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+ Family Planning Quality Improvement and Health IT

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1 + Family Planning Quality Improvement and Health IT

2 + Background: HHS Office of Population Affairs and the Title X Family Planning Program

3 + Title X Family Planning Public Health Service Act of 1970 established the Title X Family Planning Program Administered by the HHS Office of Population Affairs (OPA)Office of Population Affairs (OPA) Mission: To provide individuals with the information and means to exercise personal choice in determining the number and spacing of their children, including access to a broad range of acceptable and effective family planning methods and services Within HHS, OPA sits within the Office of the Assistant Secretary for HealthOffice of the Assistant Secretary for Health However, Title X budget is authorized through HRSA $286 million in FY14 90% of budget must fund service delivery grantees 3 A grant making contraceptive service delivery program 3

4 + Family Planning Encounter A documented, face-to-face contact between an individual and a FP provider that takes place in a Title X service site. The purpose of a family planning encounter is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies Services generally include: Contraceptive services to prevent pregnancy Pregnancy testing & counseling Preconception health counseling & services Basic infertility services to achieve pregnancy STD/HIV screening, diagnosis &treatment Related preventive health services 4 4

5 + 8.6million encounters annually 4.8million clients 4189Service delivery sites in 1138Sub recipients 50+States, territories, DC monitored by 93Grantees monitored by 20Regional Office Family Planning staff Supported by 10Regional Health Administrators 5National Training Centers 1HQ Title X: Diverse and wide network 5 * 2012 FPAR service data § 2013 staffing estimates The 10 HHS Federal Regions 5

6 + Title X Service Sites 6 Health Department (State, County, or Local) Community Health Center or FQHC Family Planning Organization Hospital and Community-based (school, university, correctional, tribal, faith) 6

7 + Family Planning Annual Report (FPAR)

8 + Current FPAR = stale, aggregate data Collects FPAR data on each Title X client encounter Aggregates & submits data to subrecipient or grantee Site Aggregates data from all sites Submits sub-level aggregate data to grantee Sub Aggregates data from all subs Submits grantee-level aggregate data annually populating FPAR tables Grantee Contractor aggregates grantees’ data Validates, analyzes & organizes into FPAR 8 10 Regional FPAR summaries 1 National FPAR summary January 2012 February 2013 November 2013 23 months later

9 + FPAR 2.0 = encounter-level data Regional FPAR system State HIE Grantee Data System Site B Site A Site C Site D Site F Site G Site J Site I Site H Site E FPAR 2.0 Repository 9

10 + Title X and Electronic Health Record Systems Adoption

11 + EHR systems & Title X Sites June 2013 Family Planning National Training Center Training Needs Assessment Results 454 Subrecipients and 1101 Service Sites responded 33% Using EHRs 32% Planning or implementing EHRs 35% No EHR implementation plans Variation in certification level, vendor, and functionality 11

12 + Next Gen14% FL Dept of Health Management System11% Netsmart Insight9% VistA9% Greenway (Vitera)8% eClinicalWorks5% Custom5% SuccessEHS5% Centricity/Logician (GE)4% Epic3% Ahlers (FPAR data only)2% Allscripts/Eclipsys2% Mitchell & McCormick1% PatTrac1% AdvancedMD (ADP)1% … and others Reported EHR systems in use August 2013 | N=3,489 sites 12

13 + Top Commercial EHRs by Service Delivery Type FP group Other Private Non-Profit Health Dept FQHC 13 August 2013 | N=3,489 sites

14 Common tools to record and exchange data Diverse network with specific local needs, multiple reporting structures Variety of tracking and reporting systems Understand performance at finer granularities and in real-time National improvements in electronic data capture and exchange High individual costs to support infrastructure of data capture and exchange 14

15 + The Way Forward: Encounter-level data from Title X service sites used for performance measurement

16 Operationalize QFP Recommendations Achieve NQF endorsement Provide performance feedback Validate 2.0 elements & measures 16 Title X Federal partners Subject matter stakeholders Technical expert organizations Title X Federal partners Subject matter stakeholders Technical expert organizations Study EHR implementation status & systems Pursue feasibility of data exchange & transition to encounter-level data Work within SDOs Standardize & document family planning services Promote family planning integration in healthcare Assess EHR Use and ChallengesPromote Quality FP Care Develop Structured FP Data Collaborate with Partners

