Longitudinal Coordination of Care

Pilots WGMonday, March 3, 2014

Meeting Etiquette• Remember: If you are not speaking, please keep your

phone on mute

• Do not put your phone on hold. If you need to take a call, hang up and dial in again when finished with your other call o Hold = Elevator Music = frustrated speakers and

participants

• This meeting is being recordedo Another reason to keep your phone on mute when not

speaking

• Use the “Chat” feature for questions, comments and items you would like the moderator or other participants to know.o Send comments to All Panelists so they can be

addressed publically in the chat, or discussed in the meeting (as appropriate).

From S&I Framework to Participants:Hi everyone: remember to keep your phone on mute

All Panelists

• http://wiki.siframework.org/Longitudinal+CC+WG+Committed+Member+Guidance• http://wiki.siframework.org/LCC+Pilots+WG

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ReminderJoin the LCC WG & Complete Pilot Survey

** If your contact information has recently changed, please send your updated information to Becky Angeles at becky.angeles@esacinc.com

Topic Presenter

Welcome & Announcements Evelyn, Lynette

HIMSS Updates Evelyn

2015 EHR Certification Criteria Proposed Rule Evelyn

Presentation: LTPAC Engagement Tool Jennie Harvell

Presentation: ASPE Evaluation Program for Pilots Jennie Harvell

Next Steps Lynette

Agenda

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• Purpose– Provide tools and guidance for managing and evaluating

LCC pilot Projects– Create a forum to share lessons learned and best

practices– Provide subject matter expertise– Leverage existing and new partnerships

• Goals– Bring awareness on available national standards for HIE

and care coordination– Real world evaluation of parts of most recent HL7 C-CDA

Revisions Implementation Guide (IG)– Validation of ToC and Care Plan/HHPoC datasets

Pilot Work Group Purpose and Goals

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Meeting Reminders

S&I Framework Hosted Meetings: http://wiki.siframework.org/Longitudinal+Coordination+of+Care • LCC Pilot WG meetings are Mondays from 11:00– 12:00 pm Eastern

– Focus on validation and testing of LCC Standards for Transitions of Care & Care Plan exchange

• LCC All Hands WG meetings are Mondays & Thursdays from 5:00– 6:00 pm ET are on hold for now

HL7 Structured Documents WG Meetings• **NEW** Wednesdays from 3:00 – 4:00pm Eastern

• WebEx: https://www3.gotomeeting.com/join/810637430• Dial In: +1 770-657-9270; Access Code: 310940• Focus on ballot reconciliation of HL7 C-CDA R2 Ballot comments

• Thursdays from 10:00 – 12:00pm Eastern– WebEx: https://iatric.webex.com/iatric/j.php?ED=211779172&UID=0&RT=MiMxMQ%3D%3D

– Dial In: 770-657-9270; Access Code: 310940– Focus on block voting of HL7 C-CDA R2 Ballot comments

•As of 2/21/14, 930 of 1013 comments have been reconciled

HL7 Patient Care WG Meeting Reminders

• Coordination of Care Services Specification Project– Provide SOA capabilities/models to support coordination of patient

care across the continuum– Current working documents found here: http://wiki.hl7.org/index.php?

title=Coordination_of_Care_Services_Specification_Project

– Meetings every Tuesday 5:00 – 6:00pm ET • Meeting Information:

– Web Meeting URL: https://meetings.webex.com/collabs/meetings/join?uuid=M55ZKYUA35CE2U3J4SV41XMZR3-3MNZ

» Meeting Number: 193 323 052

– Phone: 770-657-9270, Participant Code: 071582

HL7 Patient Care WG Meeting Reminders, cont’d...• Care Plan Project

– Developing user stories that define and differentiate Care Plan, Plan of Care, Treatment Plan

– Current working documents found here: http://wiki.hl7.org/index.php?title=Care_Plan_Project_2012

– Meetings every other Wednesday from 4:00 – 5:30pm ET • Next meeting scheduled for March 5th • Meeting Information:

– Web Meeting URL: nehta.rbweb.com.au

– Phone: 770-657-9270, Participant Code: 943377

HL7 Patient Care WG Meeting Reminders, cont’d...• Health Concern Topic

– Developing user stories highlighting the following: What is a Health Concern Observation; How Health Concern Tracker is Used; How Health Concern is different from Problem Concern

– Current working documents found here: http://wiki.hl7.org/index.php?title=Health_Concern

– Meetings every other Thursday from 4:00 – 5:00pm ET• Next meeting scheduled for March 6th • Meeting Information:

– Web URL: https://meetings.webex.com/collabs/#/meetings/joinbynumber

» Meeting Number: 236424669 – Phone: 770-657-9270, Participant Code: 943377

FACA Updates

HITPC Quality Measures Workgroup• The 2014 draft work plan for the first two quarters includes

certification to support quality reporting in LTPAC and BH settings.

