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Building Collaborations and Information-Sharing across Multiple
DomainsModerator: Paul Wormeli, Executive Director Emeritus, IJIS Institute; Board Member,
SOC Institute
Panelists:
• Timothy Jay Carney, PhD, MPH, MBA, Senior Director of Data Analytics and Public
Health Informatics, Association of State and Territorial Health Officials (ASTHO)
• Dan Chavez, Executive Director, San Diego Health Connect
• Mary Ann Dewan, PhD, Santa Clara County Office of Education, Superintendent of
Schools
• Mariann Yeager, MBA, CEO, The Sequoia Project
A Symposium in the NIC of Time: Advancing Information Sharing in California and Beyond
Timothy Jay Carney, PhD, MPH, MBA
Senior Director of Data Analytics and Public Health Informatics (DAHPI)
Association of State and Territorial Health Officials (ASTHO)
Building Collaborations and Information-Sharing Across Multiple Domains
A Symposium in the National Interoperability Collaborative
Advancing Information-Sharing in California and Beyond
March 26-27, 2018
ASTHO Today – 59 Members, 10 TimeZones
ASTHO Today – 20 Affiliates
The Chief Health Strategist and the 3 CPHS Pillars
Leadership - Policy and Advocacy - Capacity Building
Pro
gram
Str
ateg
y, M
em
ber
En
gage
men
t, p
ub
lic r
elat
ion
s, T
acti
cs, a
nd
To
ols
Clinical to Community Connections (CCC)
Data Analytics and Public Health Informatics (DAPHI)
Health Equity and Social Determinants of Health (HESDOH)
Promote through policy and practice strategic alliances of public health with health care payers and providers
Use technology and informatics to develop state capacity and leadership for integrated and informative systems technology solution that use health care, human services and public health data
Assure health equity through state health agency’s strategic partnerships with capacity to lead change and commit to promote health in all policies
ASTHO Data Analytics and Public Health Informatics (DAPHI) Team Promotes a Public Health Systems View to
Impact on Population Health Outcomes
Public Health Agencies and Practitioners
Community
Patients/Health
ConsumersResearchers
Health
Providers
Health Care Organizations
Views the State Health Official as
Chief Health Strategist
Current Representation on the IDPN
States/Territories with IDPN representation
Digital Bridge and Electronic Case Report (Formerly referred to as the Public Health Community Platform)
One National Effort in Interoperability that ASTHO Supports
• ASTHO provides oversight and governance through leadership of the Digital Bridge Strategy and Governance groups
• Serves on all workgroups and subcommittees (e.g., evaluation, implementation, legal, etc.)
• Conduct site visits
• March 27th sponsoring an eCR Learning Collaborative to assist in building capacity in the next wave of states and territories
• Development of a 30-page Guidebook for State Health Officers (SHOs) to assist them in establishing the business case for eCR in their state (due out for release to SHOs soon)
What is the Digital Bridge?
• A partnership of health care, health IT and public health organizations
• Goal is to ensure our nation’s health through a bidirectional information flow between health care and public health
• An incubator for growing projects that meet this vision
• A forum for sharing ideas and solutions
• Funded by the Robert Wood Johnson Foundation and the de Beaumont Foundation. Program management provided by Deloitte Consulting and the Public Health Informatics Institute.
• Initial focus: electronic case reporting (eCR)
Contact Information
Mary Ann Cooney, MPH, MSN Chief for the Center for Population Health Strategies (CPHS)
202 371-9090 x5411; mcooney@astho.org
Timothy Jay Carney, Senior Director for Data Analytics and Public Health Informatics (DAHPI)
(404-443-1129; tcarney@astho.org)
Thank You!
