HIE Perspectives and Understanding
National, State, and Local Initiatives
Learning objectives
 Recognize and differentiate national HIE efforts
 Indicate the current level of HIE adoption
 Desc...
Agenda
 The “apples” and “oranges” of HIE
 HIE Facts and Figures
 HIE drivers, challenges and trends
 eLINC HIE and th...
About Us
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute at the Massachuse...
The “apples” and “oranges” of HIE
Collaborations
• Care Connectivity Consortium
• CommonWell Health Alliance
• Carequality...
HIE Facts and Figures
National
How many HIEs are there?
 Although estimates vary depending on the data source, there
are as many as 280 health informati...
Adoption of HIEs is on the rise
 One-half of the nation’s hospitals are now participating in a
regional, State, or privat...
4 in 10 hospitals report an exchange capability for PHI
9
Percent of Hospitals Able to Send and Receive Secure Electronic
...
51 percent of hospitals can query from external sources
10
U.S. Hospitals' Capability to Electronically Query Patient Heal...
HIE Facts and Figures
Massachusetts
HIE Participation (% among all MA practices)
12
26%
16%
18%
2%
32%
7%
Overall HIE Current and Future Participation
Current...
HIE Use (among the 26% MA practices participating in HIE)
13
77%
75%
74%
45%
39%
28%
11%
2%
0% 20% 40% 60% 80% 100%
Public...
The HIway works and delivers value!
14
219,931 Transactions exchanged during April 29
2,450,425 Total Transactions (incept...
Mass HIway Status Map - IN DEVELOPMENT
15
as of March 2014
Organization Name:Milford Regional Medical Center
HIway Status:...
HIE drivers, challenges and trends
Drivers
 Alignment to Meaningful Use objectives and CEHRT
criteria - specifically, MU2 requires HIE – to gain
incentive p...
Drivers from the Commonwealth Fund Report - “Getting it Right…”
 “Physicians sharing the same patient ordered duplicate t...
Drivers prompted locally - in MA
 All Providers able to access an EHR networked through the
statewide HIE - January 2017
...
20
Source: MA Cost Trends Report, 2013
21
Opportunity for HIE
Source: MA Cost Trends Report, 2013
Challenges
 Little implementation guidance
 Establishing convincing value proposition
 HISP-HISP and directory sharing
...
Challenges from the eHealth Institute 2013 Survey
 Interoperability – without steep technical interface costs, more
plug ...
Trends
 From exchange to interoperability
 Quality over quantity incentives being implemented
– Shifting payment models ...
25
What’s ahead
 HIE gets easier – EHRs get there, experience in the
market grows, trust established
 Exchanges show val...
The rise of private HIEs
 “In general, privately funded HIEs are growing at a much faster rate
than publicly funded HIEs....
Governed and managed by
Winchester Highland Management,
LLC.
eLINC Heath Information Exchange (HIE)
• Our eLINC HIE was formed by Winchester Hospital
and the IPA under Highland Manage...
eLINC Participant Services
• The same folks that implemented the HM supported EMRs in the
community also make up the eLINC...
Winchester Community - Current Environment
• Community of close to 400 physicians and
Winchester Hospital
– 182 out of 208...
Supported Use Cases and Activities
• Care Transitions across healthcare organizations
– Excel Orthopedics Winchester Hom...
Clinical Data Repository – eCW eEHX
Features and Capabilities:
– Integrated directly with the EMR as an IHE compliant cros...
eLINC High Level End State Diagram
33
HL7 ADT, Results
Patient Results
Ambulatory Orders
Ambulatory Orders
Secure Messagin...
Health Information Exchange
Joe Heyman, MD
Chief Medical Information Officer
June 12, 2014
The Genesis
The Whittier IPA
The need to provide services and products for
members without attaching requirements
The need...
Early history after the
● Discontinuation of the minimal system
● Four years of coming close to signing
– No references of...
After Signing
● Clinician Commitments (marketing)
● Access to databases
● Reformatting
● 17 different vendors
● Mission an...
Documents
● Mission and Vision Statements
● Operating Principles
● Policies and procedures
● Consent and assent
● FAQs
● T...
Vision and Mission
OUR VISION
The widespread use of the Wellport Health Information
Exchange will improve the quality and ...
Operating Principles
● Patients always come first.
● Patient privacy, security and confidentiality are paramount.
● We ded...
●Advantages of an IPA ownership
● Physicians are stewards of the patients’ data
● Ethical use of data for improvement of q...
●Advantages of Regional HIE
● Clinicians can see ALL patients’ data
● No silos
● Improves health of entire community
● Imp...
Long term advantage of regional
physician owned HIE
● Quality measurement for entire community
● Quality measurement for a...
Where are we now?
● How many clinicians on production
platform? 43
● How many patients on the system?
101,027
● How many p...
Health Information Exchange
Owned and Operated by the Whittier IPA, Inc.
Joe Heyman, MD
Chief Medical Information Officer
...
Questions & Discussion
Sean Kennedy, MPH, MS, PMP
Health Information Exchange Director
Massachusetts eHealth Institute at ...
52
NEXT WEBINAR!
Meaningful Use Stage 2 & Health Information
Exchange (HIE)
Thursday, July 17 at 12:00pm-1:00pm
Join the M...
53
617-371-3999
info@maehi.org
@MassEHealth
www.mehi.masstech.org
Me hi hie-landscape-webinar-2014-june
Me hi hie-landscape-webinar-2014-june
Me hi hie-landscape-webinar-2014-june
Me hi hie-landscape-webinar-2014-june
Me hi hie-landscape-webinar-2014-june
Upcoming SlideShare
Loading in …5
×