HITPC Certification and Adoption• On Feb. 7th, the Workgroup had an in-depth discussion of the

Behavioral Health EHR Certification Draft Recommendations one at a time. Their objective was to determine which of the proposed areas of certification are “key heath IT capability needed” in the Behavioral Health care setting.

• The sixth proposed key area was Clinical Quality Measures• The group could not reach consensus on this topic, so ONC will

ask the Quality Measures WG to have a representative speak regarding opportunities for LTPAC and BH settings as they relate to future work.

FACA Meeting Updates, cont’d…

HITPC Certification and Adoption, continued•The LTPAC/BH discussion was continued in the Feb. 14th meeting.•The work group will finalize LTPAC/BH EHR certification recommendations by the next meeting.

FACA Meeting Reminders

HIT Policy Committee• Next meeting scheduled for March 11th from 9:30am – 3:00pm ET• http://www.healthit.gov/facas/calendar/2014/03/11/hit-policy-committee-virtual

HITPC Meaningful Use WG• Next meeting scheduled for March 4th from 9:30am – 11:30am ET• http://www.healthit.gov/facas/calendar/2014/02/11/policy-meaningful-use-workgroup

HIT Standards Committee• Next meeting scheduled for March 26th from 9:00am – 3:00pm ET• http://www.healthit.gov/facas/calendar/2014/02/18/hit-standards-committee

LCC Pilot WG Timeline: Aug 2013 – Sept 2014

Mile

ston

es

Revisions for HL7 CCDA IG

Complete

HL7 Fall Ballot Close

LCC Pilot Monitoring & Evaluation

LCC Pilot Proposal Review

HL7 Ballot Publication

LCC Pilots Close

HL7 Ballot & Reconciliation

LCC Pilot WG Launch

NY Care Coordination Go-Live

HL7 C-CDA IG Revisions

LCC Pilot Wrap-Up

LCC Pilot Test Spec. Complete

HL7

Bal

lot

LCC

Pilo

t WG

GSI Health Go-Live

IMPACT Go-Live

CCITI-NY Go-Live

• Healthstory Vignette at Interoperability Showcase– Successful demonstrations throughout the week– Great interest in new care plan standards

• CMS ‘Improving Quality in Home and Community Based Services Populations’ (Education Session 123)– Described Home and Community Based Services (HCBS) programs and

importance of standardizing client assessments across all HCBS programs– Discussed status of CMS CARE project to develop standardized client

assessment items– Introduced upcoming new S&I Initiative: electronic Long-Term & Support

Services• Projected start date is Q2 2014

• ‘Nutrition Data in Care Coordination-Making an Impact’ (Education Session 197)– Described IMPACT project and new revisions to C-CDA standard to

include new nutrition templates– Demonstrated key clinical scenarios where nutrition care is a critical

element of the care plan

HIMSS Updates

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• Released for public comment on Feb. 21 2014: http://www.gpo.gov/fdsys/pkg/FR-2014-02-26/pdf/2014-03959.pdf

• Voluntary certification program; not tied to MU3• Timeline provides ONC opportunity to shift regulatory

approach to a more incremental and frequent approach of publishing rules (every 12 to 18 months)

• Proposed new capabilities, standards-based requirements and public comment solicitations on potential future certification criteria included in this proposed rule will help inform ONC on what to consider for inclusion for the 2017 Edition in support of MU3 (to be published by Fall 2014)

• Public Comments due April 28, 2014 via www.regulations.gov– 2015 Final rule to be published by Summer 2014– 2017 NPRM to be published by Fall 2014

2015 EHR Certification Criteria Proposed Rule

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• New certification criteria to support patient population filtering of clinical quality measures

• New and updated implementation specification for several certification criteria including ToC, CDS, and Public Health reporting

