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Indiana Health Information Exchange The Indianapolis and Beyond ...

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  • <number>
  • Driver20072006
    Improving Quality94%91%
    Patient Safety80%82%
    Inefficiencies Experienced by Providers61%70%
    Rising Healthcare Costs59%56%
  • So services being provided still are high in results / document delivery
  • So services being provided still are high in results delivery
  • <number>
    SO WHY START AND HIE
    The goal is to ensure the right information gets to the right provider at the right time about the right patient because…..
    Safety: Medical errors take nearly 100,000 lives each year.
    Cost: Healthcare spending in U.S. is at $1 trillion. By 2050, that number rises to $5 trillion.
    Nearly 60% of Indianapolis-area patients visit more than one area hospital system over a period of several years.
    What is needed to start a state-level or regional level HIE in South Dakota - what is needed for success?
  • This clearly articulates the relationship with IHIE and regenstrief.
    It also reflects the morphing of customer service to incorporate the entire spectrum of services by IHIE.
    Reinforces our positioning of providing information when it is needed most – at the point of care. And that everything that we do involves patient care and safety.
  • Our charter is to support the existing healthcare community within Indiana, so the non-profit structure was best suited for this purpose as a non-threatening, non-competing entity. 
    IHIE is governed by a Board of 16 organizations representing the major healthcare stakeholders in Indiana. The Board members are chosen to allow for multiorganizational representation of health care stakeholders and to draw upon industry experience. The Board’s responsibilities and policies are set forth in the bylaws. The hardest work was establishing trusted organizational models, consensus on goals and requirements, and crafting participation agreements that met the legal, clinical and ownership requirements of each party.
    We have advisory groups that provide guidance and expertise to assist with future development of the DOCS4DOCS system.  Membership is multi-disciplinary including representation encompassing technical, clinical, customer service and users.  The DOCS4DOCS system currently has the following advisory groups made up of members from our charter hospitals. 
  • Our charter is to support the existing healthcare community within Indiana, so the non-profit structure was best suited for this purpose as a non-threatening, non-competing entity. 
    IHIE is governed by a Board of 16 organizations representing the major healthcare stakeholders in Indiana. The Board members are chosen to allow for multiorganizational representation of health care stakeholders and to draw upon industry experience. The Board’s responsibilities and policies are set forth in the bylaws. The hardest work was establishing trusted organizational models, consensus on goals and requirements, and crafting participation agreements that met the legal, clinical and ownership requirements of each party.
    We have advisory groups that provide guidance and expertise to assist with future development of the DOCS4DOCS system.  Membership is multi-disciplinary including representation encompassing technical, clinical, customer service and users.  The DOCS4DOCS system currently has the following advisory groups made up of members from our charter hospitals. 
    QUARTERLY MEETINGS
  • Focus on the fact that IHIE’s ‘network’ is statewide, as evidenced by the communities on this slide that use our services. The goal of this slide is to show the areas which we cover are broad.  While the lines may not be exact, the larger purpose is to show that we cover a good portion of it (in fact, it’s so large that half of Indiana’s doc’s use it, and about 1/3 of Indiana’s population is in coverage areas)
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  • Note: Depending on the audience, you can take out all the checkmarks at the end and just verbalize them.
    This service has been in place in Indianapolis for nearly 15 years.
    Its importance in the evolution of health IT and the discussions that you hear on a national level about moving health IT or health information exchange forward can not be overlooked.
    Nationally: it is setting the standard. Locally: it’s improving the care of thousands of patients every year.
  • <number>
  • Begins realigning payment strategies so that value of services is basis for purchasing
    Looking down the road to the continuum of care
    Physicians:
    Combining medical and drug claims data and clinical data to provide physicians with reports, alerts and reminders to help monitor patients’ health and wellness, including the management of common, chronic diseases.
    Health Insurers:
    Participating health insurers will also use these reports to provide meaningful incentives based primarily on the physician’s high performance and significant improvement of the overall health of their patient population.
  • 24x7x365 Customer Support
    One-stop issue resolution – physician offices call IHIE
    Research Provider Files
    New (Initial)
    Maintenance
    Application Specialists
    Implementation
    Work flow design / best practices
    Train all physician offices and data source representatives
    Help Desk Calls
    Password resets
    Result delivery issues
    Monitor non-usage of inboxes
    Monitor inactive user accounts
  • See what you think
  • Transcript

    • 1. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Indiana Health Information Exchange The Indianapolis and Beyond Story Presented to: South Dakota Health IT Summit Sioux Falls, SD October 8, 2008
    • 2. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Agenda • HIE Landscape • IHIE Background and Governance • Services – DOCS4DOCS® Clinical Messaging Service – Clinical Repository – Quality Health First • Customer Support • Discussion
    • 3. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Health Information Exchange Evolving Landscape
    • 4. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange State of the Field • Health information exchange initiatives are continuing to mature. – 130 included in the eHI annual survey (self report) – A lot more are getting started – 18 are new – Increased operation in number of HIEs (32 to 42) - 31% increase – DATA IS MOVING – Seeing impact – getting results – reducing costs and improving care delivery as part of the care process – Business model still is the struggle – Financing – securing upfront funding is the second largest challenge – 69% of the operational ones reported a positive ROI for various stakeholders (reducing costs) – More than half of the operational HIEs – labs, radiology is up this year – still supporting care delivery (CM and alerts) – increasing in population health; and public health surveillance
    • 5. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Types of Data Exchanged Types of Data 2007 2006 Labs 34% 26% Outpatient Episodes 32% 21% ED Episodes 30% 23% Inpatient Episodes 28% 23% Outpatient Lab Results 30% 22% Radiology Results 26% 20% Enrollment/Eligibility 26% 27% Outpatient Prescriptions 25% 19% From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
    • 6. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Most Difficult Challenges (Moderately Difficult and Very Difficult) Challenges 2007 2006 Developing Sustainable Business Model (56% said “very difficult” in 2007) 91% 80% Addressing Privacy and Confidentiality Issues (34% said “very difficult” in 2007) 85% 79% Accurately Linking Patient Data (25% said “very difficult” in 2007) 81% 86% Defining Value for Users of the HIE (43% said “very difficult in 2007) 81% 99% Securing Upfront Funding (53% said very difficult in 2007) 80% 90% From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
    • 7. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Funding Sources Start-Up vs. Operating Source Start-Up Operating Hospitals 54 62 Federal government 44 38 State government 42 35 Payers 33 35 Philanthropic 31 23 Labs --- 21 Public health --- 23 Physician practices --- 37 From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
    • 8. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange What Does All this Mean? • HIEs face substantial challenges, but are demonstrating steady and important progress – Development of a sustainable business model • Operational HIE organizations have pursued pragmatic, incremental local strategies to engage data sharing partners to build and expand HIE • Along with federal grants and contracts, state funding has played an important part in advancing early HIE development • One solution, does not fit all…what is the “burning platform” for South Dakota?
    • 9. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Courier just dropped off more envelopes Courier just dropped off more envelopes Prescription refill request on fax machine (Right behind the joke of the day) Prescription refill request on fax machine (Right behind the joke of the day) Unopened mail Unopened mail Printer with results from one lab Printer with results from one lab “Hey Sally! Where is Mrs. Jones x- ray?” “Hey Sally! Where is Mrs. Jones x- ray?” Unsorted results Unsorted results About to ring with stat results About to ring with stat results Web portal (from one hospital) Web portal (from one hospital)
    • 10. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Indiana Health Information Exchange Governance and Services
    • 11. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Who We Are…Over 36 Million Results Delivered Indiana Health Information Exchange • 35 FTEs – 24x7x365 Customer Support – Business Development – Technical/Programming – Physician Liaisons We are a health information exchange that bridges the gap between paper- based and technology-based medicine to electronically provide patient- specific, clinical information from various sources at the most critical time: the point-of-care. Regenstrief Institute • 95 FTEs – Research and Development – Application Support – Technical Support
    • 12. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange IHIE and Regenstrief Regenstrief Both / Either IHIE Concepts / Ideas Research Grants Business Models Customer Support Training Marketing / Sales Project Management Data Use Agreements Application Development Operations Implementation Technology: Development  Testing  Production  Maintenance
    • 13. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Governance • IHIE is governed by a Board of 16 organizations representing the major healthcare stakeholders in Indiana. The Board members are chosen to allow for multi-organizational representation of health care stakeholders and to draw upon industry experience. • The hardest work was establishing trusted organizational models, consensus on goals and requirements, and crafting participation agreements that met the legal, clinical and ownership requirements of each party. • We have advisory groups that provide guidance and expertise to assist with future development. • Membership is multi-disciplinary including representation encompassing technical, clinical, customer service and users. IHIE was founded as a non-profit 501(c)3 incorporated company on February 24, 2004 by a collaboration of fourteen institutions representing hospitals, healthcare providers, researchers, public health organizations, and economic development groups.
    • 14. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Governance IHIE Board • BioCrossroads - CEO • City of Indianapolis - Mayor • Clarian Health Partners - CEO • Community Health Network - CEO • Health and Hospital Corporation – CEO • Indiana State Department of Health - State Health Commissioner • Indiana State Medical Association - President • Indiana University School of Medicine - Dean • The Indianapolis Medical Society - President • Marion County Health Department - CMO • Regenstrief Institute - CEO • St. Francis Hospital and Health - CEO • St. Vincent Healthcare - CEO • At large (3)
    • 15. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Governance Advisory Groups Advisory Group Description Membership Steering Committee Provides general oversight of the clinical messaging project. Focus is on new functionality, issues, and problem resolution. CIOs from the charter member hospitals and representatives from IHIE and Regenstrief Institute Application Committee Provides for the development of community standards, creation of acceptance testing plans, development of training materials, implementation of physician offices, and development of application enhancements. Members from the interface teams at each of the charter hospitals who are involved in the day-to-day operations of clinical messaging from the service providers Planning Committee Identifies and evaluates potential research and other projects on which IHIE & Regenstrief can collaborate. Executive staff from IHIE and Regenstrief, as well as key project personnel from both organizations Security Committee Provides updates as to the security enhancements of the clinical messaging systems, any HIPAA issues we see from this side. Any HIPAA issues are always reported back to these people as they happen. Security/privacy officers from each of the charter hospitals
    • 16. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Indiana Health Information Exchange State Borders Do Not Exist Crown Point Dyer Hammond Michigan City Lafayette West Lafayette Crawfordsville Kokomo Beech Grove Carmel Elwood Indianapolis Martinsville Mooresville Plainfield Avon Fishers Evansville Michiana Health Information Exchange Medical Informatics Engineering Healthbridge
    • 17. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Three Things to Remember 1. Don’t make it complicated • “Free” the data – get it out of the silos and establish trust in your community • Aggregate the data and do something with it 2. Don’t Boil the Ocean 3. Data re-use is the killer application
    • 18. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange DOCS4DOCS Results Delivery
    • 19. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Health Information Exchange Services Health Information Exchange Hospital DataData repositoryrepository HealthHealth InformationInformation ExchangeExchange NetworkNetwork applicationsapplications Server Labs Outpatient RX & PBMs Physician office Ambulatory centers (e.g. imaging) Public health Services Hospitals Physicians Labs Public health Payer • Clinical Messaging • Medication Reconciliation • Shared EMR • Credentialing • Eligibility checking • Results delivery • Secure document transfer • Shared EMR • Clinical Decision Support • Credentialing • Eligibility checking • Clinical Messaging • Orders • Needs Assessment • Surveillance • Reportable conditions • ADE detection • Clinical Quality Measurement • Claims Ajudication • Secure document transfer • De-identified, longitudinal clinical data Researchers NegotiatedNegotiated AccessAccess Payers
    • 20. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange “One…two…three Strikes You’re Out!” • There were three times where the IHIE project was down on its knees: – Hospital CIO’s – “IHIE competes with individual hospitals IT strategies to link to physician offices” • How Resolved – Individual hospitals computer system (Cerner, GE, Eclypsis, Siemens, McKesson) is hospital workflow but all can participate in the city-wide network to reduce cost - PROCEED – Hospital CFO’s – “I do not see any significant ROI and recommend to CEO’s not to proceed” • How Resolved – ROI study shows hard dollar costs about the same as current cost, many tangible (soft) cost savings. Hospital CEO vision is that IHIE is the infrastructure for future healthcare initiatives and cost savings – PROCEED – IHIE – “Funding – Have plan, have community buy-in, no money” • How resolved – join Bio Crossroads and Regenstrief Initiative to obtain initial grant funding - PROCEED Almost ^
    • 21. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange DOCS4DOCS Service (Push) • IHIE’s DOCS4DOCS clinical messaging service takes text reports (e.g. lab, pathology, radiology, transcription, cardiology) from their source information systems and delivers those results to physicians associated with the source organization (medical staff or non-medical staff) via any of three methods: – Into “DOCS4DOCS”, a web-based “inbox” that is accessible via the hospital portal or other IHIE portal – Via fax (if they insist) – Directly into the physician practice EHR • We deliver only what the customers tell us they want us to deliver.
