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TRANSFORMING HEALTH CARE
… Next Step … Health Information Exchange (HIE)




Lisa Rawlins, Executive Director
Informing the Community …

SOUTH FLORIDA HIE STATUS




                            2
SF REC HIE Status … Today
• South Florida Regional Extension Center (SF
  REC) has received Federal Funds to Implement
  HIE in Support of Meaningful Use
• SF REC /HCN designated as an AHCA “early
  adopter”
• Phase One
  – Approximately 150 physicians from 25 FQHC
  Integration with FLHIE via existing Amalga utility
• Phase Two
  – 2800 SFREC members via interface with SF REC
    Platform

                                                       3
Harris Proposed Solution
                    PHASE 1                                                    PHASE 2

                   3 months                     6 months                        9 months                            12 months
                 Convert to Production        Convert to Production
      Development
  Environment, Express
          lite
                                  Development
HCN to Florida HIE gateway    Environment, Express
*REC providers have
option to join through           Load MPI with HCN
Amalga*                          Demographic data                          Up to 10 EMR interfaces to Express


         Phase 2 Project Planning & Scope                         On-board REC providers with EMR

                                                        50            50       100        100         100           100
                                                                                          Population / Care Management

   Contract in Place            Planning Starts Now                                             Quality Reporting

                                                                                                 Patient Portal

                                                                                               Orders Management

                                                                                                 Provider Portal

                                                                                         Community Referral Management

        150 GB                       500 GB                    1000 GB                             1.4 TB
Harris Proposal
                                      Florida HIE



      Express
                                                                        Registry &
                                                                       Terminology
                                          CONNECT                                      One time initial load
             Clinical
              Data       MPI/RLS           Gateway
            Repository


                                      Integration Engine
                                      DOCUMENT GENERATION




Express
                                                                                              Existing
  Lite                                                            AMALGA
                                                                                              Future

                                                                                              Group 2
                          Physician
                          Practices                         Sage EHR
                                                              EHR         Local Labs
 Hospital                                                    EHR




                                                                                                           5
MISSION AND VISION
Mission           Vision
• Provide Health           • Use the tools and
  Information Exchange       mechanisms
  (HIE) services to          developed in support
  support the SF REC         of MU Stage 2 to
  mission. Specifically,     improve the delivery
  to assist our members      of healthcare
  to achieve Stage 2         throughout South
  Meaningful Use             Florida




                                                    6
“   As a neutral, community based third
                             party, the South Florida Regional
                             Extension Center can build a Health
                             Information Exchange focused on
                             South Florida’s needs and responsive
                             to South Florida’s realities. Services,
                             outreach, collaboration, vision, trust,
                             and transparency will guide us as we
                             engage the people, processes, and
Sandy Phillips, SF HIE       technologies needed to serve the eight
                             counties making up our region.
                                                           ”
How Ready is the South Florida Community for HIE?

HIE Readiness Assessment
Readiness Assessment Areas
•   Leadership
•   Activation
•   Vision
•   Governance & Management
•   Technical Interoperability
•   Organizational Capacity
•   Readiness for Megachange
Community HIE Readiness Self Evaluation

7.0



6.0

                                4.972
5.0



4.0
        3.267        3.317                                                                      3.396
                                            3.050            3.028             2.875
3.0



2.0



1.0



0.0
      Leadership   Activation   Vision   Governance &      Technical       Organizational   Readiness for
                                         Management     Interoperability     Capacity       Megachange
Assessment Conclusions
• Input received to date reflects a very small cross
  section of the REC service area/members (20%
  response rate of 34 visits)
• The only area with “positive” result is the Vision
  section
• Our efforts must not only convene the
  community but also create trust and confidence.




