digital bridge governance principles• utility: the governance body will prioritize use of existing...

• Transparency: Stakeholders will have visibility into the governance body’s work and opportunities to provide input.

• Respect for Process: Governance body members will adhere to an agreed upon decision-making process. Members will observe delineated and agreed upon roles and responsibilities.

• Outreach: The governance body can solicit opinions and presentations from stakeholders to inform its decision-making.

• Utility: The governance body will prioritize use of existing information technology standards and infrastructure as it pursues shared and realistic goals that benefit all parties.

• Representativeness: Governance body members will represent their broader field and be responsive to the goals of the Digital Bridge partnership.

• Trust: Governance body members will honor commitments made to the Digital Bridge effort.

Digital Bridge Governance Principles

FOR DISCUSSION USE ONLY – March 7th, 2019

Governance Body MeetingThursday, March 7th, 201912:00 P.M.– 1:00 P.M. ET

This meeting will be recorded for note-taking purposes only


2


3

Meeting Agenda Time Agenda Item

12:00 PM Call to order – John Lumpkin

12:03 PM Agenda review and approval – John Lumpkin

12:05 PM Consent agenda – John Lumpkin

12:10 PM Risk log• eCR Implementation progress – Laura Conn

12:25 PM Action – John Lumpkin• eCR Transition – Bob Harmon / Michael Iademardo

12:40 PM Discussions – John Lumpkin• Proposed Legal Frameworks for eCR services – John Loonsk

12:55 PM Announcements – Charlie Ishikawa

1:00 PM Adjournment – John Lumpkin

Purpose:The purpose of this meeting is to work toward a common vision for exchanging actionable information between health care and public health.

Consent Agenda• Workgroup updates• Expansion of Pilot Conditions – Hepatitis C• Jan 2019 in-person mtg: Executive meeting

summary and suggested action items

Risk Log• Implementation progress update• Transition management

For Action• eCR Transition Recommendations

For Discussion• Proposed Legal Frameworks for eCR services


4

Consent Agenda | March 2019John Lumpkin (Chair)


Governance Meeting Consent Agenda Protocol1. Pre-meeting:

a. Chair places items that are believed to be non-controversial or routine

b. Items should be received with sufficient review time

2. Start of meeting:a. Chair asks if any member wishes to move an

item into regular discussionb. All items left on the consent agenda are

documented as approved by governance body

c. Any item removed will be discussed during the meeting

March 2019 Consent Agenda Items1. Workgroup updates

a. eCR Implementation Workgroupb. Evaluation Committeec. Pilot Participation Workgroupd. Transition Workgroupe. Legal, Policy, and Regulatory Workgroup

2. Expansion of Pilot Conditions – Hepatitis C3. In-person Meeting Executive Summary and

Suggested Actions


6

Risk Log: eCR Implementation and Transition ProgressLaura Conn and Kirsten Hagemann (eCR Implementation Taskforce Co-Chairs),Rob Brown and Jim Jellison (Digital Bridge PMO)


Update: eCR Implementation Workgroup• Hepatitis C

• The latest RCTC contains trigger codes to support Hepatitis C

• All demonstration sites have the opportunity to add on as a sixth condition

• RCKMS has been updated to accommodate this condition

Implementation Activities• The Houston site went live on November 14, 2018

• Currently in parallel production

• The Utah site went live on December 20, 2018• Currently in parallel production

• Remaining implementation sites will be participating in RCKMS training activities & authoring jurisdictional rules

• AIMS connectivity and test planning activities are occurring with the New York site• IFH/ New York City & New York State

Consent Agenda | Digital Bridge Governance Meeting | For Discussion Only 8FOR DISCUSSION USE ONLY – March 7, 2019

Up Next• Digital Bridge Technical Specifications will be updated as new RKCMS authoring process is

defined• California, Michigan, Kansas are actively working on their vendor/ provider development

activities

Jan 2019 Feb 2019 Mar 2019 Apr 2019 May 2019 June 2019 July 2019 Aug 2019 Sept 2019 Oct 2019 Nov 2019 Dec 2019

