Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Health Care Information Exchange Strategy & Roadmap


Published on

Connecting Patients, Providers and Payers

Published in: Economy & Finance

Health Care Information Exchange Strategy & Roadmap

  1. 1. Health Information Technology Connecting Patients, Providers and PayersHealth Care Information Exchange Strategy and Roadmap
  2. 2. About me Patrick Mulrooney14 years providing successful delivery of Enterprise Strategy Programs andsolutions that create and optimized IT & Business combined road-maps, whileensuring that the appropriate technologies are being utilized to maximize,Capitalize and support business strategies .Successful delivery of 50 + projects in a management role.Expertise:  Global Solution Delivery  IT Governance  Enterprise Architecture  Business Insight  Information Management  Business Value Analysis and Benefits Management  Organizational DesignGroup Affiliation: Microsoft in Health, Enterprise Architecture Consultants, Microsoft BI & Datawarehouse Professionals, IT Governance & Outsourcing, Data Architect USA, Solution Architecture Workshop of Microsoft, Microsoft Amalga, Enterprise Management Architecture.Home: Buffalo New YorkLove GolfVeteran: United States Air Force
  3. 3. Scope of Engagement Deliver Business Foundation & Road Map strategies  Nationwide Health Information Network (NHIN)  Health Information Exchange (HIE) Integrate Health Information Technology (Health IT) Incorporate Medicaid Information Technology Architecture (MITA) Map Architecture Framework  Business Architecture  Information & Data Architecture  Technical Architecture Assemble Architecture Development Model (ADM), Enterprise Continuum  Architectural Assets (Building Blocks)  Technical Designs  Solutions  Platforms  Tools……
  4. 4. Stakeholders Senior leadership (CFO, COO, CEO,CIO,CTO) Medical Professionals and Health care Providers;  Clinic managers, Nursing staff, Billing and administrative staff, Medical records staff…. Patient advocates Government agencies, Federal & Local Health plan sponsors (employers / unions). Special Investigation (SIU) Corporate Sales & CRM executives. 550,000 members/beneficiaries
  5. 5. My Role “Multiple Hats” Ensuring that the business and IT strategies were in position. Accomplish Needs analysis and roadmap development. (IBM Blue Works) Architect Solutions that were in line with current Business/IT environment. Align technology to business objectives. Business case development. Secure the active participation of key stakeholders.
  6. 6. My Role “Multiple Hats” cont Drive common approaches and expose information assets and processes across the enterprise. (Enterprise Continuum) Link the business mission, strategy and processes of an organization to its IT strategy . Show how the current and future needs of the organization will be met in an efficient, sustainable, agile, and adaptable manner. Allow both the Business and IT strategies to enable and drive each other. Making sure that there is a vision...
  7. 7. Value of my Contribution Successful alignment of IT strategy and planning with companys business goals. Optimization of information management approaches. Integrated Long-term strategic responsibility for the companys IT systems. Promotion of shared infrastructure and applications. Reduce costs and improve information flows. Ensured that projects did not duplicate functionality or diverge from each other.
  8. 8. Value of my Contribution cont. Mitigated the risks associated with information and IT assets through appropriate standards and security policies. Built staff development, knowledge and skills. Transferred understanding of evolving business needs and technology capabilities. Direct involvement in the development of policies, standards and guidelines that express the selection, development, implementation and use of Information Technology within the enterprise.
  9. 9. Business Foundation & Road Map Mission Statement Our Goal Business Value Business & IT Alignment  Eight IT Priority Areas of Focus Enterprise Road Map Required Data Exchanges Business Imperatives
  10. 10. To successfully institute a framework of business processes and technologies that support and improved program administration for the enterprise and stakeholders.  Thinking Globally  Acting Dynamically  Focus on the individual
  11. 11. Our Goal Patient Centric Health Information Exchange Diagnostic Pharmacies Labs HospitalsBehavioral Health Public Provider & Health Physicians & Patient Staff 11
  12. 12. Business Value & Benefits• Develop capabilities for standards-based, secure data exchange nationwide.• Improve the coordination of care & information among hospitals, laboratories, physicians offices, pharmacies, and other providers.• Ensure appropriate information is available at the time and place of care.• Ensure that members health information is secure and confidential.
