Meeting Name Location: Meeting Date and Time: Next Meeting Scheduled:
LCC Pilots WG Meeting Web / Conference Call Monday, May 12, 2014 @ 11:00am ET Monday, June 9, 2013 @ 11:00am ET
Agenda Welcome and Announcements Presentation: GSI Health LCC Direct Subscription Pilot Presentation (Vince Lewis, Mike Carbery and Sean
Kelly) Next Steps
Attendance Name/Affiliation Abhishek Khowala Alex Baker Amy Koizim Annalisa Wilde Atia Amin Barbara Gage Becky Angeles Becky McClaren Benjamin Flessner Beth Halley Bonnie Kohr Brett Marquard Catherine Payne Cathy Walsh Cheryl Irmiter Chris Clark Christol Green Cindy Levy David Foster David Nessim David Tao Dawn Foster Deb Castellanos Diane Evans Donna Doneski Elaine Ayers Elizabeth Amato Ernest Grove Elizabeth Serraino Enrique Meneses Evelyn Gallego Gayathri Jayawardena Gordon Raup Harrison Fox Holly Miller Holly Urban Iona Thraen Jack Kemery Janel Welch
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Name/Affiliation Jeffrey Levy Jennie Harvell Jennifer VanWinkle Jim Younkin Joanne Lynn Kari Ballou Kate Wetherby Kathleen McGrow Kathy Applin Kelly Cronin Kelton Swartz Kerrie Petrin Kris Cyr Kunal Agarwal Larry Atkins Larry Garber Larry Seltzer Laura Heerman Langford Laurene Vamprine Lee Jones Lee Unangst Leigh Sterling Lenel James Les Morgan Lester Keepper Liora Alschuler Lisa Peters-Beumer Lorie Smith Lynette Elliott Marie Chesley Mark Pilley Mark Roche Matthew Arnheiter Michael Carbery Michael Lardieri Mina Rasis Nora Kershaw Okaey Ukachukwu Pam Russell Parag More Pat Rioux Paul Burnstein Paul Lomayesva Renee Tolliver Rich Brennan Rita Torkzadeh Robert Dieterle Robert Drake Robin Bronson Rodolfo Alvarez del Castillo Russ Leftwich Sandra Raup
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Email
[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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Name/Affiliation Scott Zacks Sean Kelly Stacy Mandl Steve Stasiak Su-Hsiu Wu Sue Mitchell Susan Campbell Susan McKeever Sweta Ladwa Tara McMullen Terry O’Malley Tom Moore Vincent Lewis Wan Li Wen Dombrowski Zabrina Gonzaga Zachary May
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[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]
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Discussion
The meeting was introduced with a reminder for participants to join the LCC Work Group via the “Join the Initiative” tab in the wiki and to complete the Pilot Survey on the LCC Pilots WG wiki page. Meeting reminders were presented and included LCC WG, relevant HL7 WG meetings and meeting dates and times. Special dates/events include the following: o AHIMA 2014 LTPAC Health IT Summit. WHAT: Provides thought-provoking, interactive sessions aimed at advancing HIT Priorities; showcases implementation successes; and puts the spotlight on LTPAC technologies WHEN: June 22nd to June 24th, 2014 WHERE: Hyatt Regency Baltimore on the Inner Harbor Register at: http://www.ahima.org/events/2014june-ltpac For further information, contact Exhibits Manager:
[email protected] o LTPAC/BH Listening Session (HealthIT.gov) The Certification and Adoption Workgroup of the Health Information Technology Policy Committee has been exploring the health IT needs of LTPAC and BH settings and how those needs could be supported through ONC Voluntary EHR Certification. The Workgroup has developed a proposed set of certification criteria focused on interoperability, privacy and security, and modularity and is now seeking public comment in two ways. Participate in a listening session on Thursday, May 22th. There is limited time for this session, please register early. During the week of May 12th, the full list of the proposed recommendations and an opportunity to provide written comments on those recommendations will be provided. Click here to sign up for May 22nd listening session Timelines and milestones were presented and Pilot Work Group Purpose and Goals were restated.