Me hi hie-landscape-webinar-2014-june

580 views

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
580
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
11
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • So allow me to start by briefly working to detangle a sampling of the myriad of organizations in this HIE space. We are in a dynamic market with organizations taking shape to address the variety of “opportunities” HIE presents like building trust, ensuring conformance to standards, establishing information pathways. And while I slotted organizations or efforts into categories, few fit so neatly into one category.

    Starting with collaborations – these organizations grew out of a need to more easily exchange information. If you have not lived with this yet, you will – it takes at least two to dance in the HIE world – a sender and a receiver, so it is natural that groupings of organizations would rise to tackle the numerous barriers that exist, or to take advantage of an emerging market.

    The Care Connectivity Consortium is a collaboration among provider organizations - Geisinger Health System (PA), Group Health Cooperative (WA), Intermountain Healthcare (UT), Kaiser Permanente (CA), Mayo Clinic (MN), and Oregon HIN (OR) - in collab with HealtheWay - to develop and incubate new capabilities for consideration and adoption by eHealth Exchange participants and the broader HIE community. They provide patient matching, RLS, consent mgmt and integration services.
    http://www.careconnectivity.org/about/details/?a=about_the_ccc

    Where the Care Connectivity Consortium is comprised primarily of provider orgs, CommonWell is comprised primarily of EHR vendors – Allscripts, athenahealth, Cerner, CPSI, Greenway, McKesson, and Sunquest – and aim to tackle the problem of interoperability of EHRs. They provide patient linking and matching, patient access and consent mgmt, RLS and directed query services.
    http://www.commonwellalliance.org/about#purpose

    Carequality – while a collaboration – does not offer a set of technical HIE services, rather they are an action-oriented collaborative that aims to build upon existing exchange capabilities, leveraging existing standards and agreeing upon innovative approaches to improve exchange workflows and adoption. Similar to how banks came to together to grow the adoption of ATM networks, they aspire to do the same for HIE in healthcare.
    http://www.healthcareitnews.com/news/healtheway-convenes-carequality-take-hie-next-level
    http://www.carequality.net/what-we-are-doing.html

    Moving to the Trust quadrant -

    DirectTrust maintains a national Security and Trust Framework in support of Direct exchange and is made up of over 120 representatives covering HISPs, HIEs, certificate authorities, consultants, state agencies, EHR vendors and provider organizations. They offer a trust bundle service – essentially a way to scale trusted exchange – for accredited orgs.
    http://www.directtrust.org/

    In a related manner, the National Associate for Trusted Exchange – or NATE - developed a scalable Trust and Policy Framework that is intended to eliminate the existing barriers inhibiting the use of health information exchange. Different than DirectTrust, their membership is primarily – but not exclusively – made up of states - AL, CA, FL, HI, MI, NV, ND, UT, and OR to name a few. They also provide a trust bundle among other services to facilitate trusted exchange.
    http://nate-trust.org/about-us/

    Scooting down to the HIE box –

    HealtheWay is a non-profit spun out of ONC to manage the eHealth Exchange - a trusted, secure, nationwide HIE with shared governance and necessary shared services for orgs who wish to connect as a network of networks. They have 1,000s of providers connected and provide a gateway for exchange with participating federal government agencies.

