Overview of Health Information Exchange (HIE) in the Era of Meaningful Use December, 2010

Transcription

1 Overview of Health Information Exchange (HIE) in the Era of Meaningful Use December,

2 What Is HIE? Why Build HIEs? The HIE Environment Benefits of HIE Outline American Reinvestment & Recovery Act (ARRA) & State Level Health Information Exchange Making the Decision to Participate in HIE HIE Leading Practices What You Can Do within Your State Resources 2

3 What Is HIE? The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms, April 28, THE VERB THE NOUN 3

4 Why Build HIEs? The ability to exchange health information electronically is a basic and critical capability that is the foundation of efforts to improve healthcare in the US. The increased availability of relevant health information through HIE: Provides a key building block for improved patient care, quality and safety Makes relevant healthcare information available where and when it is needed (providers, public health, community health, etc.) Provides the connecting point for an organized, standardized process for data exchange across local, regional and state-wide HIT initiatives Provides the means to reduce duplication of services with a resultant reduction of healthcare costs Facilitates reduced operational costs by enabling automation of many (currently manual) administrative tasks Provides governance and management over the data exchange process Facilitates achievement of meaningful use requirements 4

5 The HIE Environment 5

6 Centralized Exchange Technical Models All data is housed in a shared central repository and updated based on defined polices and procedures that span interoperable requirements to privacy and security policy and procedures Pros Provides uniform data format supporting a high degree of data interoperability Requires a cohesive, centralized system with defined methods, procedures, polices and policies for access, maintenance and management/control Cons Requires strong political and governance oversight and management of data ownership and control More complex and challenging implementations ranging from technical scalability to support of privacy and security policies Cost 6

7 Exchange Technical Models Federated (Record Locator Service) The data stays at the source ~ point of service; the HIE entity manages a pointer to that information. The data source entity maintains custodianship and control over the data (i.e., medical records and indices.) When requested, data is queried from the data source organization Pros Easiest and quickest way to achieve exchange i.e., less data exchange interface work Limits conflict over data ownership Cons Management of authorized and legitimate access to third-party systems Data control and availability not guaranteed Management of data standards and profiles for exchange which ones to utilize 7

8 Hybrid Exchange Technical Models The best of both worlds, using centralized and federated models specific to each HIE entity setup, socio-economic, political and geographic environments, size, and so forth Most flexible model 8

9 The HIE Environment Many find the HIE environment challenging and confusing. Prominent and inevitable issues involved in establishing and advancing HIE locally and nationally include: Privacy expectations & regulations Economic sustainability Government funding from the federal stimulus Adoption and implementation of IT standards Building community trust Intra- and inter-hie governance State government s role EMR to HIE interconnection HIEs PHR Vendors HITSP CCHIT ihe ONC RHIOS AHIC Use Cases HHS E H R State Efforts NHIN Federal Stimulus Interoperability Security & HIPAA Privacy Standards There is a high level of ongoing discussion and activity aimed at advancing each of these issues 9

10 The Individual HIE Organization Administrative Organizational Entity Governance Domain Coordination Funding/Membership Policy Creation Practices Education Standards Adoption Certification HIE Business Model Foundational Business & Clinical Services Adoption Transformation Clinical Process Quality Exchange Services Foundational Data Exchange Functions/Utility Interoperability Privacy / Consent Security Connectivity 10

11 Types of Organizations That Drive HIE Providers Dominant provider(s) in a given geographic or medical trading area determines the need for HIE Employers Large employer(s) with targeted business objectives (e.g., reducing costs, PHR offering to employees) coalesce around area providers Payers Dominant payer(s) may drive the process by sponsoring initial meetings, facilitating initial development activities, providing initial seed money or offering claims based data or software Private/Public Communities or Coalitions Local/regional stakeholders coalesce around unique business and/or geographic interests State-Sponsored/State-Directed Collaboration State acting as convener, may organize state-wide HIE and/or encourage local/regional HIEs and may provide funding for these regional initiatives through grants for planning and implementation 11

12 HIE Leading Practices Engage key stakeholders early Keep them engaged through regular communication Engage opinion leaders to build stakeholder support Develop trust and support Set realistic expectations Build a realistic plan for creating and implementing services and communicate it often Start early to develop a financial plan Work with key stakeholders to create a business model based on revenue. Too much grant funding can be a moral hazard and a temptation to postpone defining a sustainable financial model ROI is achieved over time Engage opinion leaders to build stakeholder support Listen to your community Your community will drive the services that the HIE should provide Technical strategy & deployment follows the Business and Service goals and requirements 12

13 Benefits of HIE 13

14 Benefits of an HIE Convergence of Healthcare Delivery and Technology to Speed the Evolution of the Healthcare System An HIE Provides a vehicle to support improved patient care quality and safety Provides a mechanism to reduce duplication of services and reduce healthcare costs Facilitates operational and administrative efficiencies resulting in reduced operational costs Enables the integration of sick (illness)-care with well-care Links first-responder teams with trauma care teams Stimulates consumer education and involvement in their healthcare process Promotes transparency of service and cost 14

