REALD Technical Workgroup Meeting December 3, 2020 Recap
The REALD Technical Workgroup Meeting held on December 3, 2020, covered various updates, discussions, and progress reports related to health IT coordination and data collection efforts in Oregon. Key topics included OHA updates, technical coordination progress to date, future work plans, and introductions of stakeholders. The meeting highlighted the collaboration among different healthcare organizations and outlined steps for addressing challenges and aligning standards.
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Presentation Transcript
REALD Technical Workgroup Meeting December 3, 2020 Susan Otter, Director of Health IT, OHA Karen Hale, Oregon Provider Directory Program Manager and Certified EHR Technologystandards lead, Office of Health IT Belle Shepherd, MPH, HB4212/REALD Lead, OHA External Relations Helen Kidane and Renee Harger, Acute & Communicable Disease Prevention
Agenda Welcome and Introductions OHA Updates Tiger Team report out race/ethnicity crosswalk work Open discussion/Q&A/Updates from you Next Steps Other Resources/Reference Slides Remaining time: Office hours with OHA
Welcome and Introductions Hospitals/Health Systems: Hospitals/Health Systems: Asante Kaiser Legacy OHSU PeaceHealth Providence Salem Health Samaritan Sky Lakes Southern Coos Hospital & Health Center St. Charles Health Care FQHCs and Partners: FQHCs and Partners: Multnomah County (FQHC) Neighborhood Health Center (FQHC) Northwest Human Services (FQHC) Yakima Valley Farm Workers(FQHC) Oregon Primary Care Association OCHIN Other Guests: Other Guests: Apprise Health Insights CareOregon Epic HIT Commons OHA: OHA: Staff Health Tech Solutions (OHA'stechnical SME)
Technical Coordination Progress, Future work
Technical coordination progress to date OHA Phase 1 REALD Technical Workgroup: Progress to date: Answering questions on OHA s requirements and principles for REALD collection Supporting a coordinated approach to Epic implementation of REALD, Epic coordination supported through single Epic technical coordinator, AJ Ankenbauer Received great input on how OHA can be supportive, including some corrections needed in OHA s template or spec OHA s Technical Workgroup materials, organization roster, and recordings - https://www.oregon.gov/oha/OEI/Pages/REALD-Workgroups.aspx
Technical coordination progress to date OHA Tiger team (subgroup) to crosswalk federal and REALD race, ethnicity standards Progress to date: Updated data crosswalk to align REALD to the HRSA standards Future work: Tiger Team is on pause Other alignment issues (e.g., languages) may come up in the new year We can reconvene the Tiger Team to meet any urgent data challenges that may arise, or identify other subgroups for focused topics
OHA REALD Learning (Webinar) Series: 10/9/2020: REALD 101 Introduction What and Why 10/14/2020: Implementing New REALD Data Collection for Providers 10/16/2020: How to ask the questions 11/10/2020:Implementing REALD for Providers: Updates and FAQs 11/20/2020: Using REALD Data to Advance Health Equity [Additional Webinars TBD] *Webinar registration, materials and recordings: https://www.oregon.gov/oha/OEI/Pages/REALD.aspx 7
Technical coordination Future work Further support/coordination for EHR implementation? 11/18 OAHHS Non-Epic Hospitals Webcast OHA likely to convene Cerner coordination group, engaging other non- Epic organizations Thinking ahead to Phase 2 coordination needs/workgroup any advice? What s been helpful? REALD interoperability Options for electronic reporting (ELR, ECR)
Health System Listening session 11/19 OHA leadership met with several health systems to hear concerns related to REALD implementation and timing OHA is developing a response which will be released no later than Monday
REALD Rules Update Rules Advisory Committee - Fiscal Impact Survey underway - Temporary rules in place - Permanent rulemaking expected in March 2021 REALD Rules Page: https://www.oregon.gov/oha/OEI/Pages/REALD-Rules.aspx
