School of Technology 1 P00471 Software Production Internationalisation David Lightfoot.
Get Connected don’t imagine the future > live it Technology Models for Building Health Information...
-
Upload
jonas-allen -
Category
Documents
-
view
213 -
download
0
Transcript of Get Connected don’t imagine the future > live it Technology Models for Building Health Information...
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it
Technology Models for Building Health Information Infrastructure I
John LightfootVP Technology
Healthvision, [email protected]
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it Agenda
> Value of Health Information Interoperability
> How does a community get there?
> Real-life RHIO example
> Technology Models
> Standards
> Challenges for a National Model
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it CITL HIEI Taxonomy
Level Description Examples
1 Non-electronic data Phone, US Mail
2Machine-transportable data
Fax/Email without categorization
3Machine-organizable data
Text reports, HL7 messages
4Machine-interpretable data
LOINC-based lab results from lab system; codified medication hx
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it HIEI National Net Cost-Benefit
Level 2
Level 3
Level 4
$22B
$24B
$78B
Annual Net Return after
Implementation
$141B
-$34B
$337B
Net Return over 10-year
Implementation
Value of HIE standards is the difference between Level 3 & 4
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it
$(200)
$(100)
$-
$100
$200
$300
$400
0 1 2 3 4 5 6 7 8 9 10
Years
10-Year Cumulative Net Return by HIEI Level
Level 1
Level 2
Level 3
Level 4
in
bil
lio
ns
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it The Connected Healthcare Community
> Patient-centric design
> Disparate IT systems are unified through a shared information architecture
> Collaborative Care Model
> All providers have access to complete, up-to-date patient information
Physicians Physicians
& Staff& Staff
HospitalsHospitals
PharmaciesPharmaciesDiagnostic Diagnostic
LabsLabs
PatientsPatients
Managed Managed CareCare
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it How does a community get there?
Four Step Process
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it
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
Strategic Planning Governance Funding Models Information Systems Strategy
Information Systems Strategy e-health Interoperability Platform Implementation / Integration Services
Application / ASP / Service Delivery
Phases
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it Reality
> Taconic IPA (Mid-Hudson Valley, NY) has established an operating RHIO
> 1000+ 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.
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it “Stunning” Interoperability
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it Healthvision - Scale
> 1000+ 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it Healthvision Interoperability platform
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it 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?
Get Connecteddon’t
im
agin
e t
he f
utu
re >
liv
e it
Questions or Comments
John LightfootHealthvision, Inc.
[email protected](972) 819-4353
Thank You!