Health Information Sharing Maturity Model · A maturity model will enable Health Information...

© 2018 The MITRE Corporation. All rights reserved. Approved for Public Release; Distribution Unlimited. Case Number 18-0621.

Health Information Sharing Maturity Model

G. Hamilton

T. Novak

March 8, 2018

The MITRE Corporation operates the Centers for Medicare & Medicaid Services (CMS) Alliance to

Modernize Healthcare (CAMH), a federally funded research and development center (FFRDC)

dedicated to strengthening the nation’s health care system. MITRE operates CAMH in partnership

with CMS and the Department of Health and Human Services.

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What is Health Information Sharing (HIS)

The sharing of health and healthcare

information (HIS)

Electronically across key participants

and stakeholders to

Improve health and healthcare practices

▪ Ensures health information is available at the

right place at the right time for the right person

▪ Lowers burden on healthcare providers and

patients

▪ Improves efficiency of healthcare system and

lowers costs

▪ Best of all, IMPROVES HEALTH OUTCOMES!

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Enabling Health Information Sharing:The HIS Maturity Model (HISMM)


▪ A maturity model will enable Health Information Sharing by:

– Providing states with a mechanism to assess the maturity of health information exchange within a state’s

healthcare Enterprise.

– Ensuring the most effective use of scarce resources, leveraging common efforts, both public and private

– Ensuring that best practices and lessons learned, such as increased modularity, are incorporated

– Improving reuse of solutions across states

▪ HIS Maturity Model benefits

– Helps prioritize areas that may require technology supports/enhancements

▪ Reveals the mitigations and workarounds needed to support a program

– Helps you understand gaps, where you may need to make more Health Information Technology (HIT)

investments

▪ Demonstrates how to mature a capability based on cost/benefit analysis and resource

– Helps with overall HIT planning

▪ Helps identify gaps and determine steps to incrementally improve the capability

▪ Provides the steps to use in building the roadmap to improve the capability

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Why Do We Care About Maturity Levels


Low Maturity

• share inaccurate information• require manual entry • have inefficient workflows

HIS capabilities that:

• share accurate information• enable automation• have efficient workflows

High Maturity

• better care coordination for patients

• less burden on providers• reductions in admin staff and

contractors

HIS capabilities that:

Results in: Results in:

Overall, a capability with a high maturity can achieve delivery system reform goals

• medical errors• provider burden• need for additional staffing

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Proposed HIS Capabilities to Include in Maturity Model


Only select the ones that support your program goals

Admission, Discharge and Transfer (ADT) Events/Encounter Alerting

Advanced Directives

Analytics Reporting

Care Plans

Claims Information Sharing/All-Payer Claims Databases

Death Reporting

Disease and Public Health Registry Information

Electronic Prescribing

Eligibility and Benefits Information

EMS Integration

Financial Information

Health Record

Image Sharing

Immunization Registry

Lab Orders

Lab Results

Patient Consent

Patient Education

Patient-Generated Data

Patient Identifier

Patient Portal Information

Patient Record Locator

Population Health Information

Prescription Monitoring

Provider Attribution

Provider Directory

Quality Reporting

Referral Management

Risk Assessment

Social Determinants of Health

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HIS Maturity Model Components

▪ Programs: The Why (Goal)

– Provides understanding of what capabilities are needed

to achieve a State Medicaid Agency goal

▪ Example: Behavioral Health Integration

▪ Capabilities: The What

– The functionality you are exploring

▪ Example: Provider Directory

▪ Dimensions: The How

– The tool/mechanism that supports a specific

functionality

▪ Example: Measure the level of Usability

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HIS Maturity Model Components: Program Sheets


Example: Behavioral Health

Integration Program

▪ Used to Identify

– Main objectives

– Outcomes

– Stakeholders

– Relevant capabilities

▪ How to use:

– To review capabilities and identify priorities

– Refer to relevant Capability sheet to help estimate

maturity level and target level

– To identify additional stakeholders and outcomes

– As a communication tool to socialize needs with

stakeholders

Purpose: To layout what is needed to attain program goals.

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HIS Maturity Model Components: Capability Sheets


▪ Identify

– Programs

– Stakeholders

– Low, medium, high, maturity level summary

▪ Provides a common mechanism for

communication

▪ How to use:

– Review capability description

– Identify additional stakeholders

– Review maturity level descriptions – to

estimate as is and target maturity state

Purpose: Provides a capability definition and example of maturity levels to

help communication/understanding

Capability Example: ADT Events

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HIS Maturity Model Dimensions: Criteria for Assessment


Is the data being shared, timely, usable, high quality, complete and relevant?Information Quality

What is the maturity of the data transport mechanisms used? Push/PullTransport

What mechanisms are in place to ensure data is shared securely?Security

What is the level of adoption of the Application Programming Interface (API) used?Transaction/Query

How easy is the information to consume? Is the information incorporated into the workflow?Usability/Workflow

How many different mechanisms are available?Alignment/DuplicationCan all possible participant types (providers, patients, payers, ...) for the capability, participate, and how many are actually participating?Participation

