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November 2, 2010 CBCC Conference Call

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Community-Based Collaborative Care Working Group Meeting

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Attendees

Agenda

  1. (05 min) Roll call, approve minutes October 26th, call for additional agenda items & accept agenda
  2. (55 min) Continue new project proposal discussion - Semantic Health Information Performance Standards, revised draft 11/1/2010

Minutes

1. Action Items

Serafina:

  1. Follow up with Freida Hall for information related to a new project that will be headed by the National Quality Forum (NQF) related to the ability to automate some of the quality measures to address Meaningful Use 2013 & 2015 goals based on standard terminologies. Once the project scope statement has been drafted, Serafina will being the project information back to this work group
  2. Forward a link to the announcement of plans to build a national database of health care claims data covering tens of millions of individuals covered, or soon to be covered, under three government health plans

Ioana and Serafina:

  1. Ioana and Serafina to create a draft project scope statement based on these discussions (past, present and future) and will present it for the work group's review at a meeting in the future

2. Resolution

Continue to meet over the next week or two to focus on developing a new project scope statement based on these work group conversations and the Semantic Health Information Performance Standards outline.

  • In the next few weeks, a draft project scope statement will be presented for group evaluation and approval.

3. Updates/Discussion

Semantic Health Information Performance Standards

Today’s meeting was a continuation of the discussion that started last week to explore a new CBCC project that would expand on the domain analysis model for Security & Privacy and potentially tie into the ontology for Security and Privacy.

  • Richard revised the document used to guide today’s discussion. The outline was sent out to the Security and CBCC lists prior to today’s meeting.
  • The premise: the Security & Privacy DAM already describes the information that would be required to share lots of clinical information across organizations and in service of quality improvement and outcomes measurement.
    • Looking to shift focus (for the CBCC WG) from security & privacy issues specifically, toward consideration of the community policy/ government policies that are part of health care reform (in the US, but this could be extended to apply universally as well).
  • The overall proposal is to look at quality improvement methodology as a useful context in which to discuss the information content of PHR, EHR or HIE data.
    • To support this effort, we would develop a new DAM(s) that analyzes policy options that are important for saving money, improving quality and restructuring the system to support Pay for Performance (P4P).
      • The idea: to define the terms that would be necessary for consumers to express their privacy preferences (to allow the information necessary to support quality improvement measures) so that there is congruence with what is said in an organization’s privacy policies.
      • A primary purpose is to define the reasons that might be persuasive for consumers to share their health information.
  • Ioana: Are you looking at new ways in which we could specify the usefulness of the information exchange in addition to the obvious applicability to quality measures?
  • Richard: Yes, it is important for me to know that I am sharing my information for a specific purpose. The idea is to put some context around the reasons for sharing information, so that consumers are not putting themselves at risk for sharing, but also that they are informed of the potential payoff for sharing. The personal payoff may be pretty small, but the greater good may be achieved through sharing. I think it is critical for consumers to understand the larger community goal(s) for sharing their health information.
  • Ioana: In the Health Care Devices WG, we’re creating detailed clinical models (DCM) which is a domain analysis model with an emphasis on standards based terminology.
    • It’s basically a DAM with an underlying ontology, all related to a set of standard codes. Perhaps this is an approach that we can discuss in a future meeting.
    • Another project that is going to get underway at HL7 is with the National Quality Forum (NQF). Floyd Eisenberg is heading a project to come up with standard value sets for quality measures. But those value sets on their own, without an underlying ontology, could be much more useful if they fit into an ontology in order to automate reasoning, instead of being standalone value sets.
    • Action Item: Serafina to follow up with Freida Hall who is helping to formulate that HL7 project scope statement and will being information back to the group about this project.
  • Ioana: I think we need to continue to elaborate on the privacy terminology (from the DAMs) to gain a stronger handle on the reasons for disclosure and the exchange of health information.
  • Serafina: The HIPAA Privacy rule states that health information can be exchange between covered entities for the purpose of treatment, payment and operations. So consent isn’t necessary to share under these circumstances and these are the primary reasons health information is being exchanged.
    • Walter Suarez pointed out that some states have more stringent protection than federal HIPAA protection provides, so that some states may require consent, even for treatment, payment or operations. HIPAA does not preempt state law.
    • Ioana: I think this is one of the criteria that Richard identified – defining what is important from a community-based perspective. This community-based perspective is the jurisdictional level that allows privacy rules to be further constrained.
  • Serafina: I mention this because there was a recent announcement that the federal government is going to establish a national claims database to collect claims data for individuals covered under the existing Federal Employee Health Benefit Program and two programs created under the health reform law.
    • These two programs, the National Pre-Existing Condition Insurance Program and the Multi-State Option Plan will provide a range of coverage nationwide.
    • Action Item: Serafina to forward the link to this announcement to the CBCC list
  • Walter: Part of the question is whether the data being reported for quality purposes is aggregated data that reflects the quality performance of a particular setting rather than raw data at the patient level that then can be used by government agencies to run their own analysis. The MU quality metrics are only numerator and denominator data. They’re not raw data. On the other hand, this announcement is referring to a large scale data base containing raw claims data.
    • Ioana: Quality measures use aggregated data, not identifiable data, and is generally not subject to consent. What Richard is envisioning is a situation like state-specific jurisdictional requirements where the rules are more restrictive, as well as having the ability to relate rules to real data sets and to be able to express rules using standards-based value sets.
      • We could beef up the analysis we’ve already done for Security & Privacy, to add real-world, standards-based value sets. We could these to the DAM as well as to the CDA IG for Consent Directives.
      • It would be advantageous to work with the NQF project as we do this so when referring to data used for quality measures. Where there is an intersection between the data used for quality measures analysis and protected data, that’s the sweet spot.