    Similarly, Mass HIway is our HIE on the State level, and I will hold off on sharing any detail on eLINC or Wellport and allow them to speak for themselves in a couple minutes.

    And wrapping up in the certification & accreditation category –

    These two bodies work to promote consistency in the market by certifying or accrediting issuers of digital certificates.

    Federal Bridges is the federal government’s common infrastructure to administer digital certificates and public keys, including the ability to issue, maintain and revoke public key certificates. The term Federal Bridges cross-certified implies a ‘HISP’ conforms to the Federal Bridges Certification Authority requirements

    The Electronic Healthcare Network Accreditation Commission aims to achieve quality and trust in health information exchange by accrediting HISPs, CAs, RAs and HIEs through their various accreditation programs like HIEAP (HIE) and DTAAP (HISP).

    This is a dynamic and remarkably confusing environment. The key take-way is that all work together to enable trusted, secure, scalable exchange.
  • So let’s move on to a few facts and figures about HIE…
  • Based on a 2012 survey, there are roughly 280 HIEs – some public, some private - and as of today likely a few less.

    PRWeb. 71% of U.S. hospitals plan to purchase new health information exchange (HIE) technology solutions; 2012 CapSite U.S. Health Information Exchange (HIE) Study; September 14, 2012.
  • Regardless of how many HIEs there are, adoption is clearly on the rise…

    US-globally - htttp://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Digital-Doctor-Is-In.pdf#zoom=50
  • ONC published a series of dashboards to display data from their ONC/AHA survey.

    In this one 4 in 10 hospitals – or 41% - report an exchange capability for patient health information to and from external sources.

    http://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Capability-Secure-Electronic-Messaging.html
  • Further, 51% of hospitals can query from external sources which is an uptick from the 38% in 2012.


    http://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Electronic-Query-Capability.html
  • Moving to MA…
  • MeHI recently conducted a survey of MA-based provider organizations. While this data is self-reported from practice managers, it provides a reasonable estimate of HIE adoption among MA-based provider organizations.

    It is reported that overall 26% of Massachusetts health care practices participate in an HIE. Of that 26%, 51% are participating in the HIway or other private exchanges including Wellport, Holyoke Connect and eLINC. However, a number of practices that reported participating in HIE could not name the exchange in which they were participating, indicating that these exchanges may not be well known.
  • Of those 26% that indicated they are participating in an HIE, here is how they said they were using it.
  • So, specific to the HIway – our public, statewide HIE – organizations are joining and transactions are happening.
  • This HIway status map – while in development – graphically shows who is participating in the HIway and provides a sense of their progress – in-progress, connected, transacting.

    Our goal is to get a lot of green dots out there. The more green dots, presumably the more valuable the HIE becomes due to more trading partners.

    And what we very much want to do is to maintain a library of ways people are using the HIway in an effort to grow adoption. You can see a sample of what we are thinking with our Milford example.
  • Here is a sampling of the drivers to HIE.

    If you want incentive pmts you need to align to…

    REC, State HIE program, Beacon Communities

    There are also the new shared risk / shared reward healthcare reimbursement models that require the sharing of data

    Then there are the patient safety concerns…
  • In a study from 2004 funded by the Commonwealth Fund and conducted out of Duke entitled, “Electronic Medical Records— Getting It Right and Going to Scale,” they cite a # of examples where the lack of information leads to patient safety or care coordination concerns.


    Presumably making info more available at the point of care could reduce some of these findings.
  • Pay for outcomes, United Health Foundation ranks MA at 4th healthiest state – behind HI, VT and MN. NY is 15, PA -29, OH – 40, …TX – 36.

    A few categories of care account for a large part of the difference – hospital care, LTC/HH, professional services

    Tech to address some issues – HIX, EHR, HIE

    We have an active legislature…

  • The need for HIE is clear, but it will not be a smooth road
  • Micky did a nice interview where he described that workflow and ecosystem maturity are the biggest challenges to meeting the ToC and VDT objectives of MU2 – two of the roughly 6 groupings of objectives with an HIE component
    http://www.clinical-innovation.com/topics/policy/hitpc-workflow-ecosystem-maturity-are-biggest-challenges-mu-stage-2-hie-requirements

    While organizations are gaining great experience connecting to HIEs, there remains little imp guidance; documentation lags product availability

    Well funded HIEs – in the days of ONC grants – could get by without a well-defined value prop, but now that we are in the era of sustainability, a solid value prop is an imperative. Is the value the HIE proposes more than the effort and funding required to change workflows, build technical connections and invest in staffing resources?