Can patients control (provide consent) who has access to data about them to a granularity appropriate to the capability?Consent/Privacy

How mature are the processes to govern data involved in exchanges?Data Governance

How mature is the organizational structure and associated processes to govern exchanges for this capability?Stakeholder Governance

What are the resources available to sustain efforts for any capability; people, funds, skills, leadership?Sustainability

People & Process

Dimensions

Governance Dimensions

Technical Dimensions

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HIS Maturity Model Assessment Steps


Identify Program

Identify the State program goal that will drive the needed Information Technology (IT) capabilities

Identify Capabilities & Stakeholders

Use the program sheets to determine and prioritize the required capabilities

and identify all stakeholders that will be involved in the assessment

Review Capability

Sheets

Use capability sheets to determine expectations for the capability maturity level

Use Dimensions

Assess current maturity for each capability against each dimension.

Target Maturity Level and

Identify Gaps

Determine target maturity for each capability against each

dimension. Use dimension sheet to identify gaps to achieve

desired level.

Identify Steps to Address

Identify incremental steps to address the gaps.

Use these identified steps to inform a roadmap

to improve capability.

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HIS Maturity Model on Centers for Medicare & Medicaid Services (CMS) zONE


▪ HISMM available for review on zONE

▪ Maturity Model

– Executive Summary

– Presentation

– Spreadsheet model

▪ Information/Capability sheets

– Behavioral Health

– ADT Events

– Health Record Information

▪ Discussion Forum

– Leave comments, ask questions!

▪ Instructions available for access

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For More Information


To learn more or provide feedback on the HIS Maturity

Model, please contact Tom Novak ([email protected]).

mailto:[email protected]

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Follow up

To download a copy of this presentation, visit:

https://health.mitre.org/himss18


Data Interoperability to Reduce Clinician Burden

Follow us on social media: @MITREhealth

https://health.mitre.org/himss18

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Reference Slides

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How a Maturity Model is Used to Improve a Capability


▪ A maturity model shows how a capability can be improved “step by step”

▪ Each level lays out critical success factors for the capability

– Expectations are made clear

▪ As objectives to improve the capability to get to the next level are clear this enables:

– Incremental Improvement: Helps identify gaps and determine steps to incrementally improve the capability

– Roadmap Development: Provides the steps one can use to build the roadmap for improving the capability

▪ Identify realistic target

– Can determine which level is achievable for the capability based on cost/benefit analysis and resources

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How a Maturity Model is Used to Improve a Capability (Continued)


technical people and process governance

level Information Quality transport Security Transaction/Query Alignment/Duplication Dimension

Usability/ Workflow participation consent/ privacy data governance stakeholder governance sustainability

Is the information timely, of high quality, complete and relevant ?

Is the mechanism used to exchange the data

standardized, documented, and proven? Ensure that the protocol

supports required communication between participants (e.g., request and response). Average across exchanges for the capability maturity level.Transport maturity levels for the capability maturity

level.

What mechanisms are in place to ensure data is shared securely?

What is the level of adoption of the APIs used?

How many different mechanisms for this

capability are in use by end users?

How easy is the data to consume? Is the data incorporated into the

workflow

Can all possible participant types (providers, patients, payers...) for the capability participate, and how many

actual participants are participating?

Can patients control (provide consent) who has access to data about them

to a granularity appropriate to the

capability?

How mature are the processes to govern data involved in exchanges?

Are common agreements in place, in use, and enforced between

participants?

How mature are the organizational structure

and associated processes to govern exchanges for

this capability?

What are the resources available to sustain efforts for any capability; people, funds, skills, leadership?

0 No exchanges occurring for information in this capability area

1 Information available in external systems.Some Information is non-human readable

Mainly unstructured, little structured meta data, across multiple systems

No metrics defined for information quality.

All protocols custom and private and not

documented

Baseline CIA policies have been defined but implementation is ad

hoc and manualSeparation of duties mainly admin

definedSystems meet all required Federal

and state security policies CIA needs defined

Using DIRECT (to push information)

Multiple efforts that duplicate capability, with

no effort to reconcile

Information available in separate system

Information is available but not readily accessible.

less than 25% of the potential participant types (as defined by capability) and not all participants of

those types exchanging

all or nothing general consent only

some exchanges of the same type of data for the

capability do not have governance agreements in

place

no governance organizational structure in

place

Uncertainty in funding over the next year.Funding is unstable

Inconsistent leadership support.

2 Measurable metrics defined for information qualityMeasurable metrics defined for information

completenessSome (not all) information from less than 50% of

external systemsSearchable: Results mainly unstructured, ad-hoc

formats or PDF with key meta-data structuredHuman readable

Identification of process improvement

documented non-standard protocols

Some automation to meet CIA baseline policies. These processes are repeatable require no manual

input.Identification of all policies that

could be automated.Commitment to tracking policy

conformance is in place.Ongoing efforts to further automate.Baseline requirements met, threats

identified and plan to mitigate defined

Undocumented API (to query information)-

proprietary

Multiple efforts that duplicate capability,

Identification of areas of overlap

Information available in same system but not

integrated.Requires extensive manual

effort to reconcile, or duplicate data entryAreas identified for

automation and improvement .

less than 25% of the potential participant types (as defined by capability)

but all participants of those types exchanging

all or nothing consent to data access for specific providers but no other

participant types

all exchanges of the same type of data have

governance agreements in place but not from a

common basis

governance organizational structure in place but does not include representation

from all stakeholders (participant types that

participate in capability) and defined governance

processes exist

Uncertainty in funding over the next 5 years

Funding source is unstableInconsistent leadership

support.

