December 18, 2013
A Closer Look at HIE/HIO & the Direct Protocol:
Exploring the Connection to Meaningful Use Stage 2
Implementation & Information Exchange
Facilitator: Lee Barrett, Executive Director, EHNAC
Panelists
Catherine Costello JD, Project Manager Ohio Health Information Partnership
David Kibbe MD, MBA President/CEO DirectTrust
Alex Kontur, Research Analyst, eHealth Initiative (eHi)
Lee Stevens, Director, State HIE Policy, ONC
Andrea Perry MPA, Privacy Officer, Ohio Health Information Partnership
Andrew VanZee, Director Healthcare Strategies & Technology Indiana Family &
Social Services Admin. For National eHealth Collaborative (NeHC)
Mariann Yeager, Executive Director HealtheWay
Agenda
• L. Barrett: Panel Intro. & Setting the Stage
• L. Stevens: ONC Nationwide HIE Strategy
• A. Kontur: eHi 2013 HIE survey and Summit key topics
• A. VanZee: NeHC Workgroup Certification/Accreditation
Inventory initiative
• M. Yeager: HealtheWay Exchange Connectivity
• D. Kibbe: The role of DirectTrust and the Direct Protocol
• C. Costello/A. Perry: OHIP Case Study
• Q&A
2
Webinar Objectives
• Explore how organizations can assure interoperability
and scalable trust;
• Explain the significant differences between EHR
technology software certification and security/trust
accreditation for HISPs, CAs and RAs who partner
with EHRs;
• Provide best practice examples of how to facilitate
security, interoperability and trust among exchange
participants, fostering public confidence, and
promoting the adoption and success of all
exchange stakeholders;
3
Webinar Objectives cont.
• Describe ways to reduce PHI exposure risks
through the demonstration of comprehensive risk
management programs; and
• Outline how to prepare your exchange for
implementation of secure communications in
support of Meaningful Use requirements by the
ONC.
4
Challenges
• Understanding the role of the
various industry organizations
• What are the various
exchange models in use
today
• Stakeholder Trust
• Managing Risk & Risk
Mitigation
• Privacy and security issues
5
L. Stevens: Nationwide HIE Strategy
6
Nationwide HIE Strategy
Lee Stevens
Director
State Health Information Exchange Policy Office
ONC
Information Securely Follows Patients
Whenever and Wherever They Seek Care
QUERY-BASED
EXCHANGE
MULTIPLE
MODELS
DIRECTED
From Health Affairs, March 5, 2012
CONSUMER-MEDIATED
EXCHANGE
8
HIE Market Reality
• HIE facilitated by a variety of organizations/sources
including:
– HIOs
– HISPs
– EHR vendors
– National services providers
– Hospitals
– ACOs
– Health Center Controlled Networks
– Others
9
ONC’s Approach
• HIE is a journey, not a
destination
• Leverage government to
create conditions of exchange
• Health information exchange
is not one-size-fits-all
• Multiple approaches will exist
side-by-side
• Build in incremental steps –
“don’t let the perfect be the
enemy of the good”
1
0
ONC’s Role
Reduce Cost and Increase Trust
and Value To
VALUE
Mobilize Exchange
• Payment
COST
Standards: identify and urge
adoption of scalable, highly
adoptable standards that
solve core interoperability
issues for full portfolio of
exchange options
Market: Encourage business
practices and policies that
allow information to follow
patients to support patient
care
HIE Program: Jump start
needed services and policies
•
•
reforms
Meaningful
Use
Wide-scale
adoption
TRUST
•
Identify and
urge
adoption of
policies
needed for
trusted
information
exchange
ONC
11
The State HIE Program (data as of Q2 2013)
VT
WA
MN
OR
ID
ME
WI
MI
WY
PA
IA
NE
NV
IL
CO
KS
MO
OH
IN
MD
WV
VA
Directed
Directedexchange
exchangemechanisms
available
in
regions
mechanisms
broadly available
MA
NY
SD
CA
Directed Exchange Color Legend
ND
MT
UT
NH
RI
CT
NJ
DE
Directed exchange
mechanisms being piloted
Directed exchange
mechanisms not available
KY
NC
TN
AZ
OK
NM
SC
AR
MS
AL
GA
FL
TX
Other states and territories
AK
HI
AS
CNMI
DC
PR
GU
USVI
LA
Query-Based Exchange Pattern
Legend
Query-based exchange
mechanisms broadly
available
Query-based exchange
mechanisms available
in regions
•Only 3 territories do not have operational exchange options
available for providers today
•Most states now offer both directed and query exchange
options to providers
State HIE Program Progress
Adoption
Total number of clinical and
administrative staff
enabled for directed
