Family Planning Quality Improvement and Health IT

1. Family Planning Quality Improvement and Health IT FPAR2.0@hhs.gov

2. Background:HHS Office of Population Affairs and the Title X Family Planning Program

3. Title X Family Planning A grant making contraceptive service delivery program • Public Health Service Act of 1970 established the Title X Family Planning Program • Administered by the HHS Office of Population Affairs (OPA) • Mission: To provide individuals with the information and means to exercise personal choice in determining the number and spacing of their children, including access to a broad range of acceptable and effective family planning methods and services • Within HHS, OPA sits within the Office of the Assistant Secretary for Health • However, Title X budget is authorized through HRSA • $286 million in FY14 • 90% of budget must fund service delivery grantees

4. Family Planning Encounter • A documented, face-to-face contact between an individual and a FP provider that takes place in a Title X service site. The purposeof a family planning encounter is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies • Services generally include: • Contraceptive services to prevent pregnancy • Pregnancy testing & counseling • Preconception health counseling & services • Basic infertility services to achieve pregnancy • STD/HIV screening, diagnosis &treatment • Related preventive health services

5. Title X: Diverse and wide network The 10 HHS Federal Regions * 2012 FPAR service data § 2013 staffing estimates

6. Title X Service Sites Hospital and Community-based (school, university, correctional, tribal, faith) Community Health Center or FQHC Health Department (State, County, or Local) Family Planning Organization

7. Family Planning Annual Report (FPAR)

8. Current FPAR = stale, aggregate data FPAR January 2012 10Regional FPAR summaries February 2013 1 National FPAR summary November 2013 23 months later

9. FPAR 2.0 = encounter-level data FPAR 2.0 Repository Regional FPAR system Grantee Data System Site J Site A State HIE Site I Site B Site C Site H Site E Site D Site G Site F

10. Title X and Electronic Health Record Systems Adoption

11. EHR systems & Title X Sites June 2013Family Planning National Training Center Training Needs Assessment Results • 454 Subrecipients and 1101 Service Sites responded • 33% Using EHRs • 32% Planning or implementing EHRs • 35% No EHR implementation plans • Variation in certification level, vendor, and functionality

12. Reported EHR systems in use August 2013 | N=3,489 sites

13. Top Commercial EHRs by Service Delivery Type Health Dept FQHC FP group Other Private Non-Profit August 2013 | N=3,489 sites

14. Diverse network with specific local needs, multiple reporting structures Variety of tracking and reporting systems Common tools to record and exchange data Understand performance at finer granularities and in real-time National improvements in electronic data capture and exchange High individual costs to support infrastructure of data capture and exchange

15. The Way Forward: Encounter-level data from Title X service sites used for performance measurement

16. Assess EHR Use and Challenges • Promote Quality FP Care Operationalize QFP Recommendations Achieve NQF endorsement Provide performance feedback Validate 2.0 elements & measures Study EHR implementation status & systems Pursue feasibility of data exchange & transition to encounter-level data • Develop Structured FP Data Title X Federal partners Subject matter stakeholders Technical expert organizations • Collaborate with Partners Title X Federal partners Subject matter stakeholders Technical expert organizations Work within SDOs Standardize & document family planning services Promote family planning integration in healthcare FPAR2.0@hhs.gov

17. Emphasis on Quality Framework Gavin, et al. Providing Quality Family Planning Services: Recommendations of CDC and US Office of Population Affairs. MMWR Apr 2014. PMID: 24759690

18. Preparing a Path for Success Title X U.S. & Beyond

19. Comprehensive 2.0 Activities Timeline Public Comment IHE Profile Go live with 2.0 system Interoperability Showcase Connectathon Jul 2017 Apr 2015 Jun 2014 Jan 2015 2014 2015 2016 2017 FPAR 1.0 system contract Jul 2014 Sep 2017 OMB approval of current FPAR forms Jan 2014 Sep 2016 Pilot Performance Measures & Targets Apr 2014 Sep 2017 Engage OMB on 2.0 Jul 2015 Dec 2015 Jan 2016 Dec 2016 OMB review of 2.0 Jan 2014 Sep 2014 Preg Intentions Study Jan 2014 Sep 2015 JSI Data System & Feasibility Prep Contract + Query pilot? Jan 2014 Aug 2015 RFD and CQF pilot activities Market research for 2.0 Jan 2014 Apr 2016 Fund & solicit 2.0 May 2016 Sep 2016 Build & test 2.0 system Oct 2016 Apr 2017 Jan 2017 Sep 2017 Phase into 2.0 system

20. Title X Encounter Please Confirm: IHE Family Planning Profile using RFD SD-3024 Site: 6/1/2017 Visit Date:

21. Reminder of SDC

22. Family Planning Profile at 2015 Connectathon 1 Send request for FP form Pre-populate form with mappings, send back Mock Repository& Forms system 2 3 4 Display form, allow for manual corrections Send completed Family Planning Document (CDA)

