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Pennsylvania Ramping Up Connections to Public Health Gateway

April 11, 2018
by David Raths
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Regional HIOs begin to collect, send data through gateway to multiple registries
The Commonwealth of Pennsylvania is ramping up a Public Health Gateway (PHG) that was created as a single point of entry for healthcare information organizations (HIOs) submitting data for provider organizations to dozens of applications in the Department of Health and Department of Human Services. The transition has been slow and difficult, but providers are starting to sign up and see benefits. 
 
A panel of executives from the Keystone State spoke about the creation of the PHG at the 9th Annual State Healthcare IT Connect Summit in Baltimore last week. Pat Keating, CIO of the Department of Health, said that several years ago his department did an analysis and realized it had 100 applications collecting data. “We could see how one point of entry would make it easier for end users to submit data. As we recognized that, we also realized we didn’t have the infrastructure or talent to do it. It was a good idea, but not something we could do initially.”
 
But the advent of health information exchange and the Affordable Care Act brought the idea back to the table. “We decided to get rid of point-to-point connections and have a central hub, which then sends data on to agencies.” Providers send data to their regional HIO, which sends it on to the Public Health Gateway. From there it goes on to the registries in Health or Human Services. Applications include the immunization registry, cancer registry, syndromic surveillance and electronic lab reporting. (The Commonwealth also will add the prescription drug monitoring program (PDMP) to the gateway. In addition to four existing HIOs, two more are in the process of connecting.
 
“What we are trying to do is standardize onboarding providers for data collection, instead of having so many applications that are point to point with different points of contact,” Keating said. “We believe that by streamlining that process, it will help us to get more consistent data.”
 
Many states have one agency for both health and human services, Keating noted. “Having them separate makes it somewhat challenging. We are a midsize agency. Human Services is gigantic,” he said. “They receive more money from the federal government than we do. We were able to leverage their infrastructure and expertise for the Public Health Gateway.” 
 
One of the promising uses of the PGH is for submitting electronic clinical quality measures for Medicaid managed care organizations. David Kelley, chief medical officer of the Pennsylvania Medicaid program, said his organization is moving away from manual chart reviews to more effectively gather eCQMs. 
 
 “From our standpoint it is an opportunity to get out of chart review and sharing of electronic eCQMs,” Kelley said. “Not only can these be used for quality improvement and NCQA reporting, they allow us and managed care organizations to see what is happening with patients in terms of diabetes or blood pressure control in a timely manner. It is vitally important that we are moving away from paper.”
 
The Commonwealth took advantage of CMS 90/10 funding to create incentives for HIOs to create connections and lower barriers for individual member organizations to connect to registries, said Martin Ciccocioppo, director of the Pennsylvania eHealth Partnership. In 2017, it successfully got several organizations connected to the electronic lab reporting registry. But getting providers connected didn’t go as quickly as the Commonwealth and HIOs wanted, he admitted. “We have not been able to respond to demand as effectively as we wanted,” he added. “We wanted to have more connections up and offer more grants. There was a little frustration on the part of HIOs. We have been talking about this for four to five years, with the promise of a single point of connection.
 
Part of the pace of adoption problem was a capacity issue on the registry owners’ side. “They can’t handle as much onboarding as the member organizations would like. We had to limit awards based on capacity issues,” Ciccocioppo said. “But at this point we have reached a tipping point where we have successful connections, and are expanding the number.”
 
Ciccocioppo was asked about governance of the PHG. He said getting Commonwealth agencies to work together on sharing heath data has been a challenge for years. He recalled several years ago attending a monthly meeting of stakeholders on interoperability hosted by the Pennsylvania Medical Society.
 
“The thing that perplexed me was that for representatives from agencies and registries from the state, the only time they were meeting was during those meetings,” he said. “There were huge silos, and they didn’t talk even within the same agency. That monthly meeting was beneficial for them. Now we have an active governance structure involving key stakeholders from both agencies, both at the management and program level.”
 
Kelley gave examples of other programs that could take advantage of the gateway, including the Department of Aging, the Department of Military and Veteran Affairs, and the Department of Corrections. “An office in our agency is Children and Youth Services. We have programs pulling Medicaid data and manually pushing it out to 50 counties about children in foster care on antipsychotic drugs,” Kelley said. “We could automate accessing that data. We can be more efficient.”
 