exchange nationally
Total number of clinical and
administrative staff
enabled for query-based
exchange nationally
CY Quarter
2, 2012
44,061
CY Quarter
2, 2013
119,853
63,477
152,132
13
State HIE Program Progress
Transactions
Total number of directed
transactions nationally
Total number of patient
record queries nationally
CY Quarter 2, CY Quarter 2,
2012
2013
72,766,216
270,855,385
2,524,385
11,662,380
14
Focus on Exchange in the
Stage 2 Meaningful Use Criteria
• E-prescribing
• Transition of Care summary exchange:
• Create & transmit from EHR
• Receive & incorporate into EHR
• Lab tests & results from inpatient to
outpatient
• Public health reporting – transmission
to:
•
•
•
•
Immunization Registries
Syndromic surveillance
Reportable lab results
Cancer Registries
• Patient View, Download and Transmit to
3rd Party
Care and Payment Reform Activities
• Inter-professional Education & Inter-collaboratory Practice Models
• Patient Centered Medical Home (PCMH)
• Pay for Performance (P4P)
– Programs to pay for value; not for volume (outcome; not services)
• Accountable Care Organizations (ACO)
– Shared Savings Program (SSP)
– Advanced Payment ACO Model
– Pioneer ACO Model
• Center for Medicare & Medicaid Innovation Programs (CMMI)
– State Innovation Models Initiative (SIM)
– Comprehensive Primary Care Initiative (CPC)
– Bundled Payments for Care Improvement Program (BPCI)
– Community-based Care Transitions Program (CCTP)
16
Strategies to Advance Nationwide
Exchange
• Enable a governance infrastructure, including a trust
framework, that reduces barriers to exchange
• Coordinate across federal government partners on HIE
funding, innovations and implementations
• Create shared learning opportunities to identify best
practices and lessons learned to advance exchange
– Coordinate between real world implementers and the S&I
Framework to test standards and develop implementation
guidance
– Convene implementers to develop and implement “solution
packages” to thorny and important exchange challenges to drive
towards nationwide adoption
17
Strategies to Advance
Nationwide Exchange
• Support HIE as an important element of
meaningful use of EHRs
– Help vendor community (EHR and HIE) understand
meaningful use requirements and options
– Help identify and resolve technical and policy issues
– Better understand vendor needs and challenges and help
coordinate practical solutions
18
Strategies to Advance
Nationwide Exchange
• Support state-level and community HIT-enabled care transformation
– Work with CMS and vanguard states to develop models for developing and
deploying HIT infrastructure at the state level to support payment reform
and care transformation
– Support states in using policy, contracting, regulatory and convening levers
to build a stronger business case for exchange and address the exchange
needs of payment reform
– Convene state policy leaders, federal partners and other leaders to tackle
and resolve specific issues confronting on the ground implementers who are
using HIT to support state-level care transformation including quality
reporting, analytics, care coordination and patient engagement.
19
Conclusion
•
Nationwide HIE will include directed, query and consumer based exchange
•
There will be a variety of sources for exchange
•
Exchange will develop incrementally
•
MU and payment reform are important policy levers for exchange
•
Governance is required to develop the trust that will enable data to flow
between unaffiliated organizations
•
Adherence to nationwide standards and certifications will remove the “stove
pipes”
•
States will continue to be a key strategic partner as HIE supports payment
reform and state health goals
20
Stay Connected
•
•
•
•
Browse the ONC website at: healthIT.gov
Contact us at: onc.request@hhs.gov
Follow our blog: http://www.healthit.gov/buzz-blog/
Ask a question: BlueButton@hhs.gov
•
Subscribe, watch, and share:

@ONC_HealthIT

http://www.youtube.com/user/HHSONC

HealthIT and Electronic Health Records

http://www.scribd.com/HealthIT/

http://www.flickr.com/photos/healthit
Alex Kontur: eHi 2013 HIE Survey and
Summit Key Topics
22
2013 Data Exchange Survey Results
About eHealth Initiative
• Since 2001, eHealth Initiative is the only national, non-partisan
group that represents all the stakeholders in healthcare.
