November 16, 2016

Building capacity, usage, and VALUE.

What is NDHIN?

• NDHIN – North Dakota Health Information Network – a public / private

partnership for the secure exchange of health information that enables clinical

users such as providers, nurses and clerical staff to easily and efficiently view

information relating to a patient’s electronic medical record

• NDHIN allows users to view the patient’s unified longitudinal health record

over time and organizations

• Creates a roadmap of data for a more thorough understanding of patients’

conditions, allowing for up-to-the-minute decisions and faster diagnoses.

• NDHIN allows users to securely exchange clinical information.

Health Information Technology Advisory

Committee (HITAC) Membership• Chair – Lynette Dickson, Program Director,

Center for Rural Health, UND

• Vice Chair – Dan Kelly, CEO, McKenzie County Healthcare System

• Jennifer Witham, IT Director, ND Department of Human Services

• Megan Houn, Director Government Relations, Blue Cross Blue Shield of ND

• Lisa Clute, Executive Officer, First District Health

• Lisa Feldner, ND University System, Vice Chancellor for Information Technology and Institutional Research and Chief of Staff

• Neil Frame, Operations Director, Metro Area Ambulance

• Barb Groutt, CEO, Quality Health Associates of ND

• Sharon German, Enterprise Director of IT Applications & Bismarck Site Lead, Sanford Health

• Jerry Jurena, President, ND Hospital Association

• Courtney Koebele, Executive Director, ND Medical Association

• Senator Judy Lee, ND Legislature

• Matt Shahan, CEO, West River Health Systems

• Darin Meschke, Director, ND Department of Health

• Dave Molmen, CEO, Altru Health System

• Shelly Peterson, President, ND Long Term Care Association

• Mike Ressler, CIO, ND Information Technology Department

• Representative Robin Wiesz, ND Legislature

Vision Statement: Quality healthcare for all North Dakotans anywhere, anytime.

NDHIN Services

• Direct Secure Messaging (Push)

• Query Based Services (Pull)

• Clinical Portal

• CCD Exchange

• Direct Connections

• Syndromic Surveillance

• ELR

• NDIIS

• Image Exchange

• Subscription / Notification

Patient Privacy and Consent

• North Dakota is an Opt Out state• By default, all patients have opted in, unless NDHIN has been

notified and opted out, or conditionally opted out (except in an emergency)

• Opted In• With relationship – Full Access

• Without relationship – Break the Seal

• Opted Out• Patient Search – Name and ID

• Locked Access applies – Record not query able

• Opted Out Conditionally (Opt Out except in an Emergency) • Patient Search – Demographics displayed

• Locked Access applies with break the privacy seal – ONLY in an Emergency Situation

Opt Out Statistics

• Opt out

• 149

• Opt out except in an emergency

• 60

Data Feeds to NDHIN• Admission, Discharge, Transfer (ADT)

• Patient Demographics

• Encounter History

• Allergies

• Diagnosis

• Procedures

• Observation Results (ORU)

• Lab Results

• Imaging Studies

• Radiology Reports/Documents

• Medical Document Management (MDM) (Clinical Documents)

• Work Types

• Discharge Summaries

• H&P’s

• ED Visit Notes

• Consult Reports

• Operative Notes

• Encounter Summaries

• Immunizations (VXU)

• CCD/C-CDA Exchange

Prescription Drug Monitoring Program

Query / Clinical Portal - Statistics

Unique

Patients

899,828

(10-15-16)

0

500

1000

1500

2000

2500

Records Accessed

-200

-100

0

100

200

300

400

500

600

700

800

Logins -Period

Weekly user access to the clinical portal

Week of 8-14 to 8-20, 2016

Participant Logins Users

Mid Dakota Clinic, PC 241 31

Trinity Health 200 27

North Dakota Department of Health 69 11

Sanford North, Sanford West 31 6

NDHIN 26 2

Grand Forks Public Health Department 15 2

St. Andrews Health Center 14 5

Central ND Cancer Registry 10 1

North Dakota Dept of Human Services 9 1

Ashley Medical Center 6 1

Wishek Hospital Clinic Association 4 1

Prairie Assisted Living Services 3 1

Northland Healthcare Alliance/Northland PACE 3 1

Presentation Medical Center 3 1

Heart of America Medical Center 1 1

Northwood Deaconess Health Center 1 1

636 93

Week of 10-9 to 10-15, 2016

Participant Logins # of Users

Mid Dakota Clinic, PC 167 34

Trinity Health 146 25

North Dakota Department of Health 60 12

Sanford North, Sanford West 55 10

NDHIN 46 2

North Dakota Dept of Human Services 13 1

Minot Health & Rehab 10 2

Baptist Health Care Center 8 1

Grand Forks Public Health Department 7 3

Wishek Hospital Clinic Association 7 2

Northland Healthcare Alliance/Northland PACE 6 1

Prairie Assisted Living Services 5 1

Southwest Healthcare 5 3

Ashley Medical Center 4 1

Lisbon Area Health Services 4 1

ST ALOISIUS 3 3

St. Andrews Health Center 3 2

Central ND Cancer Registry 3 1

Presentation Medical Center 3 2

Valley Memorial Homes 2 1

CHI Oakes Hospital 1 1

UND School of Medicine & Health Sciences 1 1

559 110

Direct Secure Messaging - Statistics

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

Axis

Title

Messages Sent

Web Message Sent

XDR Message Sent

Linear (Web Message Sent)

Linear (XDR Message Sent)

Notifications and

Subscriptions

Notifications and Subscriptions

• Benefits

• Immediate notification of significant patient events

• Increased quality of care and enhanced health outcomes

• Avoidance of errors and adverse events

• Improved efficiency, cost-benefit, and provider and patient

satisfaction

• Available Notifications in NDHIN:

• Inpatient Admit and Discharge

• Emergency Room Admit

• Final Radiology Reports

• Abnormal Lab Observation

• Critical Lab Observation

Notification Subscriptions

Advance Directive

Repository

Imaging

eHealthViewer® ZF

NDHIN Five Year

Business Plan

Building capacity, usage, and VALUE.

