1. T EXAS C OUNCIL OF C OMMUNITY C ENTERS : D ATA W ORK G ROUP M ARCH 14, 2013 Healthcare Intelligence Partners, LLC

2. 2 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

3. 3 Overview of the Day/Approach  Conceptual Model  Review national efforts  Agreement on an approach for resolving major challenges:  Identify key areas for greater exploration  Identify areas of specific focus in Texas  Key goals for the workgroup  Meeting operations:  Group Charter  Meeting schedule

4. 4 Major Issues  Data Standards/Implementation Specifications  Patient Consent  Measurement

5. 5 Conceptual Model  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs Legal Techno- logically Possible Operationally Feasible Clinically Relevant

6. 6 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

7. 7 National Landscape  Functional Domains:  Interoperability  Privacy/Security (Consent Management)  Measurement

8. 8 National Landscape  HIE Models:  Push/Direct Model A referring provider “pushes” data to another provider. Requires a provider directory Standards developed nationally  Pull/Patient Record Locator HIEs are notified when a patient record has new information. Providers must query HIE regarding a specific patient to find out of there are other patient records available.

9. 9 National Landscape  Interoperability Terms:  Standards  Specifications  Message Components:  Message content  Message ‘envelope’

10. 10 National Landscape  Interoperability  Health Level 7 (HL7): Behavioral Health CCD Project Behavioral Health CCD implementation guide (BH CCD), which will constrain the C32 profile required for Meaningful Use Stage 1. Currently being ‘balloted’ and tested.  Center for Integrated Health Solutions (CIHS) SAMHSA/HRSA Center for Integrated Health Solutions – Health Information Exchange (HIE) of Behavioral Health and Physical Health Care Data 5 state HIE Initiative (I L, KY, ME, OK, RI)

11. 11 National Landscape  Interoperability  Behavioral Health Data Exchange Consortium Managed by RTI’s State Health Policy Consortium. Projects are expected to be completed by 3/31/13. Florida, Michigan, Kentucky, Alabama and New Mexico have joined together to develop a common set of data exchange procedures for inter-state Direct exchange.

12. 12 National Landscape  Interoperability Workgroup (IWG)  A project of the New York eHealth Collaborative (NYeC) Vendors, States, and Providers Includes Texas Not clear how information is devolving to HIEs in Texas.  Intended to create “plug and play” standards for HIE and EHR vendors.  States are supposed to use policy levers to promote the use of products that use these specifications.  Use market forces to drive interoperability.

13. 13 Privacy and Security  Patient Consent  Identity Management/Trusted Entities  Authentication  Authorization  Certificate Management  SAML Assertion  Data Use and Reciprocal Support Agreement (DURSA)  Framework for allowing participating organizations to share data.  Supported by ONC and HHS; referenced in THSA documentation.

14. 14 Privacy and Security  S&I Framework (http://wiki.siframework.org)http://wiki.siframework.org  The S&I Framework is a collaborative community of participants from the public and private sectors who are focused on providing the tools, services and guidance to facilitate the functional exchange of health information. Each S&I Initiative tackles a critical interoperability challenge through a rigorous process that typically includes  Development of clinically-oriented user stories and robust use cases  Harmonization of interoperability specifications and implementation guidance  Provision of real-world experience and implementer support through new initiatives, workgroups and pilot projects  Mechanisms for feedback and testing of implementations, often in conjunction with ONC partners such as NIST  Data Segmentation for Privacy (DS4P) (handout)

15. 15 Measurement  ONC-SAMHSA Behavioral Health Technical Expert Panel (TEP)  The purpose is to:  Recommend BH measures for widespread adoption and utilization for future stages of the Medicare and Medicaid EHR Incentive Programs  Recommend future measure development needs by evaluating available clinical research  Provide private sector input regarding measure implementation feasibility

16. 16 TEP Endorsed Measures MEASURE CONCEPTSUBGROUP Recommended PrioritySETTINGNQF#STEWARD Bipolar Disorder (BD and Major Depression (MD): Appraisal for alcohol or chemical substance useAlcohol1EP110CQAIMH BBD and MD: Assessment for Manic or hypomanic behaviorsDepression1EP109CQAIMH BD: Suicide Risk AssessmentSuicide1EP111CQAIMH Maternal Depression ScreeningDepression2EP1401NCQA Follow-up after Hospitalization for Mental IllnessDepression1EP576NCQA Risky behavior assessment or counseling by age 13 – Alcohol, Tobacco, Substance Abuse, Sexual Activity Substance Use Disorder (SUD)1EP1406NCQA Risky behavior assessment or counseling by age 18– Alcohol, Tobacco, Substance Abuse, Sexual Activity(SUD)1EP1507NCQA Alcohol ScreeningAlcohol1EH1661TJC Alcohol Brief InterventionAlcohol1EH1663TJC Bipolar antimanic agentDepression2EP580RHI From: http://www.healthit.gov/policy-researchers-implementers/behavioral-health-expert-panel (3/12/2013)http://www.healthit.gov/policy-researchers-implementers/behavioral-health-expert-panel

17. 17 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

18. 18 Texas Landscape  THSA and the Federated HIE model  Update on conversations with THSA  Collaboration Council  Pilot implementation with one HIE  Getting started on getting information

19. 19 Conceptual Model  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs Legal Techno- logically Possible Operationally Feasible Clinically Relevant

20. 20 Technological Capability  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs

21. 21 Technological Capability  Will the interfaces across EHRs in use by TCCC members and local HIEs support your legal, clinical, and operational goals?  Consider the different requirements across HIEs.  Can they be modified to support your legal, clinical and operational goals?

22. 22 Operational Feasibility  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs

23. 23 Operational Feasibility  EHRs  Eg. Anasazi and Topaz: Supported CCD standards?  Others?  HIEs:  How many?  Similarities/differences?  Supported CCD standards?  Patient consent management approaches?  Data segmentation?

24. 24 Legality  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs

25. 25 Legality  IL Document (Handout)  How do Texas privacy laws differ from federal privacy laws?

26. 26 Clinically Relevant  Functional Domains:  Interoperability  Privacy/Security (Consent)  Measurement  Infrastructure  EHRs  HIEs

27. 27 Clinically Relevant  Can you send clinically relevant content with appropriate care partners?  Do you receive clinically relevant content from care partners?  Do you have enough data to develop/use clinical quality measures?

28. 28 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

29. 29 Group Charter  Name  Goals  Objectives  In-Scope/Out of Scope  Deliverables  Roles  Meeting frequency/duration

30. 30 Content Sharing/Decision-Making  Setting meeting agendas?  When do you have enough information to make a decision?  How will decisions get made?  In-scope/out-of-scope?  Strategies?  Technical Issues?

31. 31 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

32. 32 Next Steps  Next Meeting Topic  Explore speakers?

33. 33 Agenda  Welcome and Introductions  Overview of the Day/Approach  National Landscape  Texas Landscape  Initiate Development of Group Charter  Next Steps  Meeting Schedule/Wrap-up

34. 34 Meeting Schedule/Wrap-up  Meeting date  Meeting duration

35. 35 Smarter Strategies for Better Healthcare David Bergman Founder (207) 650-0357 dbergman@hcipartners.com Healthcare Intelligence Partners