Synergies Between the Care Connectivity Consortium and Healtheway ehealth Exchange

Transcription

1 Moderator: Panelists: SUMMARY: TRANSCRIPT: Pam Matthews, RN, MBA, CPHIMS, FHIMSS, Senior Director, Informatics, HIMSS Reg Smith, EdD, Vice Chair, Informatics, Mayo Clinic-FL Dr. John Mattison, CMIO, Assistant Medical Director, Kaiser Permanente This discussion on the collaboration between the Care Connectivity Consortium provides an in-depth look at the benefits and challenges of implementing comprehensive health information exchange on a large scale. Panelists Reg Smith (Mayo) and Dr. John Mattison (Kaiser Permanente) share the collaboration s key milestones so far and plans for the future, as well as expert insights into the process of achieving interoperability and data sharing on a national scale. Recorded April 2, 2013 Pam Matthews: Welcome to the HIMSS HIE inpractice Podcast Series. This session is titled, Synergies Between Care Connectivity Consortium. I m Pam Matthews, Senior Director at HIMSS, and I will serve as the moderator. HIMSS is honored to welcome our two panelists. First, Reg Smith is Administrator of the IT Office of Governmental and External Affairs for Mayo Clinic. His career spans 34 years in healthcare, with the last 23 at Mayo. With Reg s experience and background, he will bring information technology and the administrative perspective to this discussion today. Joining Reg is Dr. John Madison, CMIO of Kaiser Permanente in the Southern Cal region. Here, he led the first and largest deployment of KP Health Connect. He is the founder of the international standard for health record exchange, now known as the CDA and CCD. He has been an active participant on the boards of both Care Connectivity Consortium and Healtheway. Dr. Madison brings the clinician s care role and patient care delivery process perspective to today s discussion. Welcome, and thank you for participating in this podcast. Reg, please share with us the vision of the Care Connectivity Consortium. Reg Smith: Well the Care Connectivity Consortium was founded by five large healthcare organizations that are quite widely dispersed across the country. We all have very strong brands, and we all care very deeply about caring for our patients and delivering the very best in care for our patients. Our vision was, as we saw health information exchange growing up, we wanted to make sure that it would be workable on a national scale across our respective organizations. And so we have very much focused on building a large working model of health information exchange to meet the needs of, first of all, the patient in delivering their information in a very timely way; and also meeting the needs of the practicing physician who s seeing the patient, to make sure that they have everything that s appropriate and pertinent to the patient before them. 1

2 John Mattison: So, I completely agree with Reg. I think that we have a very common vision of the role of the Care Connectivity Consortium. The one thing I will add is that there have been many successes on a regional scale because most information exchange is the highest volume is at a regional level. Some of the challenges Reg mentioned around identity management and ad hoc authorizations and those kinds of problems become much more interesting challenges for remote sites. So these five institutions represent a very large geographic spread across the country, and really challenge us to solve some of the more vexing problems for a truly fluid exchange of data between all of the participants. And in maintaining a longitudinal record for every patient, it is critical that we do have access to everything relevant to each individual at each of their encounters. So there s no way short of a national solution to bring about those objectives. Thank you. What are some of the synergies between the Care Connectivity Consortium and Healtheway that brought these two groups together where they could actively participate? Well, we re very fortunate that we started off on separate paths and then were drawn together by the synergies, but let me outline them briefly. First of all, Healtheway as the follow-on organization from the Office of the National Coordinator has the large, robust network at the national level to be the network of networks, if you will, serving the entire population. And so it has many of the hospitals the majority of the hospitals; it has the largest number of members; it has very rigorous criteria for onboarding; it has developed a data utilization and reciprocal agreement for treating the data. So it had put in place all of the essential infrastructure that needs to be in place for this to work at the national level. The Care Connectivity Consortium, by contrast, was very much focused on problems that are real operational problems that we could see emerging in the standards. So our work has been focused on trying to identify patients very clearly and accurately. The national standard only requires four pieces of data last name, first name, date of birth and gender and that simply isn t sufficient in some of the markets that we serve. So we needed to be much, much better in terms of matching patient identification, and then we also wanted to get something going by way of a patient consent to participate in health information exchange. It didn t make sense for us to put all of this infrastructure in place in information technology, and then have it bound by a paper process. So we re trying to make inroads, as well, into the process of automating the delivery of consent so that it facilitates the flow of information, and makes it available in a timely way, when the patient wants it there. Okay, so I think the real synergy between the CCC and Healtheway is that Healtheway has established really robust processes for onboarding, coordinating and breach notification. And what the CCC offers is really 5 organizations that have invested heavily and early in health information exchange, and who are committed to innovating and testing new services, new products that can be used for health information exchange in a test bed environment. Once we get those burned in, the expectation is that we ll transfer them over to the entire network, but having a test bed for some of the more bleeding edge capabilities makes a lot of sense, and that s where the biggest synergy comes between the CCC and Healtheway. When you take all of those synergies together, they really complement one another and they don t try and accomplish exactly the same goals for each other organization. So by putting them together, we believe that the outcome makes an organization that s much better and stronger, and creates a huge synergy in combining the strengths of both organizations to serve the people in this country. 2

3 Reg, what is the current status of the Care Connectivity Consortium? Well currently all five organizations are on board and exchanging information, or have the capability of exchanging information, between our respective organizations. That does not say, however, that we have rolled it out entirely within all of our organizations. For example, Mayo Clinic is on, but not all of Mayo Clinic is on yet. Ah, parts of Kaiser Permanente are on but not all of Kaiser Permanente. And so as you go organization by organization you ll find various degrees of roll-out, but we re all using the essential health information exchange capability, so that has been accomplished. Where we are today is we have been working now for about a year to build some new value-added services that we think will bring tremendous potential. By instead of having a federated model, to building a shared services model where we have central connectivity. So there s a suite of services right now that we are working to have online, in production state and ready to offer through Healtheway yet this year, before the 4 th quarter of the year. So, um, there s a lot of work going on within our development team right now to get that pardoned, and complete the testing and all of the other requirements that it takes to make it available as a service. We ve made giant strides when you consider that we ve been in operation as an organization for just a little over two years. And we ve had active exchanges between every pair of participants in the Consortium for real clinical circumstances. So if we look back to see how much crossover there has been between individuals who have received care at one or more of these institutions, it s actually surprising how much crossover there is, so while we don t have all of every institution 100% up on the CCC, we have a fairly high volume of crossover of individual patients who have been seen at two or more of the facilities. So we are definitely seeing activity. Thank you. Now that we have a handle on what is happening today, Reg, can you share a little bit about what the goals are for the Care Connectivity Consortium for the future? Well I ve already mentioned that we want to get the shared services platform online, but the future services is where we really want to get to. There s kind of a sweet spot out there once we get the basic services available. But let me give you a couple of examples. One of the areas we ve talked about is, let s get benefits and eligibility available. If a patient presents in an emergency room to be seen, it would be nice if the receiving organization could also find out the limits of eligibility or their coverages so that, given some foreknowledge, the physician might do whatever they could to try and meet those, practice cost-effective medicine to try and keep the cost so that they fit what s available with the plan. That s just one dimension. Another one is, let s say a patient shows up in the emergency room and they present with crushing chest pain. That could be a problem where they are in fact experiencing something that s been asymptomatic, it s never happened before; or it could be that they ve got an implantable medical device that s failing. So we see another opportunity to put in implantable medical devices to be tracked, so that when one of these devices may get recalled or may have a failure or a flaw, then we can also use this to notify wherever the patient may be seen that there is a problem and they need to get it fixed right away. 3

