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Similaire à MeHI Mass HIway Consent: Operationalizing Opt-in Webinar Sept 2014
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MeHI Mass HIway Consent: Operationalizing Opt-in Webinar Sept 2014
- 1. Mass HIway Consent: Operationalizing Opt-in September 11, 2014
- 2. MeHI is the designated state agency for: Coordinating health care innovation, technology and competitiveness Accelerating the adoption of health information technologies Promoting health IT to improve the safety, quality and efficiency of health care in Massachusetts Advancing the dissemination of electronic health records systems in all health care provider settings Massachusetts eHealth Institute MBI MASSACHUSETTS BROADBAND INSTITUTE MeHI is a division of the Massachusetts Technology Collaborative, a public economic development agency 2 Massachusetts eHealth Institute • Tech Hub Collaborative • Big Data Consortium • Advanced Manufacturing Collaborative • Innovation Index • Mass Broadband 123 • MassVetsAdvisor • Health IT Adoption & Use • Connected Communities • eHealth Services & Support • eHealth Innovation • eHealth Learning Center THE INNOVATION INSTITUTE at the MassTech Collaborative MeHI MASSACHUSETTS eHEALTH INSTITUTE
- 3. Learning objectives 1. Describe the Massachusetts HIE opt in legislative mandate 2. Locate and share community-developed Mass HIway consent resources 3. Describe the different approaches organizations are taking to meet the opt in mandate 4. Recognize the various technical, policy and procedural elements to consent 3 Massachusetts eHealth Institute
- 4. Agenda 1. Overview of the Massachusetts HIE opt in legislative mandate 2. Review community-developed Mass HIway consent resources 3. Organizational approaches to meeting the opt in mandate – Partners Healthcare / Mass General Hospital – Christine Griffin – Beth Israel Deaconess Medical Center – John Halamka 4. Questions 4 Massachusetts eHealth Institute
- 5. Meet the speakers Massachusetts eHealth Institute 5 Sean Kennedy, MPH, MS, PMP Health Information Exchange Director Massachusetts eHealth Institute at the Massachusetts Technology Collaborative Amy Caron, MPH Project Manager for Mass HIway Communications, Outreach, Education Executive Office of Health and Human Services Christine Griffin Health Information Services Manager Massachusetts General Hospital, Health Information Services John Halamka, MD, MS CIO Beth Israel Deaconess Medical Center
- 6. The Massachusetts Health Information Highway Operationalizing ‘Opt In’ September 11, 2014 www.masshiway.net
- 7. What is the Mass HIway? Mass HIway: Secure, statewide health information exchange (HIE) network operated by the Massachusetts’ Executive Office of Health and Human Services. Mass HIway does NOT store clinical information or medical records (not a ‘hub and spoke’ model HIE). Goals: Improve and enhance information sharing and communication among cross institutional care teams in a secure and efficient way to: • Improve care coordination/transitions • Avoid readmission and medical errors • Reduce costs/duplication • Improve patient outcomes/satisfaction Services: 1) Direct Messaging enables secure “push” of health information. 2)Query & Retrieve adds functionality to allow query, location, requests and receipt (“pull”) of health information.
- 8. Why Opt In? Opt Out: All or some pre-defined set of data are qualified to be included and available for e-exchange. Patients need to take action to opt out. Opt In: No patient data are made available for e-exchange until patients express that they allow their providers to use the HIE to send/receive health information. •Builds patient trust and buy in to improve participation. •Patient- centric and sensitive to privacy concerns. •Increases patient engagement.
- 9. What are the consent policies? • Consent is only applicable for use of the Mass HIway to exchange information as allowed by law. Must follow existing laws for sending sensitive information. • Consent for Direct Messaging must mention that the Mass HIway is being used as a mode of exchange. • Must obtain new consent if implementing Query & Retrieve because more information must be provided about the functionality requirements. • Participants may get consent for all services at one time if all contract obligations are followed. • Consent must be documented and auditable. • Process must be in place for patients to change their consent preferences and for Mass HIway to be notified. • Process must be in place for patients to request and receive an audit log of Mass HIway transactions from the Participant. • Consent time limits are up to Participants; must follow consent policies for emancipated minors and minors turning 18 years old. • Does NOT apply to mandatory DPH reporting or BAs.
- 10. Consent Publish Query & Retrieve Consent preference sent to Mass HIway in ADT Message using Direct Protocol. If “Yes”, demographic data is pulled and stored in Master Patient Index (part of the RLS). If “No”, it’s discarded. Patient relationship to Participant published to Relationship Listing Service (RLS). Made viewable by search to other authorized users on the Mass HIway. Participant uses the RLS to search for where other records are held and are available, based on consent. Can request health information through Clinical Portal. Recipient can reply over Mass HIway. Reply sent to requestor directly, not viewable or stored by Mass HIway. Why is consent different for Q&R?