  13. 13. Business Value & Benefits cont• Offer members new capabilities for managing and controlling their personal health records as well as providing access to their health information from Electronic Health Records (EHR) and other sources.• Reduce risks from medical errors.• Supporting the delivery of appropriate, evidence based medical care.• Lower healthcare costs by reducing inefficiencies, medical errors, and incomplete patient information.
  14. 14. Enterprise Road Map Required Data Exchanges2013 Lab results delivery ePrescribing Claims and eligibility checking Quality & immunization reporting2014 Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Receive public health alerts Home monitoring Populate Personal Health Records (PHR)2015 Access comprehensive data from all available sources Experience of care reporting Medical device interoperability
  15. 15. Joint Business & IT Priority Areas “Road Map”1. Incorporate technologies that protect the privacy of health information and promote security in a qualified electronic health record.  Including for the segmentation and protection from disclosure, of specific and sensitive individual identifiable health information.2. A nationwide health information technology infrastructure that allows for the electronic use and accurate exchange of health information.3. The utilization of a certified electronic health record for each person by 2014.4. Technologies that, as a part of a qualified electronic health record, allow for the accounting/auditing of disclosures made by a covered entity.
  16. 16. Joint Business & IT Priority Areas (cont.)5. The use of certified electronic health records to improve the quality of health care.6. Technology solutions that allow individually identifiable health information, to be rendered unusable, unreadable, to unauthorized individuals.7. The use of electronic systems to ensure the comprehensive collection of patient demographic data, including at a minimum, race, ethnicity, primary language, and gender information.8. Technology solutions that address the needs of children, elderly and other vulnerable populations.
  17. 17. Business Benefits
  18. 18. Change the Way We Think  Beneficiary & Member centric focus  Public & private collaborations  Dynamic synergy with the Department of Health
  19. 19. Change the Way Weinteract With Technology Develop & Require Best Practices Expand Project Management Disciplines Engage Enterprise Solution Architectures Integrate Testing & Quality Assurance Faster “Time to Market” Create successful business-technology roadmaps
  20. 20. Change the Way We Work Learning & Growth Organize Around Strategy Align to Create Synergy Promote Process Innovation Mission Based Motivation
  21. 21. Change the Way We Govern Business Based Priority Setting Govern Based on Facts Goal & Objective Based Decision Making Execution Based Upon Value
  22. 22. Change the Way We lead  Strategic Accountability  Performance Accountability  Operational Excellence  Strategic Flexibility
  23. 23. Give us Strategic Advantage  E-prescribe, MTM, Part D  Electronic Health Records  Linking our Health Community  Business Agility  Member Empowerment  Improved Health of Members & BeneficiariesMTM=Medication therapy management, Part D = Medicare Prescription Drug Benefit
  24. 24. Make us a Better Company
  25. 25. Nationwide Health Information Network (NHIN)
  26. 26. Health Information Distribution
  27. 27. Goals NHIN seeks to achieve • Developing capabilities for standards-based, secure data exchange nationwide. • Improving the coordination of care information among hospitals, laboratories, physicians offices, pharmacies, and other providers. (Amalga ) • Ensuring appropriate information is available at the time and place of care. • Giving consumers new capabilities for managing and controlling their personal health records as well as providing access to their health information from Electronic Health Records (HER) and other sources. ( Health Vault ) • Reducing risks from medical errors and supporting the delivery of appropriate, evidence-based medical care. • Lowering healthcare costs by reducing inefficiencies, medical errors, and incomplete patient information.NHIN =Nationwide Health Information Network
  28. 28. Health Information Exchange (HIE)
  29. 29. Health Information Exchange (HIE) is designed to: • Improve individual patient care. • Provide early detection of infectious disease outbreaks around the country. • Improved tracking of chronic disease management. • Provide quality measurements.  ( HEDIS )HEDIS = Health Care Effectiveness Data for Information set
