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CurrentCare Advisory Committee Meeting Minutes
Thursday January 29, 2015, 7:30 -9:00 a.m.
Robert Arruda
Bill Cadieux
Carole Cotter, Chair
Susan Cerrone
Jay Decosta
Diane Evans on phone
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Rebekah Gardner, MD
Suma Gaddam
Marland Hobbs
Elizabeth Lange, MD
Nicholas Oliver
Al Zannini
Amy Zimmerman
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RIQI Staff:
Charlie Hewitt
Alok Gupta
Dawn Dunn
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Welcome and introductions:
Ms. Cotter called the meeting to order at 7:30 a.m. and attendees introduced themselves.
Update on State Innovation Model (“SIM”) Grant
In the absence of a report from Ms. Zimmerman, Mr. Hewitt relayed that the State was awarded $20M for the
whole program. RIQI received $2.5M over a 4-year period, although we hope that some of that will be frontloaded. $1M is dedicated to our consumer portal, CurrentCare for Me, and $1.5M will be dedicated to the
Provider Directory. 2015 will be dedicated to planning activity.
CurrentCare (CC) Dashboard Update - C. Hewitt
The dashboard hasn’t changed very much as we’ve had to carry many 2014 projects into 2015. More
information will be available at our next meeting.
CurrentCare Metrics:
Enrollment: We have 442K enrollees in CC with growth of 4K per month. Monthly growth is reduced by half
since we are targeting lower enrollment in light of our need to shift staff resources to some huge initiatives that
we face in 2015. Of nearly 97M transactions offered, 31M were posted, and the match rate is around 40%.
Hospital Alerts – 194 sites get admission/discharge notices (ADTs). In December we sent 9,000 Alerts to
practices sites (these go to subscribed physicians who have requested notification on their patients)
Viewer – 295 sites are using the Viewer
Projects in the works:
Complete
 MOLST (Medical Order for Life Sustaining Treatment, written by a physician) - We were asked to get CC to
accept these, so we have done so; but there’s uncertainty around whether they are up to date because they
can be revoked simply by striking through the paper original. Dr. MacDonald (at DOH) said they need more
policy development, so we will hold up on production.
 Query & Retrieve Document (CCD/Continuity of Care Document) Exchange - We enabled the first doc
exchange with Blackstone Valley Community Health Center on their NextGen system. They see a button on
their EHR screen that allows them access to existing records in CC formatted as a CCD. NextGen brings in
the CCD as a big piece of text; work is ongoing with Athena to give them specific sections within the CCD.
A new standard (FHIR) enables you to call up a piece of a document rather than the whole document.
Similar projects are in the works with Lifespan, Care New England, and CharterCare.
Active
 Care Management Alerts – this is another HIE (using the infrastructure that supports CC but independent of
CC) that is able to accept any patient’s records (with Business Associate Agreements in place) and alert on
anyone in a provider’s panel. We expect to go live with this during the second quarter. After we have
Master Services Agreements in place with hospitals that provide ADTs, then physicians can give us a panel
of patients on whom they wish to receive alerts. Ms. Gaddam asked how these differ from the regular Alerts
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we send now, and Mr. Hewitt explained that this applies to all patients, independent of whether they are
CurrentCare consented.
EKG images will be available in CC, beginning next month
CurrentCare For Me portal is in soft launch internally, but we are holding off on the external launch while
Intersystems works out some bugs. Also, more discussion is needed around who gets access and why, since
we want to avoid treading on the provider/patient relationship. Ms. Cotter added that if we found a way for
patients to go to one place to access their info (this involves bi-directional interoperability), then we’d solve
this problem for the state. Currently patients are asked to sign into a portal everywhere they see doctors.
Mr. Zannini asked if we could partner with practices for a shared resource that would avoid duplication of
effort. Ms. Cotter replied that federal requirements are that everyone has a portal, so these challenges may
demand another year of planning.
Mr. Hewitt informed the Committee that Jen Bowdoin, who led the Portal initiative, has left RIQI, and we
are in the process of hiring another consumer-focused manager. In response to Ms. Gaddam’s question about
what work other HIEs have done in this area, Mr. Hewitt replied that he hopes to learn more about that at this
weekend’s conference of the Office of the National Coordinator in D.C.
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Provider Directory: RIQI is using the first version, and we are awaiting software revisions regarding master
data management. The next version will be available for testing in July, and the data model will include the
insurance plans that providers participate in. HSRI is interested in relying on RIQI to provision the PD. The
data model is very tricky (inconsistent input data), but we have the right people to make it work.
Patient Summaries: we have projects to implement CCD feeds from Care New England, CharterCARE, So.
County and Lifespan -- all are expected to be running by mid-year or earlier.
Update on the 2015 Operating Plan – Dawn Dunn
Ms. Dunn explained that we used two documents to develop the Operating Plan:
 the Roadmap of interdependent elements needed to realize ROI (additional data, enrollment and utilization)
 the Strategic Plan with four goals: expanding CC and the Regional Extension Center; developing brand;
levering assets and sustaining RIQI.
