Overview of REALD Technical Workgroup Meeting Highlights
Dive into the REALD Technical Workgroup Meeting held on October 8, 2020, discussing the importance of REALD data collection under HB4212 for addressing health inequities, reporting requirements, and the comprehensive approach needed for implementation. Learn about the data to be collected during COVID-19 encounters and the goals of utilizing REALD data to achieve health equity.
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Presentation Transcript
REALD Technical Workgroup Meeting October 8, 2020
Agenda Welcome HB4212 Background Workgroup Orientation REALD Reporting Requirements and Certified EHR Technology (CEHRT) Background Reporting REALD Wrap Up and Next Steps
REALD under HB4212 HB4212, -30 amendment adopted Required OHA to adopt rules for collection and reporting of REALD data by a healthcare provider related to COVID encounter (includes positive and negative tests, hospitalizations, death, and MIS-C due to COVID) Required a healthcare provider report the data in accordance with rules adopted under ORS 433.004 Establishes a phased approach for REALD data collection and reporting, beginning 10/1/2020 Requires, to the extent possible, data collection and reporting not duplicative States data subject to federal and state privacy laws Enforcement authority effective 12/31/2021
Importance of REALD Comprehensive collection of REALD data will allow OHA to unmask inequities and institutional structures that propel inequities. REALD data is a critical building block to eliminate health inequities in order to achieve full health equity and rectify the root causes related to racism, discrimination and oppression. With REALD data, OHA can: Use information to improve access to testing, medical care and vaccinations (when they are available) Design culturally appropriate and accessible interventions to improve testing, prevention and medical care Reallocate resources and power needed to effectively address these inequities.
REALD Technical Workgroup Convene provider partners to develop coordinated REALD implementation approaches so that maximum efficiencies are realized EHR implementation -System updates to incorporate REALD (e.g., data collection, data feeds) Reporting to public health Options for electronic reporting Start with Epic users but work to include other EHR users in the process Include vendor representatives in meetings Meet every other week for 6-8 weeks can extend Membership asking organizations to designate a couple of participants, others welcome to listen in. Likely to expand group.
REALD Reporting Requirements and CEHRT Background
What is Collected? Information must be collected from individuals during a COVID-19 encounter on race, ethnicity, preferred spoken and written language, English proficiency, interpreter needs and disability status, in accordance with the REALD standards adopted by the authority under ORS 413.161 (OHA s Oregon Administrative Rules 943-070-0000 through 943-070-0070)
Who needs to collect it? Providers subject to REALD data requirements can design their workflows to use clinic staff or others to collect and submit the REALD data to OHA
Whats a COVID-19 Encounter? An encounter is an interaction between a patient, or the patient s legal representative, and a health care provider, whether in-person or through telemedicine, for the purpose of providing health care services related to COVID-19. Health care services related to COVID-19 include, but are not limited to, ordering or performing a COVID-19 test. REALD information does not need to be submitted to OHA after every COVID-19 encounter, just if there is a disease reporting obligation
When is it collected? Reported? Providers must collect REALD data from a patient at the time of an encounter or as soon as possible Data must be reported to OHA when reporting COVID-19 information, as required in OAR 333-018-0016. COVID-19 test results (positive/negative) Hospitalizations, deaths, MIS-C Providers are not required to collect and report REALD data if data were reported to OHA within the last year (prior 365 days)
Recording Demographics in CEHRT 170.315 (a)(5)Demographics Enable a user to record, change, and access patient demographic data including race, ethnicity, preferred language, sex, sexual orientation, gender identity, and date of birth. REALD only CEHRT and REALD* Disability Race & Ethnicity Languages Although these categories overlap, the underlying data (e.g., races, ethnicities, and languages) do not always match. REALD/CDC Crosswalk: https://www.oregon.gov/oha/OEI/REALD%20Documents/REALD_CDC%20RaceEthnicityCross_Walk_2020-5-5.xlsx
Questions for group Data collection workflow: Are you planning on collecting REALD data on all patients? If so, how are you planning to only submit when there is a reportable condition? How are you planning to collect data today, and in the future? What resources would be helpful from OHA (e.g., race/ethnicity crosswalk) for customizing EHRs to collect REALD?
