Transcript LCC Pilots WG 2014-09-15

Longitudinal Coordination of Care
Pilots WG
Monday, September 15, 2014
Meeting Etiquette
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From S&I Framework to Participants:
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Reminder
Join the LCC WG & Complete Pilot Survey
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http://wiki.siframework.org/Longitudinal+CC+WG+Committed+Member+Guidance
http://wiki.siframework.org/LCC+Pilots+WG
Agenda
Topic
Presenter
Welcome & Announcements
Lynette
Presentation: VHA Care Plan Demo
Dr. Randall Rupper,
Suzette Stoutenberg,
VHA Technical Team
Next Steps
Lynette
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Pilot Work Group Purpose and Goals
• Purpose
– Provide tools and guidance for managing and evaluating
LCC pilot Projects
– Create a forum to share lessons learned and best
practices
– Provide subject matter expertise
– Leverage existing and new partnerships
• Goals
– Bring awareness on available national standards for HIE
and care coordination
– Real world evaluation of parts of most recent HL7 C-CDA
Revisions Implementation Guide (IG)
– Validation of ToC and Care Plan/HHPoC datasets
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Meeting Reminders
S&I Framework Hosted Meetings:
http://wiki.siframework.org/Longitudinal+Coordination+of+Care
• LCC Pilot WG meetings are every other Monday from 11:00– 12:00
pm Eastern
– Focus on validation and testing of LCC Standards for Transitions
of Care & Care Plan exchange
HL7 Structured Documents WG Meetings
• Thursdays from 10:00 – 12:00pm Eastern
– WebEx: https://global.gotowebinar.com/register/144336339
– Dial In: 770-657-9270; Access Code: 310940
•A pre-publication draft of CCDA R2.0 specification was distributed to
the SDWG list serv on July 3rd:
(http://www.hl7.org/Special/committees/structure/docs.cfm?).
•Comments were accepted until July 11th.
•Currently discussing CCDA R2.0 Template OID versioning issue
HL7 Patient Care WG Meeting Reminders
• Coordination of Care Services Specification Project
– Provide SOA capabilities/models to support coordination of patient
care across the continuum
– Reconciling May 2014 Ballot Cycle Comments
– Current working documents found here:
http://wiki.hl7.org/index.php?title=Coordination_of_Care_Services_Specification_Project
– Tuesdays from 5:00 – 6:00pm ET
• Meeting Information:
– Web Meeting URL:
https://meetings.webex.com/collabs/meetings/join?uuid=M55ZKYUA35CE2U3J4SV
41XMZR3-3MNZ
» Meeting Number: 193 323 052
– Phone: 770-657-9270, Participant Code: 071582
HL7 Patient Care WG Meeting Reminders, cont’d...
• Care Plan Project
– Reconciling May 2014 Ballot Cycle Comments for the updated
Care Plan DAM and story boards.
– Current working documents found here:
http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012
– Every other Wednesday from 4:00 – 5:30pm ET
• Next meeting is September 10th
• Meeting Information:
– Web Meeting URL:
https://intermountainmeetings.webex.com/intermountainm
eetings/j.php?J=621920971
– Phone: 770-657-9270, Participant Code: 943377
HL7 Patient Care WG Meeting Reminders, cont’d...
• Health Concern Topic
– Developing Health Concern DAM for September HL7 Ballot Cycle
– Current working documents found here:
http://wiki.hl7.org/index.php?title=Health_Concern
– Thursdays from 4:00 – 5:00pm ET
• Next meeting scheduled for September 18th
• Meeting Information:
– Web URL:
https://meetings.webex.com/collabs/#/meetings/joinbynum
ber
» Meeting Number: 233 955 026
» Phone: 770-657-9270, Participant Code: 943377
HL7 Patient Care WG Meeting Reminders, cont’d...
• Patient Care FHIR Resources and Profiles
• Reviewing/Finalizing storyboards for the HL7 Sept WGM FHIR
Clinical Connectathon
• Developing FHIR Resource for Referral and Transition/Transfer of
Care
• Current working documents found here:
http://wiki.hl7.org/index.php?title=FHIR_Patient_Care_Resources
– Thursdays from 5:00 – 6:30pm ET
• Next meeting scheduled for September 18th
• Meeting Information:
– Web URL: www.webex.com
– Meeting Number: 198 139 396
» Phone: 770-657-9270, Participant Code: 943377
HIMSS Health Story Roundtable
• Why attend?
