HIE Use Case Design Group - portal.ct.gov · 10/4/2017 · Meeting Schedule 4...

HIEUseCaseDesignGroup

October4,2017|2:30– 4:00pmSession#10

ADesignGroupoftheConnecticutHealthITAdvisoryCouncil

FacilitatedbyCedarBridgeGroup

AgendaWelcome/RollCall MichaelMatthews 2:30PM

Commentson8/30/17Minutes DesignGroupMembers 2:32PM

ReviewMeetingSchedule MichaelMatthews 2:34PM

PlanningFramework MichaelMatthews 2:35PM

SuggestedApproachesforUseCases Michael Matthews 3:00PM

PreliminaryRecommendationsDiscussion

Michael Matthews 3:40PM

MeetingWrap-upandNextSteps MichaelMatthews 3:55PM

2

Commentson8/30/17Minutes

3

MeetingSchedule

4

Milestones/Deliverables Dates

Session1:Kick-OffMeeting 6/27/17

Session2:ReviewUseCases(Part1) 7/12/17


PresentupdatetoHealthITAdvisoryCouncil 7/20/17



Session6:ReviewUseCases(Part 5)andPrioritizationCriteriaforUseCases 8/9/17

Session7:ReviewFinalUseCases(Part 6);ApplyPrioritizationCriteria 8/16/17

PresentUpdatetoHealthITAdvisoryCouncil 8/17/17

Session8:Select“Top10”UseCases;DiscussFinalPrioritizationCriteria 8/23/17

CedarBridge toConductAnalysisof“Top10”UseCases;ResearchFinancial,Business,Legal,andPolicyConsiderations

8/23/17-8/30/17

Session9:ValidateValuePropositions,ImplementationPriorities,andHIEServicesNeededtoEnablePriorityUseCases 8/30/17

Session10:ReviewofAdditionalInformationandPreliminaryRecommendations 10/4/17

Session11:FinalRecommendations 10/11/17

FinalReportandRecommendationstoHealthITAdvisoryCouncil 10/19/17

SustainabilityConsiderations

5

PrimaryfocusoftheDesignGrouptodatehasbeenonvaluecreationandtechnicalrequirements.

FortheState’spurposes,recommendationsforinitialusecasesaredrivenbyexperience,intuitionandbestpracticesfromotherHIEs.

TheHITOshouldincludeinthefundingrequesttoIAPDadequateresourcestodevelopasoundfinancialsustainabilityplan.

InoperationsoftheHIE,rigorousmeasuresofusageandvaluecreationshouldbeimplementedtoensureallservicesyield

positivereturnforthestakeholdersofCT,enablingadjustmentstobeimplementedasneeded.

ProcurementTimeline

6

SystemComponents

7

SystemComponentsandServices:Clinical

EncounterAlerts

LongitudinalHealthRecords

PublicHealth

Reporting

PatientPortal

ImageExchange

eCQMReporting

MPI x x x x x xProviderDirectory x x x x x xActiveCareRelationship x x x xTransformation x x x x x xMapconceptsandcodesacrosscontrolledterminologies(VSAC,SNOMED,HCPCs,etc.)

x x x x

Normalizationandstandardization x x x x xRulesEngine(s) x x xDeduplication x xConsolidation x x x xErrordetectionandcorrection x x x x x xInterfaceengine:transport/validation/translation/routing x x xDatagovernance x x x x x xLogging x x x x x xAccountmanagement x x x x xErrortrapping x x x x x xSecurity x x x x x xAuditing x x x x x xMeasurespecificationdata xSchemaMapping x x x x xCompliantGateway x xReportingtoolintegration(i.e.SSRS) x xImageExchangeGateway xEnterpriseViewer xConsentManagement x x x x x xAPIandothersubmissionmethodsofmeasurestoCMS x

HPD

MPI

ACRS

SCD

CTHub:• ExchangeBroker• Connect-NwHINexchange• XCAExchange• XDS.BExchange• RestfulInterfaces• Direct

PublicHealthBHACO/AN/CINHIEsPayersHospitalsProvidersLabsPharmacyLTPACEMSOralOther

Portals:• LongitudinalHealth

Record• PatientPortal

• eCQM• PopulationHealth

• ClinicalEncounterAlertsService• ImageExchange• PublicHealthExchange• MedicationReconciliation• MOLST/ADRegistry

