Collaborating With Your Health Plan 03/07/05

1
Collaborating With Your Health Plan 03/07/05
Health Information Technology

• To paraphrase A. Einstein We cannot solve
  todays problems with the same level of thinking
  that created them.

2
Overview

• Background for California Health Care Foundation
  California Clinical Data Project (CCDP)
• Drivers for CCDP
• The Solution
• The Benefits

3
CHCF CCDP Background

• CCDP Project Founded Spring 2004, a
  collaborative of California health organizations,
  including over 20 medical groups, health plans,
  labs, and hospitals.
• Sponsored by the California Health Care
  Foundation, with Project Driver Sophia Chang,
  MD, CHCF Director.

4
Stakeholder priorities
1. Create laboratory data standard
2. Resolve issues around existing pharmacy data
standard
3. Create and/or improve processes and procedures
for exchanging clinical data
4. Improve patient matching capabilities
5
Opportunity to improve lab data exchange and
integration
Objectives
Issues

• Consensus on standard format coding scheme

• Multiple data standards within and across labs,
  and multiple formats requested by POs and HPs

• Consensus on standard set of reports that may be
  requested from labs

• Require significant resources (time, ) to be
  expended by labs

• Consensus on rules for how data is exchanged
  (frequency, time lag, etc)

• Complicate receivers ability to integrate data

• Limit the amount of lab data that is exchanged

• Consensus on streamlined process for secure,
  electronic exchange of reports

• Cause erratic and/or lagged data transmission

• Endorsement of specifications for Lab Data
  Import Tool

6
Opportunity to improve pharmacy data exchange and
integration
Objectives
Issues

• Resolution of issues around how data is exchanged
  (frequency, time lag, etc)

• Major and minor variations from the existing
  pharmacy standard

• Are caused by confusion in meaning and
  optionality of certain data fields

• Agreement on single interpretation of existing
  pharmacy standard

• Complicate receivers ability to integrate data

• Consensus on streamlined process for secure,
  electronic exchange of reports

• Result in erratic and/or lagged data transmission

• Endorsement of specifications for Pharmacy Data
  Validation Tool

7
Opportunity to improve patient matching
capabilities
Objectives
Issues

• Address timing inconsistencies in eligibility
  data used by plans, provider organizations and
  labs for matching purposes

• Error rates in matching data that comes from
  various data sources range from 5-45 because

• Eligibility files used by plans, providers and
  labs are inconsistent

• Publish market report on available patient
  matching tools and promote their use

• Most integrators rely on basic, homegrown
  algorithms

8
Summary of purpose and approach

• Improve chronic care by improving access to and
  use of integrated clinical data by
• Establishing data standards, processes and tools
  that enable the efficient data exchange and
  integration and
• 2. Securing agreement from as many organizations
  as possible to implement those standards,
  processes and tools and to incorporate them into
  their business processes and contracts

9
CCDP Solution

• The lab data standard is based on previous work
  of the California Information Exchange (CALINX)
  project, and is therefore, called the CALINX
  Laboratory Data Standard.
• The standard is based on industry review of the
  HL7 standard and provides additional format
  specifications that facilitate the exchange of
  lab results data.
• The industry review included laboratory, provider
  organization, health plan, and vendor
  participation.
• The standard is based on the HL7 messaging
  format, version 2.4.
• Rules of Exchange have been developed and agreed
  upon by the project organization.
• These ROEs define the following Reporting
  Periods Reporting Lag Time Services Dates, and
  Data Accuracy and Completeness.

10
Rules of Exchange Reporting Periods

• Data formatted per the standard will be reported
  by clinical laboratories to contracting
  organizations at monthly (30 day) reporting
  periods.
• Exceptions can be negotiated individually between
  the lab provider and its contracted organization,
  i.e., reporting period quarterly, or bi-weekly.
• It is recognized that in some situations, factors
  beyond the control of clinical labs and provider
  organizations will result with the delay of
  reporting certain tests. Every attempt will be
  jointly made by clinical labs and provider
  organizations to minimize these delays.

11
Rules of Exchange Reporting Lag Time

• The lag time for the reporting of batched results
  by clinical labs to contracting organizations
  should not exceed 30 days from the last date of
  the reporting period, e.g., the data collected
  during a reporting period should be reported
  within 30 days of that periods end.

12
Rules of Exchange Service Dates

• For the purposes of determining reporting periods
  and lag times, the service dates of lab tests
  will be based on values of the OBR-7 Field
  (Observation Date/Time) in the standard message
  format.

13
Rules of Exchange Data Accuracy and Completeness

• The data reported to an organization from a
  clinical lab in the CALINX Laboratory Data
  Standard are expected to reflect accurately the
  lab test results for that organizations patient
  and physician populations during the reporting
  period.
• Although it may not be possible to populate all
  required fields in these data files, every
  reasonable effort will be made by the clinical
  labs to populate these fields, and every
  reasonable effort will be made by the provider
  organizations to assist clinical labs to populate
  the fields.

14
Benefits From Greek to Greek, to Greek to Geek

• A uniform data standard for the exchange of
  reporting lab test results for quality-measurement
  and quality-improvement purposes.
• The creation of the lab data standard and rules
  of exchange are intended to address the
  underlying barriers to the access and use of lab
  data to support quality improvement and chronic
  disease management at the point of care.
• To further assist organizations that use the lab
  result data, the CCDP project will deliver a data
  conversion tool. The tool will convert the CALINX
  laboratory data standard format to a flat file
  format commonly used by medical groups and health
  plans.

15
Thank You