digital bridge governance principles...1. rwjf digital bridge governance a) incubation phase for ecr...

• 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 – August 9, 2019

Governance Body MeetingFriday, August 9th, 20191:00 P.M. – 2:00 P.M. ET

This meeting will be recorded for note-taking purposes only

2FOR DISCUSSION USE ONLY – August 9, 2019

Meeting Agenda Time Agenda Item

1:00 PM Call to order – John Lumpkin

1:02 PM Agenda review and approval – John Lumpkin

1:05 PM Consent agenda – John Lumpkin

1:10 PM Risk log• eCR implementation progress – Rob Brown, Kirsten Hagemann• Transition management – Jim Jellison

1:15 PM Action• Evaluation findings and recommendations

o Jeff Engel and Lura Daussat

1:50 PM Update: Digital Bridge Sponsors – John Lumpkin• …

1:55 PM Announcements – Charlie Ishikawa

2:00 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

Risk Log• Implementation progress update• Transition management

For Action• Evaluation findings and recommendations

For Discussion• …


Consent Agenda | August 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 the governance body

c. Any item removed will be discussed during the meeting

August 2019 Consent Agenda Items1. Workgroup updates

a. Thank you• eCR Implementation Workgroup• Evaluation Committee

b. Pilot Participation Workgroupc. Transition Workgroup

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Risk Log: eCR ImplementationLaura Conn (Taskforce Co-Chair) & Rob Brown (Digital Bridge PMO)


Update: eCR Implementation WorkgroupFinal Implementation WG meeting August 13, 2019

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

• Currently in parallel production

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

• New York site went live on July 10, 2019• Currently in parallel production

• California preparing for End to End testing and AIMS connectivity• Legal agreement has been shared with UC Davis• AIMS connectivity with UC Davis in progress

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Up Next• Michigan, Kansas are actively working on their vendor/ provider development activities• New release of RCTC effective November 1, 2019

• New codes for Parkinson’s, medications (for Parkinson's only), enteric conditions, and routine code set updates for 6 conditions

FOR DISCUSSION USE ONLY – August 2019

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 12/20/18New York in production 7/10/19

TodayFOR DISCUSSION USE ONLY – August 2019

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

FOR DISCUSSION USE ONLY – August 2019

Transition Management Update

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Vivian Singletary, Jim Jellison (Digital Bridge PMO)


Summary of grants/funding streams1. RWJF Digital Bridge Governance

a) Incubation phase for eCR is ending, and eCR work is transitioning to eCR scale-up operations

b) RWJF approved no cost extension to governance grant (now ends March 2020)c) Governance body (including transition workgroup) will take on strategic issues beyond

eCR (e.g., operational model, charter revisions, potential relationships with other data exchange initiatives, determine the future we want for Digital Bridge and ready ourselves for the future use cases);

2. Other Fundinga) PMO will coordinate with Digital Bridge partners to ensure activities supported by RWJF

grant extension are coordinated with activities supported by other funding sources (e.g., CDC Foundation grant)


Workgroup Status Next Steps

eCR Implementation Initial eCR demonstrations are continuing (see related slides).

PMO is transitioning eCR support to CDC and decision support intermediary for eCR scale-up.Updated onboarding guidance and new eCR website coming soon.

Evaluation Committee Finishing evaluation of initial eCR demonstrations. Preliminary findings to be reported at Aug. governance body call.

Committee will review and comment on the full evaluation report and participate in the dissemination of eCR evaluation findings.

Transition Completed recommendations for eCR scale up. Currently addressing strategic issues beyond eCR.

Legal Policy Regulatory Submitted comments on TEFCA and other policies.

Will reconvene when charged by governance body.

Pilot Participation Current pilot participation agreement is phasing out by fall 2019; will be replaced with new agreement options supporting eCR.

New agreement options enabling eCR scale-up are in development. Current workgroup will sunset as eCR implementers move to one of two new agreement options.