3 Information searchable within workflowSome information are from less than 50% of

available external systems Data mainly structured

Human readable. Measurement of information quality against

defined metrics ad-hocMeasurement of information completeness against

defined metrics ad-hocUse cases for relevance determined. With some

metrics identified.

At least one documented standard protocol in use.

And used consistently across the organization.

Metrics collected on APIs.

Full automation to enforce need to know, separation of duties and least

privilege policies.Tracking is in place to track

conformance with policies, and identify areas for further

automation.CIA requirements monitored.Plan to address threats to CIA

implemented

Using proven standards (XDS-b, API standardized)

for query

Multiple efforts that overlap capability, with business case specific variations identified

•Information available in same system, can be

reconciled into workflow with minimal manual

effort.Metrics identified for

tracking UsabilitySome automated control, areas identified for further

automation.

at least 50% of the potential participant types (as defined by capability)

exchanging but not all participants

consent to access specific classes of data for specific

providers but other participant types

all exchanges of the data for the capability are

governed by a common governance agreement used by all exchanges

governance organizational structure in place

including representation from all stakeholders, and

defined governance processes exist

Certainty of funding over the next 3 years

Funding source is unstableConsistent leadership

support.

4 Information searchable within workflowSome information are from more than 50% of

available external systems Available same day

Human readableInformation quality enforcement with repeatable

processProcess to track and enforce information

completeness

Mostly documented standards-based protocols. Used

consistently internally and externally within the

organization.

Full automation to enforce of specified policies to meet need to

know, separation of duties and least privilege policies and CIA.

Metrics for improvement are defined for policies.

CIA requirements enforced, threat mitigation in place.

Using 1 or more documented, published,

and standards-based API(s)

Multiple efforts that have minimal overlap of

capability and ongoing efforts to reduce

duplicated capabilities

Information in same system, reconciled into workflow, with quality

controlUsability metrics captures

areas identified for improvement

Majority of capability automated, requiring

minimal input

at least 50% of the potential participant types (as defined by capability) exchanging with at least

75% of possible participants of those types

exchanging

consent to access specific classes of data in specific

ways (e.g., viewing, annotating, adding,

updating) for specific providers but no other

participant types

data exchange governance has quantitative

measurement in place to assess process


including representation from all stakeholders and

defined governance processes have

quantitative measurement in place to assess process


Funding source is stableLeadership is engaging and

providing direction.

5 All information from more than 70% of available systems

Process to incorporate data from remaining systems in place

Mostly real time, or on-demandIncorporable at a computable level (semantic and

syntactic interoperabilityInformation quality improvement process in place

Information completeness improvement process in place

Human readable

Only use of approved standards-based protocols

Full automation to enforce need to know, separation of duties and least

privilege policies, and CIAMetrics for security policies are

tracked , enforced and improvedCIA enforced

CIA Threat mitigation monitored with continual improvement

Use only documented, published, and standards-

based API (based on recommended standard –e.g., those documented in

ONC Interoperability Standards Advisory)

Single common mechanism used per

capability. Process in place to ensure

no further duplication

Real time information available on demand in same system, reconciled

into workflow, with quality control.

Process fully automated, manual input only for

human decision makingProcess for Continual

improvement of usability in place

at least 95% of potential participants of all

potential participant types (as defined by capability)

are exchanging

consent to access specific classes of data in specific

ways (e.g., viewing, annotating, adding,

updating) for specific participants of any type

based on quantitative metrics collected about

data governance, the governance agreements

and process are continuously improved.


including representation from all stakeholders, and

defined governance processes have

quantitative measurement and are continuously improved based on

measurements


Funding source is stableLeadership is providing

direction, incorporating as part of mission.

MITA similarities:

TA Integration & Utility: Utility TA Intermediary and Interface

TA Access & Delivery: Security & Privacy

TA Integration & Utility: Utility



BA Utility or Value to Stakeholders

TA Access & Delivery: Security & Privacy

IA Data Management Strategy

BA Standards Management: Manage Business Relationship

Information

BA Utility or Value to Stakeholders

Number of dimensions:

11

0

1

2

3Information…

Transport

Security

Transaction/Q…

Usability/…Participation

Consent /…

Stakeholder…

Sustainability

ADT Events :Current State

ADT Events

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How a Maturity Model is Used to Improve a Capability (Concluded)


The HIT Modular Functions Stack identifies the foundational components, core infrastructure, and health IT functionality needed for multiple use cases required to enable Alternative Payment Models (APMs).

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