Laura Bright, LJB Consulting, Inc. Gila Pyke, Cognaissance, Inc. Family Planning version 2 Brief Profile Proposal presented to the Quality, Research & Public Health (QRPH) Planning Committee Laura Bright, LJB Consulting, Inc. Gila Pyke, Cognaissance, Inc. Lauren Lemieux, ACOG Emily Decker, OPA October 19, 2016

Title X Family Planning Program WORLD Title X Family Planning Program Operated by HHS Office of Population Affairs since 1970 4300 clinics provide contraceptive services and related health services Grantees report key performance data on ~5 million patients per year Reporting is done via the Family Planning Annual Report (FPAR)

The Problem Assure appropriate reproductive care for all patients Standardization of data collection around contraception, pregnancy intention is needed to improve health outcomes. Unintended pregnancies are at higher risk for poor health and social outcomes. Reporting and Clinical Quality Measures standards are evolving Pregnancy intention and contraceptive method are essential health indicators. The usefulness and reliability of indicators and quality measures is dependent on the existence of quality data. The burden of data collection is increasing Differences in data collection methods, and data definitions, means a substantial effort is required to extract meaningful data from existing systems.

The Problem The update of the Family Planning profile will: Process The Problem The update of the Family Planning profile will: Add flexibility to the submission pathways to ensure a suitable workflow is available for all kinds of systems. Align CDA document types used in the profile with standard C-CDA documents used in other US initiatives. Define the cardinality and structure of form data, as well as CDA document data, to ensure data definition and collection is consistent across all submission pathways

Value Proposition For Title X: Improve the accuracy of collected data Process Value Proposition For Title X: Improve the accuracy of collected data Improve population representation Provide more granular, visit level data For Clinicians: Provide interoperable approach to data collection with minimal workflow burden Enable feedback to improve quality of care For Clinics: Reduce burden associated with extracting and reporting Reduce need to customize EHR software and associated costs

Existing IHE Profiles and Risks Risk of this proposal not being undertaken this cycle? Lost of momentum started with current FPAR 2.0 project Lose interest from sponsors at OPA and ACOG Miss opportunity to capitalize on available funding to provide technical resources for profile development Miss opportunity for IHE involvement in proposed pilots and implementation project

Use Case 1 Current Use Case Clinic A creates dummy CPT codes for contraceptive methods, which are added to paper billing form, and entered into practice management system by billing staff Clinic B adds custom fields to their EHR to capture the data, requiring expensive vendor fees for customization Data format and codes are not consistent across sites. Correlation of data across sites and regions is difficult, if not impossible Proposed Use Case Clinic A uses an EMR that can produce a Family Planning CDA document. The clinician records the data in the EMR. At the end of the visit, the FP CDA document is submitted to the FPAR system Clinic B queries for and displays a Family Planning form. The clinician fills out the form and submits it to the FPAR system at the end of the visit. The FP CDA document and the FP form use the same data definitions, fields and formats, enabling consistent data collection, and correlation across all sites.

Proposed Standards & Identified Systems HL7 CDA R2, C-CDA R1.1 CCD IHE Retrieve Form for Data Capture (RFD) Structured Data Capture (SDC) Vocabulary Standards SNOMED CT LOINC CPT HCPCS Electronic Medical Record (EMR) System Produce Family Planning CDA document Query for Family Planning Form Send completed Family Planning Form Family Planning Annual Reporting System (FPAR 2.0) Consume Family Planning CDA document Store Form and Form data Pre-populate Form from CCD or other CDA document types

Discussion What level of effort do you foresee in developing this profile? Moderate Effort Content Profile Inclusion of new fields, and new document types for pre-pop Definition of form fields and data formats International base profile and US extensions New Use Cases Addition of CDA document submission along with forms based workflow New Actor-Transaction Diagram No new actors, no new transactions Addition of existing IHE Actors for CDA document submission workflow - New Sequence Diagrams for new use cases Profile Editors: Laura Bright Gila Pyke Lauren Lemieux laurabright4@gmail.com gila@cogna.ca llemieux@acog.org