Provider Directory Subject Matter Expert Workgroup Meeting #3 April 2, 2014 1.
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Transcript of Provider Directory Subject Matter Expert Workgroup Meeting #3 April 2, 2014 1.
1
Provider Directory Subject Matter Expert Workgroup
Meeting #3
April 2, 2014
2
Welcome, March meeting review, agenda review
Karen Hale and Susan Otter
3
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?
4
Direct Secure Messaging Presentation
Lisa Parker
5
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
8
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
0
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
23
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.
24
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).
25
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?
29
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
31
Group Breakout Session
• Gina, Erick, Bob, Hongcheng
“HIE”
• Jessica, Stephanie, Christopher, Ray
Analytics
• Mary Kaye, Tina, Rebecca, Liz
Operations
32
Group Discussion of Use Cases
Karen Hale, Susan Otter, and Group
33
Wrap up and next steps
Karen Hale & Susan Otter
34
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