                                                       11
So what will the HIE look like?

Pricing Models, Governance,
Implementation Planning
Most operational HIEs are focused on results delivery, clinical documentation,
and eligibility checking; As new more complex functions are added, value will
increase …



                                                   Accountable
                                                      Care
                                                                 Lifetime Medical
                                    Public Health                   Information
     Degree of Difficulty




                                    Surveillance Public Health
                                                  Reporting                  Improved
                                                                             Outcome
                                                  Patient
                                Referral        Provider e            Disease           Electronic
                             Processing            mail            Management        Health Record
                                                                                     with Consumer
                                            Quality
                                                          e prescribing                  Access
                                          Reporting
                               Results
                               Delivery                                     Research
                                                     Medication
                                          Clinical Compliance Alerts to
                                        Documentati                 Providers
                                             on
                            Eligibility    Medication Immunization &
                            Checking          History Disease Registries


                                                          Value
Notional Design
Federated Model                                                           Centralized Model


                                                                                                               Ancillary
                                                                                   Hospital                    Provider

                                                       Hybrid
                                                 The federated model
                                                                                                 Patient
                                                 retrieves records from
                                                                                                  Data
                                                 any HIE-connected
                                                                                                Repository
                                                 organization, but the
                                                 HIE also maintains
                                                 that central                             Physician
                                                 repository. The size                     Practice           IDN
                                                 and intent of the CDR
                                                 can differ, ranging
Data remains under the control of the owning     from a focused           HIO collects and stores patient data in a
institution and exchanges only when              database (e.g. all       centralized repository. The HIE has control
requested. Requires Record Locator Service       immunization data) to    over the data and the ability to authenticate,
to establish where the patient’s records exist   the ultimate creation    authorize, and provide concise audit trails.
and who to direct the request to.                of a Centralized         Data is often segregated by provider
                                                 model                    institution.
Pros: Organizations retain control over their
data. Reduced startup time. Lower cost of                                 Pros: Efficiency in retrieval, audit and
HIO infrastructure.                                                       reliability checks, ability to mine data for other
                                                                          purposes
Cons: Data quality, data accuracy, and
response time may differ across HIE data                                  Cons: Security and privacy concerns, post-
organizations                                                             storage synchronization of data
Notional Design
                                            Technology “Footprint” for HIE




              Islands
              Data
                               Hosting or
                               SaaS/IaaS




Interfacing



                                                                             15
Sustainability Of Health Information Exchanges
The community has identified several critical success factors that support
HIE sustainability in the design, build, and operations phases …

             Design/Build                                   Operations

•   Business planning to define HIE scope,       •   Business model that funds on going
    services, value proposition and deployment       operations
    schedule                                           •   Stakeholder subscription
•   Policies for data ownership, security and          •   Transaction fees
    privacy along with corresponding
    governance structure                               •   Legislated mandate for ongoing
                                                           public or private funding
•   Technology architecture that supports the
    business model                               •   Achieving and reporting on the intended
•   Stakeholder buy-in as data providers, data       value proposition
    users, or funders                            •   Business office service to support
•   Stakeholder automation and critical mass         membership management
    necessary to achieve the value proposition   •   Continual engagement of stakeholders
    at each stage                                    to drive clinical adoption
•   Start up capital
•   Experienced business and technology
    partner
Health Information Organizations
In order to facilitate the continual exchange of health information, Business
Processes are a critical factor. Within every HIE there must be an effective
governance, technology and membership management program to ensure
sustainability.
                          Diagnostic             Medication
                                                                      Laboratories
                           Imaging             Intermediaries




                                       Health Information Exchange


          Healthcare                                     HIE Platform Creation
                             HIE Governance &
           Payors                                                                    Consumer
                                 Planning
                                                             HIE Systems
                                                            Implementation

                                          HIE Business Office
          Hospitals                                                                  Physicians
                                HIE Operations                  HIE Member
                                 Management                     Management




                                                           Public Health
                                       NwHIN
                                                            Agencies

                                                                                                  17
SFREC Governance Structure
The recommended governance structure seeks to balance the organization’s
need for consensus with the need to efficiently reach and implement decisions.
The result is a fairly centralized decision-making structure that seeks broader
input and participation through subcommittee and advisory group structures.


