From Interaction to Integration to Transformation: Healthcare s Journey & Information s Role

Transcription

1 From Interaction to Integration to Transformation: Healthcare s Journey & Information s Role HealthBridge is one of the nation s largest and most successful health information exchange organizations. Mike Mote Vice President Product & Service Strategy 1

2 HealthBridge Background 2

3 HealthBridge One of the nation s oldest, largest, most advanced and successful health information exchanges In operation since c3 Not for Profit One of only a handful of HIE/RHIOs nationwide with a sustainable business model (Pre ARRA) 97% of revenue from fees; <3% grants 5-12% annual return for last eight years 3

4 HealthBridge Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010 Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors, 60+ versions Provide technology infrastructure for four other HIEs Dayton HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network 26 local hospitals in Kentucky, Ohio and Indiana physicians 17 local health departments Large commercial, hospital, & physician office labs Diagnostic centers 4

5 HealthBridge 5

6 HealthBridge HIE Value Progression Meaningful Use, Medical Home and Payment Reform Basic HIE Stage 1 MU EHR Adoption (REC Services) Basic Electronic Messaging (NHIN DIRECT) Community Portal Web-Based Results Delivery Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency Intermediate HIE Stage 2&3 MU Structured Data Delivery to EHRs Results Delivery (Lab, Rad, ADT, etc.) ED, Admission, & Discharge Alerts & Notices Summary Record Exchange (CCD) Value: Necessary to achieve truly electronic workflows; Dramatic increase in efficiency Advanced HIE PCMH, ACO & Payment Reform Readiness Data Warehouse & Analytics Disease Registry Quality Reporting Support Full Integration Services & Bidirectional Exchange Value: Dramatic improvements in quality and performance 6

7 HealthBridge HIE Services EHR Integration/Interfaces Electronic Results Delivery Labs, Radiology, ADT, etc. Electronic Order Entry E-Prescribing HIE Portal & User Management HIE Technology Support Master Patient Index, Provider Directory and Record Locator Service Summary Record Exchange Nationwide Health Information Network Direct and CONNECT Gateway & Connectivity Public Health Reporting & Syndromic Surveillance Billing and Eligibility Verification HIE Consulting, Outsourced Technology & Implementation 7

8 HealthBridge Future Plans REC - Expanded Meaningful Use Assistance for Stages 2-3 Beacon - Enhanced Suite of Quality Improvement, Transformation and Accountable Services and Tools (Data Warehouse, Data Analytics, Summary Patient Records, etc.) Patient Engagement - Connectivity to Personal Health Records, Mobile Technologies and Consumer Technologies (Beacon, IN Challenge Grant) HIE Expansion Connect to new providers and stakeholders for improving continuity of care (home health, long-term care, payers, etc.) Connect with State HIEs and Provider Networks (IN, KY, OH) Use Nationwide Health Information Network (NwHIN) Direct and CONNECT platforms Spread of Advanced Technologies to Other Communities Community Credentialing 8

9 From Interaction to Integration to Transformation: Healthcare s Journey & Information s Role Creating a Community Data Repository 9

10 Healthcare s Journey Whether or not you believe that REFORM is coming here are some thoughts to ponder: The US healthcare system is broke; the current rate of growth can not be sustained; 1/6 th of the US economy is based upon healthcare New York Times article claims By 2020 the American health insurance industry will be extinct. Accountable care is coming; Value based payments are coming; Volume based payments will continue to decline Missing data today results in missed opportunities to: Prevent complications Ensure better outcomes Reduce unnecessary costs Reduce patient s safety risks Improve transitions in care 10

11 The Journey Business Realities Penalties Incentives 11

12 Delivery s Journey Transactions Individual Provider Plans with some coordination via referrals Integration Coordinated Plans & Early stage PCMH Transformation Single Plan & Advanced stage PCMH; the Medical Community 12

13 Quality Metrics Journey Transactions Patient Outcomes Measures Integration Population based metrics & health status measurements Transformation Demonstrable Improvement in Population Health with ongoing refinement of the metrics 13

14 Payment Reform s Journey Transactions Fee for Service Integration Pay for Performance & Shared Savings Transformation Providers at Partial to Full Risk 14

15 Data Analytics Journey Transactions Provider-centric reporting based upon productivity & patient care protocols Integration Population based quality & performance analysis, health status analysis, & risk analysis Transformation Predictive modeling & performance forecasting, outcomes analysis, & incentive modeling 15

16 Information s Journey Transactions Individual EHR or paper medical records; individual vendor or provider application of standards & codes Integration Clinical information sharing with standards based interoperability moving to data integration with semantic normalization Transformation Community based clinical & claims data repository with community data and coding standards 16

17 Information s Role Transactions Support Provider delivered care; support patient level quality reporting Integration Longitudinal patient record, ED & Public Health alerts; Point-ofcare decision support, PHR, & remote patient monitoring Transformation Enable predictive modeling, risk adjusted analytics, accountable care business & operational modeling 17

18 Information s Role Domain Requirements Encounters Lab Orders & Results People & Organizations Patient Referrals & Authorizations Appointments Medications & Prescription Information Immunizations Radiology & Transcribed Reports Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG ), Geography Medical Conditions (Allergies, Familysocial-medical history) Clinical Observations & Vital Signs Provider Payer Staff Facility Revenues (Charges, Grants..) Expenses (Payroll, Supplies, Infrastructure, ) Products Member Enrollment Medical & Rx Claims Revenue, Billing, & Payment Data Utilization Legend: Provider Payer 18

19 Creating a Community Data Repository & Establishing a Community Data Trustee 19

20 HealthBridge s Data Infrastructure New Suite of Health Innovation & Quality Improvement Tools and Services funded through Beacon Program: Disease Registry Clinical & Claims Data Warehouse Data Analytics and Business Intelligence Alerts & Notifications Transitions in Assistance Quality Reporting Support Process Improvement and Workflow Redesign Support 20

21 HealthBridge s Solution Components Enterprise Master Patient Index (empi) IBM s Initiate Clinical & Claims Data Repository & Clinical Analytics PluralSoft s Quotient Semantic Data Normalization Clinical Architecture s Symedical Claims Data Grouping Engines OPTUMInsight s Symmetry Patient Registry WellCentive s Registry 21

22 Why? Today this enables Identification of gaps in care Point-of- Decision Support Patient engagement Longitudinal Patient Record ED, Admission, & Discharge Alerts & Notices Information exchange at the point of Transitions in Intra-practice comparative performance analytics Interoperability between organizations ( Rosetta Stone ) 22

23 Why? Tomorrow this will enable: Population-based performance measurement Risk adjusted comparative performance analytics Risk adjusted comparative cost analytics Predictive modeling & performance forecasting Service demand forecasting Payment incentive modeling Revenue versus cost modeling ACO business and operational modeling Best practice identification & modeling 23

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