The exchange of health records include three important functions so that Federal, State, and Local privacy policies and patient consent preferences can be managed during an exchange

Five Types of Privacy Preferences (Today):

1: Opt-Out (non 42 CFR complaint)In this model, all patient information is shared with any participant on the HIE unless patients indicate otherise

2: Opt-Out with exceptions In this model, all patient information is shared with any participant on the HIE unless patients indicate otherise

3: Opt-In In this model, all patient information is shared only when patient consent is givenThis requires patient knowledge and explicit authorization to share eBHR with each node on HIEDurability of Consent: Hub and Spoke: Temporary (one-time authorization) to "Until Death"Federated HIE: Temporary to some "reasonable" criteria

4: Opt-In with exceptions In this model, some patient information is shared only when patient consent is givenThis requires patient knowledge and explicit authorization to share eBHR with each node on HIEDurability of Consent: Hub and Spoke: Temporary (one-time authorization) to "Until Death"Federated HIE: Temporary to some "reasonable" criteria

5: No SharingThe eBHR is only shared in an emergency "break the glass" scenario

Security (as specified by Meaningful Use and required by HHS) requires encryption of medical records during record exchange

Routing (managed by the HIE): Enables participating providers to retrieve address and verification information of target providers in the HIE7Health Homes are cool solutions for problems that exist todayPatients dont go to the right doctorWhat if a care coordinator could guide a patientCare transitions fail 70% of the time when the patient is responsibleWhat if the patient didnt have to facilitate communication between providersOn average it take 17 years for a best practice to become a common practice









Routing (managed by the HIE): Enables participating providers to retrieve address and verification information of target providers in the HIE2Technology standards and systems enable health homesStandards ExistIntegration EffortWe are going to show you one simple scenario of how existing systems and standards can be the infrastructure that enable your health home policies

Health HomesA Novel PrototypePerson Centered Care PlanThank YouNext SlideStandards Stack Element 1 (eHrs)The Continuity of Care Document (CCD) Standardizes Medical Records File Formats So that people have portable medical records

CCDBH Providers(WITS)HospitalsLong-Term Care/HCBSFQHCsDevelopmental DisabilitiesProviders and EHRs

EMRs have been standardized so that records can be shared between disconnected systems

In the 90s a common way of thinking about file formats was whether or not it could run on DOS or a MAC. In 2013, for healthcare, providers are ask is my EMR Meaningful Use Certified?

(August 2013) 3,372 different Meaningful UseCertifiedproducts are listed on the Certified Health IT Product List

Standard Structure/ File Format: Meaningful Use Certified Products are able to save and open medical records in the standard Health Level Seven (HL7) format referred to as a Continuity of Care Document (CCD)

Standard Terminology: Within that standard CCD format, the MU Certified Products can now use standard vocabulary to describe patients in terms of Problems (using SNOMED), Procedures (using CPT Codes), or Labs (using LOINC)

Standard Exchanges (HIEs): Exist in the form of Direct and Connect and are critical for Helath Home Functionality

6Standards Stack Element 2 (HIE)Secure Record SharingHIE+

CCD

DIRECT

An HIE is:A Directory of Participating Care Providers (Internet Address)Secure Transmission of Interoperable Records (Encryption)Assured Record Authenticity (Digital Signing)









Routing (managed by the HIE): Enables participating providers to retrieve address and verification information of target providers in the HIE8System Stack Element 3 (C2S)Consent2Share (C2S) is a patient portal that Enables patients to electronically provide and update their privacy preferencesElevates administrative burden placed on providers Secure Record SharingHIEConsent2Share 42 CFR pt2+The exchange of health records include three important functions so that Federal, State, and Local privacy policies and patient consent preferences can be managed during an exchange








Routing (managed by the HIE): Enables participating providers to retrieve address and verification information of target providers in the HIE9Standards Stack Element 3 (C2S)So that providers only share records when the patient allows:HIEs can ask C2S patients privacy preferences permit sharing of a CCD C2S can evaluate the CCD content, identity of providers seeking to share, and patients consent preferencesProviders only receive Patient Health Information when patient preferences Permit