•   Physician Advisory- Outreach and Education           REC Board &
•   Standards/Technology – TPS                            Committees
•   Clinical Transformation - MU
•   Compliance and Outreach – Workforce

                             Standing
                             Advisory                    Management
                              Groups                        Team




                                                                                  18
Notional Cost Experience for HIE
                    $4,000.0
          X 1,000




                    $3,500.0


                    $3,000.0


                    $2,500.0

                                                                                                                                      Large
                    $2,000.0
                                                                                                                                      Medium
                                                                                                                                      Small
                    $1,500.0


                    $1,000.0


                     $500.0


                        $0.0
                                  2007                   2008     2009             2010             2011                2012

    Notes & Cost Model                                               HIE Size         Planning    Development & Integration     Operations
    *The CareSpark project cost approximately $15M over 3 years           Small    $330,000.00                $3,000,000.00    $2,000,000.00
    ** Indiana HIE received $11 M of funding
                                                                         Medium    $600,000.00                $6,000,000.00    $3,500,000.00
    Estimated Cost of HIE by Stage:
                                                                          Large   $1,000,000.00              $10,000,000.00    $5,000,000.00
       1.Planning: $330 k-$1 M
       2.Development and Implementation: $3 M to $10 M
       3.Operations: $2 M to $5 M




Source: AMA: Health Information Exchange Projects
                                                                                                                                               19
HIE Examples
                            Delaware                       Maine                      Rhode Island
                              DHIN                      HealthInfoNet                RIQI Currentcare
Total hospitals                 6                             37                             11
Total physicians              2,325                         4,052                          4,141
Total Population             864,746                      1.3 million                    1.0 million
Technical               Federated/Hybrid              Centralized, “Pull”               Hybrid Model
Architecture           Utilizes a federated     Using a centralized approach        Using decentralized
                    approach whereby clinical    to share clinical data at the     servers/vaults for each
                     results are delivered or       point of care. Clinical        provider location with a
                     “pushed” to providers; a   database where participants         central repository of
                   query function has enabled    send data to one repository             exchange.
                        “pull” capabilities.      and participants query the
                                                          repository.
Services           -Clinical messaging          -Clinical data at point of care   - Med History via portal
                   -Med History                 -Med History
                   -Public health reporting


Capital                   $11.8 million                  $4.0 million                   $10.3 million
investment for            over 5 years                   over 2 years                   over 5 years
state-level HIE



                                                                                                              20
Delaware Health Information Network
(DHIN) Funding
• 34% Federal funds allocated through contracts
  will total $11.7 million through fiscal year 2012
• 35% State funds totaling $12.1 million in
  appropriations through fiscal year 2012.
• Average annual per capita State funding - $2.25
• Average annual per capita leveraged funding -
  $4.18
• 31 % Private funding (from hospitals, labs, and
  payers) through fiscal year 20

                                                      21
HIE Savings/Cost Avoidance
• 65% of value from avoiding unnecessary care.
• 27% of value from eliminated redundancies.
• The remainder, 8% of value, was due to reduced work,
  decreased operating expenses, and freed work space.




                          Source: DHIN Business Plan,
                          September 2011




                                                         22
Supporting 2,500 Priority Primary Care
Providers* Meaningfully Using EHR
Action/Implementation Planning
• Establish Working Group
• Create Plans, Policies, and Budgets
• Gather Input and Support from the
  Community
• Execute!




                                        24
What the Future Holds for US
iHT2 Health IT Summit in Ft. Lauderdale 2012 –Transforming Health Care … Next Step … Health Information Exchange (HIE)

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iHT2 Health IT Summit in Ft. Lauderdale 2012 –Transforming Health Care … Next Step … Health Information Exchange (HIE)

