Exploring Common Ground April 11, 2006 Florida Health Care Coalition Central Florida RHIO.
Indiana Health Information Exchange 12/16/041 RHIO Case Study J. Marc Overhage, MD, PhD, FACP, FACMI...
26
12/16/04 1 Indiana Health Information Indiana Health Information Exchange Exchange RHIO Case Study J. Marc Overhage, MD, PhD, FACP, FACMI President and CEO, Indiana Health Information Exchange Senior Investigator, Regenstrief Institute, Inc. Associate Professor, Indiana University School of Medicine
-
Upload
angelina-price -
Category
Documents
-
view
214 -
download
1
Transcript of Indiana Health Information Exchange 12/16/041 RHIO Case Study J. Marc Overhage, MD, PhD, FACP, FACMI...
12/16/04 1Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
RHIO Case Study
J. Marc Overhage, MD, PhD, FACP, FACMIPresident and CEO, Indiana Health Information Exchange
Senior Investigator, Regenstrief Institute, Inc.Associate Professor, Indiana University School of Medicine
12/16/04 2
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Statewide E-Health StrategyVision and Mission
• Vision– Extend Indiana as a leader in the exchange of
health care information that enables improved quality and efficiency of health care and reduced growth rate of its costs.
• Mission– Improve overall quality, safety and efficiency of
health care across the state through system interoperability and standardization of health care data.
• Within medical referral regions.• Across medical referral regions throughout the state.
12/16/04 3
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
State-wide E-Health Strategic PlanGuiding Principles
1. The intent is to develop patient centric information systems
2. The strategy should enable referral networks not influence them
12/16/04 4
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Statewide E-Health StrategyStrategy and Tactics
• Develop a self-sustaining business model that aligns the providers and other stakeholders and clearly define the value proposition for startup funding.– Tactics…
12/16/04 5
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Statewide E-Health StrategyStrategy and Tactics
• Enhance the ability of communities and other stakeholders to become more electronic.
– Assist in educating health care leaders from different communities.
– Support local efforts to adopt community-based health information networks.
– Develop a communication mechanism for addressing local and state-wide health care data issues.
12/16/04 6
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
State-wide E-Health StrategyStrategy & Tactic
• Implement specific applications– Consider developing a state-wide directory– Identify a few projects with actionable data
(e.g., public health, pharmacy data) that benefit all communities and do it!
12/16/04 7
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Statewide E-Health StrategyStrategy and Tactics
• Monitor and evaluate results and revise plans accordingly.
– Develop a consistent system to measure improvements and share with constituencies.
12/16/04 8
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
12/16/04 9
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Morgan County
Hospital
ImmunizationsNewborn screeningED encounters
12/16/04 10
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressTechnology
• How do we optimize interoperability within medical referral regions?– Northwest IN/IL, FW, SB, Muncie/Anderson, Indianapolis,
Kokomo, Terre Haute, Bloomington, Columbus, Evansville/KY, Southeast IN/Cincy/KY?
• How do we optimize interoperability across medical referral regions?– FW/SB, Lafayette/Indy, Bloomington/Indy, South
Bend/Niles, MI?• Exactly what are the data needs?
– Physician to physician, hospital to hospital, Physician to hospital
• What is the volume and value of needed transactions?
12/16/04 11
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressTechnology (Cont.)
• How do we address state-wide issues to improve access to data?– Public health, bio-terrorism, clinical trials,
academic research• What do we have to do to standardize across
the state?• How do we minimize expensive data feeds
across the state to reduce cost and complexity?
• How can we more effectively exchange data with national and state-wide data senders?
12/16/04 12
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressPolitical
• Why should Community Health Information Networks participate in a state-wide strategy?– What is the value proposition for them?
• What are the areas for collaboration vs. competition (Coopetition) among stakeholders?
• How do we build trust?
