The Value of Interoperable Health Information Technology · NHIN compliance Central Florida RHIO....

The Value of Interoperable Health Information TechnologyThe Value of Interoperable Health Information TechnologyMarch 23, 2006March 23, 2006Washington, DCWashington, DC

Florida Health Care CoalitionFlorida Health Care Coalition Central Florida RHIOCentral Florida RHIO

Florida Health Care CoalitionFlorida Health Care Coalition

Service AreaService Area•• OrangeOrange•• SeminoleSeminole•• OsceolaOsceola•• PolkPolk•• BrevardBrevard•• LakeLake•• VolusiaVolusia

Central Florida RHIOCentral Florida RHIO

Key principlesKey principles•• It’s about improving patient careIt’s about improving patient care•• Emphasize the valueEmphasize the value•• One calculated step… then the nextOne calculated step… then the next•• Infrastructure Infrastructure -- not Reformnot Reform•• Collaboration Collaboration -- not Competitionnot Competition•• Open, nonOpen, non--proprietary technology & data proprietary technology & data

exchange standardsexchange standards•• Scaleable & replicableScaleable & replicable


Key principles (cont.)Key principles (cont.)•• Highly secure, InternetHighly secure, Internet--basedbased•• “Federated, Peer“Federated, Peer--toto--Peer” approach (e.g. MAPeer” approach (e.g. MA--

SHARE)SHARE)•• Start with “fetch and view”Start with “fetch and view”•• MultiMulti--phase, planned delivery and growthphase, planned delivery and growth•• Project II Project II –– Extend as FHCC convener in South Extend as FHCC convener in South

FloridaFlorida


The CostThe Cost

Clinical ProcedureLandmark

TrialCurrent Rate of Use

Flu Vaccination 1986 (7) 55% (8)Thrombolytic Therapy 1971 (9) 20% (10)Pneumococcal Vaccination 1977 (11) 35.6% (8)Diabetic eye exam 1981 (4) 38.4% (6)Beta blockers after MI 1982 (12) 61.9% (6)Mammography 1982 (13) 70.4% (6)Cholesterol screening 1984 (14) 65% (15)Fecal occult blood test 1986 (16) 17% (17)Diabetic foot care 1993 (18) 20% (19)Source: Yearbook of Medical Informatics 2000, Diabetic Retinopathy Research Gp., Altman & Goodman

Landmark Clinical Trials and Current Rate of Use for Selected PrLandmark Clinical Trials and Current Rate of Use for Selected Proceduresocedures

GovernanceGovernance•• 501(c)(3) 501(c)(3) –– most likelymost likely•• Studies recommend neutral third party convener Studies recommend neutral third party convener

(FHCC)(FHCC)•• Chair: Becky Cherney, Florida Health Care Chair: Becky Cherney, Florida Health Care

CoalitionCoalition•• CoCo--Chair: Rick Schooler, Orlando Regional Chair: Rick Schooler, Orlando Regional

HealthcareHealthcare



Governance (cont.) Governance (cont.) RHIO CommitteesRHIO Committees•• ClinicalClinical•• TechnologyTechnology•• LegalLegal•• Financial & GovernanceFinancial & Governance•• Education & CommunicationEducation & Communication

CommitteesCommitteesClinicalClinicalChair: Phil Chen, MD, PhD (Cognoscenti Health Institute)Chair: Phil Chen, MD, PhD (Cognoscenti Health Institute)Vice Chair: Robert Vice Chair: Robert WesterganWestergan, MD, (Jewett , MD, (Jewett OrthopaedicOrthopaedic

Clinic)Clinic)

Core data setCore data setClinical protocolsClinical protocolsClinical process improvementClinical process improvement


CommitteesCommitteesTechnologyTechnologyChair: Rick Schooler, FACHE, MBA (Orlando Regional Chair: Rick Schooler, FACHE, MBA (Orlando Regional

Healthcare)Healthcare)Vice Chair: Eddie Vice Chair: Eddie SolerSoler (Florida Hospital)(Florida Hospital)

Operating standardsOperating standardsPrivacy and SecurityPrivacy and SecurityTrainingTrainingNHIN complianceNHIN compliance


