+ Family Planning Quality Improvement and Health IT

+ Background: HHS Office of Population Affairs and the Title X Family Planning Program

+ Family Planning Encounter A documented, face-to-face contact between an individual and a FP provider that takes place in a Title X service site. The purpose of a family planning encounter is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies Services generally include: Contraceptive services to prevent pregnancy Pregnancy testing & counseling Preconception health counseling & services Basic infertility services to achieve pregnancy STD/HIV screening, diagnosis &treatment Related preventive health services 3 3

+ 8.6million encounters annually 4.8million clients 4189Service delivery sites in 1138Sub recipients 50+States, territories, DC monitored by 93Grantees monitored by 20Regional Office Family Planning staff Supported by 10Regional Health Administrators 5National Training Centers 1HQ Title X: Diverse and wide network 4 * 2012 FPAR service data § 2013 staffing estimates The 10 HHS Federal Regions 4

+ Title X Service Sites 5 Health Department (State, County, or Local) Community Health Center or FQHC Family Planning Organization Hospital and Community-based (school, university, correctional, tribal, faith) 5

+ Current Family Planning Annual Report (FPAR)

+ Goals of OPA Health IT efforts Improve health IT infrastructure for Title X providers and providers who deliver the same kinds of services Structured data capture for Family Planning and related preventive health services in a range of EHR systems used in community settings Encourage standards-based mechanisms in health IT systems to support delivery of quality sexual and reproductive health services Clinically relevant performances measures Access to clinical decision support Aggregate data Process and count measures State and Regional 23 months to deliver PDF report Encounter- level data submission Clinically relevant performance measures Greater granularity Improved availability 7

+ The Way Forward: Encounter-level data from Title X service sites used for performance measurement

9 Title X Federal partners Subject matter stakeholders Technical expert organizations Study EHR implementation status & systems Pursue feasibility of data exchange & transition to encounter-level data Assess EHR Use and Challenges Operationalize QFP Recommendations Achieve NQF endorsement Provide performance feedback Validate 2.0 elements & measures Promote Quality FP Care Work within SDOs Standardize & document family planning services Promote family planning integration in healthcare Develop Structured FP Data Title X Federal partners Subject matter stakeholders Technical expert organizations Collaborate with Partners FPAR 2.0 Strategy

+ Emphasis on Quality Framework 10 Gavin, et al. Providing Quality Family Planning Services: Recommendations of CDC and US Office of Population Affairs. MMWR Apr PMID: Performance measures Quality Family Planning Recommendations National Quality Forum Meaningful Use: Chlamydia Screening Family Planning Annual Report Center for Medicare & Medicaid Services, Children’s Health Insurance Program Maternal and Infant Health developmental measures HHS common core indicators for HIV prevention, treatment, and care services Alignment with international partners that have similar clinical focus

Site B Site A Site C Site D Site F Site G Site J Site I Site H Site E Sites capture structured family planning data to suit their clinical workflow. Data is transmitted using standard formats and codes. Regional FPAR system State HIE Grantee Data System Family Planning encounter data is cleaned, de-identified, and securely transmitted. FPAR 2.0 Repository Receive structured, encounter-level data at all levels 11

Site B Site A Site C Site D Site F Site G Site J Site I Site H Site E Regional FPAR system State HIE Grantee Data System Drill down to make different geographical comparisons and dynamically stratify by different population, service site, or other factors through standard mechanisms. FPAR 2.0 Repository 12 Return data as performance-oriented measures

+ Beyond Title X All interoperable solutions should be designed to have broad applicability outside Title X providers Primary Care, Health Centers, Health Departments Emergency Departments International settings Common data elements and their definitions will satisfy evidence-based performance measurements and other benchmarks Input is welcome on data elements, definitions, and quality metrics HIT Infrastructure developments sponsored by OPA will pave the way for other providers to adopt these tools in their own systems 13

+ Providers seeking support of FP content Title X service sites Family Planning specialists National Family Planning and Reproductive Health Association Members operate or fund a network of nearly 5,000 health centers and service sites More than 8,000 publicly funded family planning centers National network of unified providers at 700 health centers Primary care and other health centers Quality Family Planning guidelines & performance measures aimed at broad clinical audience 14

+ IHE De-Identification Handbook for Family Planning

+ IHE FP profile data elements HIV Screen Ordered HIV Rapid Screen Result HIV Supplemental Result Date of HIV Supplemental Result HIV Referral Needed HIV Referred Provider Information Data HIV Referral Completed Systolic blood pressure Diastolic blood pressure Height Weight Smoking status Ethnicity Race Household Annual Income Household size Primary Visit Payer Facility Provider Visit Date Patient Identifier Date of Birth Sex Limited Language Proficiency Lifetime Number of Pregnancies Pregnancy Intention Sexual Activity Current Pregnancy Status Contraceptive method at Intake Contraceptive method at Exit Reason for no contraceptive method Date of last Pap test HPV typing CT Screen Ordered GC Screen Ordered 16

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+ Privacy and Security Roadmap Conduct data inventory Apply HIPAA requirements & industry-standard privacy principles Informs requirements for de-identification Guides selection of de-identification algorithm Details of the de-identification algorithms and results will help determine client consent and other safeguards Later privacy assessment to identify if Safe Harbor, or other methods of de-identification and pseudonymization, can be used 18

+ Risks What exactly is the final deliverable Profile Appendix to handbook Process guide Scope of effort to ensure wide applicability Challenges with cross-domain documentation Ensuring appropriate resources in IHE Bringing appropriate resources to the effort 19

+ Benefits Exposure for IHE Demonstrate relevance and usefulness of IHE products Widen contribution to IHE from new stakeholders in public health and health care 20

+ Discussion 21