Presented to HITAC

October 28, 2016

CedarBridge Group Contract Elements

1) Environmental Scan

3) Future State Brief

2) Best Practices Brief

4)Return on Investment Brief

5) Five-Year Business Plan

NDHIN Current State 1 of 2

NDHIN public/private partnership

Orion Health: technology platform

186 provider organizations connected 42 hospitals, clinics

Longitudinal medical record Over 500 look-ups/week

DIRECT secure messaging hub for major healthcare providers in North Dakota. Over 800 messages/week

NDHIN Current State 2 of 2

HIE Infrastructure eMPI, patient matchingProvider directoryLongitudinal clinical record Image exchangeHospital admission, discharge, and transfer (ADT) alertingDIRECT secure messagingSingle sign-on (SSO)Prescription drug monitoring program (PDMP) access w/SSO Immunization registryElectronic Laboratory ReportingSyndromic SurveillanceAccess to 25-30 out of state HIEs

CMS 90/10 Match Funding Opportunity

Funding is available through Sept. 30, 2021 Non-competitive, no limit in funding amount

CMS offers states 90/10 matching funds for building

HIE infrastructure to support Meaningful Use

initiative.

Some categories of technology qualify for 85/15,

75/25 and 50/50 matches.

NDHIN 5 year Development Plan

Amount spent in 3

years to date: $8.8M*

Budget for the next 5

years: $47M

Total NDHIN investment:

$55.8M

*Total stakeholder investment to date: $0

NDHIN 5 year Development Plan

85%15%

Federal Contribution

$47m

North Dakota$7m

State ContributionProviders

Contribution

Payer Contribution

$2.33m $2.33m

$2.33m

*Stakeholders only share $4.7M (8.5%)

NDHIN Future State Additions

Admin 24 temporary additional FTEs.

Out-bound Subject matter experts Internal staff

Infrastructure Orion Amadeus platform upgrade Provider directory upgrade Medications Additional single sign-on Consolidated Clinical Document Architecture (C-

CDA) discrete data Genomic data

State Systems Cancer registry Enhanced Immunization System Behavioral health EHR Developmental disabilities EHR Corrections EHR State Veterans Home EHR University health systems EHR

Federal Systems VA, IHS, DOD South Dakota “Snowbird” states 40 additional states & HIEs

NDHIN Future State Additions

Payers Access Data contribution All Plans

Medicaid Medicare Commercial Large Employer Workman’s Comp

Patients Global Personal Health Record Patient reportable data- telehealth, wearables

MU Providers Hospitals Clinics

Traditional Urgent Care Pharmacies

Large reference labs Chiropractors Optometrists Dentists

NDHIN Future State Additions

Non-MU Providers Long Term Care

Assisted living

Basic care

Behavioral health

Residential treatment centers

Home health care

Hospice, palliative care

EMS

Pharmacies

DME

Audiology

Podiatry

Prosthetics

Newborn screening

Local public health departments

K-12 Schools

NDHIN Future State Additions Strategic Statewide Applications

Care CoordinationIntegration of Orion platforms: Coordinate and Engage - social services referrals -risk scores - gaps in care - clinical & claims data

Analytics, Population Health

Statewide Credentialing

Advance Directives, POLST/MOLST Registry

Care Coordination Partners

Future State: Data Integration and Care Coordination

Clinical Care - Behavioral Health - Social Services

KeyProvidersPayersHuman ServicesCommunity Services

Behavioral Health

VA

Child care assistance

Job programs

Pharmacies

New Born Screening

NDHIN- Tools

Patient-centeredcare

Shared care plans

Collaborative worklists

Referral management

Risk calculators

Patient engagement

Medication management

Assessments

Hospitals Clinics

Long Term Care

Local Public Health

K-12 school nurses

ND DevelopmentalDisabilities

Home Health

ND University System

IHS

Medicaid

ACOs

NDPERS/ state employees health plan

Commercial

SNAP

Foster care

TANF

Autism services

Special-needsadoption

LIHEAP

Transportation

Housing Assistance

Department of Corrections

ND Veteran’s Home

Medicare

Self-insured Employers

VA

DODSSA

Chiropractors

Optometrists Hospice

EMS

Labs

University Health

DMS

Audiology

Podiatry

Prosthetics

NDHIN Operations

Interfaces: Initial and on-going maintenance

Application solution

deployment

Usage privacy audits

Security/policies/

consent

Provider/payer/

patient relations

On-boarding, participation agreements

Future Value of HIE/DIRECT Infrastructure

Connections you don’t have to make-nor do you need to maintain

Expanded data access

Economies of scale

Statewide applications difficult on your own

Future State Value

Statewide connectivity to and integration of clinical data from ALL providers

Statewide comprehensive analytics, population health, precision medicine

Statewide care coordination: patient centric, shared care plan, serving the entire care team

Statewide credentialing

$55.8m IT Investment

Funding Contingencies

State, Providers, and Payors Commitment

HITAC Approval

CMS Advance Planning Document Approval

North Dakota Governor and Legislature Funding Approval

NDHIN Staff