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What is WEDI & What Do they Do? Why should my organization get involved? April 2015 Charlie Myers, CRCE-I AHAM Representative on the WEDI Board of Directors.

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Presentation on theme: "What is WEDI & What Do they Do? Why should my organization get involved? April 2015 Charlie Myers, CRCE-I AHAM Representative on the WEDI Board of Directors."— Presentation transcript:

1 What is WEDI & What Do they Do? Why should my organization get involved? April 2015 Charlie Myers, CRCE-I AHAM Representative on the WEDI Board of Directors

2 Who We Are 2 ● The Workgroup for Electronic Data Interchange (WEDI) is a leading authority on the use of Health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency and to reduce costs of our nation’s healthcare system. ● WEDI was created in 1991 by Secretary of Health and Human Services, the Honorable Louis W. Sullivan, MD, and is named in the 1996 HIPAA Law as advisor to HHS. ● WEDI is an industry organization with nearly 400 corporate members including providers, health plans, clearinghouses, software vendors, state and federal government agencies.

3 The Louis W. Sullivan Institute 3 ● Louis W. Sullivan Institute for Healthcare Innovation is WEDI’s sister foundation organization, led by Former Secretary of HHS, Dr. Louis W. Sullivan. ● Completed formation in 2014 ● Focused on four primary areas, including: – development of patient experience journey maps – creation of standardized health IT medical curriculum – development of an industry wide health IT literacy program – development of an innovation transfer network

4 2014 Key WEDI Accomplishments (1 of 2) ● Submitted 7 letters to the Secretary on topics related to ICD-10 & HPID ● Provided NCVHS testimony on ICD-10, HPID, attachments and UDI ● Convened an emergency ICD-10 summit and developed an industry roadmap, based on a revised compliance timeframe ● Partnered with Pew Charitable Trust on examining implementation of new Unique Device Identifier requirements ● Continued work on the WEDI/EHNAC PMS Vendor Accreditation Program ● Investigated feasibility of using smart cards and mobile apps for improving quality of care, reducing fraud and improving efficiency

5 2014 Key Accomplishments (2 of 2) ● Held two major conferences and several special events on the following topics: ICD-10, HPID, attachments, new payment models, and security & privacy ● Continued work on white papers / issue briefs. Five published in 2014 and several more currently being written. Our workgroups have generated 6 surveys. ● Produced more than 50 webinars with 4,000+ attendees and 3,000+ recorded webinar downloads ● Met with senior Federal officials to discuss common goals and work efforts

6 WEDI Workgroups ● Transactions and code sets ● Security & privacy ● Dental ● Worker’s comp ● ICD-10 ● Health Plan ID ● Payment models ● HIE ● Health ID card

7 WEDI Workgroup Updates ● Payment Models Workgroup: Published Understanding Bundled Payments Issue Brief ● Bundled Payments Taskforce: Working on a review of the technology needed to operationalize payment bundles and a vendor roundup of Payment bundling technology. ● ACO Taskforce: The ACO taskforce is working to conduct a survey as an industry assessment for ACOs to be used down the road for a roadmap implementation guide for ACO technology adoption. ● Dental Workgroup: Currently has an open Co-Chair position. Please email if interested in this opportunity. The Dental ICD-10 Taskforce has been working to keep the workgroup updated on ICD-10 issues directly related to the dental industry. This group is also discussing the Comprehensive Dental Reform Act of 2015. ● Coding and Translation Subworkgroup: Working on updating the DRG shifts tool as well as an issue brief regarding necessary ICD-10 code corrections.DRG shifts tool

8 WEDI Workgroup Updates, Page 2 ● ICD-10 Workgroup: The Co-Chairs have been compiling the latest ICD-10 Survey Results and the formal summary and comment letter to the Secretary of Health and Human Services is currently in the approval process and will be distributed in April. For the April 14 overall ICD-10 call, we had two discussion topics; the need for improved clinical documentation and how doing this will not only assist with ICD-10 implementation, but will help set the stage for accommodating new payment models and we will look for feedback/input on two testing SWG products – things to ask CMS, and top 10 things for payers to post on their web sites. ● Transition Subworkgroup: Published the ICD-10 Terminology Issue Brief and have another issue brief, ICD-10 Milestones, in the review process. This subworkgroup is currently working on a new work product tentatively titled, What Providers are Worried About – Revenue Preservation.ICD-10 Terminology Issue Brief ● Testing Subworkgroup: Working on 10 Items Payers Should Have on Their Websites, compiling a message/web page of testing resources and Systems Vendors Readiness Checklist.