Provider Reporting Options Future options being analyzed Current options Enter it in the COVID-19 Reporting Portal Use Public Health approved CSV with secure transport E-Lab reporting E-case reporting
Providers - Workflows Enter in Oregon COVID-19 Reporting Portal (OCRP) Precondition Steps Precondition Steps Data may be collected on paper or may include customization of EHR to collect and store REALD data, or development of other format Workflow Workflow 1. Collect the REALD data using paper template or other template developed by the provider 2. Submit through OCRP 3. Manage documentation - Scan and load REALD data into EHR or file as per clinic s workflow/protocol 4. Retain collection dates so individuals are not asked for info again within 12 months
Provider Workflows: CSV Precondition Steps Precondition Steps Specification created by PH to include case reporting and new REALD fields (for already doing eCR, could use this spec with less required fields) Onboard with public health May include customization of EHR to collect and store REALD data, or development of other format Workflow Workflow 1. Collect patient s REALD data in EHR or other format developed by the provider 2. Extract REALD and case reporting data from own system into CSV 3. Submit CSV to public health using SFTP, Direct, or PHIN-MS 4. Manage documentation If collected on paper, scan and load into EHR or file as per clinic s workflow/protocol 5. Retain collection dates so individuals are not asked for info again within 12 months
Current CSV options: Full data: Full data: CSV file that includes REALD + case reporting, including lab reportable CSV file that includes REALD + case reporting, including lab reportable data data Complements ELR or other case reporting: Complements ELR or other case reporting: CSV file that includes REALD + patient and provider identifying data CSV file that includes REALD + patient and provider identifying data
Future Options Add REALD to ELR via Ask on Order Entry Add REALD to EiCR
Electronic Lab Reporting: AOE Precondition Steps Precondition Steps Codes created for AOE in conjunction with APHL/HL7 expert Jurisdiction-specific fields can be added in AOE segments to the payload OHA creates specification to include new REALD fields in a lab order entry Vendors need to update lab/EHR systems to collect/store REALD data Workflow Workflow REALD data are collected and entered in AOE fields in the lab order Lab reporting to OHA includes REALD Retain REALD data in EHR as well as collection dates so individuals are not asked for info again within 12 months COVID-19 case reporting is handled outside this process Gap: COVID-19 reporting of hospitalizations, deaths, MIS-C must include REALD
Electronic Case Reporting Precondition Steps Precondition Steps Coding created and balloted with HL7 for EICR There are no easy ways to add jurisdiction specific fields to the payload OHA would need to create specification or implementation guide Vendors need to update eCR feed/EHR systems to collect/store REALD data Workflow Workflow REALD data are entered in the EHR and reported to public health in an eCR feed Retain REALD data in EHR as well as collection dates so individuals are not asked for info again within 12 months COVID ELR reporting is handled outside this process
Questions for group Which path are you planning to use to report data today/near term? What s needed to get it implemented? How much time will this take your staff to implement and to train staff? For CSV submission what s needed? SFTP Site and Submitters File naming conventions Which path makes the most sense for you in the future? Feedback on ELR vs eCR options? What other resources would be helpful from OHA to support reporting REALD?
Next steps Who are we missing on this workgroup? Frequency of future meetings Epic and other vendor participation Other feedback and response to our questions send to OHA Recap: Important topics/next steps What worked well today? How can we improve? Contact: Susan Otter, Director of HIT, susan.otter@dhsoha.state.or.us Karen Hale, karen.hale@dhsoha.state.or.us
CEHRT Standards Race and Ethnicity Race and Ethnicity Over 900 900 Race/Ethnicity Options Must be able to record multiple races or ethnicities multiple races or ethnicities Must be able to be correctly roll up to the Office of Management and Budget value (i.e., American Indian or Alaska Native; Asian; Black or African American; Native Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White; and Hispanic or Hawaiian or Other Pacific Islander; White; and Hispanic or Latino Latino) Must be able to record decline to answer decline to answer A health IT developer is free to determine how the user interface is designed, including how many race and ethnicity values are displayed 170.207(f)(2) CDC Race and Ethnicity Code Set Version 1.0 (March 2000) 170.207(f)(1) The Office of Management and Budget Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity, Statistical Policy Directive No. 15, as revised, October 30, 1997 Languages Languages Over 500 language options in the standard A product does not need to display all of the language codes to meet the certification criterion. The developer has the discretion to create a default selection set or enable customization choices for providers. American Indian or 170.207(g)(2) Request for Comments (RFC) 5646, Tags for Identifying Languages, September 2009 http://www.loc.gov/standards/iso639-2/php/code_list.php
REALD Resources HB4212/REALD Provider Page: https://www.oregon.gov/oha/OEI/Pages/REALD-Providers.aspx COVID-19 Reporting Portal at healthoregon.org/howtoreport List of REALD data crosswalk to CEHRT standards: REALD/CDC Crosswalk CSV specifications are available at the Electronic Case Reporting page. To establish CSV reporting, reach out to ELR.project@dhsoha.state.or.us REALD learning sessions, including 10/14 webinar on reporting
