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  1. 1. Interoperability 4.0+ Information Exchange --> Market Exchange [email_address]
  2. 2. Agenda <ul><li>Current state: NYCLIX case study </li></ul><ul><ul><li>Network Map </li></ul></ul><ul><ul><li>Architecture (Business View) </li></ul></ul><ul><ul><li>Architecture (Consent View) </li></ul></ul><ul><ul><li>Interfaces (HL7 2.x Feeds) </li></ul></ul><ul><ul><li>NHIN II: Trial Implementation Projects </li></ul></ul><ul><ul><li>CDC: Situational Awareness through HIE </li></ul></ul><ul><ul><li>Key Principles: Public Health HIE </li></ul></ul><ul><li>Future state: the e-Marketplace pattern </li></ul><ul><ul><li>SHIN-NY SOA/ESB Architecture </li></ul></ul><ul><ul><li>The e-Marketplace Pattern </li></ul></ul><ul><ul><li>Relevance? </li></ul></ul><ul><ul><li>Requirements (Consumer View) </li></ul></ul><ul><ul><li>Online Marketplaces </li></ul></ul><ul><ul><li>An Online Marketplace For Healthcare? </li></ul></ul>
  3. 3. Network Map
  4. 4. Architecture (Business View)
  5. 5. Architecture (Consent View) Federated Model : Each NYCLIX member independently maintains consent directives for each patient receiving treatment. Disclosure Consent : Permission to disclose one’s health information to the network. Access Consent : Permission granted to a Provider to access one’s currently disclosed health information via the network.
  6. 6. Interfaces (HL7 2.x feeds)
  7. 7. NHIN II: Trial Implementation Projects Long Beach Network for Health Lovelace Clinic Foundation Indiana HIE CareSpark WV HIN NCHICA MedVirginia Delaware HIN NY eHealth Collaborative
  8. 8. CDC: Situational Awareness through HIE Accelerating State-Wide Public Health Situational Awareness in New York Through Health Information Exchange Project Vision : To improve situational awareness and reporting for public health purposes on a state-wide basis through the timely collection, analysis, and evaluation of clinical case information using a state-of-the-art public health HIE service and the emerging standards for the Nationwide Health Information Network (NHIN).
  9. 9. Key Principles: Public Health HIE <ul><li>Integration of PH Reporting Across Multiple HIEs </li></ul><ul><ul><li>Universal Public Health HIE Architecture and Standards </li></ul></ul><ul><ul><li>Central Services and Data Standards for HIE </li></ul></ul><ul><li>Bidirectional Flow of Information and Intelligence </li></ul><ul><ul><li>Public Health Participation in RHIO Data Exchange </li></ul></ul><ul><ul><li>Dynamic Querying Capabilities </li></ul></ul><ul><li>Ensuring Patient Privacy </li></ul><ul><ul><li>Implement and Enforce Privacy & Security Standards </li></ul></ul><ul><ul><li>Minimum Data Necessary </li></ul></ul>
  10. 10. SHIN-NY SOA/ESB Architecture For more on SOA patterns: http://www.ibm.com/developerworks/library/ws-soa-progmodel4/index.html <ul><li>Key Principles </li></ul><ul><li>Loose Coupling </li></ul><ul><li>Service Indirection </li></ul><ul><li>Protocol Independence </li></ul><ul><li>Multiple Bindings </li></ul><ul><li>Asynchronous Development </li></ul><ul><li>This form of emerging HIE infrastructure is well-suited to meet B2B and B2C transactional needs, and enables evolution towards an e-marketplace pattern </li></ul>
  11. 11. The e-Marketplace Pattern <ul><li>E-Marketplace defined </li></ul><ul><ul><li>An electronic gathering place bringing multiple buyers and sellers together </li></ul></ul><ul><ul><li>Consumers and providers of core/infrastructure online services (B2B) </li></ul></ul><ul><ul><li>Consumers and providers of healthcare services (B2C) </li></ul></ul><ul><ul><li>Consumers and providers of e-marketplace services? (competing markets) </li></ul></ul><ul><li>Market makers can achieve drastic improvements </li></ul><ul><ul><li>Improved quality and efficiency </li></ul></ul><ul><ul><li>Compressed process time </li></ul></ul><ul><ul><li>Decreased costs </li></ul></ul><ul><ul><li>Improved business processes </li></ul></ul><ul><li>What might the technology stack look like once implemented? </li></ul><ul><ul><li>Virtualized across all architectural layers </li></ul></ul><ul><ul><li>Cloud/grid-based for near-linear scalability and low latency </li></ul></ul><ul><ul><li>Open-source core with value-added extensions </li></ul></ul><ul><li>Where might the technology come from? </li></ul><ul><ul><li>IT for securities markets (exchanges, trading systems, auction systems) </li></ul></ul>