9 WEDI Workgroup Updates, Page 3 ● Privacy and Security Workgroup: Re-opened the Cloud Computing Subworkgroup and welcomed a new Co-Chair, Ryan Witt. Creating a checklist of items that organizations should be considering as they are making a decision about purchasing Cyber Liability coverage. ● Cloud Subworkgroup: Working on creating tools to help assess internal compliance, assess the compliance of new cloud vendors (new to the entity; including what documents to ask for such as a SOC 2 report), assess the compliance of current vendors who have become cloud vendors and assess advantages versus risks when deciding whether or not to move forward with a cloud vendor (including questions related to onshore versus offshore vendors). ● Secure Messaging Subworkgroup: Working on the development of template Use Case to distribute and raise awareness of secure messaging ROI, development of current cost and reduction in future costs, trying to find sponsors for WEDI Webinar - “Many colors of interoperability – CONNECT, DIRECT & FHIR”.

10 WEDI Workgroup Updates, Page Transactions and Code Sets ● 835 Subworkgroup: Discussing COB and Compliance concerns and work products to address those concerns. ● 837 Subworkgroup: Working on 837 Changes from 5010 to 6020 Issue Brief ● Attachments Subworkgroup: Electronic Health Record regarding attachments survey in approval process, discussed the Attachments Collaboration Project, beginnings of a work product; Business Level Needs for Attachments. ● EFT Subworkgroup: Continue to work on EFT to ERA Issue Brief. ● P&C Subworkgroup: Went over the NCVHS subcommittee hearing testimonies, provided an ICD-10 update and discussed ASCX12 7030.

11 Why Join WEDI?

12 Benefits of Membership ● Access to whitepapers, issue briefs and webinars that help you understand and adapt to new regulations and a changing business environment ● Networking opportunities with industry experts and decision-makers within the nation’s government and healthcare system ● Access to best practices that help you succeed ● Opportunities to influence the direction of health IT policy through participation in WEDI workgroups or public forums ● Access to Health Committee IT Tracking ● Regular updates on regulatory, legislative and standards changes ● Discounted rates to WEDI’s educational programming ● Industry news bulletins, daily newsletters and webinars that provide the latest health IT updates

13 Corporate & Affiliate Membership Benefits ● Full access to all information and educational resources for all employees within the Member organization. ● Access to and participation on WEDI listserves. ● Preferred Member discounts for all employees to WEDI conferences and events. ● Voting privileges on association issues and Policy Advisory Group (PAG) recommendations. ● Corporate Representative eligibility to vote for and serve on WEDI Board of Directors. ● Opportunity to participate in and/or serve in leadership capacity on WEDI/WEDI SNIP committees, task groups and workgroups. ● Recognition as WEDI Corporate Member on WEDI website and at all major WEDI conferences and events. ● Link to company website from WEDI online Member directory. ● Ability to place a banner advertisement on the WEDI home page. ● Standard Annual Membership dues are based on the type of company and gross annual revenue.

14 So Where Are We? Progress Towards the 2013 WEDI Report January 2015

15 2013 WEDI Report Recommendations 15 1. Standardize the patient identification process across the healthcare system. 2. Expand Health IT education and literacy programs for consumers to encourage greater use of Health IT, with a goal of achieving better care management and overall wellness. Patient Engagement 3. Identify and promote effective and actionable electronic approaches to patient information capture, maintenance, and secure and appropriate access that leverage mobile devices and "smart" technologies and applications.

