@Steven, we were told yes.

Meeting materials, including the chat log, will be made available on the DxF website after the meeting. https://www.chhs.ca.gov/data-exchange-framework/

Can/should we align this list with the definition of Clinician under federal regulation, e.g., for purposes of Information Blocking prohibitions?

I also suggest that we consider including language to clarify that genomics laboratories are Laboratories under the rules.

OHCA legislation defined physician organizations and seems to track somewhat with your characterization of physician practices with greater than 25 physicians. This may be a useful reference.

Re Bill's comment about physician practices with >25 physicians (providers?), I hope that we do not end up excluding/excusing smaller practices from requirements to participate fully in the DxF over time. It is true that smaller practices may require additional support and/or time in order to participate and comply.

To Steven's point, please see https://www.chhs.ca.gov/data-exchange-framework/#dxf-data-sharing-agreement-and-policies-procedures for the Policies and Procedures developed prior to today's meeting.

Strongly agree that Consent Management and Authorizations should be prioritized particularly because exchange of Part 2 data (with appropriate auth) was added to P&P#4

List of existing P&Ps: https://www.chhs.ca.gov/data-exchange-framework/#dxf-data-sharing-agreement-and-policies-procedures

7/1/22 P&P re Permitted, Required and Prohibited Purposes: https://www.chhs.ca.gov/wp-content/uploads/2022/07/6.-CHHS_DSA-Permitted-Required-and-Prohibited-Purposes-PP_Final_v1_7.1.22.pdf

@Courtney, is this the time to bring up other ideas for P&Ps not explicitly on this slide?

@Mark. Yes. I think we're just starting this part of the discussion. Please chime in!

Data quality should be coordinated with HCAI, given that they will issue regulations on data submittals under the Healthcare Payments Database, right?

See https://www.chhs.ca.gov/wp-content/uploads/2022/07/9.-CHHS_DSA-Individual-Access-Services-PP_Final_v1_7.1.22.pdf for the P&P on individual access.

The larger Health IT community has embraced the use of the term "individual" in lieu of "patient".

Individual access also includes access by family members and other caregivers requesting information/data exchange on behalf of a patient.

I second Elaine's thought. This would be helpful.

Steven, legally family members and caregivers are not considered personal representatives - entitled to the information - unless they are legally authorized to make medical decisions for the patient.

+1 Deven. This needs to be made clear. Of course many family members and other caregivers ARE authorized in this manner. Lots to clarify here, and/or point to controlling HIPAA or other regs.

Once a competent adult has access to their information, they can then share it with whom they want -- but to grant access generally to caregivers raises a number of potential issues. But of course we can discuss this further when we get to further fleshing out individual access P&Ps.

Apologies, I need to excuse myself for a minute - be right back.

Agree, agree, agree about targeted support and TA for CBOs and SSOs.

They never had an incentive program to help them build capacity and workflows.

You do entertain public comment/question at the assigned times. There is that process.

It is worth noting that there are 61 public attendees at this meeting, which is a testament to the level of general interest in this important work.

There is a tremendous amount of work going on at the federal level, mostly by ONC and CDC, to improve interoperability between Public Health and providers. CA has not been actively involved in those discussions, beyond representation from provider organizations. Should we have CDPH more actively involved in this DxF work effort so that we can address their identified needs and align with federal efforts?

Slides from last week's Data Exchange Framework webinar are available on the CalHHS website at: https://www.chhs.ca.gov/wp-content/uploads/2022/09/CalHHS-CDII-DxF_Webinar-1_September-13-2022_Final-1.pdf. Information on future webinars will also be made available on the website.

ONC is expected to issue a new draft regulation in October (more or less). May present new thoughts about needed P&Ps.

Here is a helpful fact sheet regarding the federal healthcare provider definition: https://www.healthit.gov/cures/sites/default/files/cures/2020-08/Health_Care_Provider_Definitions_v3.pdf

@Tom: Yes

VERY helpful Information Blocking FAQs that have been posted by ONC: https://www.healthit.gov/faqs

You might note in Q&A the suggestion to include CBO participation in these meetings. We have asked some of our contacts for recommendations in that space, asked our IAC members earlier this week, and would extend that ask to our Subcommittee members. Please send suggestions you may have to cdii@chhs.ca.gov.

ONC has also offered this most recent accounting of the Information Blocking complaints that they have received through their web site: https://www.healthit.gov/data/quickstats/information-blocking-claims-numbers

There are costs to establishing and maintaining connectivity so some DSA participants may feel that no ability to cover those costs may be an undue burden or "tax"?

There is a tremendous collection of resources available from the Sequoia Project to support compliance with Information Blocking prohibitions: https://sequoiaproject.org/resources/information-blocking/

The Content part of the Content & Manner exception essentially expires next month when the scope of EHI expands from USCDI V1 to All EHI included in the DRS.

I apologize but I will need to drop at 11:15. In the future, I will be able to clear my calendar for the full meeting but for this one, the limited lead time made that problematic. Thanks for including me in this important discussion.

Auditing, monitoring and enforcement may provide another opportunity to align with and/or leverage Federal efforts regarding Cures Act compliance. As there is not statutory authority for State level enforcement efforts, we might refer compainants to the federal reporting processes as applicable. Specifically for Information Blocking, complaints can be submitted at: https://inquiry.healthit.gov/support/plugins/servlet/desk/portal/6

I concur with Morgan, with the PRA this could be a risk of exposure for departments.

great point Jason

See https://www.chhs.ca.gov/wp-content/uploads/2022/07/4_CHHS_DSA-Data-Elements-to-Be-Exchanged-PP_Final_v1_7.1.22.pdf for the health and social services information that DSA signatories must provide access to or exchange.

Clinical Labs are ALREADY required to respond to these queries under federal Information Blocking prohibitions. See fact sheet noted above regarding the healthcare provider definition: https://www.healthit.gov/cures/sites/default/files/cures/2020-08/Health_Care_Provider_Definitions_v3.pdf

"The term 'health care provider' includes … a laboratory..."

This transaction could also be triggered by an event in the system generated by Dr Smith. Such as a referral. Wouldn't each vendor have to develop the ways to trigger the transactions?

Many physician organizations mention to me that they cannot access their patient's ADT information with local hospitals. Other organizations that are within the integrated system do not have this problem. The nature of the problem is elusive at present, but it is critical that these connections for exchange of ADT information between physicians and hospitals gets handled during this DxF process.

Would we have authority to prioritize transactions?

With referrals, there has been a thorny problem identified in the national discussion regarding when a Treatment relationship begins. Is this at the point that a referral request is received for evaluation, at the point that the patient is registered or scheduled in the receiving provider's system, or at the time of patient arrival for care. There is often a need to evaluate clinical data when determining whether a patient will be see at a referred to provider/organization. This also comes up when a patient enrolls in value-based care and the responsible organization wants/needs to collect clinical data on new enrollees to identify high risk individuals before these folks have been scheduled or presented for care.

Broadcast Request for HI is a very important transaction which should be maintained in our scope. This is a common clinical scenario. It is also common that a competent patient presents for care and does not know where there data may be; hence the significant value of Record Locator Services.

Wouldn't we have to identify the data each transaction would contain, assuming standard transaction sets.

Wouldn't they also need to be tied to consent tracking in the provider's application before the transaction is sent or before a response is provided?

Perhaps we could incorporate into our state-supported/mandated directory service support for these sorts of pub/sub transactions.

I do feel strongly that Pattern 5 is made mandatory.

@Rim, consider whether individual request for information, individual direction to transmit data, and individual contribution of PGHD are parts of these four patterns, or are new patterns.

Great meeting. Thanks!