CommitteesCommitteesLegalLegalChair: Greg Chair: Greg ChairesChaires, Esq. (Webster, , Esq. (Webster, ChairesChaires & Partners)& Partners)Vice Chair: Michael Lowe, Esq. (Michael Lowe, PA)Vice Chair: Michael Lowe, Esq. (Michael Lowe, PA)

Legal structure Legal structure –– 501(c)3501(c)3Articles of Incorporation & ByArticles of Incorporation & By--lawslawsTerms and conditions of participant agreementsTerms and conditions of participant agreementsConsent formsConsent forms


CommitteesCommitteesFinance & GovernanceFinance & GovernanceChair: Becky Cherney (FHCC)Chair: Becky Cherney (FHCC)Vice Chair: Andrew Crooks (CIGNA HealthCare)Vice Chair: Andrew Crooks (CIGNA HealthCare)

PlanningPlanningDevelopmentDevelopmentOperationalOperationalBoard of 5 Chairs for 2006Board of 5 Chairs for 2006Add 2 to 4 members 2007Add 2 to 4 members 2007


CommitteesCommitteesCommunication & EducationCommunication & EducationChair: Karen Van Caulil, PhD (District VII Health Chair: Karen Van Caulil, PhD (District VII Health

Planning Council)Planning Council)Vice Chair: George Ellis, MD (PCAN & OCMS)Vice Chair: George Ellis, MD (PCAN & OCMS)

Marketing strategyMarketing strategyCommunication planCommunication planWebsite managementWebsite managementMedia managementMedia managementPatient involvement strategiesPatient involvement strategies


CommunicationsCommunications•• Engage consumers and industry stakeholdersEngage consumers and industry stakeholders•• Focus groups, surveys, public announcementsFocus groups, surveys, public announcements•• Education, education, education!Education, education, education!•• Sell the value… why do we need this?Sell the value… why do we need this?•• High school seniors and olderHigh school seniors and older•• Use industryUse industry--recognized subject matter expertsrecognized subject matter experts•• Distribute brochures (e.g. Distribute brochures (e.g. CareScienceCareScience use of physician use of physician

offices to obtain patient consent to share information)offices to obtain patient consent to share information)


Local SupportLocal Support•• Orlando SentinelOrlando Sentinel

Editorial urged support for sharingEditorial urged support for sharingclinical informationclinical information

•• myregion.orgmyregion.orgAn organization of citizens andAn organization of citizens andleaders from public, private andleaders from public, private andinstitutional sectorsinstitutional sectors““RHIOsRHIOs are a key health initiative”are a key health initiative”


Phase IPhase I•• 2 Health Systems (14 Hospitals)2 Health Systems (14 Hospitals)•• 22--3 Community Medical Groups3 Community Medical Groups•• Reference LabReference Lab•• Health Care Center for the HomelessHealth Care Center for the Homeless•• Primary Care Access Network (Orange County)Primary Care Access Network (Orange County)

Future PhasesFuture Phases•• Extend to South FloridaExtend to South Florida•• Seek “links” with other Seek “links” with other RHIOsRHIOs


Central Florida RHIO FundingCentral Florida RHIO Funding•• InitialInitial•• Employers and FoundationsEmployers and Foundations $1,500,000$1,500,000•• Grants (government) Grants (government) $500,000$500,000•• Health PlansHealth Plans $1,500,000$1,500,000•• Pharmaceuticals and othersPharmaceuticals and others $500,000$500,000

$4,000,000$4,000,000


Health PlansHealth Plans•• ParticipationParticipation•• FundingFunding•• DataData


eValue8eValue8•• Disease managementDisease management•• IT adoptionIT adoption•• Administrative efficiencyAdministrative efficiency


5.4 M years5.4 M years 5050

Community HealthCommunity HealthThe Shape Of Things To ComeThe Shape Of Things To Come

The Economist The Economist December 13, 2003December 13, 2003


Incremental GrowthIncremental Growth

“Don’t try to pop all the corn in the field.”“Don’t try to pop all the corn in the field.”Jerry RankinJerry RankinCareScienceCareScience, Inc., Inc.