    • 22. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange
    • 23. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Results Delivery History 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 Q 1 2005Q 2 2005Q 3 2005Q 4 2005Q 1 2006Q 2 2006Q 3 2006Q 4 2006Q 1 2007Q 2 2007Q 3 2007Q 4 2007Q 1 2008Q 2 2008Q 3 2008 Fax IHIE Poral EMR
    • 24. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Sustainable With Results Delivery • Basic Conceptual Principles of HIE Sustainability – HIE is a business – Leveraging of High-cost, High-value assets – No Loss Leaders – Independent Local Sustainability – Natural Monopoly – The Need for Scale – Avoidance of Grants for Operational Cost
    • 25. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Interdependency of HIE Components Layer I: Including Interface Engine, Community Trust, … Layer II: Including Mapped/Normalized Data… New Value- added Service Layer III: Including Repository Services… New Value- added ServiceMedication Profile Public Health Surveillance Clinical Messaging Clinical Quality Services Ambulatory Results Review ED Abstract and Results Review New Value- added Service Inpatient Results Review Value-added services that can be built upon the HIE investment A layer of necessary investment In the beginning, HIE assets are interdependent and how assets, once created, can be leveraged to deliver additional services.
    • 26. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Community-Wide Clinical Repository Indiana Network for Patient Care
    • 27. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Clinical Repository Background (Pull) • Securely aggregates and connects patient information electronically outside an individual healthcare organization. Provides an abstract that contains the most accurate, up-to- date information available a patient, regardless of treatment location. • Available at over 130 locations in Indianapolis area, including ED and ambulatory • Data on over 6 million patients. • Used by approximately 15,000 active users. • One study indicated the repository results in $26 savings per ED visit. • Other participants include: – National and regional laboratories – Local imaging centers – All four homeless care systems – Public health departments (county and state)
    • 28. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Clinical Repository Data • 16 million registration events • 41 million orders • 1 billion coded results • 25 million text reports • 9 million radiology reports • 12 million drug orders • 750,000 EKG tracings • 140 million radiology images
    • 29. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Indiana Network for Patient Care Data Sources – Growing Beyond Central Indiana • Hospitals – Over 20 hospitals including the 5 major hospital systems and other hospitals in the Indianapolis-area • Payors • Labs and local imaging centers • Public health departments (county and state) • Ambulatory Physician Practices – Approximately 1/3 of ambulatory physicians
    • 30. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Participants’ Agreement The Participant Controls the Use of Their Data • How can participants share health data to treat patients? • Who may have access to personal health information for treatment purposes? • What information is to be stored on the network? • How may the personal health information be used for research purposes? http://www.regenstrief.org/medinformatics/inpc
    • 31. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Silos of Information Electronic MedicalElectronic Medical Record SystemRecord System Data delivered toData delivered to immunizationimmunization registryregistry Jane Receives ImmunizationsJane Receives Immunizations and other careand other care (measurements, labs,(measurements, labs, diagnoses, etc) @ Clinicaldiagnoses, etc) @ Clinical PracticePracticeData delivered toData delivered to EMREMR ImmunizationImmunization RegistryRegistry Jane Receives ImmunizationsJane Receives Immunizations @ Health Department@ Health Department