16 Patient Engagement 16 ● Current Efforts – Several initiatives are underway regarding patient ID (e.g. NSTIC) and patient matching efforts (e.g. ONC) but no national strategies are on the horizon – A number of private industry initiatives (payer and provider) are underway piloting the use mobile and web technologies to engage consumers – The Sullivan Institute for Healthcare Innovation & WEDI are looking to conduct pilots of using insurance benefit cards and BB+ as a way to enable patients to use smart devices to store personal health records and benefit eligibility. (e.g. virtual clipboard) – The Sullivan Institute for Healthcare Innovation has launched a Patient Experience Council to develop “information flows” from the patient’s perspective as we envision the future of healthcare information exchange

17 Patient Engagement 17 ● Challenges & Barriers – Little federal regulation drives attention on these areas of focus and private industry attention is difficult to focus given competing demands – A leading challenge will be to facilitate consumers to actually use the tools available: Source: Pew Charitable Trusts

18 Patient Engagement 18 ● Industry Progress – Based on several strong initiatives to improve the patient experience and private industry efforts to jump start pilots of new methods for patient controlled health records and insurance identification, WEDI has rated industry progress as “green”, or on track to meet the recommendations as identified in the 2013 WEDI Report:

19 2013 WEDI Report Recommendations 19 1. Develop a framework for assessing critical, core attributes of alternative payment models -- such as connectivity, eligibility/enrollment reconciliation, payment reconciliation, quality reporting and care coordination data exchange, and education -- and the technology solutions that can mitigate barriers to implementation. Payment Models

20 20 Current Efforts ● Efforts to create a framework for assessing critical, core attributes of alternative payment models are largely still nascent and known efforts are largely WEDI driven. – WEDI has crated a new payment models implementation workgroup that will work to evaluate use cases and an assessment of transactions in order to support leading payment models. – WEDI workgroup will evaluate areas for needed clinical and administrative data convergence to support new payment models – During the WEDI Report, we identified over 100 different variations of new payment models currently being implemented across the industry

21 Payment Models 21 ● Challenges & Barriers – Competing demands for time and resources (e.g. regulatory demands) – The volume of new payment models makes entry into this recommendation difficult, fragmented and highly complex (the Wild West) – Payment models are continuing to evolve very quickly, making the assessment process difficult – Sustainability and attrition

22 Payment Models 22 ● Industry Progress – Based on the nascent efforts to assess core attributes of new payment models and to develop a framework to address data exchange issues, WEDI has rated industry progress as “yellow”, or needing further directed effort in order to achieve the recommendations outlined in the 2013 WEDI Report:

23 2013 WEDI Report Recommendations 23 1. Identify and promote consistent and efficient methods for electronic reporting of quality and health status measures across all stakeholders, including public health, with initial focus on recipients of quality measure information. 2. Identify and promote methods and standards for healthcare information exchange that would enhance care coordination. Data Harmonization & Exchange 3. Identify methods and standards for harmonizing clinical and administrative information reporting that reduce data collection burden, support clinical quality improvement, contribute to public and population health, and accommodate new payment models.

24 Data Harmonization & Exchange 24 ● Current Efforts – Efforts to standardize healthcare information exchange: ●Care-e-quality / Healtheway ●Direct ●CommonWell Health Alliance ●State level HIEs & Data consortiums ●FHIR (HL7) ●BB+ and new efforts to leverage the benefit card to extend BB+ ●Virtual clipboard (WEDI, HIMSS, MGMA, etc.) – Efforts to streamline quality measurement. ●While there are a number of organizations dedicated to quality measurement and improvement (NQF, NCQA, JCAHO), we are currently unaware of any industry wide efforts to address the challenge with quality and process for reporting

25 Data Harmonization & Exchange 25 ● Challenges & Barriers – Wide scale Interoperability has not been achieved given the fragmented nature of efforts. A recent report to Congress (2014), ONC indicated that “practice patterns have not changed to the point that health care providers share patient health information electronically across organizational, vendor, and geographic boundaries” – While CMS has hinted at a future effort to streamline quality reporting, there has not yet been a formal structure to do so* – Private registries used for public health reporting are still very much “silo’d” and industry efforts to standardize them have not been started *11/19/14: “The Centers for Medicare & Medicaid Services (CMS) today announced the formation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination”