CoreServices

UseCaseServices

DataSharingOrganizations

eHealthExchangeCarequalityCommonwell

NationalNetworks

HL7C-CDACCD,QRDAFlatFileReport/PDF

C-CDACCD

HL7C-CDACCD,QRDAFlatFileReport/PDF

HIEServices

8

UseCasesUnderReview

n eCQMReportingSystemn ImmunizationInformationSystemn LongitudinalHealthRecordn PublicHealthReportingn Clinicalencounteralertsn Imageexchangen Medicationreconciliationn MOLST/advancedirectivesn Populationhealthanalyticsn Patientportal/personalhealthrecord

9

eCQMReportingSystem

Priorusecasehighlights

• eCQMDGrecommendations• Functionandpurpose• Valueproposition• Actors

Additionalinformation

• Business,financial,legal,andpolicyconsiderations• Requirementsdocumentation• RFPpreparation

Proposedapproach

• Procurement• NecessaryenablingserviceswillbeincludedintheIAPD-U;developmentand

deploymentofeCQM analyticswillbefundedbySIM

10

ImmunizationInformationSystem


• IISDGrecommendations• Functionandpurpose• Valueproposition• Actors


• Business,financial,legal,andpolicyconsiderations• AcceptanceofrecommendationsbyHealthITAdvisoryCouncil9/21/17

Proposedapproach

• InclusioninIAPD-U• Procurement

11

LongitudinalHealthRecords


• Functionandpurpose• Valueproposition• Actors


• Business,financial,legal,andpolicyconsiderations• RequirementsofPA16-77• 21st CenturyCuresAct• Privacyandsecurity• Value-basedcare• Nationalnetworks(eHealthExchange,CareQuality,Commonwell)• BorderstatesHIEinitiatives• ExistinginteroperabilityassetsinCT

• Technicalrequirements

Proposedapproach

• “FirstWave”usecase• Federatedmodel• Leveragenationalnetworks• Providerportal• InclusioninIAPD-U

12

SampleProviderPortal

o ClinicalDocumentSummary(C-CDAandC62)renderingthathasmultipleclinicalcomponents– Demographics,Providers,Allergies,Encounters,Immunizations,Medications,Payers,Problems,Procedures,Results-ClinicalNotes,Laboratory,Radiology,Pathology,etc.

o Filteringandprintingbyparticipant,acrosssources,withinsections,withinresults13

PublicHealthReporting




• Business,financial,legal,andpolicyconsiderations• IISDGrecommendationsacceptedbyHealthITAdvisoryCouncil• Needforgatewaytosubmit/queryforimmunizations(plussyndromicsurveillance,

reportablelabs,tumorregistry)• APHLInformaticsMessagingServices(AIMS)• Technicalrequirements

Proposedapproach

• “FirstWave”usecase• Furtherassesspotentialtoleverage/expandAIMS• Onboarding• Technicalassistance• InclusioninIAPD-U

14

AIMS:APHLInformaticsMessagingService

15

ClinicalEncounterAlerts




• Business,financial,legal,andpolicyconsiderations• PA16-77• Value-basedcare

• ConnecticutHospitalAssociation/PatientPingreview• Technicalrequirements

Proposedapproach

• “FirstWave”usecase• Furtherrefinebusinessandtechnicalrequirements• RFItoassessexistingCTassets• Procurement/contracting• InclusioninIAPD-U

16

17

PatientPing

MedicationReconciliation




• Business,financial,legal,andpolicyconsiderations• Furtherresearchonmedicationreconciliationprocess• DiscussionswithUCONNPharmacyre:initiativetoaddressprocessandtechnology

Proposedapproach

• Initialprojectfocusonprocessre-designandassociatedtechnologysupport• Technologyprocurementasindicated• Statewiderollout• InclusioninIAPD-U

18

MedicationReconciliationChallenges

19

ImageExchange




• Business,financial,legal,andpolicyconsiderations• Furtherresearchonimageexchange• Discussion/informationfromNYeC• Radiology-to-radiologyusecase• Referralusecase