Workgroups Status


Action: Evaluation Findings & RecommendationsJeff Engel (Evaluation Committee Chair)


Multisite Evaluation of Digital Bridge Electronic Case Reporting (eCR) Demonstration Projects -Preliminary Findings and Recommendations for Actions The Evaluation CommitteeAugust 9, 2019

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Agenda for TodayI. Background and IntroductionII. FindingsIII. RecommendationsIV. Discussion

Please note, the final report is not complete and this is preliminary content and some content may be refined as reviews continue

Background and Introduction

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Evaluation GoalsI. Identify and describe the processes

for eCR implementation and initiation and the influencing factors

II. Determine eCR functioning and performance, completeness, accuracy and timeliness

III. Identify the resources needed to initiate and implement an eCR system

IV. Identify the potential value and benefits of eCR to stakeholders

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Participation in Each Stream of Data Collection by Demonstration Site

Utah Houston NYC/NYS Kansas California Michigan MassachusettsKIIs Complete Complete Limited KII

completeLimited KII complete

Not Initiated Not Initiated Limited KIIS complete

Extract from Health IT

Complete Complete Not Initiated Not Initiated Not Initiated Not Initiated Not Initiated

Extract from PHAs

Complete Not Initiated Not Initiated Not Initiated Not Initiated Not Initiated Not Initiated

Data on Cost Complete Complete Complete Complete Complete Complete Complete

Site data, RCKMS data

Complete Complete Complete Complete Complete Complete Complete

Findings | eCR Functioning, Performance and Completeness

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Health Care Encounter Definitions and Data Collection PeriodsHealth Care Organizations Encounter Specifications Data Collection PeriodHouston Methodist Hospital

Inpatient admissions and outpatient clinic visits and

orders only

3 months

Intermountain Healthcare Inpatient visits, office visits, and

emergency room visits

2 months

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Electronic Initial Case Reports (eICRs) and Reportability Responses (RRs) from Intermountain Healthcare and Utah Department of Health, Feb. 12-April 12, 2019*

Total Number of Patient Encounters: 1,225,574

Intermountain Healthcare Utah Department of Health

Reportable Condition eICRs Sent

ReportabilityResponsesreceived

eICRsreceived

ReportabilityResponsesreceived

Non Reportable NA 8,595 NA NA

Chlamydia 9,72518,137

9,06318,295

Gonorrhea 9,584 9,226

Pertussis 6,172 173 186 185

Salmonellosis 1,202 22 22 22

Zika 0 0 0 0

Total 26,683 26,927 18,497 18,502

Key Takeaways:• Automation was

achieved and trigger codes generated eICRs as intended.

• ReportabilityResponses were sent to public health and providers as authored in RCKMS

*For the counts of eICRs and RRs, due to date/time stamps, reprocessing, and other system variations, the counts are not one-to-one matches. All identified issues have been identified and resolved.

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eICRs Sent to AIMS and Reported to Houston Methodist Hospital, March-May 2019

eICRs Sent to AIMS and Reported to Houston MethodistMarch 2019

Total Number of Patient Encounters:

158,244

April 2019Total Number of

Patient Encounters: 172,210

May 2019Total Number of

Patient Encounters: 174,222

Number of eICRssent to AIMS

4,191 4,680 4,565

Number of eICRswith a reportable condition sent on to public health

98 151 160

Key Takeaways:• Automation was

achieved and trigger codes generated eICRs as intended.

• Reportable conditions were automatically sent to the public health agency.

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Findings on the Completeness of eICRData Elements in 8,341 eICRs: Utah Department of Health, Feb. 12-March 12, 2019

% Complete Data ElementData element required by

Epidemiologists to initiate case investigation?

98-100%

Date and time of report submission YesProvider Name Yes

Provider Office/Facility Name YesFacility Address Yes

Patient ID Number NoPatient Name Yes

Patient Date of Birth (DOB) YesPatient Sex No

Visit Date/Time YesPatient Ethnicity No

Resulted lab test code and name (Result Observation) Yes

Patient Address NoResulted lab test code and name (Trigger) Yes

Laboratory Result (Trigger) YesProvider Address Yes

Provider phone number NoPatient or Parent/Guardian Phone No

91.90% Patient Race No61.80% Diagnosis Date Yes59.50% Diagnosis Yes54.80% Patient or Parent/Guardian Email No43.80% Laboratory Results Yes