DIRECTCCD

XACMLSecure Record SharingHIEConsent2Share 42 CFR pt2++Permit=

SharingThe exchange of health records include three important functions so that Federal, State, and Local privacy policies and patient consent preferences can be managed during an exchange








Routing (managed by the HIE): Enables participating providers to retrieve address and verification information of target providers in the HIE10Transition: txtSystem Stack Element 4 (Pop Health)In the medical fields, it take 17 years for advances in treatment to become mainstreamMeasuring Quality is one way to determine how well/quickly providers are adopting these Best Practices

Quality is measured by how many times was the correct procedure/intervention administered over the the number of times that the criteria where a Best Practice would have been advisable

As with medical records, HL7 has a standard file format for reporting Quality (used in both Pop Health and Query Health) within a Health Home

Unlike Medical Records, however, quality measures do not contain PHI (only numerators and denominators) and can be shared without restriction.

11

Quality Reporting Document Architecture

QRDAStandards Stack Element 4 (POP Health)

In the medical fields, it take 17 years for advances in treatment to become mainstreamMeasuring Quality is one way to determine how well/quickly providers are adopting these Best Practices




12

Transition: txtSystem Stack Element 5 (Query Health)In the medical fields, it take 17 years for advances in treatment to become mainstreamMeasuring Quality is one way to determine how well/quickly providers are adopting these Best Practices




13

Quality Reporting Document Architecture

QRDAStandards Stack Element 5 (QUERY Health)

Continuity of Care Document

CCDHealth Quality Measures Format

HQMF

In the medical fields, it take 17 years for advances in treatment to become mainstreamMeasuring Quality is one way to determine how well/quickly providers are adopting these Best Practices




14

Standards Stack Element 6 (Health Home)Transition: txtCare Coordinators Use HIE technology to perform Four Functions to Improve Patient Care:Referrals so that: Providers stop using local administrative staff to refer patients (where only 30% of patients attend their first visit, and

Providers start using a Person Centered, Care Coordinator to manage care transitions (where greater than 65% of patients attend their first visit)Plans of Care so thatProviders stop ordering redundant or counter-productive labs and procedures (insert fact from IOM here), and

Providers start utilizing existing care plans and re-using patient lab resultsCare Coordination so thatProviders stop treating co-morbid patients sequentially, and

Providers start improving outcomes by treating interrelated problems simultaneously

Billing so thatProviders stop collectively spending $7.6 billion dollar overhead expense for medical coding assistance, and

Providers start centrally leveraging a common billing resource15

So that Care Coordinators can.Transition: txtCare Coordinators Use HIE technology to perform Four Functions to Improve Patient Care:Referrals so that: Providers stop using local administrative staff to refer patients (where only 30% of patients attend their first visit, and

Providers start using a Person Centered, Care Coordinator to manage care transitions (where greater than 65% of patients attend their first visit)Plans of Care so thatProviders stop ordering redundant or counter-productive labs and procedures (insert fact from IOM here), and

Providers start utilizing existing care plans and re-using patient lab resultsCare Coordination so thatProviders stop treating co-morbid patients sequentially, and

Providers start improving outcomes by treating interrelated problems simultaneously

Billing so thatProviders stop collectively spending $7.6 billion dollar overhead expense for medical coding assistance, and

Providers start centrally leveraging a common billing resource16

Now a Novel Look at a Health Home ProtoType

DIRECTCCDXACMLQuality MeasuresStatisticsSystem Stack17Secure Record SharingHome Health Functions

ReferralsPlans of CareBillingBH Providers(WITS)HospitalsLong-Term Care/HCBSFQHCsDevelopmental DisabilitiesHIEConsent2Share 42 CFR pt2+Query HealthpopHealth+Quality MeasuresCustom QueriesProviders and EHRsCare CoordinationSystem Stack18Home Health Functionality

ReferralsPlans of CareCare CoordinationBillingBH Providers(WITS)HospitalsLong-Term Care/HCBSFQHCsDevelopmental DisabilitiesProviders and EHRs

CCD

HIEConsent2Share 42 CFR pt2+

XACMLQuery HealthGoldpopHealth+Quality MeasuresCustom Queries

DIRECT

Quality Measures

StatisticsSystem Stack19WITSProviders and EHRs

Documents

Health Homes Novel Prototype