Represents over 15 different stakeholder groups and 39 states
across the nation.
• Mission to promote use of information and technology in
healthcare to improve quality, safety and efficiency.
• Last year, over 4500 individuals attended our events and 500+
individuals participated in our national councils and workgroups
• eHealth Initiative focuses its research, education and advocacy
efforts in four areas:
– Data and Analytics
– IT Infrastructure to Support Accountable Care
– Technology for Patients with Chronic Disease
– Data Exchange & Interoperability
24
About the 2013 Survey
• 10th annual survey
• Comprehensive survey to determine the state of
the field; covers governance, sustainability,
operations, stakeholder participation, privacy
policies, and more
• 199 of 315 identified organizations completed the
survey
– 90 community HIEs, 45 SDEs/state HIEs, 50 healthcare
delivery organizations, others include public health, payers
25
What We’ve Learned
• 84 have reached stage 5 (operational) or higher
• Who provides HIEs with data?
– Hospitals (160), ambulatory care providers (142),
independent labs (85), community and/or public health
clinics (82)
• Who accesses data?
– Ambulatory care providers (159), hospitals (145),
community/public health clinics (105), behavioral or
mental health (90)
26
What We’ve Learned
• Interoperability is a major concern
– 142 respondents cited interoperability as a pressing
challenge
– 151 organizations have had to build interfaces with
disparate systems (68 have had to build 10 or more; 32
have had to build 5 or more)
• 65 participate in an ACO; 65 plan to do so in the
future
• 90 currently use Direct
– Transitions of care is the most common use case (65)
– 30 are NOT planning to use Direct
27
What We’ve Learned
• What services do HIEs offer?
– Connectivity to EHRs (125), exchange of health summaries
(115), master patient index (114), results delivery (104),
provider directory (84)
• What data types are available?
– Results (131), admission/discharge summaries (125), care
summaries (125), diagnoses (115), CCDs (113), allergy
info (113), patient histories (111), medication
data/prescriptions (109)
28
What We’ve Learned
• Who is funding HIE?
– Hospitals (79), state or federal funding (64), ambulatory
providers (38), private payers (23), Medicaid (15)
• How?
– Memberships fees (71), assessment fees (66), fees for
specific services (48), state funds (39) federal funds
(34)
• Are they sustainable?
– About half (52) receive sufficient revenue from
participants to cover operational expenses
29
What We’ve Learned
• Opt-out is the most common consent model (115)
• 109 organizations do not offer patients granular
consent controls
– controls for sensitive information are most common (43)
• Limited patient access
– 31 organizations offer patients access to their data
– 102 plan to offer access in the future
– 56 have no plans to do so
30
Looking Forward
• Evolving sustainability plans
– Private payers
– less emphasis on public sources
– shift to service fee model
• HIEs are turning the corner
– Interoperability is now a more pressing concern than
sustainability
31
Looking Forward
• Health reform has helped create the business case
for HIE, and service offerings will reflect this
– HIEs anticipate offering provider alerts (83), patient access
(78), analytics (74), reporting to disease registries (66)
32
Thank You!
Contact info:
Alex Kontur
202.624.3280
akontur@ehidc.org
33
Andrew VanZee: NeHC Workgroup
Certification/Accreditation Inventory
Initiative
34
Definitions
*As determined by the Accreditation & Certification workgroup
Accreditation
• A process in which certification of competency, authority, or
credibility is presented
• The accreditation process ensures that their policies and
practices are acceptable, that organizations behave ethically
and employ suitable quality assurance and, if appropriate, that
they are competent to test and certify third parties
Certification
• The process of certifying that a certain product has passed
performance tests and quality assurance tests, and meets
qualification criteria stipulated in contracts, regulations, or
specifications
35
Forum HIE Accreditation and
Certification Workgroup
Workgroup Charge
• Develop an inventory of national, regional, and state
accreditation and certification programs, providing a
landscape of these efforts including their purpose, scope and
source of authority
Workgroup Purpose
• This landscape will provide stakeholders with an
understanding of the categories of programs, where and why
they are emerging, and what they are intended to address
36
Accrediting and Certifying Organizations Data
Request
•
Key accreditation and certifying bodies, including state designated entities, were invited to share
information to provide understanding of the HIE accreditation and certification landscape
–
Purpose of Accreditation/Certification program:
–
Who is this accreditation/certification relevant to? Who is the target audience?
