Interoperability for Texas: Powering Health 2016...Interoperability for Texas: Powering Health 2016 THE HEALTH AND HUMAN SERVICES ... November 17, 2016. Presentation Overview House

Update on Interoperability for Texas:Powering Health 2016

THE HEALTH AND HUMAN SERVICES COMMISSION’S REPORT ON THE INTEROPERABILITY OF HEALTH AND HUMAN SERVICES INFORMATION SYSTEMS

HOPE MORGAN, OFFICE OF THE CHIEF TECHNOLOGY OFFICER, HEALTH AND HUMAN SERVICES COMMISSION

STEVE EICHNER, HIT POLICY DIRECTOR, DEPARTMENT OF STATE HEALTH SERVICES

November 17, 2016

Presentation Overview

House Bill 2641 Requirements

Draft Report to the Governor and the Legislative Budget Board

Next Steps

Contacts

11/17/2016eHAC Advisory Committee Presentation 2

House Bill 2641Planning and Reporting Requirements

▪ The commission and each health and human services agency shall establish an interoperability standards plan for all information systems that exchange protected health information with health care providers.

▪ Report to the Governor and the Legislative Budget Board on the commission's and the health and human services agencies' measurable progress in ensuring that relevant information systems are interoperable with one another and meet the appropriate standards.


Systems that are Subject to HB 2641 Interoperability Standards Requirements

New information systems planned or procured after September 2015 that are used by the Texas Health and Human Services Commission (HHSC) or other State of Texas health and human services agencies (Collectively, HHS agencies) to send or receive protected health information (PHI) to/from health care providers.


Approach to Report Development

▪ The work team developed a consolidated report addressing interoperability across all HHS agencies

▪ Draft shared for comment with stakeholders

▪ This report includes:

▪ Definition of “Interoperability”

▪ Background on Health Information Technology (HIT) policy at the state and federal levels

▪ Highlights of HHS systems’ current interoperability capacities

▪ Identification of internal supports for interoperability

▪ Identification of external supports for interoperability

▪ Discussion of activities currently in development to enhance interoperability

▪ Discussion of standards and standards development

▪ Planning framework


Interoperability Defined and Explained

The ability of two or more systems to exchange and use electronic health information from other systems without special effort on the part of the user.

Interoperability enables entities involved in health care, including providers, payers, and public health, to efficiently interact with each other to provide improved health care services, improve the patient experience, better manage costs, facilitate research and protect the public from health risks.


Collaboration as a Theme

Collaboration between trading partners is essential to achieve success in advancing interoperability. Collaborative activities include:

▪ Identifying what health information should be made available between information systems

▪ Standards development

▪ Managing privacy and security

▪ Technology planning and implementation

▪ Defining success measures


Legislative/Policy Background- Federal

▪ In the 2004, then-President George W. Bush introduced his Health Information Technology Plan ▪ “By computerizing health records, we can avoid dangerous

medical mistakes, reduce costs, and improve care.”- essentially the Triple Aim.

▪ Created the Office of the National Coordinator for Health Information Technology (ONC)

▪ The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009▪ Revamped activities at the national level

▪ Established two federal advisory committees charged with making recommendations to the ONC

▪ Established Electronic Health Record (EHR) Medicare and Medicaid Incentive Payment Programs

▪ Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)


Institute for Health Improvement, www.ihi.org

The Evolution of the Nationwide Health Information Highway

▪ First established by ONC

▪ Has had several iterations

▪ Nationwide Health information Network

▪ Health Information Exchange (NHIE)

▪ Currently known as the eHealth Exchange, managed by the Sequoia Project


Ongoing Efforts to Promote Interoperability at the National Level

▪ Transformation of Medicare EHR Incentive Program into the Merit-Based Incentive Payment System (MIPS) and new Advanced Alternative Payment Models (APMs).

▪ Charge from HHS to the health IT industry to improve interoperability and eliminate information blocking

▪ ONC’s 2017 Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, a plan through 2024

▪ ONC’s annual Interoperability Standards Advisory

▪ Collaborative entities like the Standards and Interoperability (S&I) Framework, HL7, the Sequoia Project, Carequality, and CommonWell▪ Blue Button (S&I Framework)

▪ Vendor-neutral Interoperable national infrastructure (CommonWell)

▪ Data Standards (HL7)

▪ eHealth Exchange (Sequoia)

▪ Enabling the exchange of clinical care data between different EHR platforms (Carequality)