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Advocate and build support for the Health Story Project
Collaborate and network with Health Story Project supporters
Engage with industry leaders in monthly meetings
Participation is open to any HIMSS Members at no additional cost
• Meets monthly on the 1st Monday from 4pm-5pm ET. Upcoming
meetings scheduled for October 6th
– Web URL: Click here to view agenda and download the calendar
invitation (this link will also work to join the meeting)
– Meeting Number: 927 311 214
– Meeting Password: meeting
– To receive a call back, provide your phone number when you join
the meeting, or call the number below and enter the access code.
• Call-in toll-free number (US/Canada): 1-866-469-3239
• Call-in toll number (US/Canada): 1-650-429-3300
FACA Meeting Reminders
HIT Standards Committee
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Next meeting scheduled for September 10th from 10:00am – 2:00pm ET
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http://www.healthit.gov/facas/calendar/2014/09/10/hit-standards-committee
HIT Policy Committee
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Next meeting scheduled for November 4th from 9:00am – 3:00pm ET
http://www.healthit.gov/FACAS/calendar/2014/08/06/hit-policy-committee
Aug-Sept 13
Nov 13
Dec- Jan 14
Feb- Mar 14
Apr- May 14
Jun- Jul 14
Aug- Sep 14
HL7 Ballot
LCC Pilot WG
LCC Pilot WG Timeline: Aug 2013 – Sept 2014
LCC Pilot Proposal Review
LCC Pilot Monitoring & Evaluation
LCC Pilot Wrap-Up
HL7 Ballot & Reconciliation
HL7 C-CDA IG Revisions
LCC Pilot
WG Launch
HL7 Ballot
Publication
Revisions for
HL7 CCDA IG
Complete
Milestones
HL7 Fall Ballot Close
LCC Pilot Test Spec.
Complete
LCC Pilots Close
29SEP14
GSI Health Go-Live
NY Care Coordination Go-Live
Upcoming LCC Pilots Meeting Presentations
• Upcoming presentations:
• September 22nd:
• GSI Health Pilots & Healthix Lessons Learned
• September 29th:
• LCC Pilots Initiative Closing Ceremony
VHA Initiative
and PrototypeDemo
Dr. Randall Rupper
[email protected]
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Veterans Health Administration (VHA)
Office of Rural Health (ORH) Outreach Initiative
Improved Information Management to Enhance
Care Coordination for Rural Veterans
September 2014
For internal MITRE use
© 2013 The MITRE Corporation. All rights reserved.
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VHA ORH Focus
 Improve access and quality of care for rural Veterans by
developing evidence-based policies and innovative practices
that support the unique needs of Veterans residing in
geographically remote areas
 Provide outreach to Veterans and care providers in rural areas
to identify, assist, and inform rural Veterans about VA benefits to
which they are entitled
 Build partnerships with community agencies and organizations
that currently serve rural communities
Apply innovation and technology to improve access and quality
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Problem
 Veterans in rural areas who require home healthcare are often
referred to home healthcare providers outside the VA
 Coordination of care between VA and private providers for those
Veterans is handled primarily manually
 Manual coordination of care often results in significant delays
and errors in providing care
VHA Primary Care Physician doesn’t
have access to patient’s medications
and progress toward goals at home
Records are moved manually
between facilities
Home health provider can’t get
access to patient’s record at VA
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Goal of Rural Health Pilot
 Investigate a Web-based approach to coordinating home health
plans of care
 Develop and refine requirements for Veterans home health
 Facilitate enhanced coordination of care between VA and private
Home Health providers
– Enable a faster process
– Reduce errors
– Eliminate lost/ duplicative paperwork
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Approach
Leverage power and scalability of the Web to share information securely
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Outcomes
 Pilot that demonstrates the “art of the possible” for
management of non-VA home healthcare
– Use pilot to gather feedback, refine requirements, and develop
ideas on the way forward
 Recommendations on a way ahead for implementing home
healthcare solutions for rural Veterans
– Share home healthcare requirements with team building next
generation VistA
– Transition useful components as appropriate to next generation
VistA
Enhanced care coordination ~ Enhanced transitions of care
Equal care for all
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Storyboard
Mr. Lewis Barnes suffers from Type II Diabetes, Afib,
Obstructive Sleep Apnea, and COPD. He has back
pain and limited movement. He is on warfarin and
insulin. His wife helps to care for him.