12/16/04 13
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressOrganizational
• How do we address the scale issue organizationally?– Need to be able to do large scale projects
that cut across medical referral regions.– Has to work at each level
• Medical referral region• Multi-referral region• State-wide• National
12/16/04 14
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressOrganizational
• What are the roles and relations of various parties at the local, regional, and state-wide levels?– Areas include: Governance, grants, funding, usage of data,
allocation of resources, interface with feds, etc.– Entities include, among others:
• Community health information networks• State Health Department• Regenstrief Institute and other researchers• Federal and state initiatives – Medicare, Medicaid, QIOs• Economic development• Vendors
• What is IHIE’s role – state-wide grantee, community health information network, vendor?
12/16/04 15
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Barriers to AddressFinancial
• How do we fund projects through out the state when federal funding is not a reliable source?
• Few people will want to pay for a state-wide interface engine. How do you get it paid for?
• How do we access large $ on behalf of the entire state?
12/16/04 16
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Scenario 1 – Centralized Interface ModelState-wide Messaging
Organized Health Information Network
No formal community structure
IHIE
BEHC
MHIN MIE
Overseer & coordinator of regional IE and RS
Others
12/16/04 17
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Scenario 1 – Centralized Interface ModelFlow of State-wide Messages
Out of Region
Hospital
Out of Region
Lab
Com. HIN
If Any
Interface Engine &
Record Search
(Central)
Public Health Data
Requesting Doc
Non-Local data
12/16/04 18
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Scenario 2 – Regional Interface ModelState-wide Messaging
Organized Health Information Network
No formal community structureIHIE
BEHC
MHIN MIE
Regional interface engine and record search
Overseer & coordinator of regional IE and RS
Others
Messages sent via Reg. Utility
Coordination between Reg. & Coordinator
12/16/04 19
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Scenario 2 – Regional Interface ModelFlow of State-wide Messages
Out of Region
Hospital
Out of Region
Lab
Com. HIN
If Any
Interface Engine &
Record Search
(Regional)
Public Health Data
Requesting Doc
Non-Local data
12/16/04 20
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Referral Region:Preferred Modes of Exchange of Data
Single Hosp. System Multiple Hosp. Systems
Relatively High % Internal Referrals
Relatively High % External Referrals
•High need
•Com. Health Info. Network
•Rural – Part of HIN or messaging with referral hospitals
•Low need
• Cross-com. messaging
•High need
•Hospital integrated EHR
•Cross-com. Messaging
•Rural – Integration with referral hospital or messaging
•Low need
•Com. HIN
•High need
•Hospital integrated EHR
•Rural – Integration with referral hospital or messaging
•Low need
•Cross-com. Messaging
•High need
•Com. HIN
•Cross-com. messaging
•Rural – Part of HIN or messaging with referral hospitals
12/16/04 21
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
State-wide Data UsersRequired Information Flows
• Public health– Continuous specific data for a patient’s
condition
• Provider referrals– Specific data for a patient
• Need to fill in this chart!
12/16/04 22
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Typical Statewide Data Feeds
• Those with high value/high volume– Lab– Radiology reports– Prescription data– ADT– Transcription– Other?
12/16/04 23
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Strategy QuestionsTechnology – Interface Models
• What is the appropriate interface model based on the following factors?– Cost/benefit– Overall costs– Funding opportunities– Sustained business model– Data scrubbing and data mapping requirements– Ability of Regenstrief to license the engine to the local
Health Information Networks– Value of aggregated data to all communities– State-wide role vs. local role– Impact on local control
12/16/04 24
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Strategy QuestionsClinical and Patient/Consumer
• Increasing provider electronic usage is done at the community level. – How do we catalyze culture change in the
communities to increase utilization?– Who are the people in each community we
need to be working with?– How do we involve community reps in this
planning process?
12/16/04 25
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Strategy QuestionsOrganizational, Legal, Financial
• Given the required data flows and the technical, business and political issues:– What are the guiding principles for
organizational relations?– What are organization options?– What are the role relations of key parties?
12/16/04 26
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h In
form
atio
n E
xch
ang
eIn
dia
na
Hea
lth
Info
rmat
ion
Exc
han
ge
So the question is…
• How can multiple local efforts (LHIIs) be integrated to create a coherent statewide strategy?
