PHClinic Interoperability with KHIN/HIE and Functionality Improvements

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1 PHClinic Interoperability with KHIN/HIE and Functionality Improvements Considerations for Participating in Health Information Exchange Written by Trisha Harkness and Terri Kennedy Synōvim Healthcare Solutions, Inc SW Wanamaker Dr. Topeka, KS (785)

2 April 2015 Table of Contents Background and Purpose... 1 Lessons Learned Considerations for Participating in HIE... 1 Patient data Availability Integration Considerations... 2 Direct/Secure Messagingg... 2 Patient Data Privacy and Security... 2 Population Health and Aggregation of Data... 2 Immunization Submission to WebIZ... 3 Miscellaneous... 3 Use Cases... 3 Provider Portal... 3 Direct Secure Messagingg... 4 Future Use of HIOs... 4 KIPHS to KHIN Hub: Cost Analysis... 4 Purpose of Evaluating the Hub... 4 Process Overview... 4 HIE Participation Options... 4 Cost Comparison... 5 HIO Decision Points... 5 Recommendation and Supporting Statements... 5 PHClinic Interoperability with KHIN/ /HIE and Functionality Improvements Grant ii

3 BACKGROUND AND PURPOSE In July 2013, the Kansas Association of Local Health Departments (KALHD) was awarded the PHClinic Interoperability with the Kansas Health Information Network/Health Information Exchange (KHIN/HIE) and Functionality Improvements grant by the Kansas Health Foundation (KHF). The purpose of the grant is to provide funding to KALHD for enhancements to PHClinic to improve functionality for local health departments. An interface to KHIN/HIE will be developed and tested for local health departments currently using PHClinic and will be deployed to interested health departments. The purpose of the PHClinic Connection Costs to KHIN component of the project is to evaluate and identify a single connection to KHIN for all Local Health Departments (LHDs) in Kansas who utilize PHClinic. KALHD contracted with Synōvim Healthcare Solutions, Inc. (Synōvim) to provide assistance with this evaluation. The initial step in the evaluation was to solicit input from LHDs. Representatives from five LHDs (Johnson County, Lawrence Douglas County, Reno County, Sedgwick County, and Shawnee County) participated in two online meetings to share their insight and experiences with respect to Kansas HIE. The table below contains some general information about the LHDs participating in the meetings. Connection to HIE Status of Data Sharing # LHDs KIPHS interfaced to KHIN Sharing data, using the provider portal 2 No interface (NetSmart) Using the provider portal, planning to share data 1 No interface Using the provider portal, no plans to share data 1 (ClearHealth) No interface (NetSmart) Not using, waiting for system to mature 1 Many lessons have been learned by those LHDs. During the meetings, participants shared some considerations and potential use cases for HIE. A synopsis of the information conveyed follows. LESSONS LEARNED CONSIDERATIONS FOR PARTICIPATING IN HIE PATIENT DATA AVAILABILITY Healthcare partner participation in HIE is varied. o Some regions have few HIE participants so the amount of patient data in the health information organizations (HIOs) is limited. o Other regions have many participants and an abundance of patient data. o Many hospitals have been sharing data for a significant period of time, so the amount of patient data for some regions is significant. Some hospitals are not yet able to exchange patient continuity of care data. 1

4 There seems to be a lack of standards and consistency in data being shared. o Some patient data from local hospitals, such as discharge summaries, is currently inconsistent. o Some vendors are choosing the patient data to share on a global basis so there is a lack of control with the data points that are being shared. Patient data consistency from one vendor to another may result in sharing varied data points. INTEGRATION CONSIDERATIONS Adding HIE to the LHD s workflow is one of the big changes. o It is important to determine what patient data is needed by the LHD. o Then, determine what patient data is available from the HIOs. o Immediately prior to HIE participation (if applicable), ensure that staff are trained in how to access needed patient data and how to incorporate that data into the LHD s workflow. Evaluate the benefit to your organization of integrating with KHIN to share patient data versus using the provider portal to look up patient data. Accept the training offered by KHIN for the provider portal and Secure Messaging. DIRECT/SECURE MESSAGING Direct/Secure Messaging component is available to participants and can be used to communicate with other participating clinics and hospitals. Direct Messages have to be sent to a specific person so if the person is out of the office, the message may sit for a significant period of time. Providers may be able to assign a surrogate to review messages when they are out. No group message function. PATIENT DATA PRIVACY AND SECURITY Minors cannot opt out of KHIN. Because there are concerns about sharing patient data for minors, especially for STDs and pregnancy, KIPHS has the functionality to withhold sensitive patient data from being sent to KHIN. There is currently no Secondary Use Data Sharing Policy finalized on the state level. General privacy and security concerns for electronic patient data. POPULATION HEALTH AND AGGREGATION OF DATA Concerns exist about interpretation of population health data across multiple counties due to incomplete and/or inconsistent patient data in the system and varying participation and data sharing among counties. Aggregate reporting is built at the HIE level, not the local level. 2