    • 32. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Silos of Information ImmunizationImmunization RegistryRegistry Electronic MedicalElectronic Medical Record SystemRecord System Registry WebRegistry Web InterfaceInterface EMR InterfaceEMR Interface ?????????????????????? “Amid all the discussion, Indiana may be mentioned more often than any other state as a model for how to develop a successful HIE.” – For the Record, September 2007
    • 33. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Consolidating the Silos ImmunizationImmunization RegistryRegistry Electronic MedicalElectronic Medical Record SystemRecord System Patient ID: 123LMNOPPatient ID: 123LMNOP Name: Jane DoeName: Jane Doe DOB: 01/01/04DOB: 01/01/04 SSN: N/ASSN: N/A Address: 555 Johnson RoadAddress: 555 Johnson Road City: IndianapolisCity: Indianapolis State: IndianaState: Indiana ZIP: 46202ZIP: 46202 Patient ID: 6789XYZPatient ID: 6789XYZ Name: Jane Ellen DoeName: Jane Ellen Doe DOB: 01/01/04DOB: 01/01/04 SSN:123-45-6789SSN:123-45-6789 Address: 555 Johnson RoadAddress: 555 Johnson Road City: IndianapolisCity: Indianapolis State: IndianaState: Indiana ZIP: 46202ZIP: 46202 Global PatientGlobal Patient IndexIndex ConceptConcept DictionaryDictionary Global ID:Global ID: 4567845678 Name:Name: Jane Ellen DoeJane Ellen Doe Lots of Demographics..Lots of Demographics.. MRF1 ID:MRF1 ID: OU81247OU81247 MRF2 ID:MRF2 ID: 45643564564356 PH MRF ID:PH MRF ID: 123LMNOP123LMNOP MRF3 ID:MRF3 ID: 6789XYZ6789XYZ DTaP Dose Count:DTaP Dose Count: 30936-930936-9 HIB Dose Count:HIB Dose Count: 30938-530938-5 IPV Dose Count:IPV Dose Count: 33555-433555-4 VZV Dose Count:VZV Dose Count: 30943-530943-5 MMR Dose Count:MMR Dose Count: 30940-130940-1 HepB Dose Count:HepB Dose Count: 30937-730937-7 Jane Doe’s Immunizations:Jane Doe’s Immunizations: 3/1/043/1/04 DipTetaPurDipTetaPur 3/1/043/1/04 HemInfBHemInfB 3/1/043/1/04 PolioVirPolioVir 3/1/043/1/04 HepaBHepaB Jane Ellen Doe’s Shots:Jane Ellen Doe’s Shots: 5/1/045/1/04 DTaP ImmDTaP Imm 5/1/045/1/04 HIB ImmHIB Imm 5/1/045/1/04 IPV ImmIPV Imm 7/9/047/9/04 DTaP ImmDTaP Imm 7/9/047/9/04 IPV ImmIPV Imm 30936-930936-9 30938-530938-5 33555-433555-4 30937-730937-7 30936-930936-9 30938-530938-5 33555-433555-4 30936-930936-9 33555-433555-4
    • 34. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Consolidating the Silos ImmunizationImmunization RegistryRegistry Electronic MedicalElectronic Medical Record SystemRecord System Global PatientGlobal Patient IndexIndex ConceptConcept DictionaryDictionary St. VincentSt. Vincent MRFMRF ClarianClarian MRFMRF WishardWishard MRFMRF Community MRFCommunity MRF Public HealthPublic Health MRFMRF Global PatientGlobal Patient IndexIndex IUMG MRFIUMG MRF ConceptConcept DictionaryDictionary
    • 35. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange The clinical repository can tell the story when the patient cannot… Dr. Watson Dr. Thomas’ office  ED visit data (free-text chief complaint)  Registration Records (demographics)  Radiology Reports  Discharge Summaries  Operative Notes  Pathology Reports  Medication Records  EKG Reports  Laboratory Data  Inpatient and outpatient hospital encounter data demographics  Coded diagnoses and procedures for hospital admissions and ED visits  Ambulatory encounter (visit) data • Patient presented at emergency department complaining of ‘having trouble’ with his heart. • Standard treatment for heart attacks: blood thinners. • Before embarking on treatment path, physician checked the repository for additional information on patient. • Repository showed head scan performed at another hospital 3 weeks ago. Patient recovering from head injury. • Repository helped physician determine best course of care to avoid complications.