15 An HIE also Benefits of an HIE (continued) Creates a potential for feedback loop between research and actual practice Enables public health to meet its commitment to the community Facilitates the efficient deployment of emerging technology and healthcare services, such as e-prescribing Provides the backbone technical infrastructure for leverage by the NHIN and state level HIT initiatives Provides a basic level of interoperability between physicianmaintained EHRs and patient-maintained PHRs 15

16 American Reinvestment and Recovery Act (ARRA) ~ State Level Health Information Exchange 16

17 State Health Information Exchange Cooperative Agreement Program Supports Statewide HIE Leverage existing HIE efforts & resources Electronic eligibility and claims transaction Example: Master Patient indexes, HIOs, Medicaid Management Information Systems Facilitate shared directories and technical services Providers (practice locations, specialties health plan participation, etc.) Lab Service Providers, Radiology Service Providers, etc. Health Plans including contact and claim submission information, required lab or diagnostic imaging service providers Share services Examples: patient matching, provider authentication, consent management, secure routing, advance directives and messaging, etc. 17

18 State Health Information Exchange Cooperative Agreement Program Domain Requirements Governance Collaborative Governance Model State Government HIT Coordinator Accountability and Transparency Finance Sustainability Technical Infrastructure Interoperability Technical Architecture/Approach Business & Technical Operations Implementation how to develop HIE capacity Legal & Policy Privacy and Security State Laws Policies and Procedures Trust Agreement Oversight of Information exchange and enforcement 18

19 State Health Information Exchange Cooperative Agreement Program Identified HIE Services Electronic eligibility and claims transaction Electronic prescribing and refill requests Electronic clinical lab ordering and results delivery Electronic public health reporting Quality reporting Prescription fill status and/or medication fill history Clinical summary exchange for care coordination and patient engagement 19

20 Making the Decision to Participate in HIE 20

21 Making the Decision to Participate in HIE Prior to committing to participation in an HIE, there are several factors that should be evaluated and understood. These include: The goals and philosophy of the HIE The services the HIE offers Participant technology requirements The economics and sustainability of the HIE (financial costs and benefits) The anticipated non-economic benefits such as improvements in quality or safety Involvement of state and federal regulations and activities Any risks such as liability, project failure or security breach The leadership, governance and contracts such as data use agreements The HIE s current level of developmental maturity vis-à-vis other HIEs The legal structure of the HIE 21

22 Making the Decision to Participate in HIE HIMSS HIE Toolkit The HIMSS Guide to Participating in a Health Information Exchange is a tool that assists in the decision-making process of joining a health information exchange (HIE). The toolkit provides the background necessary to understanding HIEs, followed by common approaches and data standards. The appendices include case studies outlining different models, terminology glossary and a checklist of questions that should be considered in the evaluation of a particular HIE opportunity. 22

23 What You Can Do within Your State 23

24 What You Can Do Get to Know your State! State level organizations and key players Local/ regional organizations and players Seek tools and resources Take advantage of networking opportunities Build your personal health information network of connections and connectors or meaningful relationship 24

25 Get to know your state What You Can Do Attend state public meetings Get to know key regional, state and local level organizations and players Understand how your state is addressing healthcare issues such as Medicaid reimbursement under HITECH Meaningful Use Understand the key drivers of your state and region. Use the HIMSS State Government resources: HIMSS State Government Affairs 25

26 What You Can Do Get to know your state s HIT /HIE plan and activities Identify the state designated (HIE) entity (SDE) Identify your state s Health IT Coordinator and his/her role in supporting state government participation in HIE Familiarize yourself with the state s strategic and operational plan for their HIE entity deployment Understand the expectations and requirements for participating in your state (designated ) HIE Understand how other HIEs, HIE networks, RHIOs will participate in the state HIE 26

27 What You Can Do Get to know your organization s activities Understand your organization s role in participating in the state s HIE activities Understand your organization s role with HIE/RHIO entities located in your state Understand your organization s role, goals and intersection with ARRA HITECH, Healthcare Reform, etc.» Remember: This is about change!» Examples include financial, quality, patient satisfaction, clinical research, community leadership, all of the above, etc. 27

28 28 Resources HIMSS HIELights Electronic Newsletter: HIMSS HIE Resources: HIMSS HIE Common Practices Survey White Paper: pdf State Level HIE Consensus Project: National Governor s Association-Center for Best Practices: 010a0/ National Conference of State Legislatures:

29 Resources HIMSS ARRA Information: ARRA Summary and Analysis FAQs, Tools, Resources Timelines, RRS Feeds, Social Media HIMSS Meaningful Use & Certification Webpage: Healthcare Reform Webpage: 29

30 Resources ONC: CMS: United States Official ARRA Website: 30