Leveraging Telecommunication Capabilities: Integrating ... · Telehealth and Allscripts “The EHR...
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Leveraging Telecommunication Capabilities: Integrating Telemedicine, Health Information Exchange and Electronic Health Records Systems Christopher B. Sullivan, PhD Image Research Taxwatch Cornerstone Conference 20 November 2014 1
Transcript of Leveraging Telecommunication Capabilities: Integrating ... · Telehealth and Allscripts “The EHR...
Leveraging Telecommunication
Capabilities: Integrating Telemedicine,
Health Information Exchange and
Electronic Health Records Systems
Christopher B. Sullivan, PhD
Image Research
Taxwatch Cornerstone
Conference
20 November 2014
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Presentation Coverage
The following presentation addresses:
Telemedicine versus Health Information Exchange (HIE)
Similarities between Telemedicine and HIE
The status of Telemedicine
The status of HIE in Florida
Incentives or reimbursement for both Telemedicine and HIE
The need to take an integrated policy approach to Health Care
Telecommunications in Florida
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What is Telemedicine?
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Florida Senate - SB 1646
“Telemedicine” means the practice of medicine through the use
of advanced communications technology by a telemedicine
provider at a distant site…
Florida Board of Medicine - 64B8-9.0141
“Telemedicine” means the practice of medicine by a licensed
Florida physician or physician assistant where patient care,
treatment, or services are provided through the use of medical
information exchanged from one site to another via electronic
communications.
American Telemedicine Association - What is
Telemedicine?
…telemedicine is the use of medical information exchanged
from one site to another via electronic communications to
improve a patient’s clinical health status.
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Florida Senate - 2014 CS for SB 1646
http://www.flsenate.gov/Session/Bill/2014/1646/BillText/c1/PDF
Florida House of Representative - Bill No. HB 751 (2014)"Telehealth" means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services…http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=622299.docx&DocumentType=Amendments&BillNumber=0751&Session=2014
Florida Board of Medicine - 64B8-9.0141 Standards for Telemedicine Practice.https://www.flrules.org/gateway/ruleNo.asp?id=64B8-9.0141
The American Telemedicine Association - What is Telemedicine?…telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VGTJIck_c7k
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Diagram of a Telemedicine Project
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Columbia University’s Informatics for Diabetes Education and Telemedicine (IDEATel) Project: Technical
Implementation© Image Research 2014
Journal of the American Medical Informatics Association Volume 9 Number 1 Jan / Feb 2002Application of Information Technology ■Columbia University’s Informatics for Diabetes Education and Telemedicine (IDEATel) Project: Technical ImplementationJUSTIN STARREN, MD, PHD, GEORGE HRIPCSAK, MD, SOUMITRA SENGUPTA, PHD, C. R. ABBRUSCATO, MSEE, PAUL E. KNUDSON, MD, RUTH S. WEINSTOCK, MD, PHD, STEVEN SHEA, MDAbstract The Columbia University Informatics for Diabetes Education and Telemedicine IDEATel) project is a four-year demonstration project funded by the Centers for Medicare and Medicaid Services with the overall goal of evaluating the feasibility, acceptability, effectiveness, and cost-effectiveness of telemedicine. The focal point of the intervention is the home telemedicine unit (HTU), which provides four functions: synchronous videoconferencing over standard telephone lines, electronic transmission for fingerstick glucose and blood pressure readings, secure Web-based messaging and clinical data review, and access to Web-based educational materials. The HTU must be usable by elderly patients with no prior computer experience. Providing these functions through the HTU requires tight integration of six components: the HTU itself, case management software, a clinical information system, Web-based educational material, data security, and networking and telecommunications. These six components were
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integrated through a variety of interfaces, providing a system that works well for patients and providers. With more than 400 HTUs installed, IDEATel has demonstrated the feasibility of large-scale home telemedicine. ■ J Am Med Inform Assoc. 2002;9:25–36.http://jamia.bmj.com.ezproxylocal.library.nova.edu/content/9/1/25.full.pdf+html?sid=5d698fb3-fe15-4f90-ba57-2b6f623a505cDownloaded from http://jamia.bmj.com/ on November 16, 2014 - Published by group.bmj.com
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Telemedicine as Interactive Video
5Organizations Aim to Standardize Telehealth Practices
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Organizations Aim to Standardize Telehealth PracticesBy Cori Turner and Megan Phillips on June 9, 2014Posted in Children's Hospitals and Pediatric Providers, Hospitals & Health Systems, Physicians, Post-Acute Care & Nursing Facilities, Technology & Information Systemshttp://www.intechopen.com/books/telemedicine/telemedicine-reducing-trauma-in-evaluating-abuse
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Florida Child Protection Team Map
6Telemedicine: Reducing Trauma in Evaluating Abuse © Image Research 2014
Telemedicine: Reducing Trauma in Evaluating AbuseSunshine Arnold and Debra Esernio-JenssenRamesh Madhavan and Shahram Khalid (eds.) (2013). "Telemedicine"http://www.intechopen.com/books/telemedicine/telemedicine-reducing-trauma-in-evaluating-abuse
http://www.floridahealth.gov/alternatesites/cms-kids/families/health_services/telemedicine.html
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What is Health Information Exchange?
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National Alliance for Health Information Technology,
Health Information Exchange (HIE)
The electronic movement of health-related information among
organizations according to nationally recognized standards.
Office of the National Coordinator for Health IT
Electronic health information exchange (HIE) allows doctors,
nurses, pharmacists, other health care providers and patients to
appropriately access and securely share a patient’s vital medical
information electronically…
HIMSS HIE Guide Work Group, 2009
An HIE automates the transfer of health-related information
that is typically stored in multiple organizations, while
maintaining the context and integrity of the information being
exchanged.
