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1. HIE & ACO Interoperability Testing
– Test Quickly and Securely
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3. Agenda
 Interoperability
 MU 2
 HIE’s
 ACO’s
 Standards
 Models of Interaction
 Testing
3

4. INTEROPERABILITY
4

5. Definition
Interoperability allows disparate
information systems … to readily work
together and exchange data. *
5
*Microsoft (http://www.microsoft.com/about/legal/en/us/interoperability/default.aspx)

6. MEANINGFUL USE
6

7. Definition
The Medicare and Medicaid EHR Incentive
Programs provide incentive payments … as
they adopt, implement, upgrade or
demonstrate meaningful use of certified
EHR technology.*
*CMS (http://www.cms.gov/Regulations-and- 7
Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/)

8. Components of MU
Stage 1 - Use of certified EHR in a
meaningful manner
Stage 2 - Use of certified EHR technology for
electronic exchange of health information to
improve quality of health care
Stage 3 - …….
8

9. MU Stage 1
80% of patients must have records in EHR
Common Objectives - Individuals & Institutions:
 Computerized provider order entry (CPOE)
 Report clinical quality measures to CMS/States
 Implement one clinical decision support rule
 Provide patients with electronic copy of health information
 Record demographics
 Up-to-date problem list of current and active diagnoses
 Maintain active medication list
 Maintain active medication allergy list
 Record and chart changes in vital signs
 Record smoking status for patients 13 years or older
 Exchange key clinical information among providers of care and patient-
authorized entities electronically
Protect electronic health information
9

10. MU Stage 2
Common Objectives - Individuals & Institutions:
 CPOE - For more than 60% of medication, 30% of laboratory, & 30% of radiology
 Demographics / Vital Signs / Smoking Status – Record for more than 80%
 Interventions - 5 clinical decision support interventions + drug/drug and drug/allergy
 Labs - Incorporate lab results for more than 55%
 Patient List - Generate patient list by specific condition
 Patient Access - Provide online access to health information for more than 50% with
more than 5% actually accessing
 Education Resources - EHR to identify and provide education resources more than 10%
 Rx Reconciliation - Medication reconciliation at more than 50% of transitions of care
 Summary of Care - Summary of care document for more than 50% of
transitions of care with 10% sent electronically and one sent to a recipient
with a different EHR vendor or successfully testing with CMS test EHR
 Immunizations - Successful ongoing transmission of immunization data
 Security Analysis - Conduct or review security analysis and incorporate in risk
management process
10

11. Audit Failure
“If CMS determines during the audits that
the provider has failed to meet any one of
the reporting requirements, it plans to take
steps to recoup incentive payments.”*
*GAO (http://gao.gov/assets/600/590538.pdf/) 11

12. HEALTH INFORMATION EXCHANGES
12

13. Health Information Exchange (HIE)
 Reliable and interoperable electronic health-related
information sharing
 Conducted in a manner that protects the confidentiality,
privacy, and security of the information.
 Create a standardized interoperable model that is trusted,
scalable and reliable.
 Public HIE - Community-based and are open to, and
governed by, participants from multiple organizations.
 Private HIE - Operate under the governance of an
Integrated Delivery Network (IDN) or a single healthcare
system.
13

14. ACO
14

15. Accountable Care Organizations (ACO)
Groups of doctors, hospitals, and other health care
providers, who come together to give coordinated
care to Medicare patients.
The goal is to ensure that patients get the right care
and avoid unnecessary duplication of services and
medical errors.
When an ACO succeeds both in both delivering high-
quality care and spending health care dollars more
wisely, it will share in the savings it achieves for the
Medicare program.
15

16. Types of ACOs
Medicare Shared Savings Program—a program that
helps a Medicare fee-for-service program providers
become an ACO.
Advance Payment Initiative —a supplementary
incentive program for selected participants in the Shared
Savings Program.
Pioneer ACO Model —a program designed for early
adopters of coordinated care.
16