    From a HISP, getting different secure “networks” to talk to one another is a hard nut to crack. Then working to share provider directories further complicate the problem.

    As we advance toward interoperability, ensuring exchanged data is usable by the receiver is a big deal.

    “You…

    Overhage - http://www.innovations.ahrq.gov/content.aspx?id=3944, March 2014

    3 Prestigiacom J. Private HIEs on the upswing. Healthc Inform. 2012;29(3):24, 26. [PubMed]
  • eHI 2013 survey

    Finance – hospital and payers funding most exchange activity; 16 reported sustainability in 2012 – 35 in 2013

    Competive – exchange limited to within an org or affiliates; much fewer with unaffiliated

    Patient engagement – communicating opt-in, patient receipt of health data

  • From exchange to interoperability. Interop = transport, content, vocabulary/code sets. The S&I initiative has been diligently working to ensure we are not just moving data around, but are trending toward creating interoperable solutions.
    http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf

    There is a lot of effort being put into transitioning from fee for service to value based payment models. This move of quality over quantity translates into participation in incentive programs – like MU or ACOs or PCMHs. The success of these new payment and delivery models depends on their capability to gather and analyze clinical and claims data, report on quality measures, and provide actionable information in support of improving care and outcomes for individuals and populations.

    Another trend, perhaps not as positive, is that adoption of EHRs seems to outpace HIE adoption. HIEs moved from – 14% (2010) to 30 (2012) to 41 (2014); where as EHRs moved from 19% (2010) to 56 (2012) to 78+ (2014).

    If you haven’t felt it yet, the consumers are coming. In a Deloitte study, they describe that the…
    Patients now routinely ask, “do you have an EHR?” May they soon ask, “are you connected to an HIE?”
    http://www.deloitte.com/assets/dcom-unitedstates/local%20assets/documents/health%20reform%20issues%20briefs/us_chs_issuebrief_2012consumersurvey_061212.pdf

  • Value – As more organizations join HIEs, as more information is exchanged and more use cases are born, the value of the exchanges will grow.

    IOM recently published their recommended domains of social and behavioral data to facilitate organized capture in EHRs. There is clearly a thirst for this type of data among providers, and with the new recommendations from the Privacy and Security Tiger Team to tag such data to enable deeper data segmentation of EHR data – this may soon come to pass.
    http://iom.edu/~/media/Files/Report%20Files/2014/EHR-Phase-1/EHRdomains.pdf

    How do you analyze data sets that are not aggregated in one location? This concept of distributed analytics allowing for federated queries is being considered.

