+
Family Planning Quality
Improvement and Health IT
FPAR2.0@hhs.gov
+
Background:
HHS Office of Population Affairs and the
Title X Family Planning Program
+
3
Title X Family Planning
A grant making contraceptive service delivery program

Public Health Service Act of 1970 established the Title X
Family Planning Program

Administered by the HHS Office of Population Affairs (OPA)

Mission: To provide individuals with the information and
means to exercise personal choice in determining the
number and spacing of their children, including access to a
broad range of acceptable and effective family planning
methods and services

Within HHS, OPA sits within the Office of the Assistant Secretary
for Health

However, Title X budget is authorized through HRSA
 $286 million in FY14

3
90% of budget must fund service delivery grantees
+
4
Family Planning Encounter

A documented, face-to-face contact between an individual and
a FP provider that takes place in a Title X service site. The
purpose of a family planning encounter is to provide family
planning and related preventive health services to female
and male clients who want to avoid unintended
pregnancies or achieve intended pregnancies

Services generally include:

Contraceptive services to prevent pregnancy

Pregnancy testing & counseling

Preconception health counseling & services

Basic infertility services to achieve pregnancy

STD/HIV screening, diagnosis &treatment

Related preventive health services
4
+
5
Title X: Diverse and wide network
The 10 HHS Federal Regions
8.6 million encounters annually
4.8 million clients
4189 Service delivery sites in
1138 Sub recipients
50+ States, territories, DC monitored by
93 Grantees monitored by
20 Regional Office Family Planning staff
Supported by
10 Regional Health Administrators
5 National Training Centers
5
* 2012 FPAR service data
§ 2013 staffing estimates
1 HQ
+
6
Title X Service Sites
Hospital and Community-based
(school, university, correctional, tribal, faith)
Community
Health Center or
18%
FQHC
8%
Health Department
(State, County, or Local)
53%
21%
Family Planning
Organization
6
+
Family Planning Annual Report
(FPAR)
+ Current FPAR = stale, aggregate data
January
2012
Site
Sub
February
2013
Grantee
• Collects FPAR data on each Title X client
encounter
• Aggregates & submits data to
subrecipient or grantee
• Aggregates data from all sites
• Submits sub-level aggregate data to
grantee
• Aggregates data from all subs
• Submits grantee-level aggregate data
annually populating FPAR tables
10
Regional
FPAR
summaries
FPAR
• Contractor aggregates grantees’ data
• Validates, analyzes & organizes into
November 2013
23 months later
1
National
FPAR
summary
8
+ FPAR 2.0 = encounter-level data
9
FPAR 2.0
Repository
Regional
FPAR
system
Site
A
State
HIE
Site
B
Site
J
Grantee
Data
System
Site
I
Site
C
Site
H
Site
D
Site
E
Site
F
Site
G
+
Title X and Electronic Health Record
Systems Adoption
+
11
EHR systems & Title X Sites
June 2013 Family Planning National Training Center
Training Needs Assessment Results
 454
Subrecipients and 1101 Service Sites responded
 33% Using EHRs
 32% Planning or implementing EHRs
 35% No EHR implementation plans
 Variation
in certification level, vendor, and functionality
+ Reported EHR systems in use
Next Gen
FL Dept of Health Management System
Netsmart Insight
VistA
Greenway (Vitera)
eClinicalWorks
Custom
SuccessEHS
Centricity/Logician (GE)
Epic
Ahlers (FPAR data only)
Allscripts/Eclipsys
Mitchell & McCormick
PatTrac
AdvancedMD (ADP)
… and others
14%
11%
9%
9%
8%
5%
5%
5%
4%
3%
2%
2%
1%
1%
1%
August 2013 | N=3,489 sites
12
+ Top Commercial EHRs by Service
Delivery Type
All other commercial vendors
FL HMS
Greenway
Health
Dept
FQHC
38%
Other
Private
Non-Profit
Next Gen
Netsmart Insight
VistA
7%
17%
60%
FP group 13%
13%
11%
38%
13%
2%
2%
86%
68%
13
31%
1%
1%
August 2013 | N=3,489 sites
Diverse network with specific
local needs, multiple
reporting structures
14
Variety of tracking and reporting
systems
Understand performance
at finer granularities and
in real-time
National improvements in
electronic data capture and
exchange
High individual costs to support
infrastructure of data capture
and exchange
Common
tools to
record and
exchange
data
+
The Way Forward:
Encounter-level data from Title X service
sites used for performance measurement
Assess EHR Use and Challenges
16
Promote Quality FP Care
Operationalize QFP
Recommendations
Study EHR implementation status
& systems
Achieve NQF endorsement
Pursue feasibility of data exchange
& transition to encounter-level data
