Data Exchange Explainer Series

Webinar 1: Overview of Data

Exchange

February 16, 2023

© Copyright 2021 by California Medical Association 1

David T. Ford

• Chief Executive Officer, CMA

Physician Services

• VP, Health Information

Technology

• Previous: Executive Director,

CalHIPSO (Regional Extension
Center for most of California)

© Copyright 2021 by California Medical Association 2

We Want to Hear from You!
• Your questions and feedback during and after this presentation help
inform the rest of CMA’s Outreach and Education effort

• Options:

• Enter questions or comments into the chat box

• Post webinar survey

• Email questions to DxFQuestions@cmadocs.org

• Email survey (coming soon!)

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2023 Data Exchange Explainer Series
FREE TO ALL!

• Webinar 1 – TODAY. Overview of Data Exchange

• Webinar 2 – April 13. Data Exchange Policy & Legal Environment

• Webinar 3 – June 15. Deep Dive into the Data Exchange Framework & Data
Sharing Agreement and What Your Practice Needs to Know

• Webinar 4 – August 15. How to Optimize Your Practice's Current EMR for Data
Exchange

• Webinar 5 – October 12. How to Optimize Your Practice's Workflows for Data
Exchange

• Webinar 6 – December 15. Incentives and Other Funding Opportunities for Data

© Copyright 2021 by California Medical Association 4

Agenda
• What is Data Exchange?

• Data Exchange Technologies

• Health Information Organizations
• National Networks
• Other Technologies

• “Rules of the Road” – HIPAA, CMIA, etc.

• The CA Data Exchange Framework (DxF)

• Question + Answer

• (Post-Webinar) Survey
What is Data Exchange?

6
What is “Data Exchange?”
• Traditional Term: “Health Information Exchange” or “HIE”

• ONC: “[HIE] allows doctors, nurses, pharmacists, and other health

care providers and patients to appropriately access and securely
share a patient’s vital medical information” (emphasis added)

• More Modern Term: “Data Exchange”

• Similar to HIE, but inclusive of non-medical forms of data, such as

housing, food insecurity, and the like

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Important Terminology

• “Data Exchange” or “Health Information Exchange” is a verb!

• The action of exchanging patient information

• The noun is “Health Information Organization” or “HIO”

• An HIO is an entity that facilitates HIE

• Examples: Manifest Medex, LANES, Santa Cruz HIO

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Three Main Types of Data Exchange
• Directed Exchange – ability to send and receive secure information
electronically between care providers to support coordinated care

• Query-Based Exchange – ability for providers to find and/or request

information on a patient from other providers, often used for
unplanned care

• Consumer-Mediated Exchange – ability for patients to aggregate and

control the use of their health information among providers
Source: https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-hie

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Ex. 1: Directed Exchange
• Dr. Garcia, an IM physician, is performing a
routine check up on patient, Frankie

• Dr. Garcia notices some irregularities, and

refers Frankie to Dr. Williams, a cardiologist

• Using XYZ HIO, Dr. Garcia sends Frankie's

complete medical history (labs, x-rays,
medications, etc.) to Dr. Williams

• Using this information, Dr. Williams begins

working on a diagnosis and treatment plan

• By the time Dr. Williams sees Frankie, they

save time and effort on getting her well

© Copyright 2021 by California Medical Association 10

Ex. 2: Query-Based Exchange
• Dr. Wang is an Emergency
physician in a busy ER in an urban
center

• Dr. Wang is called to treat an

unconscious patient

• Using information taken from the

patient’s driver license, Dr. Wang
is able to perform a query using
Carequality

• The HIO query returns the

patient’s complete medical history

© Copyright 2021 by California Medical Association 11

Ex. 3: Consumer-Mediated Exchange
• Jennifer is moving to a new city for
work

• Before leaving, she downloads all of

her health data onto an app on her
smartphone

• When Jennifer arrives in her new city,

she safely sends that data to her new
doctor

• Jennifer’s new doctor can begin

working with Jennifer right away,
without having to collect her health
history

© Copyright 2021 by California Medical Association 12

Data Exchange Technologies

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Data Exchange Technologies
• Health Information Organization (HIO)