  12. 12. Relevance? <ul><li>Need for structural correction to the US healthcare marketplace </li></ul><ul><ul><li>Well recognized problems compared with other industries </li></ul></ul><ul><ul><ul><li>High cost (macro-scale) / unclear costs (micro-scale) </li></ul></ul></ul><ul><ul><ul><li>Uneven quality (overuse, under-use, misuse) </li></ul></ul></ul><ul><ul><li>Virtually no transparency into quality/cost </li></ul></ul><ul><ul><ul><li>Few consumer tools to drive decision-making </li></ul></ul></ul><ul><ul><ul><li>Ex: persistence of paper-based EOBs </li></ul></ul></ul><ul><ul><li>Dis-empowered consumers – paradoxically less choice? </li></ul></ul><ul><ul><ul><li>Multiple intermediaries between actual buyers and sellers </li></ul></ul></ul><ul><ul><ul><li>Restricted choice/access due to constraints imposed by payor/provider networks </li></ul></ul></ul><ul><ul><ul><li>Asymmetrical access to market information between buyers and sellers </li></ul></ul></ul><ul><ul><ul><li>Persistent lack of information portability </li></ul></ul></ul><ul><li>Not the same discussion as universal coverage </li></ul><ul><li>How is the consumer's interests being represented in future state planning? </li></ul>
  13. 13. Requirements (Consumer View) <ul><li>“ I would like to be able to book an appointment…” </li></ul><ul><ul><li>At the earlier possible date </li></ul></ul><ul><ul><li>As close as possible to my home </li></ul></ul><ul><ul><li>With the best available specialist </li></ul></ul><ul><ul><li>Who accepts my insurance </li></ul></ul><ul><ul><li>And is accepting new patients </li></ul></ul><ul><ul><li>At the lowest possible cost to me </li></ul></ul><ul><li>“ And, I would like to know…” </li></ul><ul><ul><li>Ahead of time whether all procedures/tests ordered are covered </li></ul></ul><ul><ul><li>Or choose a service provider who will cover them </li></ul></ul><ul><ul><li>Pay the lowest possible price for these services </li></ul></ul><ul><ul><li>And get an electronic EOB for the services </li></ul></ul><ul><li>“ And, I need a tool that can…” </li></ul><ul><ul><li>Manage these electronic transactions with my providers and health plans </li></ul></ul><ul><ul><li>Manage my Health Savings Account and/or High Deductible Health Plan </li></ul></ul><ul><ul><li>Help me accurately budget for future healthcare expenditures </li></ul></ul><ul><ul><li>Let me comparison shop and purchase health insurance online from many health plans competing for my business </li></ul></ul>
  14. 14. Online Marketplaces
  15. 15. An Online Marketplace For Healthcare? <ul><li>The highest priority for Interoperability 4.0 is defining consumer requirements </li></ul><ul><li>Independent health record banks for consumers represent a key enabling online service </li></ul><ul><li>Support for electronic transactions between consumers and health plans is a long-overdue and key enabling integration priority </li></ul><ul><li>Consolidation between the well-established claims clearinghouse infrastructure and the still maturing clinical exchange infrastructure is likely to be the highest technical priority for Interoperabilty 4.0. </li></ul><ul><li>The technical underpinnings to support consumer-focused online healthcare marketplaces are emerging rapidly </li></ul><ul><li>Consumer-focused websites designed to meet these requirements could emerge within the next 3-5 years </li></ul>?
  16. 16. Policy Resources <ul><li>Markle Foundation Connecting for Health </li></ul><ul><li>California Healthcare Foundation </li></ul><ul><li>American Health Information Management Association </li></ul><ul><li>eHealth Initiative </li></ul><ul><li>Health Information Management Systems Society </li></ul><ul><li>National Alliance for Health Information Technology </li></ul><ul><li>Health Information Security and Privacy Collaborative </li></ul><ul><li>Certification Commission on Healthcare Information Technology </li></ul>