5 IMMUNIZATION SUBMISSION TO WEBIZ Two primary methods of data submission to WebIZ: o Direct, manual data entry to WebIZ via user account and token Built in verification checks and error message pop ups to ensure complete, clean data entry If an EHR has been implemented, often results in dual entry (i.e. EHR and WebIZ) Immunization record searches Interface with WebIZ inventory tool Multiple reporting functions including inventory Some LHDs maintain their current direct entry access to WebIZ to keep inventory tracking and other token based activities. o One to one or HIO submission via HL7 Immunizations entered in EHR and pushed to WebIZ electronically If built in by the vendor, some data verification via error messages after data is saved Immunization record searches No interface with WebIZ inventory tool Limited reporting options MISCELLANEOUS Some processes can be improved through KHIN but processes are still transitioning. There can be a significant time savings in disease investigation. (Please see Sedgwick County s Use of the Secure, Electronic Kansas Health Information Network (KHIN) for Notifiable Disease Investigations ) There is a time savings for receiving labs and reports from other clinics/hospitals. USE CASES LHDs sharing data with KHIN are sending daily updates of demographics, procedures, diagnosis, vitals, and smoking status. PROVIDER PORTAL Determine services that clients have already received See a patient s previous diagnoses, labs, and tests Verify that a procedure has been completed Patient care continuity and care coordination Disease investigation and/or more effective disease management Epidemiology 3

6 DIRECT SECURE MESSAGING Sending patient data to the Medical Director and other consulting providers (replacing current fax process) Communication with other providers and hospitals Disease investigation inquiries FUTURE USE OF HIOS Determine the effectiveness of LHD interventions Obtain aggregate data reporting Access and interpret population health data intra county Population health management Use data to discover disparities A trigger mechanism when a specified number of disease diagnoses are made within a region Disease investigation automation o Ideally, a form would be automatically triggered when a flagged diagnosis comes through the HIO Improve community health and awareness KIPHS TO KHIN HUB: COST ANALYSIS PURPOSE OF EVALUATING THE HUB The purpose of a KIPHS to KHIN Hub is to build upon the successful HL7 pilots and develop a single connection for all LHDs utilizing PHClinic from KIPHS to KHIN. It is proposed that the Hub will include a server housed at the KIPHS offices that will be connected to KHIN. Data from all LHDs using PHClinic will be aggregated by the KIPHS server and patient data will be exchanged with KHIN. PROCESS OVERVIEW The process followed during our analysis includes the steps below. 1. Research the costs of the HIE participation options. 2. Evaluate input from LHDs. 3. Determine the feasibility of the Hub. HIE PARTICIPATION OPTIONS Two alternatives were considered for this review. Hub Connectivity With this option, the LHDs send patient data to a Hub located at KIPHS who will then send the data to KHIN via a VPN connection. Direct Connection With this option, the LHDs send patient data directly to KHIN via a VPN connection. 4

7 COST COMPARISON The tangible costs associated with each option are: Cost Item Hub Connectivity Direct Connection Installation, Configuration and Development Server* $7,000 $0 Listening Software $5,000 $0 PHClinic Side Development $5,000 $0 Hub Server Development $10,000 $0 KHIN Connection $5,000 $5,000 per LHD Total Installation, Configuration and Development $32,000 $5,000 per LHD * Includes server hardware, server operating system, firewall, and security software as well as installation and configuration of server hardware, server software, firewall, and VPN to KHIN. Ongoing maintenance costs for the hub will be incorporated into the KIPHS annual maintenance fee. Fifty seven (57) LHDs use PHClinic; two (2) of these LHDs are already connected to KHIN via the HL7 pilot project. If the fifty five (55) remaining health departments connected individually to KHIN, the cost would exceed the $275,000 for KHIN Connectivity as many of the LHDs would have to hire external technical support to set up the VPN connection. HIO DECISION POINTS Are your healthcare partners participating in an HIO? What functionalities of an HIO are most important to your LHD? How would your LHD benefit from HIO participation? How would your healthcare partners benefit? How would your patient population benefit? Is HIO participation financially feasible? What challenges are likely to impact your desire and/or ability to participate in an HIO? RECOMMENDATION AND SUPPORTING STATEMENTS Based on the analysis performed, the Hub is recommended. The overall cost of direct connections raises at least $5,000 each time an LHD exchanges data with KHIN. As the chart below illustrates, more than 7 LHDs connecting to KHIN exceeds the anticipated cost of implementing the Hub. The Hub also creates a central point from which to troubleshoot data exchange issues. 5

8 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $5,000 $50,000 $45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $