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Hub ImplementationApril 4, 2019
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.
You Asked, We Listened
©Copyright 2019 eHealth Exchange. All rights reserved2
Hub
Platform
Carequality PULSE
Integration
Record
Locator
Future:
• Push vs
Pull
FHIR
Directory
Future:
• FHIR
Resources
• Patient
Matching
Purpose of
Use
Future:
• PDMP
• Images
Direct
Messaging
Future
Enhance
Architecture
Expand
ReachPrepare NotifyStreamline
Expand
BreadthRefer
Qualified Health Information Network (QHIN) Analysis
Roadmap
What’s changing?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.3
SSA(150+)
VA(200+)
Tiger Institute
(3)
Michiana(6)
DoD(60+)
Dignity(20+)
SSA
VAMichiana
DoD
Dignity
Hub
Current StateMultiple Connections Per Participant
Future State1 Connection Per Participant
Expands Reach Lowers Cost Introduces New Capabilities
4
Why Are We Doing This?
2019 © eHealth Exchange. All rights reserved.
1 connection vs 270+
1 C
on
nectio
n 1 C
on
nectio
n
1 Connection Participant
Participant
Participant
Participant
Hub
Participant Participant
Participant
Participant
One Connection to eHealth Exchange Participants
5 2019 © eHealth Exchange. All rights reserved.
1 interface vs 300+
1 C
on
nectio
n 1 C
on
nectio
n
122 ConnectionsEpic Care
Everywhere
NextGen
Commonwell
eCw
Hub
NetSmart AthenaNet
Surescripts
Participant
Why Are We Doing This?One Connection to All Carequality Networks
Who Selected The Hub?
• Formal Request for Proposal (RFP) process
• Evaluation Workgroup scored vendor responses
• Unanimously recommend Intersystems’ HealthShare
Evaluation Workgroup:• Advent Health• California HIE Association• Childrens Dallas• CRISP• DaVita• Common Spirit• DoD• Kaiser• Humana• OCHIN• Superior Health Plan• SSA• VHA• Walgreens
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.6
What Will the Hub Do?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.7
Initiator(Your organization)
HubDirect your queries to the Hub’s Endpoint URLs listed
in the new Hub-aware directory instead of using
the Responder’s endpoints
using the Responder’s Home Community ID.
(No change)
Hub Aware Directory
Responder(eg General Hospital)
Sub-organizations are differentiated by the Assigning
Authority, by HCID, or by repository unique IDs
depending upon gateway design
Directory and Hub rules reduce duplicate Carequality queries
and excess volume
How Will Data Flow?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.8
How Does Hub Security Work?
– Governance (the DURSA)
– Operating Policies and Procedures
– Technical Specifications
– Security-Focused Standards
– Reduced Cyber Threat Attack Surface Area
– Encryption of PHI In-Transit
– Certificate Trust
– Auditing
– eHealth Exchange Staff
– Encryption at Rest and In-Transit
– Cryptographic Signatures
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.9
The eHealth Exchange has applied its secure by design architecture, Federal Bridge Certification Authority (FBCA) operational policies and procedures, and a leading edge PKI production assessment process, to the Hub via:
What is the Likely Timeline?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.10
Coordinate (March-June): Participant Firewall IP whitelisting Environments Test Patients Hub IP whitelisting
Sign amended Participation
agreement
May 30, 2019
Expect the Hub’s test harness to initiate a query to Participants’ gateways for the test patient coordinated for use
Most Participants can be liveresponding to queries originated via the Hub
Early July 2019
August 2019
The Hub’s implementation team helps remediate any issues
September 2019
April 30, 2019
Return checklist
Help prioritize new capabilities for the eHealth Exchange
October 2019Each Participant initiates a test query to the Sequoia Interoperability Platform (ITP)’s home community ID (HCID) with the Hub’s Responding Gateway (RG) endpoint to make their connection bi-directional.
Most Participants can be live initiating queries to the Hub instead of using point to point
What is Carequality Timing?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.11
1 C
on
nectio
n
1 C
on
nectio
n
multipleEpic Care
Everywhere
NextGen
CommonWell
eCw
Hub
NetSmart AthenaNet
Surescripts
Participant 1 Connection
What Do I Need To Do Now?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.12
Submit Technical Information via Checklist
Non-Technical Actions
• Test Patient
• IP Address(es)
• Firewall Whitelisting
1. Sign Amended Participation Agreement
2. Attend eHealth Exchange Meetings for more information
Please return the Hub Connectivity To-Do Checklist by April 30, 2019.