• Policy revisions that changes certification approach for ToC• Path for certification of ‘non-MU’ EHR technology• Codifies ONC regulatory guidance provided in FAQ issued in

2014 Edition Final Rule• Revision to 2014 Edition syndromic surveillance certification

criterion• Closer alignment with other HHS program policies(e.g. CLIA)

and to address OIG recommendations• Discontinuation of ‘Complete EHR’ definition and issuance• Solicit comment on new capabilities and standards-based

requirements for potential future certification criteria

2015 EHR Certification Criteria Proposed Rule:Specific Highlights

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• Proposes the adoption of the updated CCDA standard (current in ballot) in 170.205(a): Patient Summary Record to include the new sections & templates:– New document templates: Care Plan; Referral Note; Transfer

Summary– New sections for: Goals; Health Concerns; Health Status

Evaluation/ Outcomes; Mental Status; Nutrition; Physical Findings of Skin

• Proposes reference use of new standard in proposed 2015 Edition ToC Certification criterion as well as three other certification criteria: VDT, Clinical Summary and Data Portability

• Proposes EHR technology must be capable of including the UDI for patient’s implantable device(s) as data within a CCDA formatted document

2015 Proposed Rule: Updated C-CDA Standard

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An Outreach and Educational Campaign onElectronic Health Information Exchange for Persons Receiving Long-Term/Post-Acute

Care Services

Standards and Interoperability FrameworkLongitudinal Coordination Care Workgroup

Pilots CallMarch 3, 2014

Jennie Harvell, HHS/ASPE

Educational Campaign on Electronic HIE in LTPAC

Agenda • Brief overview of Need for HIE with and by

LTPAC• Barriers to HIE by LTPAC• Draft HIE Curriculum for LTPAC Providers and

Methods of Delivery and Evaluation• Discussion: HIE education/support provided

and/or needed in Pilot Sites

04/18/23 19

Overview of Need

• Health Information Exchange (HIE) with and by LTPAC and BH providers is necessary to support transitions of care (ToC) and instances of shared care.

• Experts in ToC identify “improving information flow and exchange” as the most important tool to improve care transitions.

• Interoperable HIE has the potential to empower individuals and increase transparency; enhance the ability of health care providers, payers, and regulators to study care delivery and payment systems; and achieve improvements in care, efficiency, and population health.

04/18/23 Office of the National Coordinator for Health Information Technology 20

Overview of Need

• Health Information Exchange at times of ToC and during shared care is often incomplete and impacts quality, safety, and costs of care:

– Significant percentage of adverse drug events (ADEs) occur at times of ToC and resulting in hospital readmissions and billions in unnecessary costs.

– Information is often missing when:• multiple physicians treat patients following a hospital discharge,

and • the patient is sent to the Emergency Department.

04/18/23 Office of the National Coordinator for Health Information Technology 21

Overview of Need

• Health information exchange is expected to:

– improve communication;

– reduce medication errors and adverse drug events, unnecessary and redundant tests/procedures, avoidable hospitalizations and emergency room visits; and

– reduce health care costs.

04/18/23 Office of the National Coordinator for Health Information Technology 22

Barriers to HIE with and by LTPAC• While some LTPAC providers use health IT and EHRs, their use lags behind that of

physicians and acute care hospitals, and use of HIE is even less common.– Approximately 43% of nursing homes (NHs) and home health agencies (HHAs) are

reported to have some type of EHR. Resnick et al 2009 (for NHs) and 2010 (for HHAs).– Only 6% of long-term acute care hospitals, 4% of rehabilitation hospitals, and 2% of

psychiatric hospitals have a basic EHR system.• EHRs (without HIE capabilities) are estimated to cost less than 1% of revenues for

for-profit mid-size NH chain providers and HIE costs have declined significantly.• There is widespread recognition (by providers and State and Federal officials) that

many LTPAC providers lack important information about HIT/EHRs and HIE, and that this a key barrier to their participation in HIE.

• Premise: Providing education/information about HIT/EHRs/HIE to LTPAC providers will accelerate their engagement in HIE.

04/18/23

Office of the National Coordinator for Health Information Technology 23

Proposal: Pilot an HIE Curriculum focusing on Exchange with LTPAC

• Pilot an outreach and education campaign that focuses on HIE between LTPAC providers and others.

