Building Collaborations and Information-Sharing across Multiple

DomainsModerator: Paul Wormeli, Executive Director Emeritus, IJIS Institute; Board Member,

SOC Institute

Panelists:

• Timothy Jay Carney, PhD, MPH, MBA, Senior Director of Data Analytics and Public

Health Informatics, Association of State and Territorial Health Officials (ASTHO)

• Dan Chavez, Executive Director, San Diego Health Connect

• Mary Ann Dewan, PhD, Santa Clara County Office of Education, Superintendent of

Schools

• Mariann Yeager, MBA, CEO, The Sequoia Project

A Symposium in the NIC of Time: Advancing Information Sharing in California and Beyond

Timothy Jay Carney, PhD, MPH, MBA

Senior Director of Data Analytics and Public Health Informatics (DAHPI)

Association of State and Territorial Health Officials (ASTHO)

Building Collaborations and Information-Sharing Across Multiple Domains

A Symposium in the National Interoperability Collaborative

Advancing Information-Sharing in California and Beyond

March 26-27, 2018

ASTHO Today – 59 Members, 10 TimeZones

ASTHO Today – 20 Affiliates

The Chief Health Strategist and the 3 CPHS Pillars

Leadership - Policy and Advocacy - Capacity Building

Pro

gram

Str

ateg

y, M

em

ber

En

gage

men

t, p

ub

lic r

elat

ion

s, T

acti

cs, a

nd

To

ols

Clinical to Community Connections (CCC)

Data Analytics and Public Health Informatics (DAPHI)

Health Equity and Social Determinants of Health (HESDOH)

Promote through policy and practice strategic alliances of public health with health care payers and providers

Use technology and informatics to develop state capacity and leadership for integrated and informative systems technology solution that use health care, human services and public health data

Assure health equity through state health agency’s strategic partnerships with capacity to lead change and commit to promote health in all policies

ASTHO Data Analytics and Public Health Informatics (DAPHI) Team Promotes a Public Health Systems View to

Impact on Population Health Outcomes

Public Health Agencies and Practitioners

Community

Patients/Health

ConsumersResearchers

Health

Providers

Health Care Organizations

Views the State Health Official as

Chief Health Strategist

Current Representation on the IDPN

States/Territories with IDPN representation

Digital Bridge and Electronic Case Report (Formerly referred to as the Public Health Community Platform)

One National Effort in Interoperability that ASTHO Supports

• ASTHO provides oversight and governance through leadership of the Digital Bridge Strategy and Governance groups

• Serves on all workgroups and subcommittees (e.g., evaluation, implementation, legal, etc.)

• Conduct site visits

• March 27th sponsoring an eCR Learning Collaborative to assist in building capacity in the next wave of states and territories

• Development of a 30-page Guidebook for State Health Officers (SHOs) to assist them in establishing the business case for eCR in their state (due out for release to SHOs soon)

What is the Digital Bridge?

• A partnership of health care, health IT and public health organizations

• Goal is to ensure our nation’s health through a bidirectional information flow between health care and public health

• An incubator for growing projects that meet this vision

• A forum for sharing ideas and solutions

• Funded by the Robert Wood Johnson Foundation and the de Beaumont Foundation. Program management provided by Deloitte Consulting and the Public Health Informatics Institute.

• Initial focus: electronic case reporting (eCR)

Contact Information

Mary Ann Cooney, MPH, MSN Chief for the Center for Population Health Strategies (CPHS)

202 371-9090 x5411; mcooney@astho.org

Timothy Jay Carney, Senior Director for Data Analytics and Public Health Informatics (DAHPI)

(404-443-1129; tcarney@astho.org)

Thank You!