What Do I Need To Do This Summer?
1. Setup to Respond to queries other Participants send your organization via the Hub (“Responding Gateway”)
• Goal – No effort on your part unless your organization utilizes firewall whitelisting. If so, configure your firewall to trust the Hub
• Goal - Your system successfully matches the test patient and returns a clinical message
• Expect Hub implementation team to contact your organization
• Expect for Hub to initiate a test message to your organization using the test patient we agree upon via the Excel checklist.
2. Setup to Initiate queries to other Participants via the Hub (“Initiating Gateway”)
• Goal - Confirm your organization can send patient searches to other Participants via the Hub and receive requested clinical documents.
• Configure your system to begin using the new Hub-aware directory
• Initiate a test query to the Sequoia Interoperability Testing Platform (ITP)’s Home Community ID (HCID) with the Hub’s endpoints.
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.13
July 2019
August 2019
Which eHealth Exchange Directory Should I Read?
• If your organization initiates requests to the Hub to retrieve patient information from other Participants, even if some of the responding Participants are not yet connected to the Hub, configure your system to use the new Hub-aware directory
• If your organization does not initiate requests via the Hub with another Participant, assuming your organization and that Participant have mutually agreed to continue using point to point connections, continue using the traditional eHealth Exchange directory.
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.14
FHIRor
SOAPAPIs
SOAPAPI
What are Potential Future Hub Capabilities?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.15
Above and
beyond
reliance upon
the existing
Sequoia
Project FHIR
directory, we
hope to begin
offering
additional
FHIR
capabilities for
meds
problems,
allergies,
vitals, & lab
results
Optional
service
randomly
running
Partner CDAs
through the
Content
Validation test
scripts
Optional
service
automatically
pushing
unsolicited
CDAs via IHE
XDR (or
perhaps via
XDS.b)
ADT
Notifications
Optional
service
Optional
service that
combines
multiple CDAs
for a given
patient
Patient
Matching
Optional
service
tbdParticipants
connecting to
Carequality
via the
eHealth
Exchange
could leverage
this optional
service
FHIR RLS AggregationPatient
Matching
Quality
ScansPush
ADT
Notificationstbd
Must my organization connect to the Hub? If your organization exchanges for Treatment, creating 1 connection to the Hub is more practical than creating and maintaining connections with over 250 other gateways who exchange for Treatment
– If your organization exchanges with any other eHealth Exchange Participant for Treatment purposes, your organization has a Duty to Respond to all other eHealth Exchange Participants exchanging for Treatment, even if their queries arrive infrequently from distant regions, and even if information cannot be provided.
– Your organization can fulfill its DURSA obligation to exchange for Treatment by either:
• Creating 1 connection to the eHealth Exchange Hub to connect with other Participants exchanging for Treatment, or
• Mutually-agreeing with other Participants exchanging for Treatment to maintain direct point-to-point connections. Importantly, your organization may not require another Participant who has implemented the HUB to spend resources to establish or maintain direct point-to-point connections with it.
CONFIDENTIAL: eHealth Exchange Participants' Use Only16
When responding to Treatment queries, how may my organization respond?
When responding to Treatment queries, Participants may respond with any of the following:
• Clinical document(s)
• “Patient not Found” message if the requested patient couldn’t be matched to the responder’s master patient index
• “Unable to Respond” message if the responder uniformly applies supplemental requirements
CONFIDENTIAL: eHealth Exchange Participants' Use Only17
Why is the Participant Agreement Changing?
To Amend the Existing Agreement Structure
• To enhance the agreement structure to facilitate the use of contract addendums
• General housekeeping
To Add a Hub Addenda
• To establish guardrails regarding use of the Hub
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.18
To Add a BAA Addenda
• Participants’ attorneys (not the eHealth Exchange) will likely insist upon signing a BAA since the eHealth Exchange is not a party to the DURSA and the eHealth Exchange is providing the Hub service on behalf of Participants
• This BAA is not replacing or superseding the DURSA.