  30. 30. Patient Visit/Discharge Summary Exchange 4 Patient receives care and 3 details are noted in hospital medical record As a result of a referral, admission, or emergency, patient registers in hospital HIE service checks 7 provider directory for 2 routing instructions Consents and Standard format provider routing discharge summary preferences are sent or ER report is to HIE service transmitted to HIE network 6 Patient is discharged from hospitalPatient visits PCP or specialist HIE service routes and establishes trusted discharge summary torelationship and consents for PCP, specialist or 5 release of data other interested and 1 trusted party (e.g., health insurance case HIE = Health Information Exchange manager) PCP = Primary Care Provider 8
  31. 31. 2 Provider refers patient to a Referrals specialist, hospital or other provider for consultation or service 4 3 HIE service checks provider directory for routing HIE service submits instructions and sends referral referral authorization request with pertinent patient information / history, diagnosis request to payer for and service requested to approval and referral # consulting provider; business rules can be stored in HIE service for elements of real- time decision support Patient visits PCP HIE service routes 1 or specialist and visit summary to PCP, Patient visits consulting establishes trusted specialist or other Standard format provider, receives relationship and interested and trusted visit summary with services, and details are consents for release party (e.g., health consultation notes noted in patient chart , of data; consents insurance case transmitted to HIE electronic medical and provider routing manager) network record or other result is preferences are created (e.g., at lab) sent to HIE service 7 6HIE = Health Information Exchange 5PCP = Primary Care Provider
  32. 32. Laboratory Results 2 Consents, lab results, and provider routing preferences are sent to HIE service 3 HIE service checks provider directory for routing instructions and sends laboratory results to patient’s preferred provider1 4Patient undergoes tests from his or her Authorized providers physician, establishes can access patient’strusted relationship and laboratory resultsconsents for release of laboratory dataHIE = Health Information ExchangePCP = Primary Care Provider
  33. 33. Standardized Quality Data 2 Consents, provider routing preferences and applicable data are sent to HIE service Standard format visit1 summary or batch with data for determining quality metrics is Patient visits PCP, sent to payer, government specialist, hospital or agency or other quality metrics other provider and 3 organization based on patient establishes trusted consent and business HIE relationship and service.consents for release of data HIE = Health Information Exchange PCP = Primary Care Provider
  34. 34. Community Provider Directory 3 HIE service consolidates organizational provider information into a single 1 community provider 4 directory Provider Provider information Authorized HIEorganizations track from each provider users can access and maintains organization is sent community provider internal provider to HIE service directory directory 2 HIE = Health Information Exchange PCP = Primary Care Provider
  35. 35. Health Information Technology (Health IT)
  36. 36. Health Information Technology (Health IT) Health Information Technology (Health IT) is the use of computer applications to record, store, protect, retrieve, and transfer, clinical, administrative, and financial information electronically within health care settings. New Health Reform laws requires implementation of uniform standards for electronic exchange of health information by 2013. 36
  37. 37. Health IT Strategic Goals  Develop the infrastructure for Electronic Health Records, including privacy, confidentiality, and data standards.  Provide incentives and create tools to facilitate the adoption of Health IT and EHRs. EHR = Electronic Health RecordsEHR = Electronic Health Records 37
  38. 38. Benefits Associated withBroad use of HIT Improve health care quality Prevent medical errors Reduce health care costs Increase administrative efficiencies Decrease paperwork Expand access to affordable care
  39. 39. Benefits: Better Engaged Patients  Electronic Health Record systems can connect patients to community resources and support.  Provides information that permits them to participate in shared decision-making with their healthcare provider.  Supports home monitoring of reported symptoms related to chronic conditions with the goal of preventing unnecessary hospitalization.HIT = Health Information Technology (Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001) 39