–
What is the scope (technical, policy, etc.)?
–
What are the issues that are addressed?
–
What are the types of assurances that are gained?
–
What is the source of the authority; i.e. state, regional, national organization?
–
Is the program voluntary or required?
–
Is it an evaluation or a registry?
–
Are there any standards that are being used as a baseline for their certification or
accreditation?
–
Are you aware of any overlap in the industry regarding HIE accreditation and certification? If
yes, please provide details on overlap.
–
What are the gaps in current HIE accreditation or certification activities; i.e. what other
matters would be best served by receiving an accreditation or certification by a third party?
–
What type of entity is best suited to perform this additional verification?
37
Organizations Who Provided Information
National
- Surescripts
-
EHNAC
CCHIT
DirectTrust
Healtheway
-
Statewide
State of Indiana
State of Kansas
State of Pennsylvania
State of Vermont
Minnesota Dept. of Health
State of Texas
38
Initial Conclusions from Information Gathered
from Accrediting and Certifying Organizations
•
A continuing theme around these efforts is that to increase trust and
interoperability.
•
Much of the target audience consists of HISPS, HIOs, providers, vendors, or
HIEs.
•
The scope of the accreditation & certifications center around:
– Technology
– Policy/Legal including trust agreements
– Security
– Financial Sustainability including fee structures
•
Approximately half are required and half are voluntary with some – Texas –
being voluntary unless you would like to be listed as a trusted entity.
•
The majority of accreditation & certifications are evaluations
•
Many states are using national sources like EHNAC, DirectTrust, Healtheway,
and CCHIT as a basis for their accreditation and certification efforts but some –
Vermont, Indiana mostly, and Pennsylvania – pull from other sources as well. 39
Potential Gaps
• What are the gaps in current HIE accreditation or
certification activities; i.e. what other matters would
be best served by receiving an accreditation or
certification by a third party?
– We do not yet have a reliable and comprehensive testing
and certification service unique for HISP/STAs. These
entities may be partially tested and certified when using
specific EHR vendor modules as “relied upon software”
within the context of the 2014 Edition Certificate Criteria.
However, not all HISPs have these partnerships.
40
Additional Verification
• What type of entity is best suited to perform this
additional verification?
– Initially at this early stage, state programs are adequate;
however ultimately a public/private non-profit should be
responsible
– Verification standards and other criteria should be set by a
community entity or government
– Verification against criteria should be performed by an
independent third party
41
Data Request of Non-Accrediting and
Certifying Organizations
•
Invited non-certifying bodies to provide information about accreditation and
certification programs they are subject to.
– Organization Name:
– What HIE accreditation and certifications are you required to comply with?
– What voluntary HIE accreditation and certifications do you currently comply
with?
– Are they evaluation or registries?
– Are you aware of any overlap in the industry regarding accreditation and
certification requirements?
– What are the gaps in current HIE accreditation or certification activities; i.e.
what other components would be best served by receiving an accreditation
or certification by a third party?
– What type of entity is best suited to perform needed accreditation or
certification?
42
Non-Accrediting and Certifying Organizations
Who Provided Information
- Great Lakes HIE (GLHIE)
- Brooklyn Health Information Exchange (BHIX)
- Rhode Island Quality Institute (RIQI)
- Oregon Health Authority/CareAccord (OR HIE)
- ConnectHealthcare
- Advanced Answers on Demand, Inc.
43
Initial Conclusions from Non-Accrediting and
Certifying Organizations
• The majority of respondents are not required to comply with any
accreditation or certification programs although states (OR, NY) are
slowly developing these programs that may be required in the future.
• Many are voluntarily certified and accredited with EHNAC and CCHIT.
• Many did not understand the question about registries vs. evaluations
so we did not receive a good sense of their answer.
