_experience the commitment TM

John W. Loonsk, MD FACMI

Chief Medical Officer

TAG HealthOpportunities in HITECH and Next Steps for the National HIT Infrastructure

Opportunities in Health Information Technology

Payment

/ Claims

Health

Insurance

Reform

Electronic

Health

Records

Clinical Care

/ Public Health

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Network Effects and IT Adoption

Email

PC Cards

HTTP://

• Critical mass of participation

• Common platform

• Secondary, sometimes

unintended, value

Changing the Health Value Equation

4

Mature Data and IT Environments Can Support Value

5

Need:

• Stable and coherent policies for data access and management

• Business alignment

• Shared standards/ transaction specifications for transacting and storing

• Data and services architecture

• Value in data exchange

Environment Attributes:

• Sustainable infrastructure

• Software and services market

• Well defined software environment

• Multiple products working together

• Many participants – valuein others

Information Sharing in Health – Market Driven Chaos

Type Attributes

Community Hospitals

Academic medical centers

Affiliated physicians

Independent physician practices

Integrated Delivery Systems

Payers

Preferred Provider Organizations

Health plans that provide care Best alignment?

Labs, pharmacies and other ancillary health

organizations

Public health and government (state, local and federal) Differences between states

New permutations

EMR companies EMR “Hub”, organizational, community

Personal Health Records Personally controlled and views on EMRs, claims

Health Information Organizations / Exchanges Opt-in and opt-out, federated and centralized and hybrid

Some Desirable Health Data and IT Environments

1. Inside of hospitals

2. Around regional health transactions

3. Population health data stores

4. Around a “managed”, longitudinal patient record

• Community record, medical home, PHR

5. The collective - network of networks

• RHIOS / HIEs, IDNs, government, ancillary networks, etc.

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Architecting Data and Technical Solutions in a Market Driven Health System

• Increase value of participation

• Payment reform

• Pay for some services• Clinical information management

• Summary record

• Reconciled medication list

• Health information exchange

• Infrastructure• Directories, Identity proofing, etc.

• Public health

• Incent data exchange

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HITECH

• Federal• EMR adoption through Medicare

• Meaningful use, standards, certification

• Nationwide Health Information Network

• National Institute for Standards and Technology

• State-level• EMR adoption through Medicaid

• Health Information Exchange

• Regional• Extension centers

• Beacon communities

• Workforce development

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Health Insurance Reform

• Quality reporting

• Enrolment standards• From HIT standards and policy committees

• Care coordination• Demonstration projects

• Data Collection in Federal Programs• Race, ethnicity, sex, primary language, etc

• Administrative simplification• Determination of individual’s eligibility and financial responsibility

• Community-Based Collaborative Care Network Program• “Comprehensive coordinated and integrated health care services”

grants to support low-income populations

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Its not about the technology?

• Computerize what is• Example: Implement EMR

• Technology building blocks• Example: Network look-up and routing

• Example: Implementation guides for

network transactions

• Example: Rigorous test harnesses and

one to many testing

• Electronic process outcomes• Example: Computerized Patient Order Entry

• Example: Maintain active problem list

• IT Enabled health outcomes• Patient and population

• Example: Improve quality of care

• Example: Reduce costs

• Example: Prevent spread of disease

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It’s Also About the Data...

The data are central to technology considerations, outcomes and value, but many issues:

• Business value of not sharing data

• Confidentially concerns for inappropriate data access

• Challenge of having well recorded data

• Challenges of transacting data between systems

• Ambiguities and complexities of selective data access

• Confusing “ownership” and “stewardship”

• Concerns about commercialization of data

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Architecting Data and Technical Solutionsin a Market Driven Health System

• Standards and interoperability

• Harmonize down• Complex information space

• Many standards and SDOs

• Specify up• Specified transactions

• Detailed implementation guidance

• Test harnesses

• Many to many testing

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Harm

oniz

eE

ngin

ee

r

Some Further Needs - Interoperability and Standards

• HITECH Helps• Advances for structured recording of data inside

organizations

• Still optionality

• Need for engineered transactional specifications• Incentives for use

• Strategic, but detailed and rigorous

• HIPAA provides for claims

• Nationwide Health Information Network specifications

• Required transaction testing

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Some Further Needs - Interoperability and Standards

• Process for parallel work in ancillary areas• Public Health, behavioral health, long term care etc.

• Include shared services

• Operate on date environment for external customer

• Standard versions and “legislative lock”

• One to many testing

• Testing infrastructure• Test Harnesses

• Data sets

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Tools for Trusted Mobilization of Data

• Legislation• HIPAA, HITEC, state

• Certification of software• Standards and capabilities

• Accreditation of organizations?• Assurance of on site policies and procedures

• DURSA• A common operating agreement

• Governance• Both dynamic and legislated roles

• Consumer preferences

Some Further Needs - Policy Environment

HITECH helps• Raises HIPAA floor

• State HIPAA variability documented

Enable secure, “network sharing” of health data• Past point to point data use agreements

• Governance

Clarify data stewardship / management roles• Managed longitudinal record

• Population health data reporting

Further ensure exchange of data• Incentives and penalties to providers for EMR use – not

always in their control

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Into the States

• Medicaid HIT plans

• HIE• Intra and inter – state

• State responsibility / no authority

• NHIN - organizational vs. direct

• Public health• Outbreak / case management

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