The discussion took a turn that has the potential to re-focus our efforts

  • Walter: When I first read the SHIPS profile, I thought this was referring to segmentation of information (“data segmentation”). In other words, identifying categories of information that constitute sensitive health information and creating some mechanism to allow those segmented data to be sequestered.
  • Ioana: The term “data segmentation” does not have a clear definition of what it means.
    • What it really means is having data with clearly defined semantics and you can apply automatic rules to segment it into protected versus non-protected information based on certain policies.
    • If we can add an objective to the project to create some clarity around what is meant by segmented data, and define the properties required for a certain data element to be “segmentable”, then those properties could be allocated to specific types of data, whether or not it’s protected data.
    • We have this already in the DAM to some degree, but we’re not using the term “segmentation” and we’re not providing guidance to someone who wants to have segmented data.
  • Walter: Guidance for this would be very timely because in a few weeks, NCVHS is going to release a letter with recommendations on this topic – data segmentation and sequestration – to the Secretary of HHS. There have been months of debate and discussion within this group about these concepts. There have even been recommendations about specific categorization of data within the context of certain types of data following federal and state law. That kind of policy-level background would be very useful to this endeavor.
  • Ioana: What is needed is the connection between the technical properties of a data element and whether the data is sufficiently described to support the policies. What are the preconditions have to be met to require sequestration?
  • Walter: We’ve also defined both terms (data segmentation and data sequestration).
  • Ioana: Could you provide us with these definitions?
  • Walter: The letter is currently sequestered (laughs) but was approved today. I will check to see whether I can share the definitions of these terms with the group.
  • Ioana: Do you think there would be value in tying those definitions to the standards that we’ve already developed?
  • Walter: Absolutely. Consistent use of these terms, not only at the policy level and across groups, but at the technical level as well will be quite valuable.
  • Suzanne: Sounds like we’re forming a project proposal? Is there someone who will put together a new/different project proposal, and is this part of the outline for Semantic Health Information Performance Standards?
    • Ioana: I think the next step is to take all the discussion points and condense them into a specific project proposal – I agree.
  • Richard: What I am trying to do with the DAMs and an ontology, is to help to frame the policy level/personal level decision making issues when they are being discussed and to clarify them, so that there is a trust building, communications-building exercise. So that it is possible to create a “report card” of what is actually in “my” record, or what kind of information on me does the HIE have (if they store anything). So you could have an evaluation schema, based on a standard definition of terms, to say what kind of semantically useful information is in some system.
    • And I would like to marry this to something that John Ritter is talking about for the PHR functional model – that it is not only intended to define the functionality of the PHR, but what is the value of the information, what does this information facilitate or what goals does the information support. To be able to assess the value of information in an EHR or PHR, you’d have to be able to say there are certain qualities of these data. If the data has these qualities, then the information is useful; if the data doesn’t have these qualities, then it isn’t useful.
    • My vision of this project is to start with policy options and move toward an assessment process, so that we’re not just talking about performing certain functions (as in the case of the EHR-S FM), but how well does the EHR-S perform that function (e.g., by producing data that supports quality measures)? What is the value of information to be used to improve quality or control costs? “We’re swimming in data and starving for information”.
    • We also need to expand the type of data being collected. We’re not just talking about what goes on in direct patient care. We need to better understand what is happening in the community and to be able to connect that information to what is happening in people’s lives (their health information). We can’t get far in defining preventive measures without this. Perhaps there is some role here for HL7?
    • The idea is if we can measure things like how my kids do in school, my encounters with the criminal justice system, with social services, all the things that state safety net agencies collect information on people electronically, we may be able to for the first time, especially in the area of Behavioral Health and perhaps in other clinical areas as well, assess the relative productivity of different providers. We can’t do that now.
    • Richard is particularly interested to know whether there are any people in this work group with a knowledgeable perspective about quality improvement. (there was no response from anyone on today's call).
  • Suzanne: So we’re looking for CBCC to continue hosting these discussions, and for someone to put together a scope statement for a new project, is that right?
    • I’m wondering whether the work that Security group is doing with the ontology and the harmonization effort Mike is talking about that will be used to continue work on the Composite Security & Privacy DAM could contribute toward this new effort?
  • Serafina: There may also be an opportunity to collaborate on the NQF project mentioned earlier.
  • Action Item: Ioana and Serafina to create a draft project scope statement based on these discussions (past, present and future) and will present it for the work group's review at a meeting in the future.

There was a motion to adjourn the meeting by Serafina at 3:00 PM EDT, seconded by Suzanne


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