4 Other areas are getting more and more towards common clinical vocabularies, simply because it will facilitate the clarification and the common understanding as the patient moves through the healthcare ecosystem. Um, we d like to see and we believe there s an opportunity to reduce the cost of repeated medical tests. If the chest X-ray and the lab results gotten at Mayo today could be seen two days later when the patient is flown to southern California without having to repeat some of these same tests or at least to have them as a baseline with which to compare current tests there s a tremendous amount of value that that brings to the patient and the physician in terms of their ability to treat. So we just see this growing, in terms of building a longitudinal record that can follow a patient wherever they may go as they are mobile across the country, and still provide the base of information so that we don t do anything to compromise their care when they begin to be cared for not in their home locale. Dr. Mattison, from your perspective? Sure, one of the common assumptions is that interoperability is just a matter of reaching agreement on a standard and then implementing it, but in fact it s really quite complex and difficult in practice. So this question about where do we see us going in the future once we can establish an effective common level of interoperability, slay that dragon, we can then move to what is really the holy grail, and that is shareable knowledge. So, sharing data across institutions to allow for continuous care of each individual patient is the primary goal, but the real holy grail is being able to share knowledge through decision support, and there s a tremendous amount of excitement among all the participants on the long-term goals of creating better opportunities for sharing knowledge through decision support. Thank you. From each of your perspectives, who benefits the work of both of these organizations with this collaboration. Reg? Well the beneficiary s clearly the patient. It s in the best interest of the patient to have their information available at the direction of the patient when it s needed. We want to get the right information on the right patient to the physician who s going to be overseeing their care at the right moment, so that everything converges exactly as it should. And it can be done efficiently and effectively, so that the patient receives the very best in patient care. Dr. Mattison? So, really, everybody benefits from the Care Connectivity Consortium and Healtheway, and especially the collaboration. If you look at the benefits to the individual patient, having a continuous record no matter where they re seen is obvious. If you look at the provider organizations being able to render the best possible care in every circumstance, they benefit tremendously. If you look at the quality of care for the entire population, it is absolutely inconceivable that we could really optimize our quality without having a complete record to deal with. And likewise, there will be significant reductions to the cost of care through our ability to exchange information freely. So the patient wins, the provider wins, the quality goes up, the costs go down the collaboration between CCC and Healtheway is absolutely critical to achieving all of those goals, and so there is no downside. 4

5 One of the troublesome areas about health information exchange is the sustainability model, and people say, Well, where s the model? Where s the business case? Until you reach a tipping point where it becomes just common practice for every provider and every patient to have full access to everything at every encounter, it s difficult to initiate that workflow in every instance where it could be of value. But there will be a tipping point where the prevalence of that experience is so high that it will occur at every opportunity. And when that occurs, all of those benefits are going to be profound and especially with respect to driving the quality up and driving the cost down. So HIE really is a no-brainer in terms of the values. It s, How do we most quickly get to the tipping point? And I think this synergy and collaboration between the two entities is going to accelerate that work and bring the tipping point forward in time. Thank you. While we ve talked about the benefits, the future in terms of activities to accomplish and what you are doing today, what are some of the challenges around data sharing, and how can we address those challenges? Reg? Well [laugh], there are many challenges. So if you think this course we ve chosen is easy, then you d be mistaken. The two that come immediately to mind when you think about it is, first of all, there are over 500 or about 500 electronic medical records that have been certified for use to meet the requirements of Meaningful Use. With that many vendors offering different solutions, the uniformity of exchanging data and interoperability is a huge challenge. So it s just not simple to pass information from one EMR to another. Some of that has been ameliorated with the use of the CDA and CCD that Dr. Mattison has referred to earlier. Those have gone a long ways to help, and you can t underestimate the value of standards and uniformity when these things come along. But even so, you re still dealing with 500 or about 500 different vendors in terms of exchanging data. And then when you get to a rudimentary level of exchange, what we mean by interoperability is that if a patient has a medication list that s on a Cerner electronic medical record, for instance, and they come under the care of a Kaiser Permanente physician who s dealing with an Epic medical record, in ideal interoperability that medications list would go from the Cerner system into the Epic system without somebody having to sit and manually re-key the data. The same is true for discrete lab values, and for other test data, clinical notes, um, the list goes on and on of all the things that can make their way into an electronic medical record. And that s the goal is to get full interoperability. But it s going to be a ways off, and especially with 500 vendors out there. So that s perhaps the most significant challenge. The other dimension of that is that it works best when it flows right into physician workflow. So until you get that interoperability, how smoothly you can pass the data from one system to another so that the physician has it in an efficient and effective way, is another challenge. Other challenges that we ve encountered, you know, in a perfect world money and labor would not be expensive resources. Had we had bigger amounts of funding available, if we had more staff we might be even moving more quickly. But despite those challenges, we ve come a long, long way by working together over the last two years. If anyone organization tried to do this, we all are aware of company politics. And company politics quite often get in the way of making progress in some areas. And one of the strong things about the way this 5