  40. 40. Benefits: Clinical Decision Support Systems (CDS)  Clinical Decision Support systems are seen as critical components in creating EHR-based “learning systems”  CDS continually incorporate clinical advances, applying them to ever-growing and more detailed patient databases  CDS increase the providers abilities to predict (based on patient data and demographics) which interventions will offer the best outcome. EHR = Electronic Health RecordsSources: Grantham, D. (November/December 2010) CDS systems seek “real life” data. Behavioral Healthcare. pp. 35-39;Moore, J. (January/February 2011) CDS: more signal, less noise. Government Health IT, pp. 25-27EHR =Electronic Health Records, Vitamin D deficiencies 40
  41. 41. Strategic Outcomes for Health IT Adoption Strategic HIT Performance HIT Strategic Focus Areas Outcomes Performance Metrics Meaningful Use of Reduced Unnecessary EHR to reduce Cost/Utilization = Cost Reduced PMPM & Duplication, Errors ContainmentStrategic Planning Logic Map and improve Lower % Admin Cost Admin Efficiency Meaningful Use of Improved Quality Quality EHR to better Against HEDIS and Improvement coordinate care and Other Benchmarks Quality Performance Meaningful use of Higher Provider Administrative EHR to Reduce Satisfaction & Efficiency Admin. Process Reduction in Admin. Cycle Times Cost Public Meaningful Use of Public Health EHR to build Health & Responsiveness Population Reduction in Research Health Mgmt. & Health Disparities Research 01/05/13 Barrier USE Meaningful PERFORMANCE Management Barrier
  42. 42. Advantage: A Connected Health IT System Hospital Care Diagnostics Specialist Referral Coordination Primary Order Care Entry Lab Medical Result Home Reporting EHR/HIE Provider Research & E-Prescribing Comparative Remote Patient Medical Mgmt. & Effectiveness Self Monitoring AdministrativeEHR = Electronic Health Records DataHIE= Health Information Exchange
  43. 43. Medicaid InformationTechnology Architecture (MITA)
  44. 44. Medicaid Information Technology Architecture (MITA)MITA represents a business-driven enterprisetransformation.MITA is firmly grounded in enterprisearchitecture principles.MITA defines a business transformation over a5-year and long-term (10 years and greater)timeframe, and defines a technical architectureand a transition strategy to enable the businesstransformation.
  45. 45. MITA Objectives  Promote reusable components through modularity.  Adapt data and industry standards.  Promote secure data exchange.  Promote efficient data sharing.  Beneficiary centric focus.  Integration of clinical and administrative data to enable better decision making.  Breakdown artificial barriers between systems, geography, and funding within the Title 19 program.The Medicaid Title 19 program is designed to help persons who are age 65 years or older, or persons with disabilities between theages of 18 and 65, who are blind or who receive public assistance to pay medical expenses
  46. 46. MITA Goals Develop seamless integrated systems that effectively communicate through interoperability and standards. Provide an environment that supports flexibility, adaptability, and rapid response to changes in programs and technology. Establish a national framework of enabling technologies and processes that support improved program administration for the Medicaid enterprise. Dedicated to improving healthcare outcomes for Medicaid beneficiaries.
  47. 47. Nation Wide Framework
  48. 48. “Partnerships” Business and IT Alignment MITA is intended to foster integrated business and IT transformation across the Medicaid enterprise to improve the administration of the Medicaid program. It is a common business and technology vision for state Medicaid organizations.MITA is conceived in the context of:  E-Gov Federal Enterprise Architecture  Office of the National Coordinator for Health Information Technology (ONCHIT).  The Centers for Medicare and Medicaid Management (CMS)  National Health Infrastructure Initiative (NHII).
  49. 49. Architecture Framework (MITA) Business Architecture Information Architecture Technical Architecture
  50. 50. Business Architecture Concept of OperationsThe “Concept of Operations” is a methodology used to describe current business operations and to envision a future transformation that meets the needs of stakeholders. Definition of As-Is operations. Identification of current and future stakeholders. Identification of major business and data exchanges between stakeholders. Description of To-Be operations. Listing of key enablers required to meet the To-Be transformation.