17 + Emphasis on Quality Framework 17 Gavin, et al. Providing Quality Family Planning Services: Recommendations of CDC and US Office of Population Affairs. MMWR Apr 2014. PMID: 24759690

18 + Preparing a Path for Success ActivityTypeTimeline JSI Data System & Feasibility Study Contract9/13 - 9/15 ChildTrends Pregnancy Intention Study Research Cooperative Agreement 9/13 - 9/14 ActivityTypeTimeline Contraceptive Effectiveness Measure NQF Proposal2013 - 2014 S&I Framework Chlamydia Screening CDS /CQM Pilot ONC Collaboration4-12/2014 IHE Family Planning Technical Profile International Collaboration 9/13 - 2015 Title X U.S. & Beyond 18

19 2014201520162017 Go live with 2.0 system Jul 2017 Interoperability Showcase Apr 2015 Connectathon Jan 2015 Public Comment IHE Profile Jun 2014 Jul 2014Sep 2017 FPAR 1.0 system contract Jan 2014Sep 2016 OMB approval of current FPAR forms Apr 2014Sep 2017 Pilot Performance Measures & Targets Engage OMB on 2.0 Jul 2015Dec 2015 Jan 2016Dec 2016 OMB review of 2.0 Preg Intentions Study Jan 2014Sep 2014 Jan 2014Sep 2015 JSI Data System & Feasibility Prep Contract Jan 2014Aug 2015 RFD and CQF pilot activities Jan 2014Apr 2016 Market research for 2.0 Fund & solicit 2.0 May 2016Sep 2016 Build & test 2.0 system Oct 2016Apr 2017 Phase into 2.0 system Jan 2017Sep 2017 Comprehensive 2.0 Activities Timeline 19 + Query pilot?

20 + IHE Family Planning Profile using RFD Title X Encounter Please Confirm: Site: Visit Date: SD-3024 6/1/2017

21 + Reminder of SDC 21

22 + Family Planning Profile at 2015 Connectathon 22 Mock Repository & Forms system 1 2 4 3 Send request for FP form Pre-populate form with mappings, send back Display form, allow for manual corrections Send completed Family Planning Document (CDA)

23 + IHE profiles: SDC vs. FP The Structured Data Capture (SDC) Content Profile provides specifications to enable an electronic health record system or other application to retrieve a data capture form and submit data from the completed form. The SDC profile utilizes the IHE Retrieve Form for Data Capture (RFD) Profile and an ISO/IEC 19763-13 Meta-model for Framework Interoperability (MFI) form compliance model. This profile also supports optional use IHE Data Element Exchange (DEX) profile for retrieving and submitting forms in a standardized and structured format. The Family Planning (FP) Profile describes the content and format to be used within the pre-population data part of the Retrieve Form Request transaction from the RFD Integration Profile. It is expected that the Form Filler and Form Manager will implement the RFD transaction as specified in the RFD, and this profile does not include any additional constraints or extensions on the RFD transactions.

24 + Actor diagrams: SDC vs. FP

25 + Pre-population: SDC vs. FP

26 + IHE FP profile aligns  FPAR 2.0 Contraceptive Method at Exit Date of Last Pap test HPV Co-test Ordered CT Screen Ordered GC Screen Ordered HIV Screen Ordered HIV Rapid Screen Result HIV Supplemental Result Referral Recommended Date Referral Visit Completed Date Systolic blood pressure Diastolic blood pressure Height Weight Smoking status Facility identifier Clinical Provider identifier Patient identifier Visit Date Date of Birth Administrative Sex Pregnancy History Limited Language Proficiency Ethnicity Race Annual Household Income Household Size Visit Payer Current Pregnancy Status Pregnancy Intention Sexual Activity Contraceptive Method at Intake Reason for no contraceptive method (Intake and Exit) 26