 
 
 

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Tripathi will also discuss the future of data exchange, advancements of standards such as FHIR, the reality of information blocking challenges, and more in this latest Healthcare Informatics webinar, which gives a high-level view on the many market forces that impacting nationwide interoperability.

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Epic Lowers App Orchard Program Fees, Introduces New Low-Cost Tier

November 1, 2018
by Heather Landi, Associate Editor
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Verona, Wis.-based Epic plans to lower program fees for health IT developers participating in its App Orchard program, and will launch a new entry-level program tier, called Nursery.

Epic announced the App Orchard updates at its App Orchard conference last week at its Verona headquarters, according to reporting from Politico published Oct. 26.

In an email statement, Brett Gann, App Orchard director, confirmed the company is reducing and simplifying the costs associated with participating in the app developer program. The three tiers of the program will see program fee reductions ranging from 33 to 80 percent as part of the update, Gann said.

Epic launched its App Orchard in 2017 as an online marketplace for third-party developers with 13 applications.

To date, more than 350 companies in the healthcare industry participate in Epic’s app developer program, where they have access to hundreds of application programming interfaces (APIs), documentation, testing tools, individual technical support, training, conferences, and integration with the Epic community, Gann said,

Gann also said the program updates announced last week at the annual App Orchard Conference in Verona will “engage a broader community of developers and increase access to APIs through simplified and reduced costs.”

The updates will help drive healthcare innovation as interested developers have the opportunity to build on top of Epic’s health record platform, using emerging industry standards such as FHIR (Fast Healthcare Interoperability Resources), Gann said.

Epic also announced a new program tier, Nursery, that will enable early-stage startups to enroll in the app developer program to access Epic’s public API documentation, tutorials, and sandboxes. Early-stage startups also will have access to FHIR, SMART on FHIR, and CDS Hooks, Gann said.

Enrolling in the Nursery program tier will cost participants $100 per year, Gann said, and when a company is prepared to go to market with its product, it may graduate to one of the other three tiers.

Nursery members will have access to Epic’s FHIR sandboxes, classroom and online learning opportunities, and the ability to engage with the online community of Epic, health system, and vendor developers and experts.

In addition to the program fee reductions, as part of the update, Epic will offer new program benefits to participants in the other three tiers, such as additional training opportunities, developer events, support services, sandboxes, and program accounts.

Gann also said Epic has simplified the pricing model for API-based integrations, eliminating the minimum fees, and reducing the cap. “It’s our expectation these updates will be a price reduction for nearly all program members,” he said.

Some developers, particularly smaller developers, have complained in the past that the fees to participate in the vendor app store are too steep.

Earlier this year, Politico reported the experiences of Rick Freeman, CEO of Interopion. Freeman told Politico that a family planning questionnaire app he developed for HHS’s Office of Population Health could have cost him up to $750,000 to run on Epic or Cerner for a year.

As reported by Politico in its October 26 report, in response to the program updates, Freeman said he is “very happy with the changes.”

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Improving the Communication Infrastructure: Healthcare’s Next Big Wave?

October 31, 2018
by Rajiv Leventhal, Managing Editor
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CHIME’s latest report, which surveyed the association’s C-suite provider membership, looks at several trends and challenges in the health IT landscape today

With access to patient health information now commonplace among providers, the next core investment could be in communication channels with patients, according to CHIME’s 2018 HealthCare’s Most Wired survey.

The survey findings, released on October 31 at the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego, included more than 600 participants, and revealed an array of findings related to interoperability and integration, data security, value-based care and population health, and patient engagement.

This is the first year that CHIME conducted the Most Wired survey and the first year a trends report based on survey data has been made available for the industry, according to the associations’ officials.

Many organizations reported that they do have the capability to consume data from outside entities such as an external hospital system or a retail pharmacy, although less so with home health agencies, skilled nursing homes and chronic care facilities.