• Sometimes incorrectly called an “HIE”

• Connect physicians (and others) using multiple EHR systems

• Examples: Manifest Medex, LANES

• National Networks

• Connect physicians (and others) using EHR-based systems

• Example: Epic Care Everywhere, Carequality

© Copyright 2021 by California Medical Association 14

Other Technologies
• Direct Trust Email
• Highly secure email system used for sending PHI

• App-based Exchange
• Smartphone apps where patients store and share their data

• Community Information Exchange (CIE)

• Used for exchanging non-medical information

• “Private HIE”
• A proprietary system used by a medical group, IPA, hospital, or other
similar enterprise to exchange data within their system

© Copyright 2021 by California Medical Association 15

NOT Data Exchange
• Faxing of Patient Records

• Unsecured Email - *Should

NOT be used!*

• Sending patient records by

medical courier

• Calling other physicians to

discuss a patient case

© Copyright 2021 by California Medical Association 16

“Rules of the Road”

17
Federal Laws and Regulations
• Health Insurance Portability and Accountability Act (HIPAA)

• Enforced under the HIPAA Privacy and Security Rules

• Defines “Covered Entities,” and sets forth standards for protection

of patient health information

• 21st Century CURES Act

• Defines “Information Blocking”

• Expands patient access to information, including clinical notes

• Final Rule lays out 8 exceptions

© Copyright 2021 by California Medical Association 18

California State Laws
• Confidentiality of Medical Information Act (CMIA)

• CA Civil Code 56

• Provides patient protections above HIPAA

• Defines “sensitive information”

• Patient Access to Health Information

• Health and Safety Code 123148

• Allows physicians to withhold some information in the interest of

the patient

© Copyright 2021 by California Medical Association 19

CA Data Exchange Framework

20
The California Data Exchange Framework
(DxF)

For More Information: https://www.chhs.ca.gov/data-exchange-framework/

© Copyright 2021 by California Medical Association 21

DxF: What it is. What it is not.

• What the DxF is: A governing body and legal

framework intended to facilitate the exchange of
health and human services data

• What it is NOT: A statewide health information

exchange

© Copyright 2021 by California Medical Association 22

Components of the DxF

1. Governance Entity – A “Covered California-like” body that will

administer the Data Sharing Agreement (DSA) and update the
Policies and Procedures as needed
https://www.chhs.ca.gov/wp-content/uploads/2022/05/5_CalHHS_DxF_Governance_Draft_05-12-
2022.pdf

2. Single Data Sharing Agreement (DSA) – Common data sharing

agreement that all organizations are required to execute
https://www.chhs.ca.gov/data-exchange-framework/#stakeholder-advisory-group-past-meeting-
materials

© Copyright 2021 by California Medical Association 23

CMA DxF Outreach and Education Campaign
• Supported by a grant from California Health and Human Services
Agency

• Webinar Explainer Series

• Number 2: “Policy and Legal Environment”

• Sign Up Here: https://www.cmadocs.org/events

• Online Resource Center (coming soon!)

• Physician Learning Collaborative (coming soon!)

© Copyright 2021 by California Medical Association 24

CMA Publications and Activities

• DxF Page on the CMA Website:

https://www.cmadocs.org/digital-health/dxf

• Data Exchange Framework Fact Sheet and FAQs

• Successfully advocated for $50 million for technical

assistance for small/safety net practices

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SPRING 2023 CONFERENCE
Health IT: Powering Value-Based Care
Join thought leaders from across California and the nation to explore the intersection of technology
and payment reform. Guest speakers include:

Medell Briggs-Malonson, M.D.

Micky Tripathi, Ph.D. Mandy Cohen, M.D. UCLA Chief of Health Equity,
National Coordinator for Health Aledade Executive Vice President Diversity and Inclusion
Information Technology and Chief
e Executive Officr

Visit cmadocs.org/healthIT to register and learn more!

QUESTIONS?

© Copyright 2021 by California Medical Association 27

 Thank You
DxFQuestions@cmadocs.org

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