    And finally, interoperability - ONC recently released their 10-year vision for interoperability where they describe the health IT ecosystem, paint a vision for interoperability, offer some guiding principles and agendas for the next 3, 6, and 10-years ultimately evolving into the “Learning Health System”. They also offer five building blocks:
    1. Core technical standards and functions
    2. Certification to support adoption and optimization of health IT products and services
    3. Privacy and security protections for health information
    4. Supportive business, clinical, cultural, and regulatory environments
    5. Rules of engagement and governance
    http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf
  • And, in transition to our guest speakers, they reflect their own trend – the rise of the private HIE.
    http://www.innovations.ahrq.gov/content.aspx?id=3944
    [PubMed]
  • Eddy Ropside is the EMR/HIE Director for Winchester Highland Management where he has tireless worked to help build the Winchester and eLINC connections to the HIway. Prior to joining Winchester Highland Mgmt, Eddy served as the Director of IS-Data Integration Services at Albany Medical Center, and prior to that he was the Director of Professional Services at Wellogic. Of note, Winchester Highland Mgmt is also one our 32 HIway Implementation Grantees.
  • -Acknowledge the acronym, define it.
    -Explain HISP services and what it will mean for our hospital and practice physicians.
  • Our main stakeholders are Winchester Hospital and Highland Healthcare Associates IPA with the HIE in the middle.
    We currently deliver results from Winchester Hospital and the IPA to physicians who have interfaces from Winchester into their EMRs.
    One of our main goals is for eLINC HIE participants to send their clinical encounter data to the eLINC HIE for data aggregation and provider access at the point of care.
    Delivering electronic ambulatory orders from the IPA practice EMRs to Winchester hospital is also one of our goals for this year to start on.
    We deployed our eLINC HISP to allow for direct secure messaging between eLINC HIE participants.
    The eLINC HISP is now connected to the MA state Hiway so our providers can send and receive messages directly to Winchester Hospital and any other provider connected to the MA state Hiway.
    One of the phases of the MA state Hiway is to allow providers to perform a patient record location search. eLINC will serve as the recipient for such searches on behalf HIE participants sending data to the clinical data repository. Since the HIE will contain patient consent information across the network, it is the logical place to respond to queries.
    We need to determine how will we will connect to our tertiary healthcare providers and other potential HIE participants.
    Our providers will have the ability to do the following.
    Receive patient results directly in their EMR from Winchester Hospital
    Send and receive secure messages to each other and others connected to the MA State Hiway
    Send laboratory and radiology orders electronically to Winchester Hospital for their patients.
    Access patient data in the HIE via one of the following ways.
    They may log into a provider portal and search for the patient data. If the patient gave consent then the provider may access the patient information while providing care to the patient.
    The provider may click on a magic button right in their EMR.
    The provider may access and consume the HIE data directly in their EMR.
  • Joe Heyman, MD is a former chair of the American Medical Association Board of Trustees, former president of the Massachusetts Medical Society, and just finished a three-year stint as Chair of the National Physician Advisory Board of Optum, Inc. He served on the Board of Commissioners of the Joint Commission and the Board of Directors of Joint Commission Resources/ International. He serves on three subcommittees for the Office of the National Coordinator for Health Information Technology, the Bryan University Advisory Board and the advisory board of Digital Collaboration Solutions. He is the founder, former president and the chief medical information officer of the Whittier IPA, Inc., a non-profit organization of physicians in the Merrimac Valley that owns and operates the Wellport Health Information Exchange. He practiced Obstetrics and Gynecology in both a group and solo practice for 41 years, having retired from clinical practice in March 2014.
  • Me hi hie-landscape-webinar-2014-june