1% Diagnosis Trigger Yes

0%

Facility phone number NoPatient Preferred Language No

Patient Occupation NoPregnancy Status No

Hospital Unit NoDate of Onset No

Ordered lab test code and name (Planned Observation) Yes

Ordered lab test code and name (Trigger) YesMedications Administered No

Key Takeaways:• Electronic case reporting from

electronic health records provides critical clinical and demographic data that may not be included in lab report

• eICRs can add valuable information to the cases in the public health surveillance system

• Health IT has a role in improving the completeness of eICR

Findings | Resources Needed to Initiate and Implement an eCR System

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Cost of eCR Implementations• Demonstration sites were asked to compile cost and resource information

• Eight public health agencies, two health care providers, and one health IT vendor• Substantial variation in costs and duration of implementation across the sites• Data showed costs are dependent on:

• Existing eCR infrastructure• In-house expertise• Resources available (human and technical)

• Some costs spent in demonstration are not likely to continue with eCR scale-up

Summary Findings of eCR Implementation

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Summary Facilitating Factors of eCR Barriers to Implementing eCR

• Communication in organizations and across organizations improved transparency and trust

• Access to professionals with existing knowledge and SMEs

• Peer-to-peer sharing assisted sites in sharing insights and lessons learned with other jurisdictions

• Explicit leadership support in the health care setting

• Challenges related to human and fiscal resources inhibited eCR implementations

• Cited limited technical resources and staff turnover

• More detailed technical documentation and guidance requests from implementers

• Integration with homegrown systems and vendor solutions delayed implementations

Benefits of eCR Weaknesses of eCR• Accurate and more complete case data• Improved legal and security compliance• Automated case reporting and reduced provider

burden

• Implementations can be complex and challenging for innovators and early adopters, but as a result of these demonstrations, tasks can be less complex and less challenging

Recommendations for Action

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RecommendationseCR Readiness and Resources1. eCR implementers should conduct eCR

readiness assessment prior to initiating implementation.

2. eCR implementers should validate alignment between vendor solutions and capabilities and eCR business requirements before implementation.

3. eCR operators should focus on supplemental training, the availability of expert technical assistance and the importance of keeping technical artifacts up to date for implementer use.

Communications and Collaboration4. eCR implementers, need to gain leadership

buy-in to ensure adequate resourcing.

5. eCR implementers should validate partner engagement, set expectations and identify the eCR team’s strengths and limitations prior to implementation.

6. eCR operators should provide a platform for technical collaboration among eCR implementers.

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Recommendations (cont.)Technology and Process Alignment

7. eCR implementers, recognizing vendor to vendor variation, should document clinical and patient care workflows and trigger code configuration early on in implementation to facilitate the most complete transmission of data in the eICR

Ongoing Evaluation8. eCR operators and relevant stakeholders should

consider the evaluation of supporting organizations and the future of eCR evaluation as eCR expands nationally.

9. eCR operators and relevant stakeholders should assess the most appropriate method of cost analysis.

10. The Digital Bridge evaluation committee provided crucial input and guidance throughout the evaluation process. Any future eCR evaluation activities should include a similarly diverse workgroup (e.g., site representatives, partner organizations) to contribute to planning, implementation and use.

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Proposed Dissemination Activities for the eCR Evaluation Findings

Communication Method Intended Audience Purpose Estimated Date of Delivery

Presentation to implementation workgroup

Current implementation sites

To share overview of work completed, draft contents and release date of final report

August 13, 2019

Evaluation report • Governance body• Implementation sites• Future eCR

implementers• Other interested parties

To summarize all evaluation findings in a report

September 1, 2019

Webinar on evaluation findings and recommendations for action

• Implementation sites• Other stakeholders

To take a deep dive into the evaluation report

Mid- to late September

Evaluation report post on eCR website

• Future implementation sites

• Anyone interested in eCR

Full access to the eCR evaluation report

Mid- to late September

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Discussion and Questions• Thanks to the evaluation committee for their input and review of this

presentation and work on the evaluation

Discussion: Digital Bridge SponsorsJohn Lumpkin (Governance Body Chair)


PLACEHOLDER

AnnouncementsCharlie Ishikawa


UPCOMING MEETINGSVirtual Meeting: Thursday, September 5, 2019 12:00 – 1:00 PM ET

Action Items- Survey


digital bridge governance principles...1. rwjf digital bridge governance a) incubation phase for ecr...

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