Hub Implementation - Amazon S3 · FHIR RLS Aggregation Patient Matching Quality Scans Push ADT Notifications tbd. Must my organization connect to the Hub? If your organization exchanges

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

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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


What Will the Hub Do?


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?


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


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?


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?


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?


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.


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.


FHIRor

SOAPAPIs

SOAPAPI

What are Potential Future Hub Capabilities?


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


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 [email protected]

mailto:[email protected]

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.


How Can I Obtain More Information?


• 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)

https://ehealthexchange.org/participant-area/ehealth-exchange-operations-wiki/hub-development-updates

https://ehealthexchange.org/events


mailto:[email protected]


Next Steps


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.



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!

Documents

Hub Implementation - Amazon S3 · FHIR RLS Aggregation Patient Matching Quality Scans Push ADT Notifications tbd. Must my organization connect to the Hub? If your organization exchanges