Building Collaborations and Information-Sharing Across Multiple Domains

A Symposium in the NIC of Time:

Advancing Information-Sharing in

California and BeyondDan Chavez

March 27, 2018

13

Six Domains

14

HIT

EMS

Public

Safety

Public

Education

Human &

Social

Services

Public

Health

Source: Camden Coalition

The Goal…

Hepatitis A Case Example

• Homeless, age 30

• 10 ED Visits (Mar–Aug)

• 1 Hospitalization

• 1 Hep A Vaccination

• Hx ETOH

March

April

May

June

August

ED Visit 3/31

July

ED Visit 4/3

ED Visit 5/6

ED Visit 5/19

ED Visit & Hospitalization 7/16

ED Visit 7/12

ED Visit 8/20

ED Visit 8/31

ED Visit 6/19

ED Visit 6/22

Hep A Diagnosis 7/16

Hep A Vaccination 6/7

Cellulitis & abscess of lung

Blisters on hand

Abdominal pain

Cough & brown phlegm

Vomiting

Convulsions

Rib pain

ETOH withdrawal

Weakness, cough, fever, chills

Onset of illness 6/16

ETOH withdrawal & Seizure

Nationwide Interoperability Efforts

Key:Network-to-NetworkPerson-centric network

Provider-centric network

Secure messagingnetwork/RLSConsumer-directed network

*Year of launch

** For purposes of this scan, HIMSS’s

Interop & HIE Committee usedEPICtorepresent one example of vendor-mediated

exchange.

eHealth ExchangeSequoia

2012*

Carequality

2014

Care Everywhere

(EPIC)**

2008

CommonWell Health Alliance

2013

NATE

2013

Surescripts

2008

Patient Center Data

Home™ (SHIEC)

2015

Community HIEs

2005

DirectTrust

2011

CARINAlliance

2016

MEMBER

Key Findings from Environmental Scan

Multi-pronged approach

to exchange

Limited measurement of

standards

implementation, adoption

and use

Provider centric

system of exchange

Semantic interoperability

a barrier to data

exchange

Inconsistent quality

lowers value proposition

No common solution on

patient matching

Six Domains Interoperability

19

HIT

EMS

Public

Safety

Public

Education

Human &

Social

Services

Public

Health

Patient identification

Data quality

Data provenance

PHI and PII

Public health to primary care

Proper presentation summary

Closed loop referral system

Notifications and alerts

Linking data together:

Coordinated Cross Sector Care Management - A Requirement

Connecting All for

Better Health & WellnessCOMMUNITY INFORMATION

EXCHANGE

@

Many New, Local

Programs Require

Case Management• Be There

• CACHI

• Whole Person Wellness

• Project One for All

• Data Driven Justice

Population Health is the Future of HIE

21

Patient Practice PublicPopulation

Informatics, standards, workforce, business drivers, governance

Source: AMIA, Fridsma

National Interoperability CollaborativeMarch 27, 2018

23

Establish & Maintain

Data Security

Data Privacy

Confidentiality

3 Levels of Protection

Technical

Legal

Governance

Trust

Building Institutional Trust

SCCOE DataZone Vision

Low-cost data warehousing

Dashboards for decision making

Secure partitions

Support LCAP goals

Aggregate multiple data sources (SIS, Assessments, HR,

Finance)

Improved data quality

26

How DataZone Works

SIS

Assessment

Finance

Other Data

Sources

Data

Warehouse

Analysis

and

Reporting

Tools

Reporting and Analysis

ServicesTurning data into useful

information

TrainingLearning how to use data to

make informed decisions.

State and Federal

ReportingMeeting reporting compliance

DisseminationSharing data with the

community (ie: report cards)

Schools Interoperability

Framework

US US DOEDOE’’s s Vision of Data Flow for a DVision of Data Flow for a D33M SystemM System

Data Sources

Students, Subgroups, Cohorts

Teacher

CELDT, SBAC

Formative AssessmentsStudent & Teacher Attendance

Discipline

Programs

Schools, Grade Levels

Years Teaching, Professional Development

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

Courses, Grades, GPA

Data for Instructional Coherence

SCCOE DataZone and Foster Vision

FosterVision

District DataDistrict Data

District Data

Other Agency Data

Social Services

Juvenile Probation

FosterVision

DataZone and FosterVisionAnalytics to produce timely and relevant information

Data Visualization to synthesize data across multiple

sources, make actionable connections and identify

solutions.