17. STANDARDS
17

18. Health Information Organizations (HIO)
 Organizations that oversee HIE
 Employ nationally recognized standards to enable
interoperability, security and confidentiality
 Ensure authorization of those who access the
information.
 Effort to improve the way systems in healthcare share
critical information.
 Develop integration profiles to facilitate health
information passing seamlessly from one system to
another.
18

19. Integrating the Healthcare Enterprise (IHE)
The Healthcare Information Management & Systems
Society (HIMSS) provides leadership for the optimal use
of information technology and management systems for
the betterment of healthcare.
Healthcare Information Technology Standards Panel
(HITSP) purpose of achieving a widely accepted and
useful set of standards specifically to enable and support
widespread interoperability among healthcare software
applications.
19

20. MODELS OF INTERACTION
20

21. Major Models
Federated
Centralized
Hybrid
21

22. Federated Model
 Each participating
Participant
organization retains
control of their
healthcare
Participant Participant
information and
responds to queries
when information is
requested.
Participant
22

23. Centralized Model
Participant
 A central
organization
collects information
from participating
Participant Information Participant
Exchange organizations and
stores the
information in a
centralized place to
provide access.
Participant
23

24. Hybrid Model
Participant
Some information
is stored centrally
and other
information is
Participant Information Participant
Exchange stored at
participating
organizations.
Participant
24

25. TESTING
25

26. Issues
Individual participants can prepare all they want, but
bad data can snarl the exchange.
Normalization of data across multiple independent
organizations leaves data more vulnerable to
contamination, duplication and mix-ups.
Medicare collection of extensive data, raising privacy
concerns and administrative costs.
Aggregating, analyzing and managing Utilization and
Total Medical Cost (of a patient) across organizations.
26

27. Obstacles
Ownership
Normalization
Analytics
Privacy
27

28. TESTING –
OWNERSHIP
28

29. Testing - Ownership
 Each participant must concede a certain amount of ownership of
resources and timelines for projects to the “Greater Good”.
29

30. TESTING – NORMALIZATION
30

31. Normalization - Federated Model
 Each participating
Participant
must maintain a
cross reference
table of Patient
Participant Participant
Master ID’s and
other data that
needs to be shared.
Participant
31

32. Normalization - Centralized / Hybrid
Participant
 A Master Patient
Reference and
other Cross
Reference is
Participant Information Participant
Exchange maintained by the
Information
Exchange and
accessed by
participants.
Participant
32

33. TESTING – ANALYTICS
33

34. Testing - Analytics
Data Analytics
Warehouse
 Calculation and
understanding of
Participant
Utilization and Total
Cost of Expenses
Participant
Participant
Participant Participant
Participant
 Reporting for
Individual Participants
Participant
Pre-  Government reporting
Processor
Participant
 Proper Entitlements to
view reporting.
Information
Exchange
34

35. TESTING – PRIVACY
35

36. Testing - Federated Model
 One participant
organization has the De-
Identification Hub.
Agent
Participant
 Sensitive Data Discovery
is automated for each
participant.
Hub Agent  The Hub maintains the
Participant Participant
complete sensitive data
inventory from all
participants.
 The other participants
have remote agents
Participant
which process discovery
Agent and de-identification on
their own network so
that no PHI data leaves
their network.
36

37. Testing - Centralized / Hybrid
Agent  The Information
Participant Exchange has the De-
Identification Hub.
 Sensitive Data Discovery
is automated for the
Agent
Information Exchange as
well as each participant.
Information
 The Hub maintains the
Participant Participant
Exchange Hub
complete sensitive data
Agent
inventory including that
of all participants.
 Each participant has a
Participant remote agent which
process discovery and
Agent de-identification on their
own network so that no
PHI data leaves their
network.
37

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39

40. Data De-Identification - DMsuiteTM
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40

41. Questions or Further Discussions
Contact: Joe Santangelo
Email: jsantangelo@axistechnologyllc.com
Phone: (646) 596-2670
Twitter: @DataPrivacyDude
41

42. Compliance Simplified – Achieve , Illustrate, Maintain
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© Copyright 2011 Axis Technology, LLC 43