• The curriculum would target:– LTPAC providers (i.e., NHs, long-term care hospitals, in-patient rehabilitation facilities,

HHAs, and home and community based providers); and – their health information trading partners (e.g., physicians, hospitals, State Health

Information Exchange Organizations, Medicaid programs, etc.).

• The curriculum would be piloted using different delivery methods:

04/18/23 Office of the National Coordinator for Health Information Technology 24

Webex National Conference Presentations

Local Face-to-Face Presentations/Small Conferences

Proposal: Pilot a HIE Curriculum focusing on Exchange with LTPAC

• The curriculum would include the following topics from the following perspectives:– Federal perspective: includes information on: benefits of HIE, HIT/EHR adoption

and use in LTPAC, business drivers for HIE, activities for accelerating HIE (e.g., incentives, program requirements, HIT standards, EHR certification, and costs).

– Local LTPAC Provider Perspective: includes information on: considerations/lessons learned during HIT/EHR planning, acquisition, and implementation (e.g., considerations and impact on work force, work flow, costs/benefits, and barriers/stumbling blocks and solutions (if any)).

– State Perspectives: includes information on: HIE activities the State has implemented/will implement that involve LTPAC providers and the type of information exchanged, technology used and methods for obtaining/accessing the technology, technology/exchange costs to the LTPAC provider, issues encountered in implementing the HIE activity and their resolution, and how the LTPAC provider can learn more.

04/18/23 Office of the National Coordinator for Health Information Technology 25

Delivery Method and Evaluation

04/18/23 Office of the National Coordinator for Health Information Technology 26

Webex National Conference Presentations

Local Face-to-Face Presentations/Small Conferences

PROs •Low cost for both participants and presenters

•Participants and presenters need to travel to conference

This approach is most likely to secure participation of appropriate LTPAC staff/leaders and their trading partners

CONs •Focused attention by participants may be difficult •Securing participation by appropriate trading partners may be difficult

•May not have participation of LTPAC decision makers and clinical leaders•Securing participation by appropriate trading partners may be difficult

High Cost for presenters

Evaluation •The effectiveness of the curriculum to impart information to participants would be compared and contrasted across each delivery method.

Discussion and Feedback

1. Do you agree with the premise that providing information about HIT/EHRs/HIE will accelerate provider participation in HIE activities?

2. Have Pilot sites identified the need for education on HIT/HIE among program participants? If so, for which participants?

3. What types of education/information have pilot participants needed?4. What methods have been used to deliver needed information to pilot

participants? 5. Have pilot sites targeted their education efforts to certain types of pilot

participants? 6. How do/could pilot sites assessed the effectiveness of their educational

efforts? 7. What resources have been/could be leveraged to support the delivery

of needed education/information to pilot participants?

04/18/23 Office of the National Coordinator for Health Information Technology 27

Additional Questions/Comments

• Please contact:– Jennie.Harvell@hhs.gov

04/18/23 Office of the National Coordinator for Health Information Technology 28

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ASPE Evaluation Program for Pilots

Jennie HarvellJennie.Harvell@hhs.gov

• Homework Assignments:– Complete Pilot Survey– Sign up as an LCC Committed Member– Submit Pilot Documentation Proposals

• Available on the LCC Pilot SWG Wiki: http://wiki.siframework.org/LCC+Pilots+WG

• Email to Lynette Elliott (Lynette.elliott@esacinc.com)

Next Steps

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• LCC Leads– Dr. Larry Garber (Lawrence.Garber@reliantmedicalgroup.org)– Dr. Terry O’Malley (tomalley@partners.org) – Dr. Bill Russell (drbruss@gmail.com) – Sue Mitchell (suemitchell@hotmail.com)

• LCC/HL7 Coordination Lead– Dr. Russ Leftwich (Russell.Leftwich@tn.gov)

• Federal Partner Lead– Jennie Harvell (jennie.harvell@hhs.gov)

• Initiative Coordinator– Evelyn Gallego (evelyn.gallego@siframework.org)

• Project Management– Pilots Lead: Lynette Elliott (lynette.elliott@esacinc.com)– Use Case Lead: Becky Angeles (becky.angeles@esacinc.com)

LCC Initiative: Contact Information

31LCC Wiki Site: http://wiki.siframework.org/Longitudinal+Coordination+of+Care