26 Data Harmonization & Exchange 26 ● Industry Progress – Based on the nascent efforts on quality reporting standardization and continuing challenges in standardizing healthcare information exchange, WEDI has rated industry progress as “yellow”, or needing further effort in order to achieve the recommendations outlined in the 2013 WEDI Report:

27 2013 WEDI Report Recommendations 27 1. Identify use cases, conventions, and operating standards for promoting consumer health and exchange of telehealth information in a mobile environment. 2. Facilitate adoption and implementation of “best-in-class” approaches that promote growth and diffusion of innovative encounters across the marketplace and that demonstrate value for patients, providers, and payers. Innovative Encounters 3. Identify existing or proposed federal or state-based laws or regulations that create barriers to the implementation of innovative encounters (including licensure).

28 Innovative Encounters 28 ● Current Efforts – Numerous private industry efforts are underway to deploy innovative encounter technology (e.g. Kaiser Permanente, Cleveland Clinic, etc..) however these efforts are typically more large scale in nature. – WEDI has created an innovative encounters workgroup to help identify use cases, conventions, and operating standards for promoting consumer health and exchange of telehealth information in a mobile environment. – In 2014, the Federation of State Medical Boards created an interstate compact to help set a common bar for medical licensure, which should help to accelerate telehealth initiatives

29 Innovative Encounters 29 ● Challenges & Barriers – Fragmented efforts surrounding telehealth and lack of integration between mobile application / devices makes it difficult for wide scale adoption. Concerns over security exist. – New payment models are evolving, which should drive adoption of innovative encounters technology, however, that transition is still occurring – Industry has not been able to focus fully on developing use cases and to normalize these exchange efforts given competing demands

30 Innovative Encounters 30 ● Industry Progress – Based on the growth of new mobile applications surrounding telehealth and moves by the Federation of State Medical Boards to create a state compact to resolve licensure, WEDI has rated industry progress as “green”, or on track to meet the recommendations as identified in the 2013 WEDI Report:

31 It All Fits Together 31

32 Convergence Is Here 32 ● Consider wearable devices or other monitoring / communication tools – Patient Engagement ●The patient is involved by having the device ●How frequently will it be used? – Payment Models ●How will clinicians’ time be compensated? ●Are there co-pays? – Data Harmonization and Exchange ●Information from the device must be consumable in both directions – Innovative Encounter Models ●Telemedicine is facilitated ●What liabilities exist?

33 What’s Next 33 ● WEDI will continue to monitor progress towards the 2013 WEDI Report and will issue a report in January of 2015 that outlines these findings in further detail. WEDI conducted a survey in late 2014 regarding industry initiatives related to WEDI Report recommendations. ● Get involved in WEDI workgroups surrounding these areas, such as our new payment models workgroup and innovative encounters workgroup as we work through the information exchange challenges and solutions identified in the 2013 WEDI Report. ● Help us with mapping the next generation of healthcare information exchange from the patient’s perspective. Find out more at and get ● Consider helping us launch a pilot to create an industry wide effort to create a combination benefit / essential health record mobile app ● Consider using The Sullivan Institute for Healthcare Innovation’s Patient Experience Council as an advisor to help accelerate your organizations’ own patient-centric transformation

34 Mark Your Calendars 2015 Meeting Locations 24 th Annual National Conference May 18-21, 2015 Talking Stick Resort Scottsdale, AZ ICD-10 Forum (Summer) July 28-29, 2015 American Dental Association Conference Center Chicago, IL WEDI-CON 2015 (Fall Conference) October 26-29, 2015 Hyatt Regency Reston Reston, VA Level-Up: Architect & Developer Forum November 18-19, 105 American Dental Association Conference Center Chicago, IL WEDI will offer numerous webinar series in areas such as ICD-10, HPID, New Payment models, security, etc…

35 January 2015 THANK YOU Questions?

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