  51. 51. Business Architecture Maturity ModelA maturity model can be viewed as a set of structured levels that describe how well the behaviors, practices and processes of an organization can reliably and sustainably produce required outcomes.
  52. 52. Business Architecture Business Process Model Medicaid Business Process Model Member Provider Contractor Operations Management Management Management Management Program Business Program Care Integrity Relationship Management Management Management ManagementThe Business Process Model is a repository of business processes common to most Health Care programs. TheBPM consists of a hierarchy of business areas that lead to individual business processes.
  53. 53. Business Architecture Business Self AssessmentThe Business Self Assessment is used to determine current business capabilities and document their plans for transformation to achieve a higher level of business prowess.
  54. 54. Business ArchitectureStrategy & Governance  Prioritize business capability needs.  Formal plan for implementing capabilities.  Establish technical standards.  Solidify strategic approach.
  55. 55. Business Architecture Process Innovation Best practices in requirements gathering, project management, architecture and software development. Governance process & portfolio management.
  56. 56. Architecture Framework (MITA) Business Architecture Information Architecture Technical Architecture
  57. 57. Information ArchitectureThe Information Architecture describes a logical architecture for the Health Care enterprise. It provides a description of the information strategy, architecture, and data that may be used to define the needs that will enable the future business processes of the enterprise.
  58. 58. Information ArchitectureRational for Building a Clinical &Administrative information Architecture Facilitates Cost and Quality Transparency Essential for Continuity of Care Records Facilitates Population Health Management Improves Medical Management Improve Program Evaluation and Decision Making
  59. 59. Information Architecture Data Management Strategy Provide a structure that facilitates the development of data that can be effectively shared across a State’s Medicaid enterprise boundaries to improve mission performance. Provides a mechanism for the agency to better understand data and how it fits in the total realm of Medicaid information. Addresses fundamental areas necessary to enable information sharing opportunities. Positions the Medicaid agency to operate in an environment of global information.
  60. 60. Information Architecture Key Components to Data Management Strategy Data Governance defines the governance processes for making enterprise-wide decisions regarding MITA’s information holdings. Data Architecture establishes standard data-management procedures for the MITA data models. Data-Sharing Architecture describes technology considerations for Medicaid enterprises to participate in information-sharing communities.
  61. 61. Information ArchitectureConceptual Data ModelThe conceptual data model is usedprimarily as a communication tool betweenthe business user and IT architect toobtain agreement on the overalldescription of entities and theirrelationships in business terms. It alsorepresents the beginnings of an overalllogical structure of the data.
  62. 62. Information Architecture Logical Data Model Derived from the conceptual data model, the logical data model defines aspects of the business, broken down into data classes and attributes associated with each business process. The model identifies all of the data elements that are in motion within the system or shared throughout the Medicaid enterprise. It also shows relationships between aspects of business. The logical data model is the foundation for creating a physical data model.
  63. 63. Enterprise Level Data Repository and Decision Support Infrastructure Methods/Analytics Decision •Episodes of Care SupportExternal Data / Profiles •Performance Measures Reporting Public Health •Disease Staging Applications Evidence-Based Medical Management Medicine Comparative Fraud Detection Data Sets Data Data DataBeneficiary Data Warehouse Architecture Architecture Performance Analysis Data Management And And Sources Process Data Data Claims/Encounter Cubes Eligibility Analysis •Security Protection Cubes Clinical Data Sets •Integration Cost and Quality •Translation Analysis Demographic Data •Standardization Prescription Drug •Data Validation Profile and Screens Chronic Chronic EHR Data Illness Illness Eligibility Data Health Plan & Sub-databases Sub-databases Health Plan & Registries Registries Provider Decision Provider Decision Program Data Support Support Information Architecture
  64. 64. Architecture Framework (MITA) Business Architecture Information Architecture Technical Architecture
  65. 65. Technical Architecture The MITA technical architecture includes  Data Architecture  Application Architecture  Technology ArchitectureCollectively, they define a set of technical services and standards that can be used to plan and specify future systems.