Mr. Barnes ready for discharge from the hospital
after orthopedic surgery to have two vertebrae
fused.
Dr. Steve Smith, the surgeon, orders pain meds,
home health nurse, physical therapy.
Mr. Barnes lives in a rural area and will need a
third-party home healthcare provider.
All persons in this scenario are fictitious and are not derived from any real person or
medical situation. Any similarities to real people are coincidental.
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Create consult and referral,
approve referral
All persons in this scenario are fictitious and are not derived from any real person or
medical situation. Any similarities to real people are coincidental.
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Create and approve plan of care
All persons in this scenario are fictitious and are not derived from any real person or
medical situation. Any similarities to real people are coincidental.
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Demonstration
All persons in this scenario are fictitious and are not derived from any real person or
medical situation. Any similarities to real people are coincidental.
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Backup Slides
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Technical Approach
 Develop Web-based application to demonstrate secure, RESTful
exchange of home healthcare data
– Build on previous RESTful pilots
– Leverage lessons learned
 Implement a lightweight workflow engine that can be tailored to
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support various process workflows
Utilize Direct as a Service (DaaS) for automated notification
(future)
Utilize Fast Health Interoperability Resources (FHIR) for
information exchange (future)
Simulate VistA integration
Investigate feasibility of integrating an existing medication
reconciliation application
– Leverage MITRE Innovation Program (MIP) research project
 Secure the data exchange with OpenID Connect and OAuth
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Notional Pilot Architecture
Next Steps
• Homework Assignments:
– Sign up as an LCC Committed Member
• Members will receive invite to join upcoming eLTSS
Initiative (start November 2014)
• If you would like to learn more about participating in
the NEW eLTSS Initiative, please email Evelyn
Gallego ([email protected])
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LCC Initiative: Contact Information
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LCC Leads
– Dr. Larry Garber ([email protected])
– Dr. Terry O’Malley ([email protected])
– Dr. Bill Russell ([email protected])
– Sue Mitchell ([email protected])
LCC/HL7 Coordination Lead
– Dr. Russ Leftwich ([email protected])
Federal Partner Lead
– Jennie Harvell ([email protected])
Initiative Coordinator
– Evelyn Gallego ([email protected])
Project Management
– Pilots Lead: Lynette Elliott ([email protected])
– Use Case Lead: Becky Angeles ([email protected])
LCC Wiki Site: http://wiki.siframework.org/Longitudinal+Coordination+of+Care
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FACA Updates
as of Sept. 12, 2014
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Release of Final Rule:
2014 EHR Certification Criteria Release 2
• In consideration of stakeholder feedback, ONC adopted
a small subset of the proposals as optional and revised
2014 Edition Release 2 certification criteria and made
only a few changes to the ONC Health IT Certification
Program so that the program would be more effective
and less burdensome.