Build Partnerships among researchers, community and

family members working directly with children and families.

Continuous Development to integrate new policies,

practices, training, tools, data elements and better

methods.

• Data Governance

– Policies

– Legal requirements supporting policy,

trust and ethics explored and defined

• Technology

– Secure information sharing architecture

designed prototyped and deployed

• Engagement Readiness

– Data Governance, Legal agreements

• Policy, Practice, and Training

– Who has access?

– Data Cleaning

– Being able to ‘see’ the data

Improving Outcomes

• Changing the Conversation

– Early Warning Systems

– Chronic Absenteeism

– Social and Emotional

• School Linked Services

• Early Learning

• Joint Foster Youth Task Force

34

35

Building Collaborations and Information Sharing Across Multiple Domains

NIC SymposiumTuesday, March 27, 2018

36 2017© The Sequoia Project. All rights reserved.

Mariann Yeager, CEOO: 571-327-3640Myeager “at” sequoiaproject.orgwww.sequoiaproject.org

The Sequoia Project is a trusted, independent convener of industry and government

Supports multiple independent initiatives, each with their own mission, governance, membership and structure.

37

The Sequoia Project’s Role

NATIONWIDESECURE INTEROPERABLE

2017© The Sequoia Project. All rights reserved.

Our Initiatives Support Information Exchange in these Sectors

Supported Today

• Health Information Technology

– Treatment and care coordination

– Disability determination (Human services?)

– Quality measures reporting

– Alternative care models

• Public Safety / Public Health

– PULSE - http://www.ca-hie.org/initiatives/pulse/

Under Evaluation for Future

• Emergency Medical Services

– Ties to mainstream treatment use case

• Human and Social Services

– 2-1-1 Programs

• Other Public Health

– Previously supported (CDC pilot)

– Electronic Case Reporting

38 2017 ©Copyright The Sequoia Project. All rights reserved.

A Nationwide Public-Private Health Data Network

39

eHealth Exchange connects:

All 50 States

Four Federal Agencies(DoD, VA, CMS, SSA)

75% of U.S. Hospitals

70,000Medical Groups

3,400+ Dialysis Centers

8,300Pharmacies

Supporting more than 120 million patients

59 Regional and State HIEs

2017© The Sequoia Project. All rights reserved.

An initiative of40

Interoperability Framework and Rules of the Road Interconnect Networks (Examples below)

FutureHIEs Vendor

Networks

Service Providers

An initiative of

Accelerating Health Data Sharing in AmericaConnectivity as of Jan. 31

2018 © The Sequoia Project. All rights reserved.41

600K+ Providers

1,250+ Hospitals

34,700+ Clinics

2M+ Clinical Documents Exchanged Monthly

Lessons Learned

42

Collaboration is Needed to Build Trust and Make Progress Toward Common Goal

• Common mission

• Executive leadership and engagement

• Cooperative process

• Narrow focus on what to implement first

• Specific deliverables and milestones

• Firm commitments to implement within specified timeframes

• Progress measured in operational outcomes

43 2017 ©Copyright The Sequoia Project. All rights reserved.

Accountability Key to Success

18 2017© The Sequoia Project. All rights reserved.

Clear allocation of liability

risk among participants

Common agreement to

establish expectations,

with mandatory flow

down provisions

Active governance by

committee with dispute

resolution

Lessons Learned in Supporting National-Level Public-Private Collaboration

• Governance should be inclusive but still be operationally nimble

• Stakeholders will engage and commit if it results in real-world implementation

• There can be significant shared savings with public utility objective

• Business case is often still needed to drive adoption and utilization

• There are proven policies which have not substantively changed in 10 years

• Multi-purpose approaches maximize value in investment and simplify the addition of new use cases

20 2017© The Sequoia Project. All rights reserved.