Delaware Health Information Network
Town Hall
Wednesday, October 9, 2013
10:00 a.m. – 11:00 a.m.
Conference Room
107 Wolf Creek Boulevard
Suite 2
Dover, DE 19901
Meeting Minutes
Purpose
To keep our public informed.
Agenda
What we are doing
What we will be doing
What should we be doing (public feedback)
I. CURRENT Activities Update
DHIN is in the process of on-boarding two new labs, Med Labs Diagnostic and Mercy Diagnostic; while we have encountered a small setback with the interface, the targeted date will be early November for Med Labs Diagnostic and mid to late November for Mercy Diagnostic.
Public Health
DHIN is currently in the process of on-boarding the Public Health Lab and is in the very early stages of receiving sample messages. DHIN is currently working on a project plan with Medicity and it is expected to be in production by late January.
We mentioned last month that Nanticoke would be in full production by late September; however, we ran into issues with the source system that Nanticoke uses and are currently scheduled to be in production by late October.
St. Francis has sent in test information for reportable labs, although few problems were encountered, they are in the process of creating new messages for testing. St. Francis will re-test internally during the week of October 21st. After St. Francis has been completed, we will then move to CCHS for testing.
The Newborn Screening project with Public Health will be completed in multiple phases.
Phase 1 involves assessing the hearing testing equipment in each birthing hospital and birthing center to verify that they are using equipment capable of sending ELRs in the correct format. Once assessment has been completed and hospitals that need new equipment have been identified, the equipment replacement timeline will be a 2 or 3 month process. Phase 1 of the Newborn Screening is to obtain the equipment for hearing testing and will be covered through the Cooperative Agreement Grant.
Further phases for the project will involve metabolic screening and hearing screening which will be combined into one report and stored in community health records as well as transmitted to the provider.
DHIN continues to work with Public Health with immunization reporting. In September
56 percent of all immunizations were entered into the state registry system, DelVAX which came through DHIN. However, it has also been the first time since April that we are seeing a backlog of paper submissions not yet entered into the registry. Historically, Public Health has hired temporary staff to come in and work on this backlog and with the with flu season upon us, the backlog is growing at an alarming rate. This is a high priority for DHIN and we continue to reach out to pharmacies as well as practices to get as much automation of immunization reporting completed as possible.
In September, DHIN implemented into production the web service for the immunizations. Cerner is now using the web service for four practices to send in their EHR immunization updates and query messages. DHIN is also in the process of working with a number of organizations for testing purposes and are actively engaged in 10 organizational testings along with two additional pharmacies.
Transcribed Report
Transcribed reports are expected to be in testing next week and in production by mid November. Once on board, Nemours will be the only hospital not sending transcribed reports and discharge summaries.
Image Viewing
DHIN is currently involved in a pilot with Bayhealth and Nanticoke using two different technology approaches. Nanticoke is currently in testing and will be in production by late October. Bayhealth is currently reassessing their technology approach and may be possibly switching over to the process we are using with Nanticoke. Our plan is to have both Bayhealth and Nanticoke in production with Image Viewing by late October.
CCD Exchange
DHIN has been working for over a year on a pilot with Delaware Health Net with CCD exchange using their Allscripts EHR. There have been several technical glitches and we are not clear on how much is unique to one EHR or how many problems we may run into with other EHRS. DHIN has reached out to other HIEs asking “Who is doing this successfully”? What are they doing that we are not doing and learn from their success.
Technical issues aside, we have also been struggling for a business model that will allow DHIN to cover the cost for providing this service. Footing the bill is more of a challenge and is too important not to do so. As much as the technology is a limitation, finding an executable business model may also be a limitation.
Event Notification System
All hospitals, with the exception of Nemours have executed the updated Data Use Agreements that allow us to send reports to health plans and participating providers as to which of their members have been discharged from an emergency department within the past 24 hours.
Medicaid MCOs are currently receiving this information on a daily basis from all hospitals except Nemours. DHIN is working with the plans that the state employee benefits commission uses to get them on boarded. A kickoff with Highmark provided them the information needed; and Aetna is validating file content for the member roster information they are sending in.
A requirement under the new Health Benefit Marketplace ensures that all health plans participating are expected to participate in DHIN’s data exchange services. Open season for the Health Benefit Marketplace has begun and Dr. Lee will be working with the Health Care Commission to ensure that participating plans are executing the proper agreements and all the preliminary work is completed, so by January we will be involved in ENS reporting to all participating health plans on the market place.