Digital Bridge eCR Implementation Timeline Estimate- 2019 DRAFT

New York State - PHAProduction

New York StateConnectivity/Onboarding/Testing

Potential Interested Implementation Sites:• Allscripts• Delaware• Health & Hospitals• Illinois• Iowa• Kentucky• Maryland• MDLand• Minnesota• North Carolina• North Dakota• Ohio• Pennsylvania• South Dakota• Tennessee• Wisconsin

Anticipate discussion of how eCR onboarding will be opened up as part of eCR transition

New York City SiteProduction

Kansas SiteProduction

New York City Site Connectivity/Onboarding/Testing

Kansas Site Connectivity/Onboarding/Testing

California SiteProduction

Michigan SiteProduction

California Site Connectivity/Onboarding/Testing

Michigan Site Connectivity/Onboarding/Testing

Note: Massachusetts site currently searching for provider to participateHouston in production – 11/14/18Utah in production 12/20/18

FOR DISCUSSION USE ONLY – March 7 , 2019Today 9

All Site Progress SummaryActivities MI UT CA KS NYC MA NYS HOU

Site Development Activities

Onboarding

End to End Testing

Legal Readiness

CompletedIn ProgressNot Started

Not Currently ApplicableFOR DISCUSSION USE ONLY – March 7 , 201910

ECR TRANSITION MANAGEMENTBrief Update – Jim Jellison


11

Action: eCR Transition RecommendationsJohn Lumpkin (Chair)


eCR Transition RecommendationsQuestion charged to answer• “Beyond demonstrating and evaluating eCR,

what will Digital Bridge do for general eCRadoption and to assure eCR sustainability?”

Purpose• Share the workgroup's initial ideas with the

governance body and receive feedback to finalize recommendations for endorsement and implementation.

Governance Action Schedule1. Preliminary posted on 1/72. Discuss, modify and adopt by 1/23 – 1/243. Revised during Feb4. Penultimate delivered on 3/6

Organization Name Designation Representing

RWJF John Lumpkin – primary Hilary Heishman – alternate Member Sponsor

CDC Michael Iademarco - Co-chair Bill Mac Kenzie – primary Laura Conn – alternate

Member Sponsor

Cerner/Epic Bob Harmon – Co-chair James Doyle – alternate Member Vendors

Kaiser Permanente HealthPartners

Walter Suarez – primary Richard Paskach–alternate Member Healthcare delivery

ASTHO Mary Ann Cooney – primary Mylynn Tufte – alternate Member Public health

APHL Scott Becker – primary Patina Zarcone – alternate Member eCR operators and

public health

CSTE Kathy Tuner – primaryJeff Engel – alternateMeredith Lichtenstein – tertiary

Member eCR operator and public health

PHII/Deloitte (PMO)

Vivian Singletary – primary Andy Wiesenthal – alternate John Stinn–alternate

Observer PMO


13

Penultimate ReportChange summary1. Incorporates decisions made during the

January in-person meeting2. Adds ideas developed in breakout

sessions (e.g., governance "lite" for scale-up)

3. Eliminates redundant and unnecessary discussions

4. Reduces over all page count5. Focuses the Executive summary to one-

page


14

Scale-up eCR Governance

Scale-up Governance

Digital Bridge

Governance Body

eCROperations

Group

eCRCommunity of Practice

Group Relationship Purview

Digital Bridge Gov. Body

Independent Issues with broad, nationwide or strategic impact; legal, architecture, standards

eCR Operations CDC Partner eCR knowledge products (trigger codes and logic), on-boarding guidance, operational priority setting

eCR CoP CDC Partner Advance eCR adoption and use, contribute expertise and perspective to


15

Discussion: Proposed Legal Frameworks for eCRservicesJohn Loonsk, MD FACMI, Consultant to APHL


eCR and Health Data NetworksJohn W. Loonsk MD FACMI, Consultant to APHL


eCR and Health Data Networks• The current electronic case reporting (eCR) architecture:

• Helps to eliminate jurisdictional and program variability for clinical care organizations and EHR vendors doing eCR

• Has raised some questions about technical and trust / legal scaling and interoperability

• Health Data Networks (HDNs) offer the opportunity to address both scaling and interoperability issues and make eCR services broadly and readily accessible

• APHL and others have engaged leading HDNs to discuss opportunities for eCR• As in the context of TEFCA, the plan is to eventually have eCR services available on all

connected HDNs as a shared service

18FOR DISCUSSION USE ONLY – March 7th, 2019

1. Broad coverage of hospitals (75 percent of all U.S.), medical groups (70,000), and federal agencies (4)

2. The “push” technical transactions that eCR uses (Direct and XDR)3. An established “permitted purpose” to exchange data for public health use4. Business associate authorities without the need for APHL to sign / negotiate

any additional agreements with participating providers• The eHealth Exchange is becoming a business associate of its providers• Like the eHealth Exchange hub contractor, APHL will be a business

associate as a contractor to the eHealth Exchange5. It appears that there will be no indemnification requirements for APHL to

support6. Eventual provision of eCR services to other HDNs through Carequality


The eHealth Exchange offers the following:

• CommonWell is a promising eventual target, too. It has:• An architecture that also supports business associate authorities (CommonWell is

a business associate of its providers, too)• A rich community of participants

• CommonWell:• Needs a public health permitted purpose and push transactions or viable

alternatives• Has suggested that they would invite us to speak to their board to talk about eCR

in the future


eCR and Health Data Networks

• DirectTrust:• Has an established “push” technical transaction that eCR can use• For it to be a viable target itself, it needs trust / legal agreements that support a public

health permitted purpose for exchange, shareable business associate authorities

• Carequality:• Is more of a inter-HDN exchange agreement• It would be good to promote eCR from eHealth Exchange to Carequality and develop

demand from CommonWell and other connected HDNs now and through TEFCA



• Next steps:• DWT and APHL to review draft terms for:

• An eHealth Exchange contract for APHL provision of eCR services• DURSA and participant agreements for APHL eHealth Exchange membership

• Establish a “non-network” agreement that interested provider participants and HIEs can sign if they are not represented in the eHealth Exchange

• Work to elevate interest in eCR in CommonWell and Carequality



Additional Material


eCR Demonstration Sites and the eHealth ExchangeSite Name Provider/HIE Represented in eHealth Exchange? Notes

Houston Houston Methodist No

Utah Intermountain Healthcare

Yes Represented via Utah Health Information Network (UHIN)

Michigan MiHIN Yes

New York City Institute of Family Health Yes

New York State SUNY Upstate TBD/ PMO Researching

California UC Davis Yes

Kansas Lawrence Memorial Hospital (now LMH Health)

Yes Represented via Kansas Health Information Network (KHIN)

Massachusetts None identified N/A


eHealth Exchange(Federated Network)

eHealth ExchangeHub

APHL

Contracted eCR services(BA of eHealth Exchange )

Joins

Proposed Network Schematic(Phase I)

NewDURSAand Participant Agreement BAA

• eHealth Exchange is establishing new DURSA and participant agreements with business associate authorities for the eHealth Exchange

• APHL will then be a business associate of eHealth Exchange to provide eCR services

• APHL would also join eHealth Exchange and sign the DURSA and participant agreement establishing the public health permitted purpose

eHealth Exchange(Federated Network) CommonWell

Carequality(Inter-network

Connection Agreement)

eHealth ExchangeHub

Other networks and participants

APHLJoins

Proposed Network Schematic(Possible Phase II)

NewDURSAand Participant Agreement BAA

Contracted eCR services(BA of eHealth Exchange)

eCRand other services

AnnouncementsJelisa Lowe and Charlie Ishikawa


NEXT MEETINGVirtual Meeting: April 4th, 2019, 12:00 – 1:00 PM EST

Action Items- TBD


28

digital bridge governance principles• utility: the governance body will prioritize use of existing...

Documents