Technology Models for Building Health Information Infrastructure I. John Lightfoot VP Technology Healthvision, Inc.

Transcription

1 Technology Models for Building Health Information Infrastructure I John Lightfoot VP Technology Healthvision, Inc. jlightfoot@healthvision.com

2 Agenda > Value of Health Information Interoperability > How does a community get there? > Real-life RHIO example > Technology Models > Standards > Challenges for a National Model

3 Value of Healthcare Information Exchange and Interoperability (HIEI): CITL Key Findings > Standardized, encoded, electronic healthcare information exchange would: Save the US healthcare system $337B over a 10-year implementation period Save $78B in each year thereafter Total provider net benefit from all connections is $34B Net benefits to other stakeholders: - Payers $22B - Pharmacies $1B - Laboratories $13B - Public Health $0.1B - Radiology centers $8B > Dramatically reduce the administrative burden associated with manual data exchange > Decrease unnecessary utilization of duplicative laboratory and radiology tests

4 CITL HIEI Taxonomy Level Description Non-electronic data Machine-transportable data Machine-organizable data Machine-interpretable data Phone, US Mail Examples Fax/ without categorization Text reports, HL7 messages LOINC-based lab results from lab system; codified medication hx

5 HIEI National Net Cost-Benefit Level 2 Level 3 Level 4 Net Return over 10-year Implementation $141B -$34B $337B Annual Net Return after Implementation $22B $24B $78B Value of HIE standards is the difference between Level 3 & 4

6 in billions don t imagine the future > live it 10-Year Cumulative Net Return by HIEI Level $400 $300 $200 $100 $ $(100) $(200) Level 1 Level 2 Level 3 Level 4 Years

7 The Connected Healthcare Community > Patient-centric design > Disparate IT systems are unified through a shared information architecture Patients Managed Care Diagnostic Labs > Collaborative Care Model > All providers have access to complete, upto-date patient information Physicians & Staff Pharmacies Hospitals

8 How does a community get there? Four Step Process

9 Phases Strategic Planning Governance Funding Models Information Systems Strategy Information Systems Strategy e-health Interoperability Platform Implementation / Integration Services Application / ASP / Service Delivery Implementation / Integration Services Application / ASP / Service Delivery Connecting Hospitals, Labs, Pharmacies Connecting Physicians Connecting Patients Ongoing Training & Support Office Workflow Optimization Benefits Analysis Trading Partner Management

10 Imagine.... > Connecting 8 competing hospitals, 2 competing reference labs, and thousands of physicians and pharmacies to build an entire community s shared patient record > Providing an entire care team (primary care physicians, specialists, nursing staff and hospital staff) access to an integrated patient record view > Viewing historical and codified lab data from multiple labs (reference, in-patient and ambulatory) > Delivering comprehensive current problem lists and allergies to the point of care > Having access to a patient s medication history and knowledge tools that check allergy and drug to drug to reactions > Driving formulary compliance on prescriptions and lower cost substitutions for high prescribing physicians that save the community as much as $15,000 per physician per year > Providing a community infrastructure that supports EMR interoperability so that physicians with different IT systems can share relevant patient information among them > Implementing all of this within a 3 6 month timeframe

11 Reality > Taconic IPA (Mid-Hudson Valley, NY) has established an operating RHIO > current users (400 physicians) using a shared data exchange > 4 Hospitals, 2 Reference Labs (LabCorp and Quest) connected > EMPI established to handle person identity resolution > System live and users trained within 90 days of project kickoff Data Exchange (Connectivity) CDR Shared Patient Record Community Portal (Physician View) EMPI Person Resolution eresults Software Applications 18 Hospital and Lab interfaces > 3 EMR vendors (Allscripts, NextGen, GE) agree to interoperability w/ CCR and HL7 Data Exchange > Contract Signed on October 1, 2004 system live and users trained December 31, 2004.

12 Stunning Interoperability don t imagine the future > live it

13 Technology > Delivered via an ASP model > IBM servers on Intel architecture > Portal built on a Microsoft platform Windows Server 2000/2003 Internet Information Server SQL Server 2000 > Data exchange and routing via Cloverleaf interface engine > EMPI services provided by Eclipsys > Clinical vocabularies and libraries from IMO, Multum, Healthwise and others

14 Healthvision - Scale > hospitals utilize servers daily > Manage a Microsoft environment of approx 250 servers > Platform database grows 12-15% per month and currently is approx 2 TB in size > Over 8 million unique patients in database > Interface Engine processes approximately 310,000 clinical transactions per day > Support 2.0 Million+ unique users/month > Over 11.7 TB per year in network traffic

15 Technology Model > Regional Clinical Data Repository > Longitudinal patient record across all systems > Reference pointers back to images and documents > Single sign-on to third party systems > CCOW support > Intelligent routing of HL7 and CCR data to EMRs > Record Locator Service to find national records > National exchange of clinical data among RHIOs

16 Clinical Advantages of a Regional CDR > Effective re-use of clinical data Codified data for reporting, graphing, and clinical decision support Ongoing surveillance Hazardous conditions Missed disease management opportunities Potential errors Adverse effects > Automatic alerts to providers Data from multiple sources combined Clinical alerting rules run across combined data

17 Clinical Advantages of a Regional CDR > Longitudinal, patient-centric view Multiple providers in multiple locations easily share data from multiple systems > Proven physician and staff acceptance

18 Technical Advantages of a Regional CDR > Centralized security access model for easier management of access to protected health information > Time to market Common data framework Common configuration tools Common implementation process Reusable interface libraries > System performance and reliability End user not waiting while multiple systems are queried Easily scalable with increased number of source systems and users

19 Technical Advantages of a Regional CDR > Easy to integrate new modules Applications leverage a common set of clinical data and system services > Not dependent on source system availability Easy to provide redundancy and eliminate single points of failure > Person resolution complexity Fully decentralized system requires matching patients across multiple systems in real time Allows timely human resolution of ambiguous matches

20 Technical Advantages of a Regional CDR > Standard legacy system interfaces HL7 and now CCR Takes advantage of built-in interface capabilities already built in to most clinical information systems > Centralized security model No need to provision multiple individual systems

21 Standards > In order to deliver interoperability, adherence to standards is key HL7 for registration and results exchange CCR for visit snapshot ICD9 for problems CPT for procedures NCPDP for pharmacy X.12 for eligibility and billing > Problem with standards is definition HL7 too loose CCR doesn t define vocabularies

22 Healthvision Interoperability platform don t imagine the future > live it

23 Challenges to a national model > Scalability Can systems scale from a few million patients to a few hundred million? > Identity resolution How do you quickly resolve patient identity across systems nationally? Privacy concerns over a national patient identifier > Security model How do you know who should get access to what data on a national level?

24 Thank You! Questions or Comments John Lightfoot Healthvision, Inc. (972)