6 group has worked together is, because we come from various levels within our respective organizations, titles have become pretty meaningless, and our roles within our respective organizations are pretty meaningless. And we ve all been drawn together, and that s been one of the challenges is, How do we work together to solve this problem? And the synergy that we have created between our five organizations. And we re seeing the same thing with Healtheway as we ve begun to work with them. Your title isn t very meaningful we have technical issues to solve. And so we all get down and work on the problem, shoulder to shoulder, without worrying about our titles and our role within our respective organizations, and we ve been able to make huge gains of progress by our collegiality, and by our teamwork that we ve been able to do as we ve done this project. So while those can be challenges, some of those challenges have worked out very well for us. Dr. Mattison, from your perspective? Yeah, I d just like to reflect quickly on what Reg said and then add two more things. There have been many new friendships that have developed as a result of this level of collaboration, as Reg accurately describes it, really truly a team effort across the five institutions. Absolutely incredible. The two things I d like to add is, one, I d like to dispel an urban legend, and that urban legend says that banking long ago figured out interoperability, and what s wrong with healthcare that they struggle so long and so hard and waste so much taxpayers money, and on and on. I d just like to point out that banking has sic basic data types: they have dollars and cents, minutes and seconds, and debits and credits. They have tons of algorithms and financial instruments that may be very complex, but the data types are very, very limited. In contrast, we re taking care of the mind, body and soul of every individual human, and we have literally hundreds of thousands of unique concepts that relate to characterizing the health and the disease of every individual. And so it really is a misnomer to think that there has been resistance to interoperability it s a much tougher problem. So part of what we re doing through this collaboration is further specifying the standards around those data types to create real interoperability. Second thing I ll add is that the standards have pretty well addressed how to export data from a chart, how to pass it over the wire, and then how to read that export from the human perspective as a package at the receiving end. What has been painfully missing from either the standards or the incentive world is insuring that vendors can interpolate those data back into the location of the charts so that when a physician or other care giver reviews the chart of a patient, they can actually look at the information in something resembling a chronological order so that the course of the disease and the sequence of events can be understood at the human level. Similarly, we need to have that same kind of normalized data structure so that our decision support systems can operate on those data behind the scenes. Because increasingly, there is way too much information and way too much knowledge in order for any physician to keep it in their head, and so we rely on our decision support systems to do that mash-up between what we know and what s known about this patient to provide the best care. And absent ability to interpolate data into the chart, into the appropriate sections of the 6

7 chart which are different in the different data structures of different electronic health records we have fallen short of our goal. So that s one of the big outstanding issues. And the last thing I ll mention is efficient ad hoc authorization. When a patient shows up in the emergency room, they may not have signed up for health information exchange anywhere, but at that moment in time it s not really difficult to explain to them how important it is for their treating physician to have a complete set of their information. So having an efficient ad hoc authorization process at the point of care can become invaluable. Thank you, and one last question, and this is for both of you. If you could do anything differently in this experience, what would it be? Reg? Well I ve already referenced the fact that, you know, in a perfect world if you had more money, if you had more time those are the two commodities that we have limited available amounts to work with, and those would be beneficial. But in terms of what would I do differently, there s very little that I would do differently. I think the way the synergies of the developing of the five organizations with the Care Connectivity Consortium, and then the timing of the events with Healtheway and the opportunity for us to form this partnership in collaboration with them, has just worked out and been very very fortunate for both organizations. And I think the synergy that it creates is terrific, and there s very very little I would change. Dr. Mattison? You know, I agree with Reg, I mean, the way things have gone, it s hard to imagine anything that we could have planned better than the way it s worked out. The only thing I ll say is that, as a member of both of the Boards, there was always a sort of a looking through the telescope and saying, Well what are they doing, and how does that affect us? from both institutions. So from that perspective, the only thing I might have done a little bit differently was to have a little bit earlier strategic collaboration between the two. But actually, I wouldn t have recommended it much earlier because there was a great deal of industrialization and a real glue that came within both of the institutions, the CCC and Healtheway, during that interval. So I, you know, maybe a little bit earlier but not much. Aside from that, I m just absolutely thrilled with how things are coming together. HIMSS would like to thank Reg Smith and Dr. John Mattison for being panelists on this important and informative podcast session. We look forward to watching this collaborative, and learning more about how the Consortium will impact the industry. Please visit the HIMSS website at for additional podcasts and resources on a variety of HIT topics, including health information exchange and interoperability. 7