    1. 1. HIE Perspectives and Understanding National, State, and Local Initiatives
    2. 2. Learning objectives  Recognize and differentiate national HIE efforts  Indicate the current level of HIE adoption  Describe drivers of HIE at the national and Massachusetts levels  Delineate challenges inherent in HIE  Characterize emerging HIE trends 2
    3. 3. Agenda  The “apples” and “oranges” of HIE  HIE Facts and Figures  HIE drivers, challenges and trends  eLINC HIE and the Salter/Winchester Hospital use case  Use Case for a regional HIE: Wellport HIE 3
    4. 4. About Us Sean Kennedy, MPH, MS, PMP Health Information Exchange Director Massachusetts eHealth Institute at the Massachusetts Technology Collaborative Eddy Rospide EMR/HIE Director Winchester Highland Management, LLC eLINC Health Information Exchange Joe Heyman, MD Chief Medical Information Officer Wellport Health Information Exchange
    5. 5. The “apples” and “oranges” of HIE Collaborations • Care Connectivity Consortium • CommonWell Health Alliance • Carequality Trust • Direct Trust • National Association for Trusted Exchange (NATE) HIEs • eHealth Exchange (federal) • Mass HIway (public, state) • eLINC & Wellport HIE(private, regional) Certification / Accreditation • Federal Bridge Certification Authority (FBCA) • Electronic Healthcare Network Accreditation Commission (EHNAC) 5
    6. 6. HIE Facts and Figures National
    7. 7. How many HIEs are there?  Although estimates vary depending on the data source, there are as many as 280 health information exchanges (HIEs) in the United States that enable the electronic sharing of health- related information. 7 Source: 2012 CapSite U.S. Health Information Exchange (HIE) Study
    8. 8. Adoption of HIEs is on the rise  One-half of the nation’s hospitals are now participating in a regional, State, or private HIE, and 71 percent plan to buy new HIE technology in the next 2 years.1  Furthermore, nearly one-half of the nation’s physicians plan to join an HIE.2 8 Source: 1 2012 CapSite U.S. Health Information Exchange (HIE) Study 2 McCann E. HIEs see rise in physician enrollment; demonstration of Stage 1 gains similar traction. PhysBizTech. 2012 Oct.
    9. 9. 4 in 10 hospitals report an exchange capability for PHI 9 Percent of Hospitals Able to Send and Receive Secure Electronic Messages Containing Patient Health Information to and from External Sources Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement.
    10. 10. 51 percent of hospitals can query from external sources 10 U.S. Hospitals' Capability to Electronically Query Patient Health Information from Outside Their Organization or System Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement.
    11. 11. HIE Facts and Figures Massachusetts
    12. 12. HIE Participation (% among all MA practices) 12 26% 16% 18% 2% 32% 7% Overall HIE Current and Future Participation Currently participate in HIE Will participate in next 12 months Will participate in 1 - 2 years Will participate in 3+ years Unsure of participation date Will not participate in HIE Source: Massachusetts eHealth Institute Practice Health IT Study 2014
    13. 13. HIE Use (among the 26% MA practices participating in HIE) 13 77% 75% 74% 45% 39% 28% 11% 2% 0% 20% 40% 60% 80% 100% Public Health and Quality Measures Requests for Referral eRX Lab &Test Ordering Eligibility Verification Transitions of Care None of these Anything else HIE Users: What information are they exchanging? Source: Massachusetts eHealth Institute Practice Health IT Study 2014
    14. 14. The HIway works and delivers value! 14 219,931 Transactions exchanged during April 29 2,450,425 Total Transactions (inception to date) April Transaction Activity HIway Status (organizations) Count Contracted 200 Connected 105 SOURCE: Health Information Technology Council slides, May 2014
    15. 15. Mass HIway Status Map - IN DEVELOPMENT 15 as of March 2014 Organization Name:Milford Regional Medical Center HIway Status: Transacting Billing City: MILFORD Billing Street: 14 PROSPECT ST Use Cases: Discharge summaries from acute care to skilled nursing facility and home health in the form of a CCDA
    16. 16. HIE drivers, challenges and trends
    17. 17. Drivers  Alignment to Meaningful Use objectives and CEHRT criteria - specifically, MU2 requires HIE – to gain incentive payments  ONC grant funding to promote adoption of HIE and EHRs  Emerging value-based payment models and ACOs  Patient safety and patient care 17
    18. 18. Drivers from the Commonwealth Fund Report - “Getting it Right…”  “Physicians sharing the same patient ordered duplicate tests and therapies. The same drug and radiology exam were ordered 11 percent of the time. Half of the time, patients followed the duplicate instructions.  Physicians did not know what other physicians were doing to their patients. Primary care physicians were not aware of one of four prescriptions taken by patients.  Uncertainty and hassle reduction drove decisions. One of seven admissions resulted from missing information in EDs or primary care settings. One of five lab and X-ray tests were duplicates because of retrieval barriers.” 18 Source: Electronic Medical Records—Getting It Right and Going to Scale, W. Edward Hammond, The Commonwealth Fund, January 2004
    19. 19. Drivers prompted locally - in MA  All Providers able to access an EHR networked through the statewide HIE - January 2017  C.224 cost containment provisions 19
    20. 20. 20 Source: MA Cost Trends Report, 2013
    21. 21. 21 Opportunity for HIE Source: MA Cost Trends Report, 2013