- 11. Tell me how its done… • Mass HIway does not prescribe or require any particular process. Allows for flexibility from small to large practices. • Mass HIway, Advisory Groups, P&S officers, Participants, health literacy experts convened to develop a community approved approach to opt in that includes: 1. Using simple consent language that can be incorporated into existing consent forms or used as a stand alone form. 2. Giving the patient educational material to review before making their choice. 3. Training frontline staff on Mass HIway and consent so they can have a dialogue with patients. More details and links to resources can be found at: http://www.masshiway.net/resources/masshiwayconsent.jsp
- 14. Final thoughts… When planning consent for Mass HIway: • Changing your process and forms, and educating your staff can take time, so start early and engage all teams. • Think about your patient population and any specific needs, such as translations for educational material. • If implementing Query & Retrieve, engage your vendor early. Your system needs to be able to generate HL7s with a “Yes” consent flag to populate the RLS. • If considering getting consent for Direct Messaging only, that’s ok- just remember the process needs to be auditable and new consent will need to be obtained if you get Q&R services. • Remember, your staff should be able to discuss the Mass HIway with your patients and Participants should have an internal escalation path.
- 15. Christine Griffin September 11, 2014
- 16. Design and implement an enterprise on-line patient HIway consent model Collect patient consent one time Consistently apply patient choice throughout Partners Healthcare (including our EHR affiliates) Meet Meaningful Use Stage 2 measures related to HIE
- 17. …but how?
- 18. HIPAA Privacy Notice & Patient Acknowledgement Form ◦ flag in local registration systems and Y/N stored at EMPI Patient Portal Release of Protected Health Information Form ◦ paper ◦ scanned
- 19. Build HIway consent into PHS e-Care registration system (deploying over next 3 yrs) Sync with registration workflow Use e-form/signature pads & update form status ◦ “Received” (populates when patient signs) ◦ “Patient Refused” (staff selects if patient opts-out) ◦ “Unable to Obtain” (staff selects if applicable (e.g.: patient undecided)) Sites not on e-Care are building or using existing flags in their local registration systems e-Care and local systems interface with PHS EMPI EMPI populates future encounter visits MGH went live with e-Care registration system in July
- 20. Use patient portal to collect consent Show EMPI consent status in the EHR for clinicians to use Flip Consent flag in the EHR ◦ allows a variety of workflows for obtaining consent ◦ medical assistants, nurses and other staff may obtain consent beyond the front desk
- 27. • BICS will query EMPI at registration to determine if a consent already exists • Consent is captured in BICS and transmitted to EMPI EMPI (Future) potentially other sites Consent Data Consent Data • Consent is captured in Epic and transmitted to EMPI • Single consent for all sites. • Applies to all service areas in Epic. July 2014 BICS (Future) Epic to accept consent data from EMPI
- 28. HIway Consent Implementation Workgroup ◦ Met weekly since 2/12/14 to drive consent solution ◦ Health Information Services ◦ Information Systems ◦ Patient Access - Registration Areas ◦ PeCare ◦ Providers ◦ Legal Endorsed and supported by senior leadership via HIE Steering Committee
- 29. Establish governance and structure to effectively “operationalize” HIE Transition Consent Implementation workgroup into HIE Operating Committee ◦ set goals and objectives for 2014/2015 ◦ align with other existing committees’ efforts to accomplish MU/HIE goals, create efficiency and value ◦ determine required membership to get started
- 30. Dr. John Halamka Beth Israel Deaconess Medical Center
- 31. Existing processes • General Consent form • Medical Records release • Example from the Social Security Administration
- 32. The “push” use case • Automating existing processes • Organized Health Care Arrangement issues, affiliates, and third parties • HIPAA Considerations
- 33. The “pull” use case • Meeting the needs of many stakeholders • Putting the patients first • Passing the Boston Globe Test • The final solution • Withdrawing consent
- 35. Discussion & Questions Massachusetts eHealth Institute 35 Sean Kennedy, MPH, MS, PMP Health Information Exchange Director Massachusetts eHealth Institute Amy Caron, MPH Project Manager for Mass HIway Communications, Outreach, Education Executive Office of Health and Human Services Christine Griffin Health Information Services Manager Massachusetts General Hospital, Health Information Services John Halamka, MD, MS CIO Beth Israel Deaconess Medical Center kennedy@masstech.org amy.caron@state.ma.us cgriffin7@partners.org jhalamka@bidmc.harvard.edu http://geekdoctor.blogspot.com
- 36. NEXT WEBINAR! Effective and Proper Use of the Mass HIway Directory Thursday, October 9 at 12:00pm-1:00pm The state's health information exchange network, the Mass HIway, is a secure way for health information to be shared among providers and organizations. The Mass HIway Directory, also referred to as the Provider Directory (PD), is a listing of authorized users of the Mass HIway that can actively send and/or receive information over the network. This session will include an overview of the Directory's components, best practices on listing your organization within the Directory, the proper usage of the Directory, and how to help ensure effective transmission of health information and communication with other Mass HIway participants. 36 Register at http://mehi.masstech.org/calendar/event/2896
- 37. 617-371-3999 ehealth@masstech.org @MassEHealth www.mehi.masstech.org
Notes de l'éditeur
- Query & Retrieve functionality is new and requires that: The health care organization using the Mass HIway (Participant) send demographic data (name, DOB, gender, address, email, phone, medical record number) about the patient to the Mass HIway (State) Demographic data is stored by the Mass HIway (State) and made searchable by other authorized users. A patient’s “Relationship” to that health care organization (the patient has received care there) is published and viewable by (disclosed to) other authorized users (Relationship Listing Service or RLS). Patients also need to know that: Data is secure in transport and the Mass HIway does not receive or store any health data. They can change their mind anytime and they have access rights.