The beneficiary of the ENS service will be the practices. DHIN currently has 3 beta practices and hope to have them live by the end of this month. DHIN is working on our marketing collateral to advertise to practices and we have settled on our business model.
Out of State:
DHIN is in the early stages of kicking off a project with CRISP, Maryland HIE. A meeting took place with our vendor, Medicity to begin discussing the technical issues for that exchange; the project kickoff will be in the very near future.
EHR Integrations:
DHIN has certified results delivery interface with two additional EHRs, Glennwood System and Greenway Medical Technologies which brings us to a total of 15 EHRs.
Currently more than 70 percent of the practices enrolled in DHIN, with an EHR, are using one of the 15 that we currently have a certified results delivery interface with. Should they wish to purchase that interface from their EHR vendor they would have the ability to connect directly with DHINand the results will flow through DHIN withoutusing a separate log-in to receive those results.
Grant Funding
The end of the Cooperative Agreement is a little more than three months away. DHIN still has a lot of work to complete under grant funding and we are working hard. We continue to work with ONC negotiating what items can be paid with grant funding and we have a solid plan for spending down all grant money.
II. PLANNED Activities Update
DHIN is actively looking at other grant opportunities and with each opportunity, DHIN would need to partner with other organizations. DHIN is working with Medicaid for a possible grant from CMS to automate the Meaningful Use Reporting and it may be several months before a final decision has been made for this grant.
DHIN is also working on the State Innovation Model Design Grant and we are drawing close to a final design. Applications are due the end of October; however, we are not sure if the government shutdown will have an impact on the date. The Health Care commissions has not been able to communicate with their project officer and are at a standstill with drawing down grant funding for projects that have not already been approved.
However, the expectation is that in January, the funding opportunity announcement for the testing grant will go out. The state will then apply for the testing grant and it will be another 6 months before grant money is available.
There has been a lot of work going on behind the scenes to find funding sources and to get started on implementing the model design. Grant money can make this happen a lot faster; however, there is serious intent to pursue this model with or without grant money.
We have already submitted a grant application under the CMMI second round of grant awards for implementing iTriage state wide and a few additional activities as well.
Health Science Alliance: there is grant opportunity that has been discussed involving building out infrastructure to support clinical research and a potential to use data in DHIN to support clinical research, but we would need the consent from the data senders.
DHIN is looking into the legal framework to support it and to be able to use health data in ways that are permissible.
DHIN has retained legal counsel to help us create the legal framework allowed to use DHIN in support of clinical research.
III. Public Comment:
Q: (Joann Haase): Has there been any feedback from anyone currently receiving the Event Notification System and if it is useful?
A: MCOs have seen the value and believe that long term, it will have a positive response. The challenge is working the ENS system into the work flow. The new payers are looking for feedback as well. We have reached out to United Healthcare and DE Physicians Care Incorporated, as far as use cases and how they have incorporated ENS. We are waiting for their response back. We have found that we are not getting all the admission and discharge reasons for all patients that we hoped to and have reached out to the hospitals to enhance that information.
Q: How soon do primary doctors get the information from patients being hospitalized?
A: Information will be coming in two steps; the first, with the Medicaid MCO’s and it is in production. The second will include other health plans participating in DHIN and to include ambulatory practices.
Q: (Marie Ruddy, Nemours): Can we get an update on Nanticoke going live with sending transcribed reports? Is DHIN looking to expand transcribed reports to all reports?
A: We are looking at other types of reports, specifically cardiology reports and looking to put in place.
C: (Cathy Westhafer, Christiana): CCHS is moving forward with electronic physician documentation where transcribed reports will be replaced over the next year by physicians directly entering the information and sending through DHIN.
C: (Mary, Delaware Medicaid and EHR Incentive Payment Program Manager):
Brief update:
· Program was implemented November 2011
· 100 percent federal funded incentive payment program to go to eligible providers and hospitals ELR system
· Paid 778 providers to date, approximately 22.4 million dollars
· Completed audit of 60 selected providers with no audit findings
· This year, 4 hospitals are coming in for 3rd payment
· All 7 hospitals have come in for an upgrade payment
· 504 providers 1st year: indicating they have adopted implementations or upgraded to EHR
· 274 providers for 2nd year payment: indicating attestation to Meaningful Use
We have submitted the application to CMS to receive a grant to have DHIN work with our EHR system to assist in Meaningful Use registration and attestation and in the end hope to make it easier for providers to report clinical all quality measure.
The next Town Hall is scheduled for November 20th @ 10:00 a.m.
1-408-792-6300 Access Code: 573 535 573
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