23. IHE profiles: SDC vs. FP The Structured Data Capture (SDC) Content Profile provides specifications to enable an electronic health record system or other application to retrieve a data capture form and submit data from the completed form. The SDC profile utilizes the IHE Retrieve Form for Data Capture (RFD) Profile and an ISO/IEC 19763-13 Meta-model for Framework Interoperability (MFI) form compliance model. This profile also supports optional use IHE Data Element Exchange (DEX) profile for retrieving and submitting forms in a standardized and structured format. The Family Planning (FP) Profile describes the content and format to be used within the pre-population data part of the Retrieve Form Request transaction from the RFD Integration Profile. It is expected that the Form Filler and Form Manager will implement the RFD transaction as specified in the RFD, and this profile does not include any additional constraints or extensions on the RFD transactions.

24. Actor diagrams: SDC vs. FP

25. Pre-population: SDC vs. FP

26. IHE FP profile aligns  FPAR 2.0 Facility identifier Clinical Provider identifier Patient identifier Visit Date Date of Birth Administrative Sex Pregnancy History Limited Language Proficiency Ethnicity Race Annual Household Income Household Size Visit Payer Current Pregnancy Status Pregnancy Intention Sexual Activity Contraceptive Method at Intake Reason for no contraceptive method (Intake and Exit) Contraceptive Method at Exit Date of Last Pap test HPV Co-test Ordered CT Screen Ordered GC Screen Ordered HIV Screen Ordered HIV Rapid Screen Result HIV Supplemental Result Referral Recommended Date Referral Visit Completed Date Systolic blood pressure Diastolic blood pressure Height Weight Smoking status

27. Next Steps :Public Comment, Vendor Outreach, Testing, Other Pilots

28. ASK • IHE Public Comment Period ends July 5 2014 • transparent critique and review by • FP experts, including international stakeholders • EHR vendors • IT and standards experts • Recruitment of vendors to certify for FP at the January 2015 Connectathon • Scope out another pilot project on query-based model? • Participation on S&I CQF Chlamydia Use Case and pilot FPAR2.0@hhs.gov

29. Contact Information • Johanna.GoderreJones@hhs.gov • FPAR2.0@hhs.gov • @OPAHIT • http://opahit.sites.usa.gov/

30. More Details

31. Common reporting burden among Title X sites BPHC-UDS Private & fees HAB-CAREWare Title X PCMH Other Fed & State Organizational Medicaid Quality & Performance Immunizations, cancer registry, chronic disease registries, notifiable diseases, syndromicsurveillence, FundersReported Revenue Sources 2012 FPAR Public Health reporting

32. 32 Difficult to finding meaning across siloes and reporting hierarchies Community Quality Fed Fed Fed Practice State State State Provider Local Local Local Patient Practice Practice Practice HIV Family Planning Primary Care

33. Draft Performance Measures

34. Proposed NQF Performance Measures for Contraceptive Services Proportion of female clients aged 15-44 years who received contraceptive services in the past 12 months, that adopt or continue use of FDA-approved methods of contraception that are:

35. Data System & Feasibility Study Expert Working Group Proposal for New Data Elements Survey Possible Participants Evaluate for final selection 9 Grantees - N clients - N sub sites - Current data systems - Location - Interest & capacity Survey ? sites Updated Proposal • Rate each data element: • Clarity • Ability to collect • Modifications needed to systems • Report @ encounter-level - Compare proposal to current system - Estimate burden to change - Qualitative interview about processes and data systems Customization Guide

36. Subject Matter Stakeholders Current national partners: New national & international partners we’re reaching out to:

37. Beyond Title X • All interoperable solutions should be designed to have broad applicability outside Title X providers • Primary Care, Health Centers, Health Departments • Emergency Departments • International settings • Common data elements and their definitions will satisfy evidence-based performance measurements and other benchmarks • Input is welcome on data elements, definitions, and quality metrics • HIT Infrastructure developments sponsored by OPA will pave the way for other providers to adopt these tools in their own systems

38. HIT Success Stories in Title X HRSA BPHC Health Center Controlled Network (HCCN)East Providence, RI NCQA PCMH L3, HCCN, & Title XEHR system: NextGen NFPRHA Case Study of group EHR purchasing Indiana Family Health CouncilEHR system: iSalus HHS ONC Case Study of EHR implementationPortland, ORFQHC & Title XEHR system: Epic

39. Timeline for IHE Connectathon Ask FPAR2.0@hhs.gov Connectathon to Certify FP Profile Jan 26 Apr May Jun Jul Aug Sep Oct Nov Dec Jan 2015 2015 2014 Ask Vendors to Review FP Profile April2014 June 2014 Follow-up with Vendor contacts May 2014 August 2014 Vendors Comment on FP Profile June 2014 July 2014 Ask Vendors to Connectathon July 2014 September 2014 Vendor Engagement October 2014 August 2014 Vendor Development January 2015 September 2014

40. Vendor Outreach Seeking CDA technical input Support to develop and test