    22. 22. Challenges  Little implementation guidance  Establishing convincing value proposition  HISP-HISP and directory sharing  Compatibility of exchanged data sets  “You can’t draw a border, and say ‘patients stop here.’” – J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer at Siemens Healthcare, Health Services on HIEs ending at state borders 22 “Ecosystem maturity and workflow changes represent the two main challenges for vendors and providers as they implement two Meaningful Use (MU) Stage 2 requirements related to health information exchange: transition of care (ToC) and view, download and transmit (VDT) requirements.” Micky Tripathi, CEO, Mass eHealth Collaborative
    23. 23. Challenges from the eHealth Institute 2013 Survey  Interoperability – without steep technical interface costs, more plug n play  Financial sustainability – private vs public financing  Competitive concerns  Patient engagement remains low 23 Source: eHealth Institute, 2013 Survey on Health Data Exchange http://www.ehidc.org/resource-center/surveys/view_document/333-survey-results-results-from- survey-on-data-exchange-2013-data-exchange
    24. 24. Trends  From exchange to interoperability  Quality over quantity incentives being implemented – Shifting payment models – from fee for service to value-based  Faster adoption of EHRs than HIEs  Consumerism of healthcare – Majority (52%) of consumers want to access tools, websites rankings for quality, patients’ reviews of doctors and hospitals 24
    25. 25. 25 What’s ahead  HIE gets easier – EHRs get there, experience in the market grows, trust established  Exchanges show value  Capturing social and behavioral domains in electronic health records  Distributed analytics  Interoperability - “ONC’s 10-year plan”
    26. 26. The rise of private HIEs  “In general, privately funded HIEs are growing at a much faster rate than publicly funded HIEs. From 2010 to 2011, the number of live public HIEs in the United States rose from 37 to 67, whereas the number of live private HIEs more than tripled from 52 to 161.” 26 Source: Prestigiacom J. Private HIEs on the upswing. Healthc Inform. 2012;29(3):24, 26.
    27. 27. Governed and managed by Winchester Highland Management, LLC.
    28. 28. eLINC Heath Information Exchange (HIE) • Our eLINC HIE was formed by Winchester Hospital and the IPA under Highland Management. More info can found at http://elinc.businesscatalyst.com for now. eLINC stands for: – electronically Leveraging information – Improving care – Networking providers, and – Communicating with each other • eLINC a vehicle for our stakeholders to message each other, and share or exchange health information in a safe, secure, and non-competitive manner 28
    29. 29. eLINC Participant Services • The same folks that implemented the HM supported EMRs in the community also make up the eLINC implementation and support Team. They provider the following services: – EMR implementation – Meaningful Use Attestation assistance – Secure direct messaging accounts which can communicate with any EMR vendor who uses a HISP that participates and implemented the direct trust framework and certificate bundles respectively. – Hospital admission and discharge notifications for PCPs and ACOs – Clinicians access to patient clinical information (delivered directly in the EMR) , aggregated from many organizations (eLINC HIE), for use at the point of care • Central Data Repository (CDR) services for aggregation of patient data from HIE participant EMR systems (Deploying in June 2014) – Results delivery from Winchester Hospital laboratory, radiology, and other departments (Current) – Business Intelligence(BI) services for network and provider quality performance reporting (TBD) 29
    30. 30. Winchester Community - Current Environment • Community of close to 400 physicians and Winchester Hospital – 182 out of 208 eligible providers have attested for MU Stage 1. – There are a total of 81 interfaces between Winchester Hospital and physician practices • 23 Different EMRs but mainly 11 supported – eClinicalWorks, AthenaHealth, Allscripts Professional, NexTech, GE Centricity, Origin, Practice Partners, MDIntellesys, Vitera, Nexgen, and Amazing Charts. • 23 Practices or 27 physicians are still on paper. 30
    31. 31. Supported Use Cases and Activities • Care Transitions across healthcare organizations – Excel Orthopedics Winchester Homecare – Excel Orthopedics  Winchester Hospital surgical preadmission and testing – Salter Healthcare  Winchester Hospital ED and Medical Records department • Upcoming Activities – Deploy secure messaging across the community – Work with physicians to attest for MU 2 – Pilot HIE Clinical repository with 2 pilot eCW practices – Integrate Athena, Practice Partner EMR products as well as all your EMR vendor products to the HIE clinical repository 31
    32. 32. Clinical Data Repository – eCW eEHX Features and Capabilities: – Integrated directly with the EMR as an IHE compliant cross enterprise document repository – Access may also be through secure web login – Aggregates data from all contributing organizations – Supports C32 CCD integration – Document may only uploads only through eCW – Patient consent flows directly from ADT integrated EMRs Work in progress: – Encrypted CCD download – Patient consent capture by participant front staff in cases where no ADT interface with consent exists between participant EMR – Monitoring report on performance of live eCW EMRs when tightly integrated with eEHX – Performance report on nightly sweep of patient data from eCW EMRs where patients have opted into the eLINC HIE – Workflow concerns related to consent capture – Proper education and training of participants 32