Provide performance feedback
Validate 2.0 elements & measures
Develop Structured FP Data
Title X
Collaborate with Partners
Title X
Federal partners
Work within SDOs
partners
Subject matter Federal
stakeholders
Standardize & document family
planning services
Subject
matter
stakeholders
Technical
expert
organizations
Promote family planning integration
in healthcare
Technical expert organizations
FPAR2.0@hhs.gov
+ Emphasis on Quality Framework
17
Gavin, et al.
Providing Quality Family
Planning Services:
Recommendations of CDC
and US Office of Population
Affairs.
MMWR Apr 2014.
PMID: 24759690
+ Preparing a Path for Success
Title X
Activity
Type
Timeline
JSI Data System &
Feasibility Study
Contract
9/13 - 9/15
ChildTrends Pregnancy
Intention Study
Research Cooperative
Agreement
9/13 - 9/14
Activity
Type
Timeline
Contraceptive
Effectiveness Measure
NQF Proposal
2013 - 2014
S&I Framework
Chlamydia Screening
CDS /CQM Pilot
ONC Collaboration
4-12/2014
IHE Family Planning
Technical Profile
International
Collaboration
9/13 - 2015
U.S. & Beyond
18
Comprehensive 2.0 Activities Timeline
Public Comment
IHE Profile
Connectathon
Jun 2014
2014
Go live with 2.0 system
Interoperability Showcase
Jul 2017
Apr 2015
Jan 2015
2015
2016
2017
FPAR 1.0 system contract
Jul 2014
Sep 2017
OMB approval of current FPAR forms
Jan 2014
Sep 2016
Pilot Performance Measures & Targets
Apr 2014
19
Sep 2017
Engage OMB on 2.0
Jul 2015
Dec 2015
OMB review of 2.0
Jan 2016
Jan 2014
Jan 2014
Jan 2014
Jan 2014
Preg Intentions Study
Dec 2016
Sep 2014
JSI Data System & Feasibility Prep Contract
RFD and CQF pilot activities
Sep 2015
2015pilot?
+Aug
Query
Market research for 2.0
Apr 2016
Fund & solicit 2.0
May 2016
Sep 2016
Build & test 2.0 system
Oct 2016
Apr 2017
Jan 2017
Phase into 2.0 system
Sep 2017
Site:
SD-3024
Visit Date:
6/1/2017
+
IHE Family Planning Profile using
RFD
+
21
Reminder of SDC
+ Family Planning Profile at 2015
Connectathon
22
1
Send request
for FP form
Pre-populate
form with
mappings,
send back
Mock
Repository
& Forms
system
2
3
Display form,
allow for manual
corrections
4
Send completed
Family Planning
Document
(CDA)
+
IHE profiles: SDC vs. FP
The Structured Data Capture (SDC) Content Profile provides
specifications to enable an electronic health record system or
other application to retrieve a data capture form and submit data
from the completed form. The SDC profile utilizes the IHE
Retrieve Form for Data Capture (RFD) Profile and an ISO/IEC
19763-13 Meta-model for Framework Interoperability (MFI) form
compliance model. This profile also supports optional use IHE
Data Element Exchange (DEX) profile for retrieving and
submitting forms in a standardized and structured format.
The Family Planning (FP) Profile describes the content and format
to be used within the pre-population data part of the Retrieve
Form Request transaction from the RFD Integration Profile. It
is expected that the Form Filler and Form Manager will implement
the RFD transaction as specified in the RFD, and this profile does
not include any additional constraints or extensions on the RFD
transactions.
+ Actor diagrams: SDC vs. FP
Form Filler
Retrieve Form
[ITI-34] ↓
Submit Form
[ITI-35] ↓
Form
Processor
Retrieve Form
[ITI-34] ↓
Form Manager
Archive
Source
Documents
[QRPH-36] ↓
Archive Form
[ITI-36] ↓
Form Archiver
Submit Form
[ITI-35] ↓
Form Receiver
+
Pre-population: SDC vs. FP
Form
Filler / Metadata
Consumer
Form
Manager / Metadata
Consumer
Retrieve form
[ITI-34] Request
Retrieve
Metadata
[QRPH-44]
Metadata
Source
Retrieve
Metadata
[QRPH-44]
Retrieve Form
[ITI-34] Response
Pre-population
Auto-population
Display Form
Review and
Complete Form
Submit Form [ITI-35]
Archive Form [ITI-36]
Form
Receiver
Metadata
Source
Form
Archiver
+ IHE FP profile aligns  FPAR 2.0
Facility identifier
Clinical Provider identifier
Patient identifier
Visit Date
Date of Birth
Administrative Sex
Pregnancy History
Limited Language Proficiency
Ethnicity
Race
Annual Household Income
Household Size
Visit Payer
Current Pregnancy Status
Pregnancy Intention
Sexual Activity
Contraceptive Method at Intake
Reason for no contraceptive method
(Intake and Exit)
Contraceptive Method at Exit
Date of Last Pap test
HPV Co-test Ordered
CT Screen Ordered
GC Screen Ordered
HIV Screen Ordered
HIV Rapid Screen Result
HIV Supplemental Result
Referral Recommended Date
Referral Visit Completed Date
Systolic blood pressure
Diastolic blood pressure
Height
Weight
Smoking status
26
+
Next Steps :
Public Comment, Vendor Outreach,
Testing, Other Pilots
+ ASK
 IHE