- Stress- all the materials are flexible and you’re able to build upon them or adapt them to your population or needs.
- As I prepared to discuss our experience with implementing a HIway Consent process with you today, what I found most striking is how quickly we were able to implement the consent process despite the many complexities we grappled with during the process. I hope you’ll find our experience encouraging and I also hope that by sharing we can help others to chart their own course. I’m going to give you some history on how we got to where we are today, what we are doing currently, and where we hope to be in the near future. First, early this year, Deb Adair, who directs HI and privacy at MGH was asked to shepherd this project for Partners. Deb is the proof that you can do it, without ownership, strong leadership and the right team. One of the major drivers for the consent piece is, of course, Meaningful Use, stage 2. MU set a firm timeline for us. We needed a HIway opt-in process in place by October 1st. Oct 1st, we wanted to hit the ground running with sending SOC documents over the HIway for as many patient discharges as possible.
- With those goals in mind, we had to take an organizational approach to both maximize our opportunities to obtain patient consent and also to pool all the opt-ins so patients would not have to be asked at every appointment at every office. We also had to create a process – that would in sync -- with the fact Partners isideploying a single system-wide integrated electronic medical health record and administrative system over the next several years. With that in mind, we needed a way to collect consent one time; store it electronically, and consistently apply it.
- Believe or not, looking at existing processes was helpful. Currently, we have to give each patient a privacy notice at their first visit, collect a signed receipt and track it. Patient has to sign once, signing flips the PN flag to yes, it goes to the PHS EMPI, it populates future visits , and you don’t have to ask again. The PN is given out in all areas where patients check in for an appt or hospitalization, in pat and out pat. We also have a patient portal which serves as an efficient way to share information with the patient. But no everyone using it. Don’t want to miss certain populations.
- Decision made to build a consent process workflow that mirrors the PN. A PHS Consent workgroup began meeting in Feb. I was assigned as the consent implementation project manager April. A consent form was created /vetted/ approved. Sites on epic had a flag to use. Only 1. The form was built it Epic. The form is listed in Documents Table along with the PN and a consent to treat. Staff checks the table to see which documents a patient needs to sign. If patient has opted in or out yet, they give educational materials to read and asked if they want to opt-in. e=signing updates the status. Unable to obtain – always an option. EMPI source of truth. --- consent checked at the EMPI as part of the auto-transition of care process, we are creating.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- Staff trainings. We created a HIway toolkit: sort of a press kit for staff checking in patients to use. Business card – to introduce HIway to patient and has PO # to call with any questions. We created a short patient handout on the benefits of opting in. We use the Mass HIway Fact Sheet for Patients. We also created a Spanish translation. The consent form We have instructions on what to do Epic doc table Screenshot Script patient Q&A Powerpoint about the HIway and MGH A document that shows what’s on a Summary of Care document – to what we will be sending over the hiway Site HIS directors, managers and admitting/registrations directors working together to train staff and implement the consent form. We shared all documents. We printed, delivered 500 + toolkits and also posted them for DIY printing. We probably covered about 100 areas with toolkit trainings. At MGH, since went live with Epic in July, we implemented in inpatient and outpatient areas. Some sites, only doing inpatient.
- If patient opts-in, the EMPI will send message to the automated TOC to send a CCDA to a provider if a) he is listed as a HIway participant and b) if patient has signed or opted-in. If not, this would stop the automated TOC from sending the CCDA
- Lot of committees, PHS & site level, swirling around – with MU objectives. And lots of questions– physician education, patient education.