  • 1. TRANSFORMING HEALTH CARE … Next Step … Health Information Exchange (HIE) Lisa Rawlins, Executive Director
  • 2. Informing the Community … SOUTH FLORIDA HIE STATUS 2
  • 3. SF REC HIE Status … Today • South Florida Regional Extension Center (SF REC) has received Federal Funds to Implement HIE in Support of Meaningful Use • SF REC /HCN designated as an AHCA “early adopter” • Phase One – Approximately 150 physicians from 25 FQHC Integration with FLHIE via existing Amalga utility • Phase Two – 2800 SFREC members via interface with SF REC Platform 3
  • 4. Harris Proposed Solution PHASE 1 PHASE 2 3 months 6 months 9 months 12 months Convert to Production Convert to Production Development Environment, Express lite Development HCN to Florida HIE gateway Environment, Express *REC providers have option to join through Load MPI with HCN Amalga* Demographic data Up to 10 EMR interfaces to Express Phase 2 Project Planning & Scope On-board REC providers with EMR 50 50 100 100 100 100 Population / Care Management Contract in Place Planning Starts Now Quality Reporting Patient Portal Orders Management Provider Portal Community Referral Management 150 GB 500 GB 1000 GB 1.4 TB
  • 5. Harris Proposal Florida HIE Express Registry & Terminology CONNECT One time initial load Clinical Data MPI/RLS Gateway Repository Integration Engine DOCUMENT GENERATION Express Existing Lite AMALGA Future Group 2 Physician Practices Sage EHR EHR Local Labs Hospital EHR 5
  • 6. MISSION AND VISION Mission Vision • Provide Health • Use the tools and Information Exchange mechanisms (HIE) services to developed in support support the SF REC of MU Stage 2 to mission. Specifically, improve the delivery to assist our members of healthcare to achieve Stage 2 throughout South Meaningful Use Florida 6
  • 7. As a neutral, community based third party, the South Florida Regional Extension Center can build a Health Information Exchange focused on South Florida’s needs and responsive to South Florida’s realities. Services, outreach, collaboration, vision, trust, and transparency will guide us as we engage the people, processes, and Sandy Phillips, SF HIE technologies needed to serve the eight counties making up our region. ”
  • 8. How Ready is the South Florida Community for HIE? HIE Readiness Assessment
  • 9. Readiness Assessment Areas • Leadership • Activation • Vision • Governance & Management • Technical Interoperability • Organizational Capacity • Readiness for Megachange
  • 10. Community HIE Readiness Self Evaluation 7.0 6.0 4.972 5.0 4.0 3.267 3.317 3.396 3.050 3.028 2.875 3.0 2.0 1.0 0.0 Leadership Activation Vision Governance & Technical Organizational Readiness for Management Interoperability Capacity Megachange
  • 11. Assessment Conclusions • Input received to date reflects a very small cross section of the REC service area/members (20% response rate of 34 visits) • The only area with “positive” result is the Vision section • Our efforts must not only convene the community but also create trust and confidence. 11
  • 12. So what will the HIE look like? Pricing Models, Governance, Implementation Planning
  • 13. Most operational HIEs are focused on results delivery, clinical documentation, and eligibility checking; As new more complex functions are added, value will increase … Accountable Care Lifetime Medical Public Health Information Degree of Difficulty Surveillance Public Health Reporting Improved Outcome Patient Referral Provider e Disease Electronic Processing mail Management Health Record with Consumer Quality e prescribing Access Reporting Results Delivery Research Medication Clinical Compliance Alerts to Documentati Providers on Eligibility Medication Immunization & Checking History Disease Registries Value
  • 14. Notional Design Federated Model Centralized Model Ancillary Hospital Provider Hybrid The federated model Patient retrieves records from Data any HIE-connected Repository organization, but the HIE also maintains that central Physician repository. The size Practice IDN and intent of the CDR can differ, ranging Data remains under the control of the owning from a focused HIO collects and stores patient data in a institution and exchanges only when database (e.g. all centralized repository. The HIE has control requested. Requires Record Locator Service immunization data) to over the data and the ability to authenticate, to establish where the patient’s records exist the ultimate creation authorize, and provide concise audit trails. and who to direct the request to. of a Centralized Data is often segregated by provider model institution. Pros: Organizations retain control over their data. Reduced startup time. Lower cost of Pros: Efficiency in retrieval, audit and HIO infrastructure. reliability checks, ability to mine data for other purposes Cons: Data quality, data accuracy, and response time may differ across HIE data Cons: Security and privacy concerns, post- organizations storage synchronization of data
