September 29, 2011 Behavioral Health CCD Project Conference Call

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Financial Management Working Group Meeting

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Attendees

Agenda Topics

  1. (5 min) Roll Call, approve minutes (on next Financial Management WG conference call, 10/6), call for agenda items
  2. (15 min) Project updates
    • Behavioral Health CCD implementation guide (BH CCD) project to commence soon. The requirements analysis will be balloted in January. "HL7 Behavioral Health Domain Analysis Model, Messages, and CDA Profiles for Financial Management WG at Project Insight # 800 and TSC Tracker # 2045. Cosponsored by CBCC and SDWG, the Behavioral Health CCD project is intended to evaluate the currency and comprehensiveness of HL7 Behavioral Health and Social Service standards against emergent requirements in the US Realm."

Action Items

  1. Kathleen
    • Create the Behavioral Health CCD Project Resources wiki page containing links to applicable standards and implementation guides
    • Outreach with Madan:
      • Rick Howard, MITA Co-chair
      • Aaron Karjala, Deputy CIO, Oregon State Health Authority
    • Post minutes from the Financial Management Work Group San Diego meeting on the FM wiki page
  2. Ioana
    • Doodle poll for best weekly date/time
    • Draft outline for the Domain Analysis Model in the modeling tool (RSA 8.0)
  3. Nik Garifalos
    • Provide state contacts and/or additional state behavioral health core data sets information
  4. Madan (assisted by Erin)
    • Prepare high level project plan with milestones and target dates

Minutes

Housekeeping


  • Minutes from the September Working Group Meeting have been posted on the Financial Management. They will be approved during the next FM conference call on October 6th.
  • A new weekly call on Wednesday's at 1 PM Eastern was established to focus on the Behavioral Health project going forward.
  • The biweekly Financial Management work group call will continue every other Thursday as planned (next meeting: October 6th at 2 PM Eastern)

Overview of the Behavioral Health CCD project


Background:

  • This project stems from a need on the part of the Arizona Department of Health Services Division of Behavioral Health Services to capture patient demographic and assessment data from Behavioral Health providers in their community network.
    • The current approach is using a fixed-length file which is not easily extensible
      • When a new field is required, an existing field (of sufficient length) must be dropped to allow the new field to be added in its place. (The file has now been modified from its original state of around 168 fields to about 55)
    • The new approach proposes to use an HL7 structure. Originally planned to use Version 2, but further analysis based on the Arizona Dept of Health Services Behavioral Health Demographic and Outcome Data Set User Guide (DUG) revealed we could use the CCD and extend it based on the A_BillableSocialService_Universal (COCT_RM610000UV06) CMET (Common Message Element Types)from the 2011 Normative edition of Version 3.
      • The BillableSocialService CMET provides detailed information on social services, required to support billing information for an Invoice, Pre-Determination, Coverage Extension or Authorization. The CMET also supports the conveyance of the health, socio-economic, and functional assessment information about the client who is the subject of the social service to augment the clinical services information typically conveyed about a patient.
    • In addition to replacing the data capture approach, this project could help Behavioral Health providers who are otherwise eligible for the Meaningful Use program to exchange a relevant CCD and enable them to claim those dollars
  • This was recently approved as an HL7 project, and the next step is to gather and analyze the relevant behavioral health data sets and requirements, including code sets from the VA, DOD, SAMHSA and others, as well as any public health reporting requirements that have been included in Meaningful Use.

Scope and High-Level Timeline:

  • Domain Analysis Model (DAM) – for ballot in January 2012
  • Implementation Guide based on the DAM – constraining the CCD (with additional templates possibly) – for ballot in March (or May?) 2012

Next Steps :

  • Develop the high level project plan – milestones
  • Divide the work into chunks
  1. Map Arizona core data to CCD, focusing on C32 components (medications, problems, results, etc.) – taking into account that we will review the recent CDA Consolidation ballot for the latest pertinent information. Demonstrates early value in that it shows we can create a BH profile for Meaningful Use
    • Outreach to other community Behavioral Health providers to incorporate additional sets of requirements
    • Ensures that the requirements are comprehensive
      • Most states have a code data set based in part on SAMHSA reporting requirements
  2. Capture workflow as it impacts creation of data
    • Data captured in BH provider’s EHRs ends up in state and federal (e.g., SAMHSA) reports
  3. Review vocabulary requirements for Meaningful Use and map to the Behavioral Health data sets, looking for gaps
    • Where there are gaps, work with LOINC and IHTSDO (SNOMED-CT) to determine if new values need to be assigned
    • Create bindings to value sets
  4. Develop Implementation Guide

Discussion

  • Mapping to standard terminologies is quite a significant task. Madan has a couple of subject matter experts on the core data sets who can assist by helping to understand the core data sets:
    • Daniel Crow
    • Mike Sheldon
  • We first need to ensure that the CCD can support the conceptual message that you are trying to replace (legacy flat file); then once that is confirmed, can we put values from standardized terminologies to those data
  • Nik Garifalos (FEI) will provide contact information and/or core data sets from the 19 states that are supported by FEI.
    • The state core data sets overlap with the TEDS,NOMS and URS data set requirements)
  • Mary Kay suggested outreach for Medicaid requirements to Rick Howard, current MITA co-chair
    • Rick is a big supporter of build once, re-use
    • The challenge in getting Rick’s involvement is that MITA 3.0 is scheduled to start its implementation
      • They will be releasing a complete area at a time with a 30-day review period. First set to be released in October: Provider, Member
    • Contact Aaron Karjala, Deputy CIO, Oregon State Health Authority, as he has expressed interest in this area and the need to combine Behavioral Health data with their Medicaid data (where unlike Arizona, they can. AZ doesn’t have a data sharing agreement to do so)
    • Mary Kay suggested that we create a resource page to capture the high level next steps discussed during this meeting along with the various standards and documents that will be analyzed
  • Madan will assume lead project manager role
    • Erin Fitzsimmons will work with Madam offline to assist with some of the project management tasks

Meeting was adjourned at Noon Eastern


Next meeting scheduled for Wednesday, October 5, 1:00 PM Eastern

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