27 + Next Steps : Public Comment, Vendor Outreach, Testing, Other Pilots

28 + ASK 28 IHE Public Comment Period ends July 5 2014 transparent critique and review by FP experts, including international stakeholders EHR vendors IT and standards experts Recruitment of vendors to certify for FP at the January 2015 Connectathon Scope out another pilot project on query-based model? Participation on S&I CQF Chlamydia Use Case and pilot

29 + Contact Information @OPAHIT

30 + More Details

31 + Common reporting burden among Title X sites Medicaid Other Fed & State Title X Private & fees Funders Reported Revenue Sources 2012 FPAR Quality & Performance BPHC- UDS HAB- CAREWare PCMH Organizational Public Health reporting Immunizations, cancer registry, chronic disease registries, notifiable diseases, syndromic surveillence, 31

32 + Difficult to finding meaning across siloes and reporting hierarchies HIVFamily PlanningPrimary Care 32 Patient Provider Practice Community Quality 32

33 + Draft Performance Measures Measure SourceAligns with Proportion of sites that dispense or provide on-site a full range of contraceptive methods AGI clinic survey, PIMS Clinic survey, HP2020 Proportion of female users at risk of unintended pregnancy who adopt or continue use of the most effective or moderately effective FDA- approved method of contraception. PIMSNQF proposal, HP2020 Proportion of female users ≤ 24 years who were identified as sexually active and who had at least one test for Chlamydia during the measurement year PART, PIMS HEDIS, HP2020 Proportion of users ≥18 years of age who had their BMI documented during the measurement year. QFPHEDIS, HP2020 Proportion of users who were screened for hypertension during the measurement year. QFPHP2020 Proportion of users who were screened for tobacco use during the measurement year. QFPHP2020, Meaningful use Proportion of users who stated clear childbearing intentions. IOM, PIMS *TBD* 33

34 + Proposed NQF Performance Measures for Contraceptive Services Proportion of female clients aged 15-44 years who received contraceptive services in the past 12 months, that adopt or continue use of FDA-approved methods of contraception that are: 34 1.Most effective OR male or female sterilization implants intrauterine devices (IUDs) moderately effectiveinjectables oral pills, patch, ring diaphragm 2.Long-acting reversible methods of contraception (LARC) implants intrauterine devices (IUDs)

35 + Updated Proposal Data System & Feasibility Study Expert Working Group Proposal for New Data Elements Customization Guide Survey Possible Participants Evaluate for final selection - N clients - N sub sites - Current data systems - Location - Interest & capacity 9 Grantees - Compare proposal to current system - Estimate burden to change - Qualitative interview about processes and data systems Survey ? sites Rate each data element: -Clarity -Ability to collect -Modifications needed to systems -Report @ encounter- level

36 + Subject Matter Stakeholders Current national partners: New national & international partners we’re reaching out to: 36

37 + Beyond Title X All interoperable solutions should be designed to have broad applicability outside Title X providers Primary Care, Health Centers, Health Departments Emergency Departments International settings Common data elements and their definitions will satisfy evidence-based performance measurements and other benchmarks Input is welcome on data elements, definitions, and quality metrics HIT Infrastructure developments sponsored by OPA will pave the way for other providers to adopt these tools in their own systems 37

38 + HIT Success Stories in Title X HRSA BPHC Health Center Controlled Network (HCCN) East Providence, RI NCQA PCMH L3, HCCN, & Title X EHR system: NextGen NFPRHA Case Study of group EHR purchasing Indiana Family Health Council EHR system: iSalus HHS ONC Case Study of EHR implementation Portland, OR FQHC & Title X EHR system: Epic 38

39 Timeline for IHE Connectathon Ask 2014 AprMayJunJulAugSepOctNovDec Jan 2015 2015 Connectathon to Certify FP Profile Jan 26 Ask Vendors to Review FP Profile April 2014 June 2014 May 2014August 2014 Follow-up with Vendor contacts Vendors Comment on FP Profile June 2014July 2014 Ask Vendors to Connectathon July 2014September 2014 October 2014 Vendor Engagement Vendor Development January 2015 September 2014 August 2014

40 + Vendor Outreach Seeking CDA technical input Support to develop and test 40

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