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Health Information Exchange (HIE)

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Interoperability is one of the most critical issues facing the health care industry today. A universal exchange language is needed to assist health care providers in sharing health information in …

Interoperability is one of the most critical issues facing the health care industry today. A universal exchange language is needed to assist health care providers in sharing health information in order to coordinate diagnosis and treatment, while maintaining privacy and security of personal data. Health Information Exchanges (HIE) allow for the movement of clinical data between disparate systems; they enable providers to electronically share health records through a network. This presentation provides an overview of HIE and the Meaningful Use requirement related to the exchange of clinical information as well as information about standards of exchange and the recommended "next steps" for providers.

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  • 1. Health Information Exchange Ed Donaldson Interoperability Product Manager, SuccessEHS Justin Copeland President, Triggerfish Corporation
  • 2. Health Information Exchange
    • Verb
      • Exchange of the information within an EHR to other entities with the goal of improving care, treatment and outcomes
    • Noun
      • An organization that facilitates the exchange of health information using various data, methods and messages to do so
  • 3. Meaningful Use
    • Electronic Exchange of Clinical Information Core requirement
      • Capability to exchange key clinical information (for example: problem list, medication list, medication allergies and diagnostic test results) among providers of care and patient authorized entities electronically.
  • 4. Meaningful Use
    • Electronic Exchange of Clinical Information Core requirement
      • Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.
  • 5. Benefits of Health Information Exchange
    • Provides a vehicle to support improved patient care quality and safety
    • Provides a mechanism to reduce duplication of services and reduce health care costs
    • Enables the integration of sick-care (illness) with well-care
    • Source: Health Information and Management Systems Society (HIMSS)
  • 6. Benefits of Health Information Exchange
    • Facilitates operational and administrative efficiencies resulting in reduced operational costs
    • Stimulates consumer education and involvement with the health care process
    • Promotes transparency of service and cost
    • Source: Health Information and Management Systems Society (HIMSS)
  • 7. Health Information Exchanges
    • History
      • Regional Health Information Org. (RHIOs)
        • A health information organization (HIO) that brings together health care stakeholders within a defined geographic area and governs health information exchange (HIE) among them for the purpose of improving health and care in that community. - National Health Alliance for Health Information Technology
      • Effort begun in 2007
  • 8. Health Information Exchanges
    • History
      • HIEs
        • Taking RHIOs to the next step
        • Still issues with privacy, security, sustainability and dependability of the HIE
        • No standards yet mandated by ONC
  • 9. Current State of HIEs
    • Many in beginning stages of formation
    • Still working on sustainability
      • Beacon Grants:15 grants awarded in May 2010 to develop interoperability in areas that already have high EHR adoption rates and to use that information to help inform efforts to support meaningful use of EHRs
  • 10. Current State of HIEs
    • State Health Information Exchange Program
      • http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1834
    • Various standards being used
      • Standards haven’t been mandated in HITECH Act like labs, CCD, etc.
  • 11. Types of HIEs
    • Public Entity – Geographic
      • Statewide: funding possibly through federal grants and state or local initiatives
    • Private Entities – Coalition
      • Regional entity (hospital, physician groups) drives creation of HIE
  • 12. Directional Flow of Data
    • Methods of dataflow
      • Push
        • Example: Demographic Message
        • Send information one way – initiated by sender
      • Bi-directional Push
        • Example: Laboratory Interface
        • Send and receive information – each way initiated by sender
  • 13. Directional Flow of Data
    • Methods of dataflow
      • Pull
        • Example: Send request for CCD
        • Receive information by requesting it
      • Full Bi-directional
        • Push information
        • Send information on request
        • Receive information on request
  • 14. Standards
    • Messages: What information is being sent
      • HL7: Health Level Seven
        • Machine readable
  • 15. Standards
    • CCD: Continuity of Care Document
        • Human & Machine readable
  • 16. Standards
    • Transport: How information is being sent
      • MLLP: Minimum Lower Layer Protocol
        • IP Address and Port
      • IHE – Integrating the Health Care Enterprise
        • XDS – Cross Enterprise Document Sharing
        • Connectathon
        • HIMSS Interoperability Showcase
  • 17. Standards
    • Transport: How information is being sent
      • NHIN – National Health Information Network
        • CONNECT
        • DIRECT Project
  • 18. Surescripts Network for Clinical Interoperability
  • 19. Surescripts Network for Clinical Interoperability
    • PUSH method
    • CCD
    • Directory of participants (email address)
    • Cost
    • Availability
    • Will provide means to do one test
  • 20. Connecting with an HIE
    • Find out which one serves you best
    • Resources
      • HIMSS HIE Toolkit
        • http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=142
      • HIMSS State HIT Dashboard
        • http://www.himss.org/statedashboard/
      • Regional Extension Centers
        • http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&mode=2
  • 21. Connecting with an HIE
    • Find out which one serves you best
    • Resources
      • State Health Information Exchange Program (ONC)
        • http://statehieresources.org/state-plans/
        • http://statehieresources.org/contacts/
  • 22. HIE Customer Case Study
    • Northwest Health Services, Inc.
  • 23. Background
    • In May of 2008, Northwest Health Services began a collaborative effort with Heartland Health, a regional health center, to develop a regional health information exchange now know as the Lewis and Clark Information Exchange, or LACIE.
  • 24. Who is LACIE?
    • 501(c)(3) with a public Board of Directors
    • Formed by collaborative effort of Heartland Health and Northwest Health Services (NHS) and using Cerner as the technology provider
    • Provider led
  • 25. Who is LACIE?
    • Current, live transmission of data between members
    • Wholly owned entity of Heartland Health
      • IDN Serving 4 State Area of NW Missouri
      • 2009 Recipient of Malcolm Baldrige Quality Award
  • 26. Who is LACIE?
  • 27. LACIE Today EMR1 EMR2 XDS Document Registry Patient Registry (MPI) Auditing User Mgmt Node Reg. Analytics LACIE Network (HIE) EMR3 NHIN Gateway PHR EMR4 Heartland NWMC NWHS Harrison County Atchison St. Francis Saint Luke’s Shawnee Mission Bethany Rural Health
  • 28. LACIE Today
  • 29. Building LACIE Tiger Institute Network Built Pending
  • 30. ONC Direct Project Pilot
    • Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:
      • Demonstrate how Direct Project standards can be used as a viable method to improve coordination of care across communities.
    b.wells@direct.aclinic.org [email_address]
  • 31. ONC Direct Project Pilot
    • Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:
      • Replace traditional unsecure ad hoc communication methods (e.g. fax, phone, paper) with secure email .
    b.wells@direct.aclinic.org [email_address]
  • 32. ONC Direct Project Pilot
    • Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:
      • Meet community providers where they are today, by providing simple solutions to create instant interoperability, with a path toward more advanced methods.
    b.wells@direct.aclinic.org [email_address]
  • 33. Benefits to Patients
    • Test results and medical records available to specialists and referral providers.
  • 34. Benefits to HIE Members
    • Improved access to information will enhance the quality of patient care.
  • 35. Challenges
    • Accessing multiple systems
    • Master Patient Index (MPI) matching
    • Provider buy-in
    • How much should I rely on this information
  • 36. Opportunities
    • Leverage Direct Project to add secure communication
    • Patient Health Record portal
  • 37.
    • Click here to learn more about Health Information Exchange.

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