Legislative/Policy Background Highlights -State

▪ 2005-HB 916 (79th Legislative Session)- multi-agency Texas Health Care Policy Council (THCPC) created

▪ 2006-Health Information Technology Advisory Committee (HITAC), published the Roadmap for the Mobilization of Electronic Healthcare Information in Texas

▪ 2006-Texas Health Care System Integrity Partnership (THCSIP) identified mechanisms for operationalizing HITAC recommendations

▪ 2007-Texas Health Services Authority created by the Legislature as a nonprofit, public-private partnership to advance health information exchange and HIT

▪ 2007- HB 921 (80th Legislative Session)-Data Standards▪ Develop standards for the secure sharing of information electronically among participating agencies

▪ 2009- HB 1218 (81st Legislative Session)-Standards▪ HIT used by the commission or any entity acting on behalf of the commission in the medical

assistance program conforms to standards required under federal law

▪ 2015- HB 2641 (84th Legislative Session)-Interoperability Plan, Data Standards▪ Requires the development of Interoperability plans

▪ Requires the use of applicable data standards for certain systems

▪ 2015 SB 200 (84th Legislative Session)- HHS Sunset Bill/Transformation of HHS


Transformation of HHS Agencies

The goals of the transformation are to create a system that:

▪ Is easier to navigate for people who need information, benefits, or services

▪ Aligns with the HHS mission, business, and statutory responsibilities

▪ Breaks down operational silos to create greater program integration

▪ Creates clear lines of accountability within the organization

▪ Develops clearly defined and objective performance metrics for all areas of the organization


HHS Strategic Goals as Related to Interoperability

▪ Provide efficient and effective primary, behavioral health, and social services, including services for individuals in 24-hour state facilities

▪ Coordinate with diverse communities and organizations to strengthen and to support the provision of a spectrum of medical, health, and social services

▪ Promote consumer health and safety through focused regulatory and licensing activities

▪ Ensure the integrity of programs and the effectiveness and efficiency of system oversight and program support

▪ Improve behavioral health coordination and provide broad oversight and consultation among state agencies, local governments, and other entities to ensure a strategic statewide approach to providing services

The exchange of protected health information is a critical activity in supporting the goals outlined in the 2017-2021 HHS Strategic Plan, and advances the five themes that are the focus of the strategic plan:

▪ accountability,

▪ efficiency,

▪ effectiveness,

▪ excellence in customer service, and

▪ transparency.


Electronic Health Record (EHR) System Adoption Rates

▪ A 2015 survey of U.S. physicians conducted by Centers for Disease Control and Prevention (CDC) shows an 86.9 percent EHR adoption rate across the nation and a 93.1 percent adoption rate in Texas.

▪ A recent Medscape™ EHR 2016 Survey indicates that nationwide EHR users have converted 83% of their paper patient records to electronic format.


Interoperability Challenges

▪ Technology challenges regarding patient matching

▪ multiple, differing standards used by vendors for storing health information

▪ Healthcare economics

▪ EHR design

▪ Difficulties in establishing trust across and among healthcare entities

▪ Variation in state privacy laws


HHS HIT Roadmap Vision, Mission, and Purpose (Draft)

Health IT Vision

▪ The Health IT vision is to provide high quality health information and technology that is business-driven, secure, accessible, and available when and where it is needed to improve and protect the health and well-being of all Texans.

Health IT Mission

▪ The HHS System strives to improve public health, health service delivery, increase effectiveness, efficiencies, and reduce costs through the appropriate and secure use of health information and technology.

eHAC Advisory Committee Presentation 11/17/2016 16

Purpose

• Interoperability should be enabled when it meets a business need and sufficient resources exist to

implement exchange using appropriate, secure methods. Business requirements dictate the nature of the

information to be exchanged, how data must be formatted, the frequency at which information should be

provided, and who should have access to the information.

HHS Internal Structural Supports for Interoperability

▪ Office of eHealth Coordination

▪ Office of the Chief Data Officer

▪ Medicaid Health Informatics Services and Quality

▪ HHS Information Technology

▪ Office of the Chief Technology Officer

▪ Information Security Office

▪ Health Information Executive Steering Committee/Management Committee

▪ HHS Privacy Office

▪ DSHS HIT Policy

▪ Governance Processes


Security, Confidentiality, and Patient Privacy

▪ Data must be managed within the context of applicable law, including, but not limited to:▪ Health Insurance Portability and Accountability Act (HIPAA);

▪ 42 CFR) 2, which addresses the confidentiality of alcohol and drug abuse patient records;

▪ The Genetic Information Nondiscrimination Act of 2008 (GINA);

▪ The Texas Medical Records Privacy Act; and

▪ The Texas Identity Theft Enforcement and Protection Act.

