2021-03-23 HEPC Design Call

Item	Who	Notes	Action Items
Mapping Out Data		Need to map out certain terminology (lab and medication) that will need to be needed
		Health Catalyst has data mapped so queries and applications AC develops points to the normalized data. AC is 70% through the process for the 1st release of the tool, hence the request for the data pull timeline (delay to May data pull). AC is using OMOP linkage for labs where feasible.	Eliminate Labcorps and Quest codes before submitting?

Which cascade?		Health Center Level Cascade - more detail than HCCN cascade? Yes - can do a Network level and then a CHC view, and a combined AllianceChicago/HCN level view. AC and HCN Alliance OR HCN CHC Clinic? Site? Practice level Using Health Catalyst will allow CHCs to access the cascades at different points in the data (i.e. where patients are) to conduct quality improvement. No preference on variables AC/HCN focus on, up to the individual CHCs in terms of what is the biggest priority for them. Sub groupings (high risk behavior, drug use, etc.) — maybe this would lead to additional data elements that would be more useful for provision of care for patients Based on what was learned previously: Omit: Linkage to care - it was not tenable to evaluate, but if local sites have a way to measure and want to look at that, they should/can. there are not consistent value sets If the steps are linked - via dependencies - we lose people; we should de-couple the steps Limited and Completed treatment was combined and changed to ... SCR because of the assumption that if a person achieved SCR, they completed treatment. Testing was not clear when they had an RNA test vs an antibody. We want to know who has been screened, and who is in the pool for patients that need to be treated. People are referred in to the Center, we may not have the test result because they got tested elsewhere. The cascade does not represent the patient - maybe revise to make it patient-centered rather than care activities and test results. example: Linked to care, there is no data element from the patient point of view, but instead "referred (internally or externally) or "received follow-up care" From an office visit code, AllianceChicago could not see if this was HEPC treatment. Had to be combined or go to medication list. How CHCs follow the people they referred? How do CHCs were getting follow up at the CHC? In the pilot, we saw that there were issue with Linkage to Care - let's apply what we learned (we started with the ideal state cascade). SBR - can we capture that? We would not ask for a change in care routine, but rather pulling up the data from the encounter so we can measure it. Give us the evidence you already have about the follow-up. In the past, we could not reliably measure Linkage to Care because representation was so varied. If we define at the CHC level, and work directly with them to understand what it is for them - but when we work across centers there is a lot of chaos in the data. Gap may be that people are not getting treatment - that may be the critical piece, not who is getting referral/linkage... "Did anyone achieve SBR" Should we stick with one, validated cascade or allow CHCs to tailor? Best to use validated cascade but not if it limits them. Show where we started Time 1 cascade, Time 2 cascade, invite expansion to things you want to work on , as long as they are represented in the cascade. Log the patient where and when they show up on the cascade as patients come in and out of the system; care team will have to validate/close out the status of the patients. The PCP is the point person to track the patient rather than EHR point of care workflow. In once center this activity is logged in the Registry not the EHR.	Who
		Maui, HI example - State does not think the screening rates are high enough per population. Probably because of transience.
What steps should we take?		Meet w/CHCs and ask them to help on design or create a design and have them review and comment (yes, this). "Cast a wide net and then focus on those specific data elements"
		Encourage CHCs to think of quality improvements they can make to improve their data quality - example, data workflow is manual in places, this is a quality improvement that can be done using a dashboard. From what you learned in the first part of the project - what was most successful, but more, where were the biggest gains - where could/should we put our energies? Screening - esp targeted to high risk pops CHCs treat patients instead of referring them out (priority of one site) Get people to viral suppression (priority for one site)
		Do EMR users use the HEPC portion? Decision support around screening for HEP C - age-based. ---AC needs to ask Informatics (Shannon) Specific built treatment templates for HEP C - use of them is variable - do those need to be improve? That could be an area of study.
Workflows- Clinical and CDS	HCN team	HCN - Stephanie Martinez, HC-MBA, LSSGB (Unlicensed) and Kwesi Willacy, MPH (Unlicensed) have received the ... will loop the staff on clinical content updates within GW Intergy. Received clinical workflows from Premier Community Healthcare Group–Need to be reviewed. Need to regroup with Sys Op team and tie workflows to Intergy EMR.
Feedback from Liesl		Lots of different opportunities for which CHCs could improve the cascade. These areas line up well with the three pillars in the strategic plan for the Division: reducing morbidity and mortality due to HEPC increasing number of ppl who know their status (testing piece) reducing hep c virus-related fatalities You can keep these in mind, but also okay with working on what is needed most or what works best in the particular clinical setting. Reflex testing stood up for people with antibody testing.
Julia comments		We can do the data so that the data piece is the same for everyone but the CHCs use what they have that is common to that.
Next Steps		NACHC could update the Materials, distribute to the parties on this call, then the CHCs, get the comments back for discussion w/in 4-6 weeks.
		Who are the contact points at the CHCs? The networks are the primary route for communication, and we can work directly with state coordinators, as appropriate. AllianceChicgao: CMO Maui - state HEPC Coordinator Howard Brown - Linkage CAre Coordinator. AllianceChicago has not connected with city and state on this formally but has a relationship with them and could.	Pedro B Carneiro (Deactivated) will send out the Validated Cascade to the HEPC partners 31 Mar 2021