Presentation: GSI Health LCC Direct Subscription Pilot Presentation (Vince Lewis, Mike Carbery and Sean Kelly) Sean Kelly began the presentation with a review of the agenda: o Program Overview o Technology Overview o Demonstration Page 3
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o Pilot Architecture o Questions and Answers Mike Carbery provided the program overview. The company has been working about ten years to get where it is today with providing longitudinal care coordination across the full spectrum for seriously mentally ill individuals with multiple core morbidities in Brooklyn. Diversity, language barriers and socioeconomic resources have been challenges. o A timeline was provided depicting the milestones from 2005 to today, where they plan to provide services for one million Medicaid patients.
o A list of partners was displayed and included Care Management Providers as well as Network Providers. o Question posed: Are you currently working with the community based care transitions program awardees in Brooklyn? Response: I think that will be defined in the next nine months or so. We’re trying to get all those types of organizations involved in a coordinated and organized way. A slide depicting Care Team Responsibilities was displayed and described as being the way to engage all members of the Care Team.
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o The Brooklyn Health Home Model was displayed and included the layers of individuals and providers involved in the care process. All fifty provider organizations involved with GSI Health’s program are using the Health Home Dashboard (GSI Health Home Coordinator). o This platform is standalone, available as Software as a Service, and is interoperable with Healthix, which is the RHIO for most of downstate NY.
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Question posed: Are the Care Navigators the key point person among the interdisciplinary team members? Response: The Care Manager is. The Care Navigator is more application and administrative support for the team. Question posed: Are the services the Care Managers provide paid for with a per member per month payment? Response: The reimbursement we get is for Care Management services, yes. Everything else is billed directly, either as fee for service or capitation basis. Question posed: Have you been able to exchange a Care Plan from the GSI Health platform to the Healthix platform? Response: We have been in discussion with Healthix on how to extend our platform through this pilot to folks who need it at any one point in time. We’re also looking to team with some of the providers in our own network to integrate with their legacy systems. Response: In terms of the standard HIE model, we are currently exchanging the data with Healthix through CCD. We want to evolve this into the LCC CDA and Care Plan CDA. A GSI Health Company Overview was presented by Sean Kelly. o Veteran health IT team, including policy leadership with Federal and State governmental appointments o Product solutions focused exclusively on care coordination and population health management
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Extensible cloud-based platform Care coordination apps provide workflow functionality for virtual care teams Embedded HIE and Direct Infrastructure to interoperate with existing 3rdparty systems Embedded analytics and reporting solution utilizing 4 data types: Clinical (HIE, EHR), Claims (public and private sources), Administrative and Care Coordination o Deep domain experience in Care Coordination, Interoperability, Medicaid ACOs and Health Homes, complex patient populations The GSI Health Coordination Platform provides connectivity to clinical care delivery information systems that are already in place and leverage that information through the HIE that feeds into a clinical data repository in a common information model. o When information comes in, it can populate multiple applications and they can call upon the data as they see fit. o Alongside are Claims Systems sources that are populated with the data from the CDR into our data warehouse to allow for applications to call upon them, whether it be analytics and reporting from the data warehouse or what we call Care Coordination Apps, which are designed for everything from secure messaging to managing patient consent, building virtual patient care teams, viewing and coordinating care plans, and accessing patient summaries. A demonstration was provided showing how a change can be made to a patient’s care plan. In making that change, it will be triggering the automatic subscription based Direct messaging of the care plan to a user. Because it uses Direct it can go to any type of Direct compatible system. o In this demo, it used a specific app called the Messages app. o The demo interface represented the Health Home dashboard. This is the user interface for the virtual care team users and service providers. o The dashboard apps shown included the following: Enrollment Care Teams Reports Care Plan Patient Engagement Messages Alerts Population Manager UHC Enrollment Report o The Care Plan application was launched. This is where users come in to create documentation and assessments and to coordinate care plans. Three crisis issues had been added to this example care plan in the Profile section. They are each mapped to health concerns in the C-CDA. Diagnoses and associated care steps were also displayed as part of the example. A new crisis issue was added to the example care plan. Users affiliated with this patient have the ability to subscribe for notifications. When a new issue is added it alerts the appropriate users that an update has been made. Subscriptions to the care plan trigger the creation of the C-CDA version of the care plan, which gets attached to a Direct message. It goes through a Direct HISP to the end user at a Direct compatible end point. The user can then open and view the updated document (for this demo it was the Messages app). An architecture diagram was presented and the point was made that the messages get forwarded and the data gets captured in the Subscription Manager, which sends out notifications each time it receives updated data.
