Interoperability Call To Action & Environmental ScanEvelyn Gallego, CPHIMS, MBA, MPH

HIMSS Interoperability & HIE Committee Chair 2017-2018

June 13, 2018

FY18 Interoperability & HIE Committee Members

Special thanks to all that contributed to this work:

Evelyn Gallego, MBA, CPHIMS, EMI Advisors LLC

Debi Car, CAHIMSS, DK Carr and Associates

Charles Christian, CHCIO, FCHIME, FHIMSS, LCHIME,

Indiana Health Information Exchange, Inc.

Rebecca Ettien, RN, MS, BSN, Cerner Corporation

Mishka Glaser, Deloitte Consulting

Elizabeth Hartley-Sommers, BSN, RN, Blue Cross and

Blue Shield of Louisiana

Andrew Klackiewicz, Mott Children’s Health Center

Brian Levy, MD

Michael Marchant, UC Davis Medical Center

Scott Mash, CPHIMS, FHIMSS, MSIT, Ohio Health

Information Partnership

John Middleton, MD, MSc, SCL Health

Melody Mulaik, MS, Coding Strategies, Inc.

Gerard Muro, MD, MI, Advanced Radiology Consultants

Joshua Rubin, JD, MBA, MPH, MPP, University of

Michigan Medical School

FY17 Interoperability & HIE Committee Members

Joseph Wagner, MPA, FHIMSS, Gevity Consulting

Robert Cothren, PhD, California Association of Health Information Exchange (CAHIE)

Mark Roche, MD, MS, Avanti iHealth

All other HIMSS staff and members who shared their expertise in the development of these resources.

1. Provide update on the Interoperability Call to Action

and discuss opportunities for engagement

2. Present the Interactive HIMSS Interoperability

Initiatives Environmental Scan

Why are we here today?

Interoperability Call to Action

• There is still work to be done. Seamless, secure, nationwide interoperable health information exchange continues to elude the country

• The information needs to follow the person. Without having the right information at the right time, payment reform and the transition to value-based care is nearly impossible.

• HIMSS has the brand, influence and capacity. Working on these issues for several decades, HIMSS is positioned to lead the field, ultimately realizing the goal of a learning health system.

Why HIMSS proposed a Call to Action

• Demand Integration between the Interoperability Approaches

and Trusted Exchange Frameworks for the Public Good

• Ensure Stakeholder Participation from Across the Care

Continuum, Including Patients and Caregivers

• Identify the “Minimum Necessary” Business Rules for Trusted

Exchange to Enhance Care Coordination

• Educate the Community to Appropriately Implement Existing

and Emerging Standards, Data Formats, and Use Cases to

Ensure a Comprehensive, Integrated Approach to Care

• Standardize and Adopt Identity Management Approaches

• Improve Usability for Data Use to Support Direct Care and

Research

HIMSS Interoperability Call to Action

Access the Full

Call to Action Here!

• Demand Integration between the Interoperability Approaches

and Trusted Exchange Frameworks for the Public Good

• Ensure Stakeholder Participation from Across the Care

Continuum, Including Patients and Caregivers

• Identify the “Minimum Necessary” Business Rules for Trusted

Exchange to Enhance Care Coordination

• Educate the Community to Appropriately Implement Existing

and Emerging Standards, Data Formats, and Use Cases to

Ensure a Comprehensive, Integrated Approach to Care

• Standardize and Adopt Identity Management Approaches

• Improve Usability for Data Use to Support Direct Care and

Research

Opportunities to Improve Approaches

• Demand Integration between the Interoperability Approaches

and Trusted Exchange Frameworks for the Public Good

• Ensure Stakeholder Participation from Across the Care

Continuum, Including Patients and Caregivers

• Identify the “Minimum Necessary” Business Rules for Trusted

Exchange to Enhance Care Coordination

• Educate the Community to Appropriately Implement Existing

and Emerging Standards, Data Formats, and Use Cases to

Ensure a Comprehensive, Integrated Approach to Care

• Standardize and Adopt Identity Management Approaches

• Improve Usability for Data Use to Support Direct Care and

Research

Opportunities to Improve Data

Calls on the Office of the National Coordinator (ONC) “to develop or

support a trusted exchange framework for trust policies and practices

and for a common agreement for exchange between health

information networks”…no later than 1 year after convening

stakeholders”.

Policy Drivers: 21st Century Cures Act

Many organizations have to join

multiple Health Information

Networks (HINs), and the HINs do

not share data with each other.

WHAT THE LAW REQUIRES

WHY DID CONGRESS REQUIRE THIS?

Healthcare organizations currently

burdened with creating many costly,

point-to-point interfaces between

organizations.

3 in 10 Hospitals use five or more interoperability methods.

https://www.healthit.gov/sites/default/files/draft-guide.pdf

Draft Trusted Exchange Framework and Common Agreement

• Draft Trusted Exchange Framework published by ONC on Jan. 5 2018 in response to Cures Act’s requirement

• Incorporates wide public comment and feedback from 3 listening sessions

• Presented in 2 parts:

– PART A: Principles for the Trusted Exchange Framework

– PART B: Minimum Required Terms and Conditions

https://www.healthit.gov/topic/interoperability/trusted-

exchange-framework-and-common-agreement

Draft Trusted Exchange Framework Principles and Terms of Conditions will

help to advance the HIMSS Call to Action.