© Image Research 2014
The National Alliance for Health Information Technology Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms , April 28, 2008Health Information Exchange (HIE) The electronic movement of health-related information among organizations according to nationally recognized standards. The National Alliance for Health Information Technology “Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms ,” April 28, 2008https://www.nachc.com/client/Key%20HIT%20Terms%20Definitions%20Final_April_2008.pdf
Office of the National Coordinator for Health IT, “What is Health Information Exchange (HIE)?”Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically…http://healthit.gov/providers-professionals/health-information-exchange/what-hie
HIMSS HIE Guide Work Group, November 2009, “HIE Commonly Offered Services” What is an HIE? An HIE automates the transfer of health-related information that is typically stored in
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multiple organizations, while maintaining the context and integrity of the information being exchanged. http://www.himss.org/files/himssorg/content/files/hie/hie_guidewhitepaper.pdf
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HIE Architecture
8HIMSS HIE Guide Work Group, November 2009
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HIMSS HIE Guide Work Group, November 2009, “HIE Commonly Offered Services” What is an HIE? An HIE automates the transfer of health-related information that is typically stored in multiple organizations, while maintaining the context and integrity of the information being exchanged. http://www.himss.org/files/himssorg/content/files/hie/hie_guidewhitepaper.pdf
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HIE Emergency Department Use Case
9State Level Governance of Health Information Exchange © Image Research 2014
Sullivan, Christopher B. (2013). “Case Study: State Level Governance of Health Information Exchange.” in N. Bhansali (ed.), Data Governance - Deriving Value from Informational Assets. CRC Press, Taylor & Francis Group. 2013.
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HIE in Florida, 2014
10Patient Look-Up Onboarding Status - July 2014 © Image Research 2014
https://www.florida-hie.net/files/plu/PLUNodeOnboardingStatusMap.pdf
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Status of HIE in Florida, 2014
11Florida Health Information Exchange Organization Connection Status
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Health Care Facilities Connected to the Florida HIE, August 2014
Hospital Connection Complete Hospital Connection In Progress
Non-Hospital Connection Complete Non-Hospital Connection In Progress
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Chart based on data provided in: Florida Health Information Exchange Organization Connection Statushttp://www.fhin.net/kms/docs/FLHIEOrgConnectionStatus.pdf
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Using the EHR as a Telemedicine Portal
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Telehealth and Allscripts
“The EHR Company
Allscripts is partnering with
American Well, a U.S.
telehealth company. The
companies will work to
integrate American Well's
Online Care platform into
Allscripts electronic health
records platform.”
Can EHRs and Telemedicine Integrate
“Cloud-based EHR provider Practice Fusion has acquired
the telemedicine platform Ringadoc, which the company hopes
will provide a “springboard” into a more comprehensive,
integrated patient care ecosystem that promotes efficiency for
providers and consumers alike.”
© Image Research 2014
Can EHRs and telemedicine integrate for better patient care?Author Jennifer Bresnick | Date August 7, 2014http://ehrintelligence.com/2014/08/07/can-ehrs-and-telemedicine-integrate-for-better-patient-care/
Telehealth and Allscripts EHR, new dynamic duoCHICAGO | August 15, 2012http://www.healthcareitnews.com/news/telehealth-and-allscripts-ehr-new-dynamic-duo
J Diabetes Sci Technol. Jan 2011; 5(1): 55–62.Published online Jan 1, 2011.Utilizing Information Technologies for Lifelong Monitoring in Diabetes PatientsDavide Capozzi, Ph.D. and Giordano Lanzola, Ph.D.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045225/
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Strategic Path to Integration
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Telemedicine and HIE are considered to be two different
technology systems. In reality, they are complementary systems.
Telemedicine typically functions as a synchronous, two-way
video or data connection between one provider and another
provider with a patient.
o The Telemedicine portal is often a TV or computer monitor
running video connection software.
HIE typically functions as a two-way, asynchronous data
connection between one provider and another provider, either
via the Patient Lookup Model or Direct Secure Messaging.
o The HIE portal is typically a computer connecting to the HIE
website or through the electronic health record system.
From an architectural perspective, the Telemedicine and HIE
digital networks have similar technical configurations.
The EHR can be used as a portal for both Telemedicine and HIE.
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Planning for Telemedicine
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In planning for Telemedicine, HIE and EHRs should be included
considered for additional communication efficiencies. Planning for
Telemedicine should leverage work already done to take advantage
of the health care telecommunications potential now available.
The Florida HIE has invested $21.7 million in state-wide HIE
connectivity based on the federal funding.
o There is no further federal funding for building out HIE.
Due to the EHR Incentive Program, 47% of physician practices
in Florida have an EHR installed.
o The EHR Incentive funding will end for Medicare in 2016 and
for Medicaid in 2021.
Telemedicine programs in Florida are limited to state programs
at the Dept. of Health and private, unreimbursed initiatives.
o Legislation requiring reimbursement for Telemedicine will
function as an incentive to develop this network.
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Some Recommendations
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Recommendations for planning to develop Florida’s Health Care
Telecommunications Network might include:
Propose legislation in 2015 to require reimbursement for both
Telemedicine and HIE.
o The language of the 2014 Telemedicine bills are broad enough
to include HIE data exchange already.
Leverage the knowledge level of health care facilities that have
already implemented HIE connectivity in Florida.
Leverage the knowledge of Florida’s Regional Extension Centers
to work with physicians to install EHRs in their practices.
Address the significant broadband connectivity issues facing the
rural hospitals in Florida by:
o Leveraging the FCC CONNECT program
o Expanding the capabilities of the DMS MyFloridaNet.
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Questions?
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Christopher B. Sullivan, PhD
Image Research
850-591-2821
© Image Research 2014
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