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Question posed: When you send a CDA document to that EHR, do they know why they’re receiving that? Response: This is part of the XDR protocol—the “why” they’re receiving it is in the metadata. It will include the patient, the reason for the exchange, the type of document being exchanged and other machine parsable data. They’re not getting the raw CDA. They’re getting metadata content, as well. Question posed: Are there well defined triggers for the actual exchange or update to be sent? There could be an oversharing of information. Response: It’s configurable by customer. We do everything we can to define the triggerable parameter. Here we’ve defined specific parts of the care plan for sharing. Question posed: Who determines rule based access? Response: In the classic sense of an HIE for consent is a huge part of the system, but it’s not part of Direct. Direct does not require consent in New York for push data. Consent is configurable in the system, but the push model allows for the provider to send to another provider without consent in the receiving provider. Response: The virtual care teams are identified and persist within the platform, so care team members always know who they’re collaborating with. The consent and exposure is also included in the enrollment process so that the patient can choose who has access to what information. Question posed: On an earlier slide you talked about the ability to receive EHR data to support the development of this care plan. Response: This diagram is a small subsection of the overall system. In the absence of pervasive transparency and exchange of care plans in C-CDA format by other systems, what we often get is information in the form of CCD that can feed into our platform that can
eventually evolve into issues in the care plan. What we’ve demonstrated here in moving the care plan out is the first step in moving to being able to have XML formed care plan data that can move from system to system. o Question posed: This is an issue that’s come up with our FACAs about backward compatibility. Are you saying that by sending it using XML you’ve been able to address that issue? Response: Broadly, being able to receive documents in XML format is still not dominantly deployed in the market. We feel this is a component in the care plan process where organizations are supplying clinical content but not care plans, which are still on the evolutionary track. We convert between legacy type XML or exchange to the new stuff. We help support adaptation of old protocols and changing them to the new. Response: We want to have as a goal to ultimately provide feedback based on the paradigm of use. A nuance I wanted to point out is that this idea of exchanging care plan and the CCD that’s traditionally being used are two different concepts. It’s not just a matter of backward compatibility and establishing equity between those different formats. What we demonstrated is not an electronic health record, per se, but a planning activity. The paradigm for sharing, including triggers, is different than in a CCD case. We’re not matching up all the XML schemas so they can all be supported. o A sample message triggered by a subscription was displayed. An attachment to the message was opened and contained a summary of content as XSL and XML. The content was broken out by Health Concerns, Goals, Interventions, etc. NOTE: The content shown in this slide is available in the pdf provided by the GSI Health team, which is posted on the LCC Pilots wiki: http://wiki.siframework.org/file/view/GSI%20Health%20Supplemental%20Info.pdf/50831369 4/GSI%20Health%20Supplemental%20Info.pdf A summary was provided to state that GSI Health is working to identify third party organizations that can receive and digest CDA to promote and further understand not only the transference and equity of sharing information in the C-CDA format, but also to understand operationally how it can best work. o The team highlighted mapping care plan documents to various applications’ internal fields proprietary to standard and leveraging them from a technical and clinical inside perspective. o There are several high value use cases in New York where work is being done with virtual care teams and complex care plans. o Question posed: If you’re sharing outside of Brooklyn with an EPIC user does there need to be additional work to take structured data within the template and make sure that it’s used? Response: We’re talking about internally the type of business process that doesn’t necessarily map to a document. Once it goes outside our door, the standard should be consumable and readable by anyone. We’d like to come back to this group about where we have differences in our business processes and what’s in the current document. We want to make sure our notion of a care plan for coordinated care among disparate providers maps appropriately to the standard.
Proposed Next Steps Homework Assignments: o Complete Pilot Survey o Sign up as and LCC Committed Member o Submit Pilot Documentation Proposals Available on the LCC Pilot WG wiki: http://wiki.siframework.org/LCC+Pilots+WG Email to Lynette Elliott (
[email protected]) The next meeting will be held Monday, June 9th at 11am ET. Action Items
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