Proposedapproach

• “FirstWave”usecase• InclusioninIAPD-U

20

NYeCImageExchangeSolution

21

Image Exchange Workflow CapabilitieseHealth Connect® Image Exchange has been designed to integrate with all common PACS technologies and with virtually all HIE and EHR platforms, providing the following image-enabled clinical workflows:View all imaging studies from within the patient record on an HIE portalWith a single click, authorized HIE users can launch a study of interest from any connected imaging location on eHealthViewer® ZF—a zero-footprint, web-based viewing platform—a fully diagnostic-quality FDA 510(k) Class II medical device.View and compare imaging studies from different locationsAuthorized HIE users can access a Community-Wide Imaging Worklist for their patient. Users can manipulate, sort, and view one or multiple imaging studies from different imaging provider locations in a common eHealthViewer ZF image viewing session.Collaborate with other healthcare providers anywhere in the community in real timeWith a single click from the eHealthViewer ZF, users can initiate an immediate screen sharing consultation session with any other authorized care provider in the community—for wet reads, second opinions, and consultations between referring physicians and specialists.Access images from external locations directly from their EMR or Direct Messaging inboxCare providers seeking access to patient records from their Direct Messaging inboxes, or as delivered to directly to their EMRs can be provided “one-click” access to view imaging studies on eHealthViewer ZF. This capability has the added benefit of enabling participating institutions to meet a key imaging menu criterion of Meaningful Use Stage 2.Transfer external imaging studies directly into a local PACSRadiologists and other clinicians frequently have access to relevant external prior imaging studies on their local PACS in order to properly diagnose and treat more complex medical conditions. eHealth Connect® Image Exchange accomplishes this transfer with a few clicks directly from an HIE user interface, and will assure the key image attributes in the DICOM header, such as patient ID (MRN) and accession number, are updated prior to transferring images.

MOLST/AdvanceDirectives


• Functionandpurpose• Valueproposition• Actors• AssociatedusecaseofAdvanceDirectives


• Business,financial,legal,andpolicyconsiderations• LegislationforMOLSTPilot• ExpansionofMOLSTstatewide10/1/17• Paper-based/patient-controlledprocess• DiscussionwithmembersofMOLSTTaskForceandAdvisoryCommittee9/25/17

Proposedapproach

• PartnerwithMOLSTTaskForceandAdvisoryCommitteetoassesstechnologyvalue-add

• FurtherassesscomplementaryAdvanceDirectivesRegistry

22

MOLSTForm

23

PatientPortal




• Business,financial,legal,andpolicyconsiderations• Patientas“NorthStar”• MUrequirements• MACRA• Technicalrequirements• Safetyconcerns• Competitiveissues• Funding

Proposedapproach

• Furtherassessbusinessandfunctionalrequirements• Assessmarketplacevendorsolutions• ConsiderimplementationafterLongitudinalHealthRecordimplementation

24

PopulationHealthAnalytics




• Business,financial,legal,andpolicyconsiderations• Technicalrequirements• OverlapwitheCQMReportingSystemusecase

Proposedapproach

• Furtherassessbusinessandfunctionalrequirements• ConsiderforimplementationaftereCQMReportingSystemimplementation

25

ProposedWave1:Summary

•Procurement•ImplementationeCQMReportingSystem

•Implementation•IntegrationwithPublicHealthReporting

ImmunizationInformationSystem

•LeverageeHEX,CeQ,CW•ImplementproviderportalLongitudinalHealthRecord

•Potentialtoleverage/expandAIMS•Implementexpandeddataelements;onboardingandTAPublicHealthReporting

•Finalizebusinessrequirements•Procurement/contracting(includingleverageofexistingassets)ClinicalEncounterAlerts

•Finalizebusinessandfunctionalrequirements•FurtherdiscussionswithNYeCImageExchange

26

CandidatesforWave2:Summary

•Implementpilotforprocessre-design•Implementtechnologytosupportre-designedprocessMedicationReconciliation

•PartnerwithexistingMOLSTTaskForceandAdvisoryCommitteetoassesstechnologyvalue-add

•FurtherassessvalueofcomplementaryADRegistryMOLST/AdvanceDirectives

•PlanforrolloutafterimplementationoflongitudinalhealthrecordPatientPortal

•PlanforrolloutaftereCQMRSandrequiredtechnicalarchitecturePopulationHealthAnalytics

27

RevalidateSequencing

ProposedWave1

eCQMReportingSystem

IIS

Longitudinalhealthrecord

Publichealthreporting

Encounteralerts

Imageexchange

CandidatesforWave2

MOLST/AD

Medicationreconciliation

Patientportal

Populationhealthanalytics

Wave3+

TBD

TBD

TBD

TBD

TBD

Governance



CoreServicesTechnicalArchitecture

SupportServices 28

Rollout

29

Year1

• Coreservicesimplementation• Supportservicesimplementation• “Wave1”usecaseimplementation• “Wave2”usecaseplanning

Year2• “Wave2”usecaseimplementation• “Wave3+”usecaseplanning

Year3• “Wave3”usecaseimplementation



DiscussionandNextSteps

30

www.cedarbridgegroup.com

[email protected]

[email protected]

HIE Use Case Design Group - portal.ct.gov · 10/4/2017 · Meeting Schedule 4...

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