Please e-mail questions or concerns to administrator@ehealthexchange.com
Amended Participation Agreement (Major Changes)
1. Participation Agreement Changes• Replaced “Sequoia Project” with “eHealth Exchange”
• Enhanced agreement structure to facilitate the use of contract addendums (e.g. a Hub addenda & a BAA addenda)
• Revises the section on Fees to reflect that eHealth Exchange will offer services and that there will be fees for those services that will be included in the fee schedule. Also, clarifies that fees associated with a contract addenda (e.g. the Hub) have the same late fees. Also, clarifies that late fees and expenses can be waived if a Participant is prohibited by law from paying those fees and expenses.
• State Governmental entities are subject to their own state law
• Corrects a mistake that stated the Coordinating Committee approved the original Participation fees years ago and removes language requiring the Coordinating Committee to approve amendments.
• Says notices should be sent to the eHealth Exchange Executive Director instead of the Sequoia Project CEO
• Adds new Hub fees and future Carequality fees to the fee schedule
• States that Carequality fees won’t be charged until the eHealth Exchange onboards to Carequality
2. Added Hub AddendaParticipants agree:
• To “cooperate with eHealth Exchange and with the Gateway Vendor as reasonably requested to enhance the effective and efficient operation of the Gateway”
• To only use the Hub for eHx approved business
• To take responsibility of its users on the Hub
• To use and control access to the Administrative Portal appropriately
• Any fees their vendors charge are their responsibility
• To comply “with all applicable privacy and security laws, including the HIPAA Regulations, and local and state laws rules and regulations”
• That the eHealth Exchange can monitor and audit all access to and use of the Gateway and the content of any data or messages
• To limit the eHealth Exchange’s liability to no more than fees paid for Hub specifically in past 12 months
• That the eHealth Exchange has the right to suspend Participant’s Hub access and terminate agreement
• That the eHealth Exchange is not responsible for inaccurate data, incomplete data, Participants’ use of data, or Hub downtime
3. Added BAA AddendaClarifies the permissible uses and disclosures of protected health information by the business associate, based on the relationship between the parties and services being performed by the business associate.
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.19
How Can I Obtain More Information?
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.20
• Website – Registration for the secured Participant-only section is fast & easy
• Monthly Participant Web Meetings – Typically the 3rd Thursday of Each Month at 1 pm ET
• Hub Web Meetings – Typically Tuesdays at 1pm ET & Thursdays at 4pm ET
• Email – Any time if you have a specific question and cannot attend the Hub Web meetings
• Annual eHealth Exchange Meeting – December 4-6, 2019 at the Gaylord National Resort & Convention Center (Washington DC)
Next Steps
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.21
When What
Week of 4/8/2019 1. Receive Hub Information Packet
4/30/2019 2. Return brief checklist
May 20193. Configure firewall to trust Hub’s IP addresses [applicable to
10% of Participants]
5/30/2019 4. Return Amended Participating Agreement
Early July5. Expect test query from Hub (your system returns clinical
document)
August 6. Submit test query to receive test clinical document via Hub
Appendix AHub Fees
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.
How Much Will the Hub Cost My Organization?
• There will be no charge for any Participant to respond to queries other Participants have routed to the Hub.
• 95% of eHealth Exchange Participants will not be asked to pay any new fees to initiate queries with other Participants routed to the Hub.
• Instead, to cover a portion of vendor fees, an annual Hub technology fee will be charged to the < 5% of Participants initiating the most queries since they receive the most benefit by no longer having to maintain so many point to point connections.
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.23
©Copyright 2019 The eHealth Exchange. All rights reserved. Confidential.24
Participants’ Annual Hub Fees (volume-based)Providers & HIO (Not Vendors, Payers, or Federal Agencies)
• $0 if operate in < 5 states (Low volume, so funded by Network Participation Fees)
• $60K if 5+ states & revenue $500M - $3B
• $110K if 5+ states & revenue > $3B
Additional 50% of existing annual Network
Participation fee
• 20% for multi-network admin
• 30% for technology costs
Expands reach from 1
national network to 12+ networks
Non-Federal Partners’
Hub Connection
with eHealth Exchange
[Future]
Connect
with Carequality
$2,500-$13,500 for Non-Federal Providers & HIOs
No charge for any Participant to respond to queries other eHealth Exchange Participants have routed to the Hub!
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