  66. 66. Technical Architecture Technical Principles (MITA ) MITA is a business driven, implementation neutral, platform independent and is adaptable, extendible and scalable. The technical architecture is based on current and proven open technology. Security, privacy, interoperability and reliance on quality data are built-in. Technical principles shape MITA’s definition and the State’s implementation of the Medicaid Enterprise Architecture.
  67. 67. Technical Architecture Technical Principles cont. Guiding principles support flexibility, adaptability rapid response and will promote an enterprise view. The result should be less duplication while providing timely, accurate and usable data. The technical architecture must support performance measurement and effective communication. Provide for the adoption of data and technical industry standards and the promotion of reusable components (modularity).
  68. 68. Technical Architecture Technical Architecture Defined Business Driven Design of IT processes. The adoption and use of common industry and IT standards and best practices. Identification of business specific processes, data and technical solutions. Built in security and delivery of data. Scalability, interoperability and extendibility of IT components. Performance metrics common to the various Business/ IT operations.
  69. 69. Programmatic ApproachesEnterprise ContinuumTechnical DesignsSolutionsPlatformsBusiness IntelligenceToolsArchitectural Assets
  70. 70. Basic Health Information Exchange with Data RepositoryHealth Plan Adm.. Sys Clinical HIE Data Repository Record and Results Delivery Clinician Data Repository Provider EHR Interfaces Master Patient Index Laboratories Basic Patient Health Summary Pharmacies Web Portal Server Web Browser HIE Utility Applications
  71. 71. Health Information Exchange Platform Architecture Collaborative Knowledge ManagementValue Security and Consent PolicyAdded Web Services ApplicationWebServices Data Analysis Applications Health Data Integration and Translation LayerPlatformServices Health Data Management Layer Health Data Publication Layer Data Sources Radiology Rx History Administrative EHR Clinical Lab
  72. 72. HIT Infrastructure Platform Design
  73. 73. Architecture Overview Local Gateway Participant Local Gateway Participant Published Published Patient Data Patient Data EMRs and Other Interface Interface EMRs and Other Enterprise Systems Engine Engine Enterprise Systems or Portal Local Provider Local Provider or Portal Directory Directory HIE Application HIE Application Server / Gateway Server / Gateway Standard Messages, e-mail or fax encapsulationSecondary Local E-Mail Web Server Fax Server Fax Server Web Server E-Mail Secondary Local System Server Server System •Local gateway users control integration, etc. Summary / Results Summary / Results •Can leverage infrastructure for internal integration Viewer Viewer •Interfaces can be direct or use interface engine or similar tools Internet / Network E-mail, fax or CCD Standard Messages, HTTP HTTP encapsulation encapsulation Network Subscriber Hosted Portal Summary / Published Patient Data Results Viewer Web Server E-Mail Fax Server External Community Provider Directory Networks HIE Application Printer Server / Gateway •Hosted by service provider (MA-SHARE) •No infrastructure support requirement – just Internet connection, fax or e- •Provides document / data storage, HTTP viewing for subscribers, and mail common provider index for dissemination to local gateway participants
  74. 74. Mapping Data Partners and Data Utilities
  75. 75. Enterprise PlatformArchitecture Examination
  76. 76. Business Platform Review
  77. 77. Business Intelligence Stack
  78. 78. Business Intelligence Tool Set
  79. 79. Clinical Decision Support Systems (CDS) Amalga frees the data locked in disparate systems across the health enterprise to fuel discovery, change, and innovation. Amalga empowers users to drive improvements in near-real time, as well as accelerate continuous improvement over time. Amalga links data from different departments so that it can be shared more easily, which helps the caregiver see the “whole patient,” not just snapshots.
  80. 80. Clinical Decision Support Systems (CDS)
  81. 81. Microsoft HealthVault is a web-based platform from Microsoftthat stores and maintainshealth and fitness information.
  82. 82. Cloud Approach Research
  83. 83. To successfully institute a framework of business processes and technologies that support and improved program administration for the enterprise and stakeholders.  Thinking Globally  Acting Dynamically  Focus on the individual
  84. 84. Thank You Q&A