• Most were not aware of any overlap in the current requirements.
• Meaningful Use and HIE was cited by two respondents as a potential
gap that could be filled by a third party.
• Two respondents cited an “independent” organization as the best one
to administer the needed certification and/or accreditation. Some
cited EHNAC or CCHIT. One suggested a government agency or
accreditation commission. One suggested an entity who was fluent in
the laws of the specific state.
44
Entities to Perform Needed Programs
• What type of entity is best suited to perform needed
accreditation or certification?
– An entity best suited to perform accreditation or certification of
Qualified Entities in New York State would be one that
comprehends the complexity of the HIE environment from many
perspectives, including but not limited to technical applications,
policy and privacy concerns, overall operations as well as the
business community. The entity would also need to be well versed
in Federal Law, New York State Law as well as emerging New York
State Policy Guidance which governs health information exchange.
– We believe the current ATCB process with entities like CCHIT are
the best.
45
Suggested Next Steps
• Continue to inform and educate the community on the types of
accreditation and certification programs, status, and progress.
• Raise awareness of the value proposition and business case for
accreditation and certification.
• Identify a neutral, credible third-party organization and
encourage them to keep track of current accreditation and
certification programs for community reference.
• Encourage above organization to build on current landscape
work and collaboratively identify gaps and consider how best to
fill them.
46
Mariann Yeager: eHealth Exchange
Enabling Care Coordination and
Transitions of Care
47
eHealth Exchange
• Establishes framework that community of exchange partners
use to interconnect directly with each other based upon a
common set of rules of the road
– Technical requirements verified through technical testing
– Common expectations regarding privacy and security and other
exchange obligations
• Compliance with rules of the road enforced by contract
• Participants can exchange for multiple use cases and different
work flows under this common framework
– Push of clinical documents
– Query / retrieval of information for treatment, transitions of care,
care coordination, Social Security disability benefits, etc.
48
eHealth Exchange Anchor Participants
49
Healtheway Corporate Members
50
eHealth Exchange Growth
• Participation reaching critical mass
– 40+ Participants
– 59 in testing phase
– Hundreds of hospitals, thousands of physician practices, millions of
patients
– Dozens of others planning to onboard
• National-level coverage increasing; reaching tipping point of
adoption
• Collaboration extending breadth and depth of connectivity
– Care Connectivity Consortium – Kaiser Permanente, Mayo Clinic,
Geisinger, Group Health Cooperative, Intermountain Healthcare
• Meaningful Use (Stage 2) is one factor driving adoption among
vendors and providers
51
2014 Certified EHR Technology:
Transitions of Care Measure #2
• The EP, EH or CAH that transitions or refers their patient
to another setting of care or provider of care, provides
of summary of care record for more than 10% of such
transitions and referrals as follows:
a)
Electronically transmits C-CDA using CEHRT to a recipient (e.g.
using Direct, Direct + XDR/XDM, SOAP transport protocols)
b)
Where the recipient receives the summary of care record via
exchange facilitated by an organization that is an eHealth Exchange
participant; or
c)
In a manner that is consistent with governance mechanism that
ONC establishes for the nationwide health information network
52
eHealth Exchange: Lessons Learned
– Participants trust others in the eHealth Exchange community based upon 3 key
elements:
• Rules of the road (technical, policy, etc.), including obligations for privacy and
security are enforced contractually (Data Use and Reciprocal Support
Agreement)
• Assurance of interoperability that has been tested and verified
• Participants have eHealth Exchange digital certificates (FBCA)
– To assure interoperability, technical testing is essential to verify:
• Conformance to the underlying standards / specifications; and
• Assure that known interoperability issues are not introduced into production
– Ability to test once: exchange with many
– Automation is key to enabling efficient and robust testing
– Rigorous product testing will lower the burden of participant / partner testing
53
eHealth Exchange Product Testing
• Healtheway launching eHealth Exchange Product
Testing Program in early 2014
– Focus on compliance and interoperability testing
– Maintain tested product list: eHealth Exchange
Validated Systems
– Not formal product certification
• Will substantially off-set level of technical testing
that eHealth Exchange participants need to
complete
54
David Kibbe: The role of DirectTrust and
the Direct Protocol
55
DirectTrust Mission and Goals
DirectTrust.org, Inc.
