Meeting Minutes Health Information Technology Workgroup 11/5/2015 | 10:30 - 12:00 p.m. MT | CDPHE Room A2A

Type of Meeting: Chairs:

Workgroup Meeting David Keller, Marc Lassaux

SIM Representative:

Jean Lamont, Program Manager

Note Taker:

Matthew Welchert

Members in Attendance:

Marc Lassaux, Wes Williams, Summar Laws, Kyle Knierim, Art Davidson, Jason Greer, Samantha Lippolis, Terry Mayer

Ex Officio:

Lynnette Hampton

Observers:

Ed Bostick, Bryan Standley, Cliff Croan

Discussion Topic 1: Welcome and Introductions 

Jean Lamont opened the meeting, facilitated introductions and began an introduction of the meeting’s agenda. Topic 2: Operations Plan 

The draft Operations Plan near complete and under internal preliminary review will go to CMMI for review on 12/1 at which point the SIM Office will get feedback to revise for the final Plan. o The Governor’s Office will review the draft of the plan in mid-November. o The HIT Workgroup had a lot of input and work into the HIT portion of the Operations Plan.  The All-Stars notion: Was not called for by CMMI, but is being included because of its essential nature to the current HIT plan. o The reporting tool for the year one cohort: a short term solution to assist the first practice cohort which comes online in February.  There currently are two vendors responding to the SIM Office’s RFI related to this work

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Meeting Minutes o The long term solution will be part of the upcoming RFP to be released in the first calendar quarter of the next year.  There are concerns regarding the technical infrastructure portion which needs to be ironed out.  There are four components which vendors may bid on in the RFP process. o Quality Measurements:  Reporting periods: Will be brought to the Steering Committee. They chose a time period that fits with the grant period, however, the high level designs for the quality measurement tool would be very difficult to alter the dates so we will have to inform them to use more standardized quarters.  Changes to Year 2 (first year of implementation) quality measures:  Lipid and Diabetes LDL were removed because they are no longer the standard reporting measure.  Tobacco was removed because it was seen to be covered by the Substance Use Disorder screening measure. o Kyle Knierim: No provider uses that screening measure to report on tobacco currently. If that is the only measure to report on tobacco than the first few reports will contain no data.  Many of the workgroup members felt the new quality measures breakdown is confusing and does not demonstrate clearly how and which measures practices will report on. o Risk Mitigation:  Master Patient Index development is the most serious risk identified.  HIT workgroup may form a subgroup to work on the issue. o It can be difficult to have a discussion of this subject considering that proprietary algorithms exist. However, it may be necessary to have those groups and individuals present to discuss the subject to benefit from their knowledge.  If there is a way to do so while avoiding conflicts of interest then the group should endeavor to do so.  Data Quality: Directly from the Workgroup’s feedback. The ability to come together and determine the minimum thresholds for data accuracy and efficiency  Loss of key personal: an unavoidable risk with such a project.

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Meeting Minutes Interdependency amongst the SIM workgroups. Need to understand the needs of other workgroups in order to ensure the work we are doing is applicable and meeting the needs of others.  Needs that have been identified have been entered into the HIT timeline of the plan.  Workgroup members acting as representatives at other workgroup meetings was an issue to be avoided as the complexity can be misrepresented or misinterpreted too easily.  Governance structure and processes have mitigated these issues. o Questions and Comments regarding the Operations Plan:  Jason Greer: Has the operations plan been sent to the workgroup?  No, not yet. The Plan is still in draft phase and is not ready for a larger public release. CMMI may require a number of significant changes or not so presenting the plan now would be premature.  The Final Operations Plan will be posted publicly on the SIM Website.  Jason: Is there a technical architecture diagram for us to see?  No, there isn’t a diagram yet but a narrative. The narrative could be shared with the workgroup.  Jason: Could you clarify the RFI and RFP process? Can we see the criteria they are responding too and can we see the SOW’s?  The RFI’s have come back, there are roughly 30 we are reviewing.  There is a statement of work that exists. We have pursued a vendor who has the necessary technical expertise who will work on the infraastrucutre design validation, but will not bid on the resulting RFP or infrastructure project.  The decision on vendors for the project will be a collaborative effort within the SIM Office.  Jason: MPI and PHI: Has there been a decision on a data warehouse to hold patient level data and the MPI needed for that data or is that a decision which could be brought to the workgroup?  The application in the SIM grant was written in manner that had assumptions about a high level infrastructure. To deviate from that, we need to provide significant reasons with evidence as to why we have chosen to do so. o The workgroup may provide such recommendations and reasoning to the SIM Office to consider and take forward to CMMI. 

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Meeting Minutes Art Davidson: First task, do we have an accurate MPI, either in the master infrastructure to be a SIM ID. A bridge to cross later. But likely an infrastructure discussion.  Jason: I am unclear as to whether an MPI is needed yet or not. A diagram of what we know or do not know may be helpful to clarify.  Use cases may help delineate where we are headed.  Kyle Knierim: Has it been decided that there will be clinical level data aggregated for SIM? –That is still up in the air. The constraints of the grant do mean we are moving toward a centralized data warehouse hub. o An independent data design will be required to ensure what is best for sustainability and where potential shortfalls exist.  Summar: Are other states dealing with this same question?  Yes, I have looked at Minnesota, Vermont, and Oregon. We are not here to work in a vacuum or do what other states have done without consideration for Colorado’s unique perspective. o The workgroup could determine the pros and cons of the differing approaches to the issue and provide those recommendations to SIM. A pros and cons meeting should be planned for down the road. 

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Item 3: Public Comment:  Bryan Standley of Creative Treatment Options: My office is moving from the outpatient into becoming more integrated. How can such a small set of clinics that are mainly outpatient contribute and be a part of SIM? o Our clinics have their own EHRs. The healthcare environment we work in is very siloed. SUD monitoring is clinically important for capturing outcomes. An MPI that would not include that element is a concern to me. Client participation as a data point might be helpful.  Cliff Croan? o A few macro level questions: a list of health info and a repository or warehouse would be a political issue in that I would not want my personal health information with the government.

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.

Meeting Minutes o I am also concerned about a confidential vendor as I think that is problematic.  In response: There is no contract with a confidential vendor, the SIM Office is merely in communication with the vendor about specifics of the RFI process. Should any official contract be entered into, the vendor would be public knowledge and any contract would follow the State’s procurement processes. 

Referrals to SIM Steering Committee: -The Quality Measures diagram is confusing, please clean up and provide more clarity -Potential to discuss the HIT technical infrastructure.

Action Items: Item Responsible Party Share the technical architecture Jean Lamont narrative with the workgroup Ask for a clarified version of the quality Jean Lamont measures.

Due Date 12/3/2015 12/2/2015

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.