Factors for Creating a Successful RHIO / HIE 498DL Winter 2011 Beena Joy Paul Kuo MariJo Rugh David...
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Transcript of Factors for Creating a Successful RHIO / HIE 498DL Winter 2011 Beena Joy Paul Kuo MariJo Rugh David...
Factors for Creating a Successful RHIO / HIE
498DLWinter 2011
Beena JoyPaul Kuo
MariJo RughDavid Sumner
Examining Goals for RHIOs / HIEs
• 3 State review• Technical and non-technical
concerns– Structure and Governance– Data Security and Standards– Consent Management– Adoption
Provider Participation• Motivators
– Compliance with mandates (eg, e-prescribing)
– e-Billing mandates– Pay-for-performance incentives– Improved coding and direct links
to payers – Time savings from direct
electronic reporting – Increased payment if quality
goals are met– Cost savings to public and private
health plans– Altruistic goal to improve public
health– Quality of care and patient safety– Increased operational and clinical
efficiencies
• Barriers– Lack of interoperability– Lack of vision and goals– Security and privacy concerns– Cost– Creating a successful business
model– Limited technical support
Business Models• Membership/subscription • Transaction fees • Sales/revenue• Affiliate/revenue• Advertising revenue
• Greatest potential– Hybrid membership/subscription and
transaction model
Overview
Center for Health Transformation. (2010)
http://www.grrhio.org/about/~/media/HIE_For_A_New_Generation.ashx
Illinois HIE
Illinois Office of Health Information Technology, 2010http://www.hie.illinois.gov/assets/hiesop.pdf
Illinois HIE
• General Architecture- De-centralized, federated, 3-layer
• Financial Model- ARRA plus public-private partnership; mechanism ??
Illinois HIE• Clinical Messaging Future• Clinical Summary Exchange for Care Coordination (CCD/CCR
Standards) Future• Delivery of Structured Lab Results Operational (61%)• Electronic Order Entry Future• ePrescribing and Refill Requests Operational (89%)• Quality Reporting Future• Patient Portal Future• Repository Services Future• Eligibility and Claims Operational (44%)
Illinois HIE
• Connectivity to NHIN– 2012 – 2014 ?
Illinois HIE
Illinois Office of Health Information Technology, 2010http://www.hie.illinois.gov/assets/hiesop.pdf
Indiana HIE
• Five existing independent, private-sector, regionally-based HIOs
• Each of which has been operational and sustainable for at least five years
• Accounts for more than 12 million patient records and 12,000 physicians
Indiana HIE Mission/Vision
VanZee, 2010www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf
Indiana HIE Services• Clinical Messaging and Electronic Results Delivery (HL7
Standard)• Clinical Summary Exchange for Care Coordination
(CCD/CCR Standards)• Electronic Order Entry• ePrescribing and Refill Requests• Quality Reporting• Patient Engagement (Patient Portal)• Repository Services• Interoperability / Shared Provider Directories / Master
Patient Indexes• Eligibility and Claims
Indiana HIE StandardsTerminology Standards ICD, CPT, NDC, LOINC©, RxNorm, and SNOMED, and
HITSP constructs such as C32, C37
Data Transport and Protocol Standards
Web Services, LLP, HTTPS, Standard Object Access Protocol (SOAP), HTTPS,
SSH, SFTP, SQL, ODBC, IHE, electronic business Extensible Mark-up Language (ebXML),
Secure Socket Layer (SSL), and Transport Layer Security (TLS).
ePrescribing standards NCPDP, NCPDP SCRIPT v8.1, NCPDPFormulary and Benefit v1.0, NCPDP SCRIPT v8.1
RXHREQ, RXHRES
Image Transfer standards DICOM
EHR standards CCHIT certified
Indiana HIE – Moving Forward
• Connectivity to NHIN – existing HIOs have established connectivity
Indiana Infrastructure
VanZee, 2010www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf
• Mission• Overview of the WI
• Demographics• 4 Operational HIEs
• WHIE• OCHIN, Inc• CHIC• UNIVERSATA, Inc
• State-Level HIE Planning and Design• Phase 1 • Phase 2
Wisconsin HIE
Wisconsin HIE
• Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) Operational (Epic)
• Delivery of Structured Lab Results Operational • Electronic Order Entry Operational• ePrescribing and Refill Requests Operational • Public Health Reporting Operational
• Electronic Lab Reporting of notifiable conditions• Syndromic Surveillance• Immunization Data
• Eligibility and Claims Operational
HIE Strategic & Operational Plan Profile
Wisconsin HIE Architecture
Wired for Health Board, 2010
http://wiredboard.wisconsin.gov/SOP01.25.11Posted.pdf
State Contrasts
• IL, IN Federated – WI Hybrid models
• IN, WI Clinical Messaging - Operational• IN, WI Electronic Order Entry – Operational• IN, WI Quality Reporting - Operational• IN Patient Portal – Operational
• Technical standards - Essentially matching
HIE Functionality Required for Meaningful Use
2011• Electronically capture health information in a coded format• Use that information to track key clinical conditions• Communicate that information for care coordination purposes2013• Encourage the use of HIT for continuous quality improvement at the point
of care• Exchange HIT information in the most structured format possible.2015• Promote improvements in quality, safety and efficiency• Focus decision support for national high priority conditions• Enable patient access to self management tools• Access to comprehensive patient data• Improving population health
Recommendations for new RHIOs
• Commitment to the RHIO is a process
• Don’t give away services• Vendor-neutral architecture• Understand requirements• Encourage adoption• Plan for consent management• Base the solution on HIT and IT
standards
Conclusion: On Our Way to Sustainable HIE
• Early failures and successes have laid the road bed for the future
• State strategies further the construction• Advancements in technologies and standards
are removing the barriers• Additional opportunities/gaps to be addressed
Feedback Welcomed!
• Questions?