• The 2014 Edition Release 2 includes:
– 10 optional and 2 revised certification criteria
– A small number of changes to the ONC Health IT
Certification Program
– Administrative updates
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2014 Edition Release 2
EHR Certification Criteria
Optional Certification Criteria
Regulation Section
Title of Regulation Paragraph
§ 170.314(a)(18)
Optional – computerized provider order entry
– medications
§ 170.314(a)(19)
Optional – computerized provider order entry
– laboratory
§ 170.314(a)(20)
Optional – computerized provider order entry
– diagnostic imaging
§ 170.314(b)(8)
Optional – transitions of care
§ 170.314(b)(9)
Optional – clinical information reconciliation
and incorporation
§ 170.314(f)(7)
Optional – ambulatory setting only –
Transmission to public health agencies –
syndromic surveillance
§ 170.314(g)(1)
Optional – automated numerator recording
§ 170.314(h)(1)
Optional – Applicability Statement for Secure
Health Transport
§ 170.314(h)(2)
Optional – Applicability Statement for Secure
Health Transport and XDR/XDM for Direct
Messaging
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§ 170.314(h)(3)
Optional – SOAP Transport and Security
Specification and XDR/XDM for Direct
Messaging
Revised Certification Criteria
Regulation
Section
§ 170.314(e)(1)
§ 170.314(g)(3)
Title of Regulation Paragraph
View, download, and transmit to 3rd party
Safety-enhanced design
Adopted Optional and Revised
Certification Criteria in 2014
Edition Release 2
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Transitions of Care
View, Download, and Transmit to 3rd Party
• We decouple the “content” portion of the 2014 Edition “transitions of care”
(ToC) criterion from the “transport” capabilities, and adopted a new set of
optional transport criteria (discussed on the next slide).
• This decoupling would allow health information service providers (HISPs) and
other health IT developers to provide either content or transport capabilities
without having to be certified to both.
• We also adopt the Edge Protocols Implementation Guide (IG) v1.1 for the
optional ToC criterion to promote an EHR’s ability to reliably connect to a
HISP.
• We adopt a revised “view, download, and transmit to 3rd party” (VDT)
criterion that offers the same revisions made to the optional ToC criterion as
optional for testing and certification (e.g., Edge Protocols IG v1.1)
• Reasons for Release 2 policy changes: added flexibility and improved
interoperability
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Transmission Method
Certification Criteria
• As part of decoupling “content” and “transport” for
ToC and VDT, we adopt three optional certification
criteria for transmission methods:
• Direct
• Direct and XDR/XDM for Direct Messaging
• SOAP RTM and XDR/XDM for Direct Messaging
• Reason for Release 2 policy change: added flexibility
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Gap Certification Eligibility
• Our gap certification policy allows the use of test results from
a previous certification for certification to functionalities that
have not changed, subject to the ONC-Accredited Certification
Body’s (ONC-ACB) discretion.
• Seven Release 2 criteria are eligible for gap certification if
EHRs were certified to the 2014 Edition versions of these
functionalities:
– Three optional CPOE criteria
– Optional syndromic surveillance criterion
– Three optional transmission criteria
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Certification Program Changes
• We finalize our proposal to discontinue the “Complete EHR”
definition and Complete EHR certification beginning with the
next adopted edition of certification criteria. This does not
affect prior or future 2014 Edition certification.
– Reason for Release 2 policy change: added regulatory clarity and
flexibility
• We adopt the “ONC Certified HIT” certification and design
mark for required use by ONC-ACBs.
– Reason for Release 2 policy change: provide clarity for the market as it
relates to health IT certified under the program
• We adopt an updated standard (ISO/IEC 17065) for the
accreditation of ONC-ACBs.
– Reason for Release 2 policy change: maintains alignment with industry
practices
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Other Administrative Changes
• We finalize a proposal to remove 2011 Edition-specific EHR
certification criteria and related standards, terms, and requirements
from the Code of Federal Regulations (CFR) effective March 1,
2015.
– Reason for Release 2 policy change: EHR technology certified to
2011 Edition will no longer meet the Certified EHR Technology
definition starting in 2015
– Keeping criteria editions current for the purposes of Stark/AntiKickback EHR donation rules
• We finalize a proposal to remove the temporary certification program
regulations from the CFR on the effective date of this final rule.
– Reason for Release 2 policy change: The temporary certification
program sunset on October 4, 2012, and is no longer in
existence
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What’s Next?
• ONC will be publishing a proposed rule for the next
edition of EHR certification criteria jointly with the next
CMS EHR Incentive Programs proposed rule. We expect
these rules to be published by the end of 2014.
• We anticipate that the next edition of EHR certification
criteria will contain functionalities that will be required for
the next stage of the EHR Incentive Programs.
• The public comment we received on the Proposed
Voluntary Edition will help inform our proposals for the
next certification edition.
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