Building Collaborations and Information-Sharing Across Multiple Domains
A Symposium in the NIC of Time:
Advancing Information-Sharing in
California and BeyondDan Chavez
March 27, 2018
13
Six Domains
14
HIT
EMS
Public
Safety
Public
Education
Human &
Social
Services
Public
Health
Source: Camden Coalition
The Goal…
Hepatitis A Case Example
• Homeless, age 30
• 10 ED Visits (Mar–Aug)
• 1 Hospitalization
• 1 Hep A Vaccination
• Hx ETOH
March
April
May
June
August
ED Visit 3/31
July
ED Visit 4/3
ED Visit 5/6
ED Visit 5/19
ED Visit & Hospitalization 7/16
ED Visit 7/12
ED Visit 8/20
ED Visit 8/31
ED Visit 6/19
ED Visit 6/22
Hep A Diagnosis 7/16
Hep A Vaccination 6/7
Cellulitis & abscess of lung
Blisters on hand
Abdominal pain
Cough & brown phlegm
Vomiting
Convulsions
Rib pain
ETOH withdrawal
Weakness, cough, fever, chills
Onset of illness 6/16
ETOH withdrawal & Seizure
Nationwide Interoperability Efforts
Key:Network-to-NetworkPerson-centric network
Provider-centric network
Secure messagingnetwork/RLSConsumer-directed network
*Year of launch
** For purposes of this scan, HIMSS’s
Interop & HIE Committee usedEPICtorepresent one example of vendor-mediated
exchange.
eHealth ExchangeSequoia
2012*
Carequality
2014
Care Everywhere
(EPIC)**
2008
CommonWell Health Alliance
2013
NATE
2013
Surescripts
2008
Patient Center Data
Home™ (SHIEC)
2015
Community HIEs
2005
DirectTrust
2011
CARINAlliance
2016
MEMBER
Key Findings from Environmental Scan
Multi-pronged approach
to exchange
Limited measurement of
standards
implementation, adoption
and use
Provider centric
system of exchange
Semantic interoperability
a barrier to data
exchange
Inconsistent quality
lowers value proposition
No common solution on
patient matching
Six Domains Interoperability
19
HIT
EMS
Public
Safety
Public
Education
Human &
Social
Services
Public
Health
Patient identification
Data quality
Data provenance
PHI and PII
Public health to primary care
Proper presentation summary
Closed loop referral system
Notifications and alerts
Linking data together:
Coordinated Cross Sector Care Management - A Requirement
Connecting All for
Better Health & WellnessCOMMUNITY INFORMATION
EXCHANGE
@
Many New, Local
Programs Require
Case Management• Be There
• CACHI
• Whole Person Wellness
• Project One for All
• Data Driven Justice
Population Health is the Future of HIE
21
Patient Practice PublicPopulation
Informatics, standards, workforce, business drivers, governance
Source: AMIA, Fridsma
National Interoperability CollaborativeMarch 27, 2018
23
Establish & Maintain
Data Security
Data Privacy
Confidentiality
3 Levels of Protection
Technical
Legal
Governance
Trust
Building Institutional Trust
SCCOE DataZone Vision
Low-cost data warehousing
Dashboards for decision making
Secure partitions
Support LCAP goals
Aggregate multiple data sources (SIS, Assessments, HR,
Finance)
Improved data quality
26
How DataZone Works
SIS
Assessment
Finance
Other Data
Sources
Data
Warehouse
Analysis
and
Reporting
Tools
Reporting and Analysis
ServicesTurning data into useful
information
TrainingLearning how to use data to
make informed decisions.
State and Federal
ReportingMeeting reporting compliance
DisseminationSharing data with the
community (ie: report cards)
Schools Interoperability
Framework
US US DOEDOE’’s s Vision of Data Flow for a DVision of Data Flow for a D33M SystemM System
Data Sources
Students, Subgroups, Cohorts
Teacher
CELDT, SBAC
Formative AssessmentsStudent & Teacher Attendance
Discipline
Programs
Schools, Grade Levels
Years Teaching, Professional Development
2011-2012
2012-2013
2013-2014
2014-2015
2015-2016
Courses, Grades, GPA
Data for Instructional Coherence
SCCOE DataZone and Foster Vision
FosterVision
District DataDistrict Data
District Data
Other Agency Data
Social Services
Juvenile Probation
FosterVision
DataZone and FosterVisionAnalytics to produce timely and relevant information
Data Visualization to synthesize data across multiple
sources, make actionable connections and identify
solutions.