    33. 33. eLINC High Level End State Diagram 33 HL7 ADT, Results Patient Results Ambulatory Orders Ambulatory Orders Secure Messaging MA State HIway Secure Messaging Clinical Encounter Data Expanding Concentric Circle NEQCA SNFs Rehabs Winchester Homecare Tufts Medical Center Lahey Health TBD RLS Query/Response
    34. 34. Health Information Exchange Joe Heyman, MD Chief Medical Information Officer June 12, 2014
    35. 35. The Genesis The Whittier IPA The need to provide services and products for members without attaching requirements The need for clinical integration for contracting and avoiding antitrust issues The opportunity (2004-2008) The importance of physician independence Improving quality and efficiency of care MAeHC
    36. 36. Early history after the ● Discontinuation of the minimal system ● Four years of coming close to signing – No references of a major vendor – Change the deal about hospital sign-on – on the last day – Quadruple the price on the last day – Finally signing last summer MaeHC
    37. 37. After Signing ● Clinician Commitments (marketing) ● Access to databases ● Reformatting ● 17 different vendors ● Mission and Vision ● Committees – Policy, Usage, Technology
    38. 38. Documents ● Mission and Vision Statements ● Operating Principles ● Policies and procedures ● Consent and assent ● FAQs ● Trifold for marketing ● Education for clinicians about proper use and legitimate access ● Internal HIPAA required security documents ● Business Associate Agreement ● Service Agreements ● Mass HIway agreements (HISP to HISP) ● Vendor SOW and contract ● EMR vendor interface agreements
    39. 39. Vision and Mission OUR VISION The widespread use of the Wellport Health Information Exchange will improve the quality and efficiency of healthcare for all patients in the lower Merrimack Valley and beyond -- in an atmosphere of trust. OUR MISSION The Wellport Health Information Exchange (HIE) will provide the communication vehicle to improve the quality and efficiency of healthcare for its subscribers and their patients and clients by developing and providing services for managing and exchanging health information in an atmosphere of trust. The HIE will be guided by its Operating Principles which may evolve over time.
    40. 40. Operating Principles ● Patients always come first. ● Patient privacy, security and confidentiality are paramount. ● We dedicate our services to the entire community of medical institutions and patients regardless of affiliations. ● Clinical data are not shared for purposes other than treatment, quality measurement and improvement, and public health. ● We will not share confidential business data among institutions or physicians unless requested by the contributor of that information. ● We will not sell clinical data.
    41. 41. ●Advantages of an IPA ownership ● Physicians are stewards of the patients’ data ● Ethical use of data for improvement of quality and efficiency ● Instantaneous access to aggregated data ● No physician imprisonment ● Potential income stream for the IPA ● Private Direct addresses ● Helps with MU achievement
    42. 42. ●Advantages of Regional HIE ● Clinicians can see ALL patients’ data ● No silos ● Improves health of entire community ● Improves efficiency for entire community ● Ease of referrals – You can easily attach other clinical information (that does not come from your own practice) to a direct message over the Mass HIway ● Single patient portal
    43. 43. Long term advantage of regional physician owned HIE ● Quality measurement for entire community ● Quality measurement for any subset of the community ● Potential addition of new innovative services (billing, third party applications, mobile, analytics)
    44. 44. Where are we now? ● How many clinicians on production platform? 43 ● How many patients on the system? 101,027 ● How many progress notes? 794,233 ● How many patients have opted in? 0 ● Platform is live and running ● Patient opt-in about to begin
    45. 45. Health Information Exchange Owned and Operated by the Whittier IPA, Inc. Joe Heyman, MD Chief Medical Information Officer 255 Low Street Newburyport, MA 01950 (978) 462-2345 Office (978) 807-5365 Cell joseph.heyman@verizon.net www.wellporthealth.net
    46. 46. Questions & Discussion Sean Kennedy, MPH, MS, PMP Health Information Exchange Director Massachusetts eHealth Institute at the Massachusetts Technology Collaborative Eddy Rospide EMR/HIE Director Winchester Highland Management, LLC eLINC Health Information Exchange Joe Heyman, MD Chief Medical Information Officer Wellport Health Information Exchange
    47. 47. 52 NEXT WEBINAR! Meaningful Use Stage 2 & Health Information Exchange (HIE) Thursday, July 17 at 12:00pm-1:00pm Join the Massachusetts eHealth Institute (MeHI) for an educational webinar on health information exchange (HIE) and Stage 2 Meaningful Use (MU). Sean Kennedy, Health Information Exchange Director and Al Wroblewski, a Meaningful Use subject matter expert will lead this important session and discuss how using an HIE can assist eligible participants in meeting Stage 2 Meaningful Use measures. Important Meaningful Use topics will include transitions of care, the submission of public health measures, and patient engagement. Register
    48. 48. 53 617-371-3999 info@maehi.org @MassEHealth www.mehi.masstech.org

    ×