Meaningful use has helped drive the development and use of patient portals, and progressive providers have adopted several additional capabilities, according to the analysis. And, many patients have readily transitioned to mobile apps offered by most portals. Regulations on application programming interfaces (APIs) under Promoting Interoperability, the Centers for Medicare and Medicaid Services’ renaming for meaningful use, will expand engagement opportunities with patients but also pose security challenges for providers, according to officials who presented the findings at the CIO Forum.

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The report specifically noted, “As healthcare adopts and leverages new technologies, it is becoming increasingly complex to maintain an ecosystem in which data can be reliably shared. Poor communication between disparate systems can be one of the greatest impediments to clinicians being able to access the information necessary to provide effective patient care. Communication technologies, like remote access capabilities and emergency alerting, can improve the speed at which critical data is delivered to caregivers.”

Indeed, nearly all of the survey’s participating organizations reported that at least 95 percent of their clinicians regularly access clinical information electronically. This includes medical history, nurse notes, order sets, care plans, diagnostic study results, operative reports, medication reconciliation, discharge instructions, care plans, and clinical summaries. Similarly, almost all physicians can electronically access their organization’s EHR, CPOE, clinical guidelines, medical images, and evidence references while in the hospital or clinic.

However, only about half of physicians can access these same resources via mobile applications. Adoption of secure messaging also lags behind other remote-access functions; both represent opportunities for the industry to advance the current communication infrastructure, according to the analysis.

What’s more, over three-fourths of participating organizations send the following patient-monitoring data directly to the EHR: blood glucose, bedside blood pressure, bedside pulse oximetry, and EKG data. But there are still significant gaps in the integration between EHRs and patient-monitoring equipment—only 25 percent of participating organizations send data from their IV pumps directly to their EHR, and only 10 percent send data directly from in-bed scales. Furthermore, when tracking hospital-acquired infections, 59 percent integrate this data with their EHR, 33 percent store the data electronically, and 8 percent use manual processes.

Regarding security, few organizations (29 percent) have a comprehensive program in place, which CHIME outlines as doing all of the following: reporting security deficiencies and security progress to the board; having a dedicated CISO (chief information security officer) and cybersecurity committee; providing security updates to the board at least annually; and having a board-level committee that provides security oversight.

Indeed, having a dedicated CISO and regularly reporting security updates to an executive committee are some of the first steps to mitigating cybersecurity vulnerabilities. However, for most organizations, establishing these security foundations is still a work in progress, the report revealed.

When it comes to value-based care and population health, data aggregation is the first step toward effectively leveraging population health management technology, and while the industry has made progress, there is still room to improve data aggregation across the continuum of care, according to the report. About 57 percent of healthcare organizations are using clinical and billing data as well as an HIE to identify gaps in care. However, only one-quarter of organizations are using these tools and have the ability to access registry data at the point of care.

The analysis noted that care-management practices for areas outside of the inpatient setting are still maturing, especially for home management of chronic diseases. While most provider organizations’ population health strategies target diseases like COPD, congestive heart failure, diabetes, heart disease, and hypertension, few are tracking behavioral health, sickle cell anemia, or end-stage renal disease. Additionally, few organizations currently allow patients at home to do things like manually submit self-test results or report their medication management compliance via email.

The survey also asked participants about their patient engagement and telehealth capabilities. Within the hospital setting, adoption of patient engagement capabilities is shallow. Less than one-third of organizations support patient and family functions for ordering meals based on dietary restrictions, planning for discharge processes, controlling environments, reporting non-clinical problems, and accessing traditional whiteboard information. And roughly one-third support patient engagement–related staff functions for initiating patient pathways, while one-quarter have adopted real-time engagement.

Obstacles remain in order to truly engage patient communities, with one example being that price transparency is still emerging—only 27 percent of participating organizations provide the public with cost calculations for common procedures.

Virtual care is gaining traction, with over one-third of participating organizations offering virtual visits in a non-clinical setting. While this may seem low compared to adoption of other capabilities, it is actually high given that virtual care is still developing, and few patients have participated in it, according to the report’s analysts.

And while barriers such as reimbursement limitations and evolving regulations currently prevent healthcare organizations from harnessing the full potential of telehealth services, 89 percent of participating organizations offer some form of telehealth services. Most of these organizations are still early in their telehealth journey; few offer focused telehealth services such as eICU, rehabilitation, genetic counseling, or skilled nursing services.


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