Summary of Change

Reason

Impact

Use Case 1: NaphCare currently maintains 2015 CEHRT status for TechCare v5.0.  Application updates within v5.0 which enable functionality identified in Use Case 1 (Transitions of Care, Direct Project) were only fully approved by our selected HISP in October of 2022.  The application update was immediately made available to all customers, but only deployed by a small number beginning in November 2022.

NaphCare’s selected HISP for Direct Messaging was met with resource constraints throughout 2022 and completed our final approval process much later than anticipated. In addition, because the functionality of Transitions of Care and Direct Project were only applicable to a small subset of customers, and those customers did not have immediate partners needing information sharing via this method, the release was not widely adopted in practice.

This delay in deployment caused NaphCare to be unable to perform the testing described in this use case.

Use Case 2: Data export via C-CDAs maintained limited deployment in practice given the lack of partners where the information sharing was requested.  We maintained some success with real world deployment to HIEs in select states, however those HIEs requested now retired versions of the C-CDA standards. 

NaphCare’s corrections specific care setting limits prospective partners in the real-world use of Data Export via C-CDA.  Where partnerships did exist, it was with HIEs that had not fully adopted the revised standards for C-CDAs and NaphCare was required to use older versions not meeting the criteria of the latest revision/certification.

This prevented NaphCare from being able to document and measure the success of this measure in a real-world use case.

Use Case 3 & 4: The corrections-specific industry that is our care setting did not see direct correlation with this use case and we were unable to identify participating partners to complete this study. 

Although functionality exists for Record and Export, Application Access and is available in production environments, we were not able to find willing participants.

This prevented NaphCare from being able to document and measure the success of this functionality as defined in Use Case 3 and Use Case 4.

Measurement/

Metric

The intended goal was to capture the total number of offsite patient visits created during the test period and correlate that to the number of C-CDAs created and transmitted via Direct Edge Protocol Transmission using our selected HISP.

Expected

Outcome(s)

The expected outcome was an 80% match between offsite visits and transmitted C-CDA for those patients going to a partner hospital which accepted the C-CDAs via Direct Edge Protocol Transmission.

Outcomes

No outcomes were captured as testing was not performed.  We believe this lack of significant outcome was a result of poor use level. See additional information under Changes to Original Plan section above.

Challenges

Encountered (if Applicable)

Challenges experienced are documented above.  NaphCare has established a partner for this specific Use Case and has started a pilot deployment as of 2/1/23.  Our intent is to complete this test as a part of CY23 testing.

Measurement/

Metric

The intended goal was to capture the rate of utilization for data export to centralized repositories (i.e. HIEs) for all patients released form correctional institutions.

Expected

Outcome(s)

We expected to see at least 1 C-CDA (release/discharge) created and successfully submitted for every patient within a region supported by an integrated HIE. 

Outcomes

While we do maintain integration with HIEs in the same region as partner facilities using TechCare, the technology used for creation of the C-CDAs is a retired version of the standard.  The HIE has not fully adopted the latest C-CDA format standards based on the CURES update.  That said, we were able to validate submission of 1 C-CDA per released patient during the test period.  

Challenges

Encountered (if Applicable)

We expect to update this integration to use the latest version of C-CDA standards in CY2023 making this test/Use Case a valid metric for real world testing.

Measurement/

Metric

The intended goal was to capture successful exports of CQM data which would have been entered in the TechCare system during the course of care of a patient.

Expected

Outcome(s)

We expect all CQM data elements entered into the system directly correlate with the export of that data across the same time period.

Outcomes

While the ability to enter the specific CQM data is available in the system and its ability to be exported is validated by Live Testing as a part of CEHRT processes, its utilization real world was very limited.  No viable outcomes could be measured. We believe this lack of significant outcome was a result of poor use level based on the corrections specific care setting.

Challenges

Encountered (if Applicable)

Given the unique correctional care setting, not all typical CQM data elements are captured through the course of care.  Further, other data elements that might not be considered “standard” in other care settings, are captured in the correctional care setting. To complicate the focus of collection, there are specific auditing bodies (i.e. National Commission on Correctional Healthcare and American Correctional Association) which drive CQM data in jails and prisons and their standards do not always overlap with CQM data elements.  As a result, clinical care teams tend to focus collection on the elements specific to corrections.

Measurement/

Metric

The intended goal with this Use case was to confirm that those who attempted to access the API were granted such access securely assuming they were authorized to do so.  Then, for those who validated and successfully queried for patient data, that appropriate patient data was returned in the right format.

Expected

Outcome(s)

It was expected that 50% of API access attempts were successful, considering that ill intent actors attempted to access the API without proper authorization.  And that 80% of successful connections properly returned C-CDAs

Outcomes

We were not able to achieve any meaningful outcomes as the technology was not requested by or adopted by any customers as a means of sharing patient data.  We believe this lack of significant outcome was a result of poor use level.

Challenges

Encountered (if Applicable)

This method of data exchange was viewed as overly complex by partners.  Based on our care setting of corrections, our partners requested HIE integration or direct connections using the Direct Edge Protocol technologies.

Milestone

Care Setting

Date

Finalization of all Application Functionality/Modules including data collection mechanisms for Use Case 2, 3.

Correctional Healthcare (Jails, Prisons)

December 2021 (TechCare v5.0 2021/R6)

Finalization of all Application Functionality/Modules including data collection mechanisms for Use Case 4.

Correctional Healthcare (Jails, Prisons)

June 2022 (TechCare v5.0 2022/R3)

Finalization of all Application Functionality/Modules including data collection mechanisms for

Use Case 1.

Correctional Healthcare (Jails, Prisons)

December 2022 (TechCare v5.0 2022/R6)

Attempted engagement with partners across all Use Cases

Correctional Healthcare (Jails, Prisons)

July 2022 – December 2022