Draft Trusted Exchange Framework and Call to Action

*The Trusted Exchange Framework and Common Agreement Final Rule scheduled to be

released late 2018

Policy Drivers: Inpatient Prospective Payment System (IPPS) Proposed Rule

• Published by Centers for Medicare and Medicaid Services (CMS)

on April 24, 2018

• Will further advance CMS’ priority of creating a patient-driven

healthcare system by achieving greater price transparency and

interoperability—essential components of value-based care

• Re-names Meaningful Use Program to “Promoting Interoperability”

as part of overall focus on strengthening interoperability and the

sharing of healthcare data between providers

• Included Request for Information on possibility of revising

Conditions of Participation to revive interoperability as a way to

increase electronic sharing of data by hospitals

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-04-

24.html

Interoperability Initiatives Environmental Scan

• Initiated during HIMSS17 in recognition of emerging

exchange frameworks

• Opportunity to define each framework for broader

national awareness and understanding in terms of:

– Organization Structure

– Technical and Operational Features

– Participant Details

Interoperability Initiatives Environmental Scan

Environmental Scan Landscape

Vendor-

mediated

exchange*

*For purposes of this scan, HIMSS’s Interop & HIE Committee used EPIC as one example (among many) of vendor-mediated exchange.

COMMUNITY

HIEs

Environmental Scan: Info Collected

Organization Structure

• Governance

• Date Founded

• Geographic reach

• Primary goals & objectives

• Participation costs

Technical and Operational

Features

• Standards

• Onboarding Requirements

• Certification & Testing Requirements

• How exchange is facilitated

Participant Details

• Type (i.e. network to network, consumer-directed, etc.)

• Primary participants

• Access method/use case

• Number of live connections

eHealth

Exchange

2012*

Sequoia

Carequality

2014

Care

Everywhere

(EPIC)**

2008

CommonWell

Health

Alliance

2013

NATE

2013

Surescripts

2008

Patient

Center Data

Home™

(SHIEC)

2015

Community

HIEs

2005

DirectTrust

2011

CARIN

Alliance

2016

Nationwide Interoperability Efforts

Key: Network-to-Network; Person-centric network; Provider-centric networkSecure messaging network/RLSConsumer-directed network

*Year of launch** For purposes of this scan, HIMSS’s Interop & HIE Committee used EPIC to represent one example of vendor-mediated exchange.

Interactive Environmental Scan

http://www.himss.org/library/interoperability-health-information-exchange/environmental-scan

• Carequality plans to enable 80% of hospitals and 70%+ of

physicians to exchange data in 3-5 years.

• CARIN Alliance transmitting multi-clinician data to consumers’

preferred app, & eliminating consumer-requested access issues

• Commonwell’s extending services across new care settings,

building new APIs, and expanding consumer-mediated exchange

• Community HIEs/SHIEC’s focusing on data cubes for analytics,

expanding clinical & claims data, and delivery methods

• DirectTrust wants to expand its PKI as a service to support other

tech, and thus help scale trust nationally.

The Future of Exchange(a few examples)

Key Findings from Environmental Scan

Multi-pronged

approach to exchange

Limited measurement of

standards

implementation,

adoption and use

Provider centric

system of exchange

Semantic interoperability

a barrier to data

exchange

Inconsistent quality

lowers value proposition

No common solution on

patient matching

A Multi-Pronged Approach to Exchange

Example…

One Epic client may use: CARE EVERYWHERETo share with other Epic clients

CAREQUALITYTo share with non-Epic EHRs on the Carequality Network

COMMONWELLTo share with non-Epic EHRs using CommonWell

COMMUNITY HIETo connect to other Hospitals/Providers in the region

DIRECT MESSAGINGTo connect to others not aligned with the above networks

FAXWhen all else fails…

• CommonWell & NATE are granting membership reciprocity.

• Surescripts is accredited by, and a member of, DirectTrust.

• CommonWell can be a Carequality implementer on behalf of its

members and clients, enabling subscribers to engage in directed

queries with any Carequality participant.

• Vendor exchanges (Allscripts, eClinicalWorks, etc.) belong to

DirectTrust; some serve as accredited HISPs to provide Direct

address and secure messaging.

• Many of SHIEC’s HIE members participate with DirectTrust,

Carequality, eHealth Exchange and NATE.

Widespread Collaboration (a few examples)

Next Steps…

• Environmental Scan – Available for download

• Interoperability Champions and Supporters

– Non-profit organizations can sign on to be a Champion and

Vendors and Provider organizations can become Supporters

– Both include opportunity to be listed on the HIMSS.org page

– Questions/Inquiries can be sent to partner@himss.org.

• Join a HIMSS Interoperability & HIE Task Force or

Work Group

– Visit http://www.himss.org/get-

involved/committees/interoperability-hie

Next Steps:We want to engage with you!

Questions?