Technical Workgroup participants also represented on HB4212 Rules Advisory Committee Hospitals/Health Systems: Hospitals/Health Systems: Kaiser Legacy PeaceHealth Providence Samaritan FQHCs and Partners: FQHCs and Partners: Multnomah County (FQHC) Oregon Primary Care Association OCHIN Other Guests: Other Guests: Apprise Health Insights CareOregon HIT Commons
REALD Template Updates REALD standards changes effective 11/1 English versions of REALD template are up to date Age of onset questions adding instruction for write in: don t know or declined Spanish shouldbe available next Other translations to follow Are future changes expected? The OARs require review of standards at LEAST every two years to address changing demographics and evolving research Tribalconsultation ongoing may add questions in 2021 Sexual Orientation and Gender Identity are not included in REALD but may be required in the future; mandate to collect and report would require legislation
Reporting Tools Updates CSV update - current is Version 1.6, updates since our last meeting: Language Section: Corrected coded value for Swahili in Appendix B (should be swa ) Upcoming changes expected if 4a is equal to English only then questions 4b thru 6 are not required.Spec will be updated to indicate questions 4b thru 6 to be conditionally required (R/C) instead of required (R) English Proficiency - Added coded values (VW, W, NW, NA, U, D) Disability Section: Added response option for Do not understand (Q) to DifficultyCommunicating and DifficultyMoods Age of Onset: Added coding for entering unknown (999) and declined (777)
REALD Race/Ethnicity Tiger Team Report Out Karen Hale
How do REALD and National Standards Align? Certified EHR Technology (CEHRT) demographics categories align in some areas, but there are also gaps. Updated crosswalks to OMB standards, CEHRT standards (CDC) and HRSA race/ethnicity categories can be found on OHA s website: REALD and CDC Race and Ethnicity Cross-Map (Code Set Version 1.0) REALD to HRSA Cross-Walk Excel File Disability Preferred spoken/written language; English proficiency Race Ethnicity Primary Language Sexual orientation & gender identify CEHRT REALD Both
Task at Hand Align UDS: To REALD:
Tiger Team Activity Purpose Purpose: Federal reporting alignment with REALD, focused on race/ethnicity Output Output: Updated crosswalk connects REALD race categories to UDS and HRSA Tricky Areas Tricky Areas Data crosswalks from REALD to UDS may bepartof the solution to meet theirreportingneeds to HRSA With REALD, race may not be reported for Latinx individuals (only getting ethnicity) Race and Ethnicity data may be collected in separate asks from the patient to avoid breaking other data feeds Ideally patient will not get asked for the same data twice - use the REALD data to roll- up to the other categories
Other Alignment Areas to Tackle 1. CDC Race List (CEHRT standard) does not contain REALD categories of Somali or Slavic 2. Language Mapping questions 4a, 4b, and 4c to a list of languages (e.g., ISO 639-2)
Open Discussion, Q&A, Updates from You
OHSU Q: Which provider is responsible for collecting and reporting the REALD data? Discuss having 1st Provider ordering the COVID test being responsible for collecting/reporting REALD OHSU reporting is curious to know if/how hospitals are doing this & their thoughts If linked to the order, which provider is responsible when COVID is identified externally (there is no COVID test)? When patient REALD info is collected outside of a clinic encounter?
Optional OHA Review Process OHA could review paper prototypes, walk-throughsof"sandbox" orother testing environments, screen shares, etc. Please reach out to Susan.Otter@dhsoha.state.or.us or Karen.Hale@dhsoha.state.or.us if interested
Next steps OHA Technical Workgroup Response re: health system listening session Tribal Consult on REALD Non-Epic groups Cerner workgroup Exploring ELR,eCRoptions New FAQs, additional communication and outreach Workflow and EHR Implementation remaining issues Tiger Team on race/ethnicity crosswalk to federal standards Future: ELR/eCRinput Future: Interoperability Questions for the Group: Meetings scheduled through 2020 move to monthly in 2021? Topics for 12/17/20 meeting?
