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T A G  Health    Loonsk V2
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T A G Health Loonsk V2


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  • 1. TAG Health Opportunities in HITECH and Next Steps for the National HIT Infrastructure John W. Loonsk, MD FACMI Chief Medical Officer _experience the commitment TM
  • 2. Opportunities in Health Information Technology Clinical Care Payment / Public Health / Claims Electronic Health Health Insurance Records Reform
  • 3. Network Effects and IT Adoption • Critical mass of participation • Common platform • Secondary, sometimes unintended, value HTTP:// PC Cards Email 3
  • 4. Changing the Health Value Equation 4
  • 5. Mature Data and IT Environments Can Support Value Environment Attributes: Need: • Stable and coherent • Sustainable infrastructure policies for data access • Software and services and management market • Business alignment • Well defined software • Shared standards/ environment transaction specifications • Multiple products working for transacting and storing together • Data and services • Many participants – value architecture in others • Value in data exchange 5
  • 6. Information Sharing in Health – Market Driven Chaos Type Attributes Community Hospitals Academic medical centers Affiliated physicians Independent physician practices Integrated Delivery Systems Payers Preferred Provider Organizations Health plans that provide care Best alignment? Labs, pharmacies and other ancillary health organizations Public health and government (state, local and federal) Differences between states New permutations EMR companies EMR “Hub”, organizational, community Personal Health Records Personally controlled and views on EMRs, claims Health Information Organizations / Exchanges Opt-in and opt-out, federated and centralized and hybrid
  • 7. Some Desirable Health Data and IT Environments 1. Inside of hospitals 2. Around regional health transactions 3. Population health data stores 4. Around a “managed”, longitudinal patient record • Community record, medical home, PHR 5. The collective - network of networks • RHIOS / HIEs, IDNs, government, ancillary networks, etc. 7
  • 8. Architecting Data and Technical Solutions in a Market Driven Health System • Increase value of participation • Payment reform • Pay for some services • Clinical information management • Summary record • Reconciled medication list • Health information exchange • Infrastructure • Directories, Identity proofing, etc. • Public health • Incent data exchange 8
  • 9. HITECH • Federal • EMR adoption through Medicare • Meaningful use, standards, certification • Nationwide Health Information Network • National Institute for Standards and Technology • State-level • EMR adoption through Medicaid • Health Information Exchange • Regional • Extension centers • Beacon communities • Workforce development 9
  • 10. Health Insurance Reform • Quality reporting • Enrolment standards • From HIT standards and policy committees • Care coordination • Demonstration projects • Data Collection in Federal Programs • Race, ethnicity, sex, primary language, etc • Administrative simplification • Determination of individual’s eligibility and financial responsibility • Community-Based Collaborative Care Network Program • “Comprehensive coordinated and integrated health care services” grants to support low-income populations 10
  • 11. Its not about the technology? • Computerize what is • Example: Implement EMR • Technology building blocks • Example: Network look-up and routing • Example: Implementation guides for network transactions • Example: Rigorous test harnesses and one to many testing • Electronic process outcomes • Example: Computerized Patient Order Entry • Example: Maintain active problem list • IT Enabled health outcomes • Patient and population • Example: Improve quality of care • Example: Reduce costs • Example: Prevent spread of disease 11
  • 12. It’s Also About the Data... The data are central to technology considerations, outcomes and value, but many issues: • Business value of not sharing data • Confidentially concerns for inappropriate data access • Challenge of having well recorded data • Challenges of transacting data between systems • Ambiguities and complexities of selective data access • Confusing “ownership” and “stewardship” • Concerns about commercialization of data 12
  • 13. Architecting Data and Technical Solutions in a Market Driven Health System • Standards and interoperability Harmonize • Harmonize down • Complex information space • Many standards and SDOs • Specify up • Specified transactions Engineer • Detailed implementation guidance • Test harnesses • Many to many testing 13
  • 14. Some Further Needs - Interoperability and Standards • HITECH Helps • Advances for structured recording of data inside organizations • Still optionality • Need for engineered transactional specifications • Incentives for use • Strategic, but detailed and rigorous • HIPAA provides for claims • Nationwide Health Information Network specifications • Required transaction testing 14
  • 15. Some Further Needs - Interoperability and Standards • Process for parallel work in ancillary areas • Public Health, behavioral health, long term care etc. • Include shared services • Operate on date environment for external customer • Standard versions and “legislative lock” • One to many testing • Testing infrastructure • Test Harnesses • Data sets 15
  • 16. Tools for Trusted Mobilization of Data • Legislation • HIPAA, HITEC, state • Certification of software • Standards and capabilities • Accreditation of organizations? • Assurance of on site policies and procedures • DURSA • A common operating agreement • Governance • Both dynamic and legislated roles • Consumer preferences
  • 17. Some Further Needs - Policy Environment HITECH helps • Raises HIPAA floor • State HIPAA variability documented Enable secure, “network sharing” of health data • Past point to point data use agreements • Governance Clarify data stewardship / management roles • Managed longitudinal record • Population health data reporting Further ensure exchange of data • Incentives and penalties to providers for EMR use – not always in their control 17
  • 18. Into the States • Medicaid HIT plans • HIE • Intraand inter – state • State responsibility / no authority • NHIN - organizational vs. direct • Public health • Outbreak / case management 18