HIE & ACO Interoperability Testing Test Quickly and Securely · 2019-09-25 · of information...

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HIE & ACO Interoperability Testing – Test Quickly and Securely

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Agenda Interoperability

MU 2

HIE’s

ACO’s

Standards Models of Interaction

Testing

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INTEROPERABILITY

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Definition

Interoperability allows disparate information systems … to readily work together and exchange data. *

*Microsoft (http://www.microsoft.com/about/legal/en/us/interoperability/default.aspx) 5

MEANINGFUL USE

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Definition

The Medicare and Medicaid EHR Incentive Programs provide incentive payments … as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.*

*CMS (http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/) 7

Components of MU

Stage 1 - Use of certified EHR in a meaningful manner

Stage 2 - Use of certified EHR technology for electronic exchange of health information to improve quality of health care

Stage 3 - ……. 8

MU Stage 1 80% of patients must have records in EHR Common Objectives - Individuals & Institutions: Computerized provider order entry (CPOE) Report clinical quality measures to CMS/States Implement one clinical decision support rule Provide patients with electronic copy of health information Record demographics Up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years or older Exchange key clinical information among providers of care and patient-

authorized entities electronically

Protect electronic health information

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MU Stage 2 Common Objectives - Individuals & Institutions: CPOE - For more than 60% of medication, 30% of laboratory, & 30% of radiology Demographics / Vital Signs / Smoking Status – Record for more than 80% Interventions - 5 clinical decision support interventions + drug/drug and drug/allergy Labs - Incorporate lab results for more than 55% Patient List - Generate patient list by specific condition Patient Access - Provide online access to health information for more than 50% with

more than 5% actually accessing Education Resources - EHR to identify and provide education resources more than 10% Rx Reconciliation - Medication reconciliation at more than 50% of transitions of care

Summary of Care - Summary of care document for more than 50% of transitions of care with 10% sent electronically and one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR

Immunizations - Successful ongoing transmission of immunization data

Security Analysis - Conduct or review security analysis and incorporate in risk management process

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Audit Failure

“If CMS determines during the audits that

the provider has failed to meet any one of the reporting requirements, it plans to take steps to recoup incentive payments.”*

*GAO (http://gao.gov/assets/600/590538.pdf/) 11

HEALTH INFORMATION EXCHANGES

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Health Information Exchange (HIE) Reliable and interoperable electronic health-related

information sharing

Conducted in a manner that protects the confidentiality, privacy, and security of the information.

Create a standardized interoperable model that is trusted, scalable and reliable.

Public HIE - Community-based and are open to, and governed by, participants from multiple organizations.

Private HIE - Operate under the governance of an Integrated Delivery Network (IDN) or a single healthcare system.

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ACO

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Accountable Care Organizations (ACO) Groups of doctors, hospitals, and other health care

providers, who come together to give coordinated care to Medicare patients.

The goal is to ensure that patients get the right care and avoid unnecessary duplication of services and medical errors.

When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.

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Types of ACOs Medicare Shared Savings Program—a program that

helps a Medicare fee-for-service program providers become an ACO.

Advance Payment Initiative —a supplementary incentive program for selected participants in the Shared Savings Program.

Pioneer ACO Model —a program designed for early adopters of coordinated care.

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STANDARDS

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Health Information Organizations (HIO) Organizations that oversee HIE

Employ nationally recognized standards to enable

interoperability, security and confidentiality

Ensure authorization of those who access the information.

Effort to improve the way systems in healthcare share critical information.

Develop integration profiles to facilitate health information passing seamlessly from one system to another.

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Integrating the Healthcare Enterprise (IHE) The Healthcare Information Management & Systems

Society (HIMSS) provides leadership for the optimal use of information technology and management systems for the betterment of healthcare.

Healthcare Information Technology Standards Panel (HITSP) purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications.

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MODELS OF INTERACTION

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Major Models

Federated

Centralized

Hybrid

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Federated Model

Each participating organization retains control of their healthcare information and responds to queries when information is requested.

Participant

Participant

Participant

Participant

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Centralized Model

Participant

Participant

Participant

Participant

Information Exchange

A central organization collects information from participating organizations and stores the information in a centralized place to provide access.

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Hybrid Model

Participant

Participant

Participant

Participant

Information Exchange

Some information is stored centrally and other information is stored at participating organizations.

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TESTING

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Issues Individual participants can prepare all they want, but

bad data can snarl the exchange.

Normalization of data across multiple independent organizations leaves data more vulnerable to contamination, duplication and mix-ups.

Medicare collection of extensive data, raising privacy

concerns and administrative costs.

Aggregating, analyzing and managing Utilization and Total Medical Cost (of a patient) across organizations.

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Obstacles

Ownership

Normalization

Analytics

Privacy

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TESTING – OWNERSHIP

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Testing - Ownership

Each participant must concede a certain amount of ownership of resources and timelines for projects to the “Greater Good”.

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TESTING – NORMALIZATION

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Normalization - Federated Model

Each participating must maintain a cross reference table of Patient Master ID’s and other data that needs to be shared.

Participant

Participant

Participant

Participant

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Normalization - Centralized / Hybrid

Participant

Participant

Participant

Participant

Information Exchange

A Master Patient Reference and other Cross Reference is maintained by the Information Exchange and accessed by participants.

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TESTING – ANALYTICS

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Testing - Analytics

Participant

Participant

Participant

Participant

Information Exchange

Calculation and understanding of Utilization and Total Cost of Expenses

Reporting for Individual Participants

Government reporting

Proper Entitlements to view reporting.

Pre-Processor

Data Warehouse

Analytics

Participant Participant

Participant

Participant

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TESTING – PRIVACY

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Testing - Federated Model One participant

organization has the De-Identification Hub.

Sensitive Data Discovery is automated for each participant.

The Hub maintains the complete sensitive data inventory from all participants.

The other participants have remote agents which process discovery and de-identification on their own network so that no PHI data leaves their network.

Participant

Participant

Participant

Participant

Hub

Agent

Agent

Agent

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Testing - Centralized / Hybrid

Participant

Participant

Participant

Participant

Information Exchange Hub

Agent

Agent

Agent

Agent

The Information Exchange has the De-Identification Hub.

Sensitive Data Discovery is automated for the Information Exchange as well as each participant.

The Hub maintains the complete sensitive data inventory including that of all participants.

Each participant has a remote agent which process discovery and de-identification on their own network so that no PHI data leaves their network.

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…. A WORD FROM OUR SPONSOR

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Risk Based Solutions

Enterprise Governance, Risk and

Compliance

Strategic Business Processes / Goals

Enterprise Architecture

Reference Models, Business Architecture, Application Architecture

Information Security Architecture

Regulatory & Corporate Requirements, Environment Maturity Assessment

Operational Environment

Data Masking

(De-Identification)

Identity / Access

Management

Data

Management

Drives

Drives Drives

Drives

Information

Security

DMsuiteTMEntitlements

Management

Data

Governance

Sensitive Data

Assessment

• Axis has created a set of eGRC related solutions that leverage our overall consulting expertise as well as our DMsuiteTM and product implementation capabilities

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Data De-Identification - DMsuiteTM

DMsuite™ - A robust,

proprietary tool that has been

deployed at clients for over

8 years with:

Sensitive Data Discovery - HIPAA

Ready Out of the Box,

Data De-Identification and

Auditing functionality.

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Questions or Further Discussions

Contact: Joe Santangelo

Email: jsantangelo@axistechnologyllc.com

Phone: (646) 596-2670

Twitter: @DataPrivacyDude

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855.85HIPAA www.compliancygroup.com

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