We mapped 10 initiatives at a total expense of $8.8M. These 10 initiatives yielded 72 projects with cost
breakdowns as follows:
- Investment $535K
- Expansion $2M
- Ongoing $3.5M
- General Operating $2.8M
Ms. Dunn reviewed the initiatives to expand data and increase utilization, one of which involves acquisition of
data from eClinical Works. Dr. Fine is especially interested in eCW and wants interoperability increased. The
eHealth Exchange initiative will bring us data from the VA beginning in March. Mr. Hewitt clarified that the
VA will use the eHealth Exchange to transport CCDs; then we will have to repeat the testing protocols for any
other hookup like Kaiser, Mayo, etc. Ms. Dunn also reviewed the provider-facing activities for CC Adoption &
Use which include:
- adding 40 Alert sites and 50 Viewer sites
- linking the Prescription Monitoring Program to the Viewer. Dr. Fine has asked for this link to facilitate
pharmacies’ reporting Schedule 2 & 3 medications to the State. Use of the data in the PMP is beyond the use
permitted through CC, so we have work to do here; but we are able to provide the link. Questions arose about
what’s viewable through Surescripts (nearly all pharmacies are in Surescripts) vs. CC (only consented patients
are in CC). Gaps in Surescripts data are primarily due to lack of participation by Walmart and Stop & Shop.
Ms. Dunn reviewed the Revenue Generating Initiatives with products that we hope to sell to providers:
- Provider Directory – to include partnership with HealthSource RI
- Business Services Portfolio – alerts on full patient panels
- Analytics - intelligent alerts and care management dashboards
- Provider Services – education and assistance with Meaningful Use
Consumer-facing initiatives include:
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develop new CurrentCare for Me services, including mobile apps
online enrollment strategies to increase the more cost-effective online enrollments
We anticipate that, should we receive funding through the Transforming Clinical Practice Initiative grant, we can
re-prioritize some projects that we had to postpone due to lack of resources:
- HIE expansion: additional ADT/CCD feeds and diagnostic imaging
- Provider services: incorporate Meaningful Use Stage 2 certification in CurrentCare for Me
- Consumer facing: launch CurrentCare For Me portal and related call center
- Additional enrollments
Ms. Cotter stated that a discussion is needed regarding Bradley Hospital blocking ADT feeds. This is
complicated due to the sharing of substance abuse data. Ms. Cotter will verify that radiology images will be
included in the Epic go-live (it was deferred in the RIQI Operating Plan).
Provider Directory (PD) Update – C. Hewitt
We’re working with Intersystems to develop this product and, although some time has passed, a fresh start is
needed on the technology. Functional specs are well determined except as relates to the insurance plans. Some
activity is going into making sure this model works for all the carriers and tiers. We’ll start with the subset of
what HealthSourceRI accepts. The new version will store all data we need, ACOs, and then the pair
relationships. This is a large commitment by Intersystems and it will be a bit delayed; but we will have the best
approach when we launch this year.
Discharge Summaries – C. Hewitt
We will implement a new data type which is a deliverable in our contract with Health. We want to make sure
that we understand the implications of bringing this data type into CC. The Care Record Summary is a CDA
document type -- similar to a CCD, but includes the Care Plan -- which facilitates reporting from disparate
hospital systems. Discussion ensued about similarity to the State’s Continuity of Care document, which was
created because many healthcare facilities don’t have electronic systems.
Core Measure 15 of Meaningful Use-2 addresses the summary of care record, which must include all those items
that are in a CCD. Ms. Cotter added that if it’s a Core Measure, then our vendors will have the capability to
produce it. Discharge summaries used to be dictated; now physicians can build it in the EHR. They have 30 days
to deliver it. This may not work well, especially for skilled nursing facilities.
Mr. Hewitt posed some questions to the Committee:
1. What’s the difference between After Visit Summary (AVS) and Care Record Summary (CRS)?
Ms. Gaddam replied that the AVS pulls items from the record, so everyone’s is different. The one from Epic
is a text document. A standard AVS would be good; we should look at Cerner’s. What about in terms of
discrete data? Ms. Cotter replied that Lifespan’s AVS fulfills the state’s requirement with the COC. We
need to answer this question for all hospitals. HealthCentric already did a study of the COC vs. the CCD,
but this is more complicated. Mr. Hewitt suggested that we do a comparison on Lifespan’s formats, but Ms.
Cotter instead proposed sending RIQI a test patient AVS and the CCD (Mr. Hewitt will email her to request
this) and we’ll ask the same from everyone here. Find out if HealthCentric’s study has gone anywhere;
make it a starting point.
2. Does your system support the CRS standard? Is it implemented? Ms. Cotter said that our system has to
support the CRS standard in order to attest; we have teams looking into getting it populated.
3. What are the implications?
Dr. Gupta stated that although this is a project we’ll do this year, part of the discussion is from the hospital
prospective – whether we’ll get longitudinal (the entire record every time) or episodic. Today CurrentCare
only takes longitudinal; should it take only episodic? It would be important to understand the viewpoint
from your systems before making any change.
Ms. Cotter announced that she will not be able to attend the March meeting, so Ms. Gaddam was asked to Chair
in her stead. We wish Ms. Cotter a successful conversion to Epic.
The meeting was adjourned at 8:55.
Submitted by,
Lori Maciel
Next meeting is March 26, 2015