Other Resources, Reference Slides
REALD Resources For more information: HB 4212 and REALD: https://www.oregon.gov/OHA/OEI/Pages/REALD- Providers.aspx REALD Response Guide https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/le7721b.pdf COVID-19 Reporting Portal - healthoregon.org/howtoreport CSV File Specifications are available at the Electronic Case Reporting page. Contacts: REALD: Marjorie McGee at marjorie.g.mcgee@dhsoha.state.or.us HB 4212 requirements: Belle.Shepherd@dhsoha.state.or.us To establish CSV reporting: ELR.project@dhsoha.state.or.us Technical Workgroup: Susan.Otter@dhsoha.state.or.us
HB 4212 REALD data collection and reporting Requires OHA to establish rules for phased REALD data collection and reportingby providers for COVID-19 encounters REALD data are required when reporting COVID-19 encounters that arereportable under Oregon Disease Reporting rules (OAR 333-018-0011)* COVID-19 encounters: Interaction with provider for health care services related to COVID-19 includes ordering COVID-19 test. Note: Clinical laboratories excluded until 10/1/2021 COVID Disease reporting includes: COVID-19 tests (positive and negative) COVID-19 cases COVID-19 hospitalizations COVID-19 deaths MIS-C (Multisystem Inflammatory Syndrome in Children) *Temporary rules in place; final rules March 2021
Who is subject to report and when? March 1, 2021: Oct. 1, 2021: Oct. 1, 2020: PHASE 2 Health care facilities* Health care providers working in or with individuals in a congregate setting Excludes clinical laboratories PHASE 1 Hospitals, except for licensed psychiatric hospitals Providers within a health system Providers working in an FQHC Excludes clinical laboratories Enforcement starting December 31, 2020 All providers All must report usingelectronic method *ORS 442.015(12) *ORS 442.015(12)(a) Health care facility means: (A) (A) A hospital; (B) (B) A long term care facility; (C) (C) An ambulatory surgical center; (D) (D) A freestanding birthing center; (E) (E) An outpatient renal dialysis facility; or or (F) (F) An extended stay center. https://www.oregonlaws.org/ors/442.015 28
How often are data collected and reported? Annual REALD data collection is required Providers must collect REALD data from a patient at the time of an encounter or as soon as possible thereafter If a provider has collected REALD data from a patient within the last year (12 months/365 days) and the patient has a subsequent encounter, providers may use the REALD data previously collected to report to OHA Reporting REALD is tied to COVID disease reporting REALD data can be reported either at the time of the COVID disease reporting or can be batched to be sent daily or at least weekly.
Key Updates to REALD Rules Amends "health system" definition as follows: Health system means an organization that delivers health care through at least one hospital in Oregon and through other facilities, clinics, medical groups, and other entities, all under common control or ownership. Excludes clinical labs from the definitions of Phase 1 and Phase 2 providers. Clarifies that labs are not subject to collecting REALD in situations where a hospital lab iscollecting specimens for COVID tests ordered by community providers, or for COVID testing events.
FAQ: Are extensions to the Phase 1 reporting deadline available? OHA has made a form available to submit a request for extension. OHA will not grant an extension on the basis that a health care provider lacks the current capability of capturing REALD data in their electronic health records. A detailed explanation of why the health care provider cannot meet the deadlines must be provided in the extension request. Resources: Extension requests process/forms https://www.oregon.gov/oha/OEI/REALD%20Documents/HB-4212- Extension-Requests.pdf
Current Reporting Method: COVID-19 Portal Data Entry Portal entry includes: Provider/submitter information Patient information REALD data (option to note if previously submitted) Sexual Orientation and Gender Identity (SOGI) optional COVID-19 clinical details, test information, and MIS-C Opportunity to print report COVID-19 Reporting Portal at healthoregon.org/howtoreport
Current Reporting Options: CSV file CSV File Requires OHA approval, follows OHA specification Spec. includes REALD, patient and provider identifying data,for those submitting ELR or case reporting otherwise Onboarding expected to take 1 week if an SFTP data exchange process is already in place Frequency of submission: Daily submission is preferred Weekly is acceptable -Data for the preceding week must be received by OHA/Public Health Division not later than 10 pm each Sunday. Resources: CSV File Specification (Version 1.6) is available at the Electronic Case Reporting page. To establish CSV reporting: ELR.project@dhsoha.state.or.us
Future: Electronic Lab Reporting (ELR) or Electronic Case Reporting (ECR) OHA is exploring ELR and ECR options for REALD OHA is exploring ELR and ECR options for REALD Codes will need to be created for Oregon s REALD standards in conjunction with HL7 experts ELR: Jurisdiction-specific fields can be added in Ask on Order Entry (AOE)segments ECR:There are no easy ways to add jurisdiction-specific fields to the EICR specification. Coding would need to be proposed/balloted with the international HL7 organization, which could take multiple years After coding is created, OHA would need to create specification and vendors would need to update lab/EHR systems
