Transcript Plan Sections

VERMONT INFORMATION TECHNOLOGY
LEADERS
Vermont Health Information
Technology Plan (VHITP)
Workgroup Meeting
April 11, 2007
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Agenda
• Status and timeline
• Review Plan Sections:
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Revised Use Narratives
Revised Standards Section and open issues
Technology Section first draft
Vision Section first draft
• Discussion on upcoming Sections:
– Funding/Financing
– Governance
• From last month's agenda:
– Patient control
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Where are we
• Finalized Use Narratives
• Workgroup Topics
– Education
– Funding
– Security and Privacy
• VHITP Draft
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Skeleton
Standards
Technology
Vision
• “The checklist” – key decisions
• The timeline – who and when do we need to bring in?
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Plan Sections - Update
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Plan Sections - Update
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12 Weeks to go
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April meeting (4/11/07)
Draft sections
Draft sections
Draft sections
May meeting (5/9/07)
June meeting (6/13/07)
Plan due at end of week (6/30/07)
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The “Checklist”
 Recommendations at the application
level for EMRs in provider practices
 “There are other aspects of
government involvement, such as
access to the health information
infrastructure by municipalities…”
 “Input from the Vermont business
community”
 “A mechanism for soliciting and
managing patient, consumer, and
citizen input”
 ...and on today’s agenda.
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Use Narratives
and Vision
• Additional updates
• Still open for feedback
• Draft Vision Section includes some
narratives; others in Appendix
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Standards
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Updates
How much emphasis do we want to put on the
concept of "compliance" and should this concept
be limited to HIE standards in particular and not
HIT standards in general? Should we have
distinguish between HIE and HIT standards and
focus only on the HIE side in terms of
recommendations and/or requirements?
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A standard that stakeholders should keep an eye on but is not
recommended or required at this time (not mature enough, etc.)
A standard that is recommended and may be implemented (to be
in "compliance" with the Plan?)
A standard that is recommended and should/must be implemented
A standard that must be implemented in order to participate in any
way with the HIEN
Should we mention the CON in particular or leave it
to others to modify the CON process based on the
Plan?
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Technology
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Draft posted
VITL as the HIEN
Phases
“Document centric” vs. “Data centric”?
“Provider centric” vs. “Patient
centric”?
• IHE Profiles
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Funding Initiative - VITL
• Establish interim fund
• Issue RFP for software /
implementation vendors
• Publish criteria for pilot sites
• Select pilot sites
• Monitor progress
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Funding - VHITP
What to say beyond EMR funding initiative?
 Provide technical and operational assistance
to practices (for HIT or HIE participation)
 Provide incentives for re-using data rather than
repeating services (for example, provide a CPT
Code or modifier to an existing CPT code for
“looking up” results versus placing new
orders).
 To help ensure sustainability, provide
appropriate funding to organizations supplying
HIE/HIT services
 What about VITL?
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Governance
• Embace HISPC’s HIE Commission
concept?
– Evolving standards and compliance
– Patient Control
– Break the Glass
• Benefits
– Credibility
– Potential for increased involvement
• Drawbacks
– Why can’t VITL play this role?
– Compare to other states
– Do we really need yet another organizational
structure?
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Patient Control/
Consent/Centeredness
• Do we need a consensus on a more specific
policy/direction?
• Potential options:
1. Patient Control as an overarching principle; all HIEN
participants adhere to the principle (must be defined of
course)
2. Consent as the principle
3. No change
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– Breaches in the news
• Concern about disclosure/use of data
beyond treatment
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Personnel at health care facility
Insurance company
Employer
Public Health
• Concern about disclosure/use of data
for treatment
– Current/past conditions prejudicial to treatment
– Embarrassment
– Patients lie / withhold
Education as a cross-cutting need.
• General concerns about data security
Discrimination / Identity Theft / Embarrassment
Marketing
Understanding
patient concerns
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Framework for
Patient Consent
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Recognize limitations under current law and under
paper records (basis for educational campaign)
Recognize that HIT and HIE do in fact diminish to
some degree the patient’s control
Distinction between:
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Establish physician requirements
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Complete longitudinal health record as an exchange document –
Exchanging all clinical observations
Subset or condensed record (CCD/CCR, labs, demographics,
medications, imaging) (and what does VHITP have to say about
this?)
OK with defined subset
OK with opt-out
Not OK with arbitrary omissions
Are we faced with a 100% provider opt-out vs. a 2%
patient opt-out situation?
Can we combine an understanding of what is
exchanged with informed consent to reach an
optimal solution?
Still, what is the
Granularity of
Consent?
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HISPC
Framework
“Patient authorization for release of information”
as the organizing principle for the electronic
exchange of health information outside of
those areas that remain covered by HIPAA or
relevant state or federal law. The principle
includes three core components:
1. Providing a patient the right to make an informed choice to
participate in a health information exchange, including the
right to opt-in and to opt-out at any time, acknowledging
that an informed choice is dependent on the ability to know
what health information is in the exchange as well as to
whom the information is given;
2. Whether then the patient can block portions of his or her
record from being accessed by treating providers who
would normally have access to it under HIPAA Treatment,
Payment, and Operations (TPO) rights; and
3. If "blocking" was permitted, what liability protections can be
put in place for the treating provider.
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Project Website
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