▪ Only authorized users should have access to data, and, where HIPAA applies, only that data necessary to accomplish the business purpose should be provided.

▪ Patients may consent to share information but consent is not required for exchanging data for payment, treatment, or health care operations activities.

▪ General patient consent may not be applicable to all patient information, such as substance abuse treatment information or psychotherapy notes.

▪ Consent is also not required for disclosure to public health authorities for public health purposes including, but not limited to,” public health surveillance, investigations, and interventions.


External Structural Supports

▪ Texas Health Services Authority

▪ Local Health Information Exchanges

▪ Regional Extension Centers

▪ Provider and Industry Associations including, but not limited to▪ Texas Hospital Association

▪ Texas Medical Association

▪ Texas Council of Community Centers

▪ Texas eHealth Alliance

▪ Texas Health Information Management Association

▪ Association of Substance Abuse Programs

▪ Texas Association of Health Information Organizations


Standards and Standards Development

▪ In the realm of HIT, interoperability standards are used to help enable connectivity between systems and between entities. Healthcare providers and related entities apply and utilize standards to facilitate the interoperability of IT systems to support the delivery of health care.

▪ To accomplish the exchange of health information, a variety of different types of standards- content and transport- may be used to actually exchange messages between systems and entities.


Standards Development Process

Create Plan for Standard

Development/Modification

Develop Support

Draft Standard/Update

Ballot Standard

Gain Approval

Implement Standard/Changes


Standards Development Organizations-Examples

▪ HL7

▪ FHIR

▪ X12

▪ DICOM

▪ PCHA

▪ NAACCR


Standards Usage at HHS Agencies

Many information systems at HHS agencies already utilize data standards, including national standards to support interoperability.

Through the OCDO, agency programs, and the planning framework outlined in this report, HHS is working to align the use of data standards across programs to facilitate interoperability.


Current Interoperability at HHS

▪ HHSC

▪ Medicaid Systems

▪ Pharmacy Claims

▪ ePrescribing

▪ CARE

▪ CMBHS

▪ DADS

▪ SSLCs

▪ DFPS

▪ Foster Care Passport

▪ DSHS

▪ State psychiatric hospitals EHR

▪ Public health registries

▪ Texas Cancer Registry

▪ Electronic Laboratory Reporting

▪ ImmTrac

▪ Vital Statistics

▪ Center for Health Statistics


Systems Subject to HB 2641 Standards Requirements

▪ Syndromic Surveillance (HL7)

▪ High Consequence Infectious Diseases (HCID) Assessment

▪ HRAR Planning and Assessment Projects

▪ HIV = Human immunodeficiency virus

▪ RECN = Real-time Education and Counseling Network

▪ AIDS = Acquired immune deficiency syndrome

▪ ARIES = AIDS Regional Information Evaluation System

▪ Center for Health Statistics Discharge Data (ANSI)

▪ Pharmacy Benefits Management System (NCPDP, MITA)


Other Ongoing Activities to Support Interoperability

▪ Legal Agreements with THSA

▪ Multiple Options for Connectivity

▪ Data Asset Repository

▪ Public Health Reporting through HIEs

▪ Enhancements to governance processes

▪ Medicaid Provider HIE Connectivity

▪ HIE Connectivity and Infrastructure Improvements


HHS Interoperability Planning Framework


Reemphasizing Collaboration and Coordination to Advance Interoperability

▪ Further development of plans and activities within the planning framework

▪ Stakeholder participation

▪ Prioritizing interoperability- business driven

▪ Developing/improving measures of progress and success

▪ Standards identification and adoption

▪ Managing technology change

▪ Advancing access and connectivity


Next Steps for the Report

▪Final report currently being reviewed by the HHS Executive Team

▪Upon HHS Executive Commissioner approval, report is expected to be submitted to the Governor and the Legislative Budget Board by December 1, 2016

▪Report will be distributed to the e-Health Advisory Committee after it has been approved by the HHS Executive Commissioner


Questions?


Presentation Contacts

Steve EichnerHIT Policy Director, [email protected]: 512.776.7180

Hope MorganDirector of Technology Research, [email protected]: 512.438.4675


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Documents

Interoperability for Texas: Powering Health 2016...Interoperability for Texas: Powering Health 2016 THE HEALTH AND HUMAN SERVICES ... November 17, 2016. Presentation Overview House