1. Collaborating With Your Health Plan 03/07/05 To paraphrase A. Einstein: We cannot solve today’s problems with the same level of thinking that created them.

2. Overview Background for California Health Care Foundation California Clinical Data Project (CCDP) Drivers for CCDP The Solution The Benefits

3. CHCF CCDP Background CCDP Project Founded Spring 2004, a collaborative of California health organizations, including over 20 medical groups, health plans, labs, and hospitals. Sponsored by the California Health Care Foundation, with Project Driver: Sophia Chang, MD, CHCF Director.

4. 1. Create laboratory data standard 4. Improve patient matching capabilities 3. Create and/or improve processes and procedures for exchanging clinical data 2. Resolve issues around existing pharmacy data standard Stakeholder priorities

5. Opportunity to improve lab data exchange and integration Objectives Consensus on rules for how data is exchanged (frequency, time lag, etc) Issues Consensus on standard set of reports that may be requested from labs Consensus on standard format & coding scheme Endorsement of specifications for “ Lab Data Import Tool ” Consensus on streamlined process for secure, electronic exchange of reports Complicate receivers ’ ability to integrate data Cause erratic and/or lagged data transmission Multiple data standards within and across labs, and multiple formats requested by POs and HPs: Require significant resources (time, $) to be expended by labs Limit the amount of lab data that is exchanged

6. Objectives Consensus on streamlined process for secure, electronic exchange of reports Issues Resolution of issues around how data is exchanged (frequency, time lag, etc) Agreement on single interpretation of existing pharmacy standard Endorsement of specifications for “ Pharmacy Data Validation Tool ” Result in erratic and/or lagged data transmission Major and minor variations from the existing pharmacy standard: Complicate receivers ’ ability to integrate data Are caused by confusion in meaning and “ optionality ” of certain data fields Opportunity to improve pharmacy data exchange and integration

7. Address timing inconsistencies in eligibility data used by plans, provider organizations and labs for matching purposes Publish market report on available patient matching tools and promote their use ObjectivesIssues Error rates in matching data that comes from various data sources range from 5%-45% because: Most integrators rely on basic, homegrown algorithms Eligibility files used by plans, providers and labs are inconsistent Opportunity to improve patient matching capabilities

8. Improve chronic care by improving access to and use of integrated clinical data by: 1.Establishing data standards, processes and tools that enable the efficient data exchange and integration; and 2. Securing agreement from as many organizations as possible to implement those standards, processes and tools and to incorporate them into their business processes and contracts Summary of purpose and approach

9. CCDP Solution The lab data standard is based on previous work of the California Information Exchange (CALINX) project, and is therefore, called the CALINX Laboratory Data Standard. The standard is based on industry review of the HL7 standard and provides additional format specifications that facilitate the exchange of lab results data. The industry review included laboratory, provider organization, health plan, and vendor participation. The standard is based on the HL7 messaging format, version 2.4. Rules of Exchange have been developed and agreed upon by the project organization. These ROEs define the following: Reporting Periods; Reporting Lag Time; Services Dates, and Data Accuracy and Completeness.

10. Rules of Exchange: Reporting Periods Data formatted per the standard will be reported by clinical laboratories to contracting organizations at monthly (30 day) reporting periods. Exceptions can be negotiated individually between the lab provider and its contracted organization, i.e., reporting period quarterly, or bi-weekly. It is recognized that in some situations, factors beyond the control of clinical labs and provider organizations will result with the delay of reporting certain tests. Every attempt will be jointly made by clinical labs and provider organizations to minimize these delays.

11. Rules of Exchange: Reporting Lag Time The lag time for the reporting of batched results by clinical labs to contracting organizations should not exceed 30 days from the last date of the reporting period, e.g., the data collected during a reporting period should be reported within 30 days of that period’s end.

12. Rules of Exchange: Service Dates For the purposes of determining reporting periods and lag times, the service dates of lab tests will be based on values of the OBR-7 Field (Observation Date/Time) in the standard message format.

13. Rules of Exchange: Data Accuracy and Completeness The data reported to an organization from a clinical lab in the CALINX Laboratory Data Standard are expected to reflect accurately the lab test results for that organization’s patient and physician populations during the reporting period. Although it may not be possible to populate all required fields in these data files, every reasonable effort will be made by the clinical labs to populate these fields, and every reasonable effort will be made by the provider organizations to assist clinical labs to populate the fields.

14. Benefits: From Greek to Greek, to Greek to Geek A uniform data standard for the exchange of reporting lab test results for quality-measurement and quality-improvement purposes. The creation of the lab data standard and rules of exchange are intended to address the underlying barriers to the access and use of lab data to support quality improvement and chronic disease management at the point of care. To further assist organizations that use the lab result data, the CCDP project will deliver a data conversion tool. The tool will convert the CALINX laboratory data standard format to a flat file format commonly used by medical groups and health plans.

15. Thank You