    • 36. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Abstract Example
    • 37. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Results Review Example
    • 38. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Quality Health First® Program
    • 39. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Quality Health First
    • 40. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Quality Health First ® Program Background A disease management, preventive care and reporting service providing pt-specific and population-based management reports, clinical alerts and reminders, as appropriate either participating physicians and health plans. • Enables improved clinical decisions by combining clinical data, medical and drug claims and point-of-care data to monitor patients’ health and wellness. • Employers Forum of Indiana instrumental in program design. • Involves physicians, employers, and health plans and implemented and managed by IHIE
    • 41. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange QHF Quality Improvement Measures • Asthma Treatment • Children’s Health • Diabetes Care • Heart Health • Mental Health • Women’s Health
    • 42. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange
    • 43. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange
    • 44. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange
    • 45. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Customer Support
    • 46. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange IHIE Customer Service & Application Specialists • Support of DOCS4DOCS application - 24x7x365 Customer Support – Implementation • Acceptance Testing and Piloting • Workflow review and analysis – Communications • Marketing • Practice Verification – Training • Initial and on-going physician office and hospital training • Follow-up • Account maintenance for Data Providers and Practice Locations – Operations / Maintenance • Help Desk (for example, password resets and result delivery issues • Scrub provider files and maintain. – Provides the most accurate and up-to-date provider and practice information • Monitor non usage of inboxes • Monitor inactive end user accounts One-stop Issue Resolution / Seamless One-Call Policy Physician Offices Call IHIE, Not the Data Providers.
    • 47. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Customer Support Team 9 FT Employees • 1 FT Customer Service Manager • 4 FT Customer Service/Help Desk • 4 FT Application Specialists Supporting • 10,000 providers = 3,400 offices • 37 data providers • 6,000 application users • Average 20 incoming call per day; most common – “forgot my password” – “why didn’t I get this result”
    • 48. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Customer Support – Time Spent % of time 38% 28% 2% 15% 10% Provider File: clean up, marketing, verification Training Travel Follow up Help Desk
    • 49. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Provider File Maintenance • The average provider file from a facility has 3,000 providers – On average it takes 7 minutes to research one provider, if all the information is accurate. Verify address, phone, fax, providers, other staff, POC, delivery needs, office flow • What we find that is NOT accurate – Providers who are deceased / no longer in practice – Moved and are not listed with the correct practice – No longer practicing in the state – Expired license – They practice at multiple locations – Contact numbers and addresses are invalid
    • 50. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Discussion
    • 51. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Three Types of Business Risk an HIE Needs to Manage Operating Risk Execution Risk Market Risk  How the company is structured, and the details of its basic logistics in order for it to carry out its plan successfully  To what extent the market for the HIE’s services is ready for its adoption, what barriers or obstacles if any exist, and how well the marketing plan meets market needs and obstacles  Ability of the HIE’s team to actually execute, given the complexity of the endeavor and their track record at rolling out such products and services
    • 52. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Lessons Learned… • Technology is just one piece – How is it implemented matters! • Provide incremental value to the stakeholders – Small steps (don’t try to boil the ocean) • Customer support is crucial – Communicate with customers often (data providers and users) • Expect the unexpected – Interfaces change often and without notice • Hospitals must shut-off delivery processes – Change in culture for internal departments • Concentrate on value and satisfaction
    • 53. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange If I Had a Crystal Ball…IHIE 2010 • Acquired new data sources – Medicaid / Medicare data – Additional hospitals, labs, other data sources • Connected to other HIEs – Inside and outside of IHIE – National participation (NHIN) • Continued participation in the Indiana Health Information Commission (IN state-wide group) • Further work with quality and population-based initiatives • Extended IHIE into a new entity to market and implement our HIE solutions to other HIE communities outside of Indiana.
    • 54. IndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchangeIndianaHealthInformationExchange Questions Emily Welebob, RN, MS Indiana Health Information Exchange VP, Strategic Development ewelebob@ihie.com Phone: 317-644-1725