(DirectTrust) is a voluntary, selfgoverning, non-profit trade
alliance dedicated to the growth
of Direct exchange at national
scale, through the establishment
of policies, interoperability
requirements, and business
practice requirements.
DirectTrust operates under a
Cooperative Agreement with
ONC to support its work of
creating a national network of
interoperable Direct exchange
services providers.
Security & Trust
Framework
EHNACDirectTrust
Accreditation
Program
Trust Anchor
Bundle
Distribution
56
57
Current DTAAP Accreditation Roster
Fully Accredited and Audited
Candidate Status
• CareAccord
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
• Cerner Corporation
• DigiCert
• Infomedtrix
• ICA
• Inpriva
• MaxMD
• Surescripts
• MedAllies
Applied Research Works
Athenahealth
Covisint
DataMotion
EMR Direct
GlobalSign
HIXNy
Health Companion, Inc
Health Connection CNY
iMedior
IOD Inc.
Medicity
MRO Corporation
Orion Health
NYeC
RelayHealth
Rochester RHIO
Secure Exchange Solutions
Simplicity Health Systems
Truven Health Analytics
Updox
Utah Health Information Network
Vitalz Technologies, LLC
58
Building a National, Secure Direct Network
Transitional Trust
Bundle (PKCS7)
membership
DTAAP
Candidate
Status
+
Federation
Agreement
Trust Anchor
Review
DTAAP Full
Accreditation and
Audit Status
Trust Anchor
Review
Accredited Trust
Bundle (PKCS7)
59
of Trust Communities
EHR 1
PHR
Public Health
Lab
EHR 1
Hospital Group B
EHR 2
Cancer
Registry
HIE a
Trust
Community B
Rx
Health System A
PHR
Long Term Care
EHR 14
Long Term Care
HIE b
HIO c
EHR 3
Rural Health System
Trust
Lab
Retail Clinic
Public Health
Rx
Community C
Trust
Community A
60
Benefits to health care and public good
• All participants can reach other participants served by
accredited HISPs, regardless of location, organization,
or health IT system. A valuable network.
• Every EHR technology certified for 2014 as “Direct
ready” will be able to either be an accredited HISP, or
partner with one. Eligible physicians and hospitals will
be able to attest to Stage 2 MU objectives for
Transitions of Care and View, Download, and Transmit.
• Additional uses of Direct exchange are emerging
quickly, e.g. transport of claims attachments, referrals
from Federal Agencies, automated alerts and reminders.
61
David C. Kibbe MD, President and CEO DirectTrust.org
David.Kibbe@DirectTrust.org
kibbedavid@mac.com
913.205.7968
62
Ohio Health Information
Partnership/CliniSync HIE
Cathy Costello, JD
Regional Extension Center/MU
ccostello@ohiponline.org
Andrea Perry, MPA
Privacy Officer
aperry@ohiponline.org
63
Ohio’s HIE Landscape
 HIE structure:
o CliniSync: Brand name for The Ohio Health Information
Partnership’s HIE; State Designated Entity
o HealthBridge: HIE covering Cincinnati, northern Kentucky
 Technology vendor:
o CliniSync HIE Vendor: Medicity
64
Ohio’s Major EHR
Vendors
Acute
Ambulatory
EPIC
Meditech
Allscripts
Cerner
McKesson
CPSI
Healthland
EPIC
Allscripts
e-MDs
Greenway
NextGen
eClinicalWorks
Athena
Cerner
CliniSync Ambulatory Connections
Ohio’s Committed Hospitals
Green: CliniSync Live
Hospitals
Yellow: CliniSync Contracted
Hospitals
Blue: HealthBridge Live
Hospitals
Almost 90% of hospitals in
Ohio have committed to an HIE.
Over 87% of 11.5M Ohioans are
being served.