Build Partnerships among researchers, community and
family members working directly with children and families.
Continuous Development to integrate new policies,
practices, training, tools, data elements and better
methods.
• Data Governance
– Policies
– Legal requirements supporting policy,
trust and ethics explored and defined
• Technology
– Secure information sharing architecture
designed prototyped and deployed
• Engagement Readiness
– Data Governance, Legal agreements
• Policy, Practice, and Training
– Who has access?
– Data Cleaning
– Being able to ‘see’ the data
Improving Outcomes
• Changing the Conversation
– Early Warning Systems
– Chronic Absenteeism
– Social and Emotional
• School Linked Services
• Early Learning
• Joint Foster Youth Task Force
34
35
Building Collaborations and Information Sharing Across Multiple Domains
NIC SymposiumTuesday, March 27, 2018
36 2017© The Sequoia Project. All rights reserved.
Mariann Yeager, CEOO: 571-327-3640Myeager “at” sequoiaproject.orgwww.sequoiaproject.org
The Sequoia Project is a trusted, independent convener of industry and government
Supports multiple independent initiatives, each with their own mission, governance, membership and structure.
37
The Sequoia Project’s Role
NATIONWIDESECURE INTEROPERABLE
2017© The Sequoia Project. All rights reserved.
Our Initiatives Support Information Exchange in these Sectors
Supported Today
• Health Information Technology
– Treatment and care coordination
– Disability determination (Human services?)
– Quality measures reporting
– Alternative care models
• Public Safety / Public Health
– PULSE - http://www.ca-hie.org/initiatives/pulse/
Under Evaluation for Future
• Emergency Medical Services
– Ties to mainstream treatment use case
• Human and Social Services
– 2-1-1 Programs
• Other Public Health
– Previously supported (CDC pilot)
– Electronic Case Reporting
38 2017 ©Copyright The Sequoia Project. All rights reserved.
A Nationwide Public-Private Health Data Network
39
eHealth Exchange connects:
All 50 States
Four Federal Agencies(DoD, VA, CMS, SSA)
75% of U.S. Hospitals
70,000Medical Groups
3,400+ Dialysis Centers
8,300Pharmacies
Supporting more than 120 million patients
59 Regional and State HIEs
2017© The Sequoia Project. All rights reserved.
An initiative of40
Interoperability Framework and Rules of the Road Interconnect Networks (Examples below)
FutureHIEs Vendor
Networks
Service Providers
An initiative of
Accelerating Health Data Sharing in AmericaConnectivity as of Jan. 31
2018 © The Sequoia Project. All rights reserved.41
600K+ Providers
1,250+ Hospitals
34,700+ Clinics
2M+ Clinical Documents Exchanged Monthly
Lessons Learned
42
Collaboration is Needed to Build Trust and Make Progress Toward Common Goal
• Common mission
• Executive leadership and engagement
• Cooperative process
• Narrow focus on what to implement first
• Specific deliverables and milestones
• Firm commitments to implement within specified timeframes
• Progress measured in operational outcomes
43 2017 ©Copyright The Sequoia Project. All rights reserved.
Accountability Key to Success
18 2017© The Sequoia Project. All rights reserved.
Clear allocation of liability
risk among participants
Common agreement to
establish expectations,
with mandatory flow
down provisions
Active governance by
committee with dispute
resolution
Lessons Learned in Supporting National-Level Public-Private Collaboration
• Governance should be inclusive but still be operationally nimble
• Stakeholders will engage and commit if it results in real-world implementation
• There can be significant shared savings with public utility objective
• Business case is often still needed to drive adoption and utilization
• There are proven policies which have not substantively changed in 10 years
• Multi-purpose approaches maximize value in investment and simplify the addition of new use cases
20 2017© The Sequoia Project. All rights reserved.
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