  • 15. Notional Design Technology “Footprint” for HIE Islands Data Hosting or SaaS/IaaS Interfacing 15
  • 16. Sustainability Of Health Information Exchanges The community has identified several critical success factors that support HIE sustainability in the design, build, and operations phases … Design/Build Operations • Business planning to define HIE scope, • Business model that funds on going services, value proposition and deployment operations schedule • Stakeholder subscription • Policies for data ownership, security and • Transaction fees privacy along with corresponding governance structure • Legislated mandate for ongoing public or private funding • Technology architecture that supports the business model • Achieving and reporting on the intended • Stakeholder buy-in as data providers, data value proposition users, or funders • Business office service to support • Stakeholder automation and critical mass membership management necessary to achieve the value proposition • Continual engagement of stakeholders at each stage to drive clinical adoption • Start up capital • Experienced business and technology partner
  • 17. Health Information Organizations In order to facilitate the continual exchange of health information, Business Processes are a critical factor. Within every HIE there must be an effective governance, technology and membership management program to ensure sustainability. Diagnostic Medication Laboratories Imaging Intermediaries Health Information Exchange Healthcare HIE Platform Creation HIE Governance & Payors Consumer Planning HIE Systems Implementation HIE Business Office Hospitals Physicians HIE Operations HIE Member Management Management Public Health NwHIN Agencies 17
  • 18. SFREC Governance Structure The recommended governance structure seeks to balance the organization’s need for consensus with the need to efficiently reach and implement decisions. The result is a fairly centralized decision-making structure that seeks broader input and participation through subcommittee and advisory group structures. • Physician Advisory- Outreach and Education REC Board & • Standards/Technology – TPS Committees • Clinical Transformation - MU • Compliance and Outreach – Workforce Standing Advisory Management Groups Team 18
  • 19. Notional Cost Experience for HIE $4,000.0 X 1,000 $3,500.0 $3,000.0 $2,500.0 Large $2,000.0 Medium Small $1,500.0 $1,000.0 $500.0 $0.0 2007 2008 2009 2010 2011 2012 Notes & Cost Model HIE Size Planning Development & Integration Operations *The CareSpark project cost approximately $15M over 3 years Small $330,000.00 $3,000,000.00 $2,000,000.00 ** Indiana HIE received $11 M of funding Medium $600,000.00 $6,000,000.00 $3,500,000.00 Estimated Cost of HIE by Stage: Large $1,000,000.00 $10,000,000.00 $5,000,000.00 1.Planning: $330 k-$1 M 2.Development and Implementation: $3 M to $10 M 3.Operations: $2 M to $5 M Source: AMA: Health Information Exchange Projects 19
  • 20. HIE Examples Delaware Maine Rhode Island DHIN HealthInfoNet RIQI Currentcare Total hospitals 6 37 11 Total physicians 2,325 4,052 4,141 Total Population 864,746 1.3 million 1.0 million Technical Federated/Hybrid Centralized, “Pull” Hybrid Model Architecture Utilizes a federated Using a centralized approach Using decentralized approach whereby clinical to share clinical data at the servers/vaults for each results are delivered or point of care. Clinical provider location with a “pushed” to providers; a database where participants central repository of query function has enabled send data to one repository exchange. “pull” capabilities. and participants query the repository. Services -Clinical messaging -Clinical data at point of care - Med History via portal -Med History -Med History -Public health reporting Capital $11.8 million $4.0 million $10.3 million investment for over 5 years over 2 years over 5 years state-level HIE 20
  • 21. Delaware Health Information Network (DHIN) Funding • 34% Federal funds allocated through contracts will total $11.7 million through fiscal year 2012 • 35% State funds totaling $12.1 million in appropriations through fiscal year 2012. • Average annual per capita State funding - $2.25 • Average annual per capita leveraged funding - $4.18 • 31 % Private funding (from hospitals, labs, and payers) through fiscal year 20 21
  • 22. HIE Savings/Cost Avoidance • 65% of value from avoiding unnecessary care. • 27% of value from eliminated redundancies. • The remainder, 8% of value, was due to reduced work, decreased operating expenses, and freed work space. Source: DHIN Business Plan, September 2011 22
  • 23. Supporting 2,500 Priority Primary Care Providers* Meaningfully Using EHR
  • 24. Action/Implementation Planning • Establish Working Group • Create Plans, Policies, and Budgets • Gather Input and Support from the Community • Execute! 24
  • 25. What the Future Holds for US