28
Public Comment Period ends July 5 2014
transparent critique and review by

FP experts, including international stakeholders

EHR vendors

IT and standards experts
 Recruitment
of vendors to certify for FP at the
January 2015 Connectathon
 Scope
out another pilot project on query-based
model?
 Participation
on S&I CQF Chlamydia Use Case and
pilot
FPAR2.0@hhs.gov
+
Contact Information

Johanna.GoderreJones@hhs.gov

FPAR2.0@hhs.gov

@OPAHIT

http://opahit.sites.usa.gov/
+
More Details
+ Common reporting burden among
Title X sites
BPHC-
31
UDS
Private & fees
HABCAREWare
11%
Title X
PCMH
21%
Other Fed & State
Organizational
28%
Medicaid
Quality & Performance
40%
Funders
Reported Revenue Sources 2012
FPAR
Immunizations, cancer
registry, chronic
disease registries,
notifiable diseases,
syndromic surveillence,
Public Health reporting
+ Difficult to finding meaning across siloes and
reporting hierarchies
Community
Quality
Practice
Provider
Patient
32
HIV
Family Planning
Primary Care
32
+
33
Draft Performance Measures
Measure
Source
Aligns
with
Proportion of sites that dispense or provide on-site a full range of
contraceptive methods
AGI clinic
survey,
PIMS
Clinic
survey,
HP2020
Proportion of female users at risk of unintended pregnancy who adopt or
continue use of the most effective or moderately effective FDAapproved method of contraception.
PIMS
NQF
proposal,
HP2020
Proportion of female users ≤ 24 years who were identified as sexually
active and who had at least one test for Chlamydia during the
measurement year
PART,
PIMS
HEDIS,
HP2020
Proportion of users ≥18 years of age who had their BMI documented
during the measurement year.
QFP
HEDIS,
HP2020
Proportion of users who were screened for hypertension during the
measurement year.
QFP
HP2020
Proportion of users who were screened for tobacco use during the
measurement year.
QFP
HP2020,
Meaningful
use
Proportion of users who stated clear childbearing intentions.
IOM,
PIMS
*TBD*
+ Proposed NQF Performance Measures
for Contraceptive Services
Proportion of female clients aged 15-44 years who received
contraceptive services in the past 12 months, that adopt or
continue use of FDA-approved methods of contraception
that are:
1.
Most effective
OR
2.
• male or female sterilization
• implants
• intrauterine devices (IUDs)
moderately effective
• injectables
• oral pills, patch, ring
• diaphragm
Long-acting reversible
methods of
contraception (LARC)
• implants
• intrauterine devices (IUDs)
34
+ Data System & Feasibility Study
Expert
Working
Group
Proposal for
New Data
Elements
Survey
Possible
Participants
Evaluate for
final selection
-
Updated
Proposal
9 Grantees
N clients
N sub sites
Current data systems
Location
Interest & capacity
Survey ? sites
Rate each data element:
- Clarity
- Ability to collect
- Modifications needed
to systems
- Report @ encounterlevel
- Compare proposal to
current system
- Estimate burden to
change
- Qualitative interview
about processes and
data systems
Customization
Guide
+ Subject Matter Stakeholders
Current national partners:
New national & international partners we’re reaching out to:
36
+
37
Beyond Title X


All interoperable solutions should be designed to have broad
applicability outside Title X providers

Primary Care, Health Centers, Health Departments

Emergency Departments

International settings
Common data elements and their definitions will satisfy
evidence-based performance measurements and other
benchmarks


Input is welcome on data elements, definitions, and quality metrics
HIT Infrastructure developments sponsored by OPA will pave
the way for other providers to adopt these tools in their own
systems
+ HIT Success Stories in Title X
HRSA BPHC Health Center Controlled Network (HCCN)
East Providence, RI
NCQA PCMH L3, HCCN, & Title X
EHR system: NextGen
NFPRHA Case Study of group EHR purchasing
Indiana Family Health Council
EHR system: iSalus
HHS ONC Case Study of EHR implementation
Portland, OR
FQHC & Title X
EHR system: Epic
38
Timeline for IHE Connectathon Ask
FPAR2.0@hhs.gov
Connectathon to
Certify FP Profile
Jan 26
2014 Apr
April
2014
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
2015
2015
Ask Vendors to Review FP Profile
June 2014
May 2014
Follow-up with Vendor contacts
August 2014
Vendors Comment on FP Profile
June 2014
July 2014
Ask Vendors to Connectathon
July 2014
September 2014
August 2014
Vendor Engagement
September 2014
October 2014
Vendor Development
January
2015
+ Vendor Outreach
Seeking
CDA
technical
input
Support
to develop
and test
40