Oregon Providers Scramble to Meet New Demographic Reporting Requirements
Public health leaders stress that without accurate demographic data, it is difficult to ensure access and equity in COVID testing, treatment and vaccination. In Oregon, health systems have scrambled to comply with a new law that requires them to report Race, Ethnicity, Language & Disability data on COVID-related encounters to the Oregon Health Authority (OHA).
During a Feb. 4 meeting of the Oregon Health Information Technology Oversight Council (HITOC), OHA officials described the goals of the law (HB4212) and steps it has taken to help provider organizations with implementation. Several health system stakeholders talked about the challenges around rapid implementation of Race, Ethnicity, Language & Disability (pronounced “Real-D”) reporting requirements.
A 2013 Oregon statute requires OHA to develop data collection standards. Belle Shepherd, OHA’s external relations lead on HB4212/REALD, explained that with REALD data, the state can address identified inequities through policy and legislative efforts; reallocate resources and funds needed to effectively address these inequities; and design culturally appropriate and accessible interventions. The standards were recently updated, and the state rules require review of standards at least every two years to address changing demographics and evolving research, she said. Tribal consultation is ongoing. The state may add questions based on those conversations in 2021. Sexual Orientation and Gender Identity (SOGI) data is not included in REALD but may be required in the future.
Phase 1, which went into effect Oct. 20, 2020, included hospitals (except for licensed psychiatric hospitals) providers within a health system, and providers working in an FQHC. It excludes clinical laboratories until Oct. 1, 2021. Phase 2, starting March 1, 2021, includes healthcare facilities and healthcare providers working in or with individuals in a congregate setting. Phase 3, starting Oct. 1, 2021, includes all providers, and all must report using an electronic method.
‘A daunting task’
Three health system stakeholders described their experience trying to rapidly implement the requirement in their EHR systems. Michele Strickland, director of informatics for Asante, a three-hospital health system in Southern Oregon, called it a “daunting task.”
She said her organization was not aware this requirement was coming before the deadline hit. They started a project team with an Epic analyst, registration, process improvement and patient engagement officials. Strickland said Asante also worked with other Oregon health systems using Epic to develop a workflow so that data could be shared through its Care Everywhere platform. They built a questionnaire for use with all patients, not just COVID encounters. Asante went live at the end of the year. It required focus of staff during a time when there were many internal requests for COVID-related work flow changes. “It was not an easy task,” she said. Asante and its Community Connect partners have submitted around 41,000 REALD forms to date, she said.
They have had 2,400 of them completed through the MyChart portal. When they are done at registration in person, it has increased registration times 1 to 2 minutes, she said. “That may not sound like a lot, but it adds up quickly and creates bottlenecks. We need to work through doing that in a more timely fashion.” She said the patient registration team also can find it uncomfortable to ask intrusive questions. For volatile patients, it increases their irritability, they report.
Jenna Wilson Crain, N.D., M.S.N., M.A.A.T., director of clinical outcomes and CAM services at Neighborhood Health Center, a midsize FQHC in the Portland metro area, said her organization started designing their own workflow for REALD before they realized that their EHR provider, OCHIN Epic, was creating its own smart form the Neighborhood Health Center could use to collect that data. “We scrapped our own build and used their smart form,” she said. “Once we received it, we put together a work flow to standardize that data collection to collect it at the time of visit. They had started manually inputting data in an OHA portal, but that was time-consuming, she said. Now OCHIN Epic does batch reports of REALD data once a week to OHA on their behalf.
Colette Alvey, an IT system analyst with Northwest Human Services, an FQHC in Salem, said they also only found out about the requirement shortly before the deadline. She said it was important the implementation team included someone from all areas: clinical, reception, IT, and billing. They have been entering the data into the OHA website portal. manually and scanning it into the patient chart in their NextGen EHR. Working with NextGen they have made updates so that staff members enter data into the template instead of scanning it in. Now they are working on automated uploads rather than having to type data into the OHA portal. Alvey said they also now have access to this data internally to run their own reports on it as needed.
OHA officials noted that the ability of providers to customize their EHRs will vary, and there is a tension between state-based standards that will evolve and EHR customization, which can take a while. Also, beyond the technology, workflow and culture changes are needed to operationalize REALD.