141 Hospitals Contracted with CliniSync in Ohio
67
MU Measures Requiring Exchange Fall
Into One of Three Basic Categories
Transitions of
Care
Patient
Engagement
Public Health
Reporting
• Measures that require hospitals and
providers to share structured summary
of care records electronically for each
transition of care or referral
• Measures that require hospitals and
providers to share or communicate
information with patients electronically
• Measures that require hospitals and
providers to report information to the
Ohio Department of Health for public
health reporting purposes
68
Implementation of Meaningful Use Stage 2:
Certification and Credentialing for the HIE
Medicity
•2014 ONC Stage 2 EHR
Modular Certification
(Required; National)
•Healtheway Certification
(Required; National)
•DTAAP HISP, CA and RA
(Voluntary; National)
CliniSync
•Site Administrator
Credentialing
•Healtheway Certification
(Required; National)
•DTAAP RA (Voluntary;
National)
Hospitals/
EPs
•2014 ONC Stage 2 EHR
Certification (Required for
the CEHRT vendor;
National)
•Site Administrator
Credentialing (Required;
CliniSync)
•Authorized Users
Credentialing (Required;
CliniSync)
69
Site Administrator for CliniSync Participants
in the HIE
“The Site Administrator is responsible for performing
duties related to authentication, determining appropriate
access requirements, and notifying CliniSync in instances
of improper use as defined by CliniSync policy.”
-
CliniSync Policy Manual for Participating Organizations
70
Credentialing Site Administrators
Identity Verified Against Following Databases
• State of Ohio Medical Licensing Board
• NPPES
• Ohio Secretary of State Business Registry
Required Identity Documentation
• One federal government issued photo ID, a REAL ID Act
compliant Driver’s License or
• Two non-federal IDs, one of which is a photo ID (e.g. NonREAL ID Act compliant Driver’s License
71
Authorized Users Credentialing Process for
Access to the HIE
Site Administrator Responsibilities
• Designate authorized users from among its own organizations
workforce
• Perform duties related to authentication
• Determining appropriate access requirements (Role Based
Authorization)
• Notifying CliniSync in instances of improper use as defined by
CliniSync policy
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Process of Obtaining Consent for Protected
Health Information (PHI) to Move in the HIE
CliniSync (State Level) Credentials Site Administrator
Site Administrator (Local Level) Credentials Authorized User
Authorized User (Local Level) Obtains Patient
Consent for HIE Transfer of Records
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Development of CliniSync Consent Policy
• The CliniSync consent policy was developed over
1½ years.
• Committee was composed of healthcare
attorneys from around the state.
• Policy ultimately vetted by over 75 Ohio
healthcare attorneys.
• End product was a common consent policy for
HIE adopted for all participants in Ohio.
• CliniSync is working to embed consent in the
workflow of hospitals and physician practices.
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CliniSync Consent Policy
• Consent is not required for directed exchange
between providers to coordinate care (HIPAA
covers this).
• Consent is required to query or search the HIE
for patient information.
• A provider must have a treatment relationship with
the patient. This is tracked in the CliniSync
system.
• Patients can opt out of CliniSync if they so choose.
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Universal Health Information Exchange Consent
Health Information Exchange is a secure way for your health care providers to get the
most up-to-date medical information about you.
If you sign this consent, your health care provider may search for and get your test
results, lab results, X-rays, medication list or any other health information that has been
electronically collected from other participating providers.
Information that could help save your life in a medical emergency would be available to
the health care providers treating you. Only health care providers who have a
treatment relationship with you will be authorized to search
for your records.
Consenting and Cancellation
If you consent, you only have to give your consent one time. You can withdraw your
permission at any time by completing a Cancellation Request and submitting it to your
health care provider. They will have the form or you
can get it at www.clinisync.org.
Please check one of the boxes below.
I consent to have my records shared through the Health Information Exchange. I
have read this form. I have had a chance ask questions. I am satisfied with the
answers.
I do not want to have my records shared on a Health Information Exchange. I
understand that this means that even in an emergency, my treating physicians
may not have access to my previous records from other treating physicians. I
have read this form and have had a chance to ask questions.
Patient Name: ______________________________
_______________________________
Parent/ Guardian:
Signature:__________________________________
Signature:______________________________________
Date: ______________________
________________________
Date:
All individuals 14 and over must sign as a patient, and individuals under 18 must also
have a parent or guardian
sign this form.
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Keep your data private and secure.
• Security issues are high priority for the HIE.
• Only authorized, treating clinicians can access a patient’s
data.
• When dealing with teens, get their permission.
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Questions
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