TechnologyTechnology•• The RHIO network will be highly secure, InternetThe RHIO network will be highly secure, Internet--

basedbased•• RHIO participants retain ownership of their data, RHIO participants retain ownership of their data,

but share it given an authorized requestbut share it given an authorized request•• This approach is known as “Federated, PeerThis approach is known as “Federated, Peer--toto--

Peer”Peer”•• Features “Fetch and View” capabilitiesFeatures “Fetch and View” capabilities•• MultiMulti--phase, planned delivery and growth starting phase, planned delivery and growth starting

with seven pilot provider organizationswith seven pilot provider organizations


Central Florida RHIO

PhysicianAssociatesOf Florida

FloridaHospital

OrlandoRegional

Healthcare

CognoscentiHealth

Institute

RHIORegistry

All network participants forwardpatient identification and encounterinformation to the RHIO index

ResearchDatabases(deidentified data)

HealthcareCenter for the

Homeless

Link to otherRHIOs

May be withinor external toRHIO

JewettOrthopaedic

Clinic

OrangeCountyPCAN

Central Florida RHIO Architecture – Phase I “Fetch & View”



FloridaHospital

OrlandoRegional

Healthcare

CognoscentiHealth

Institute

RHIORegistry




Homeless

Link to otherRHIOs


JewettOrthopaedic

Clinic

OrangeCountyPCAN

ED PatientInformationRequest




FloridaHospital

OrlandoRegional

Healthcare

CognoscentiHealth

Institute

RHIORegistry




Homeless

Link to otherRHIOs


JewettOrthopaedic

Clinic

OrangeCountyPCAN

ED PatientInformationRequestAvailable

PatientInformation




FloridaHospital

OrlandoRegional

Healthcare

CognoscentiHealth

Institute

RHIORegistry




Homeless

Link to otherRHIOs


JewettOrthopaedic

Clinic

OrangeCountyPCAN

AvailablePatientInformation


RequestPatientInformation




FloridaHospital

OrlandoRegional

Healthcare

CognoscentiHealth

Institute

RHIORegistry




Homeless

Link to otherRHIOs


JewettOrthopaedic

Clinic

OrangeCountyPCAN

AvailablePatientInformation


RequestPatientInformation

ReturnedPatientInformation


ProviderProvider--Lab HIEILab HIEI

Benefits Benefits •• Improve clinician access to longitudinal test resultsImprove clinician access to longitudinal test results•• Eliminate errors from reporting results verballyEliminate errors from reporting results verbally•• Make cost information available, optimize orderingMake cost information available, optimize ordering•• Improve convenience for patientsImprove convenience for patients•• Reduce redundant testsReduce redundant tests•• Save time ordering tests, sending and receiving resultsSave time ordering tests, sending and receiving results

Evidence re current rate of redundancy, time Evidence re current rate of redundancy, time costcost•• Experts estimated HIEI impactExperts estimated HIEI impact

ProviderProvider--Lab Annual BenefitLab Annual Benefit13.6% from 13.6% from

avoided testsavoided tests

86.4% from time 86.4% from time savingssavings

$31.8B national $31.8B national benefit at benefit at Level 4Level 4

$118,000 per MD $118,000 per MD in freein free--standing office standing office at Level 4at Level 4

$0

$5

$10

$15

$20

$25

$30

$35

Level 2 Level 3 Level 4

PayersLabsProviders

in b

illio

ns

Eric Pan, MD, MSc, CITL, 2005

ProviderProvider--Radiology HIEIRadiology HIEI

Benefits Benefits •• Improve patient safety and optimize ordering by giving Improve patient safety and optimize ordering by giving

radiologist access to relevant clinical informationradiologist access to relevant clinical information•• Reduce errors of omission with automated reminders for Reduce errors of omission with automated reminders for

followfollow--up studiesup studies•• Reduce environmental impactReduce environmental impact•• Reduce redundant testsReduce redundant tests•• Save time ordering tests, sending and receiving results/imagesSave time ordering tests, sending and receiving results/images

Evidence re current rate of redundancy, time Evidence re current rate of redundancy, time costcost•• Experts estimated HIEI impact Experts estimated HIEI impact

ProviderProvider--Radiology Annual BenefitRadiology Annual Benefit35% from avoided 35% from avoided

teststests

65% from saved 65% from saved timetime

$26B national $26B national benefit at benefit at Level 4Level 4

$60,000 per MD in $60,000 per MD in freefree--standing standing office at Level office at Level 44

$0

$5

$10

$15

$20

$25

$30


PayersLabsProviders

in b

illio

ns


ProviderProvider--Pharmacy HIEIPharmacy HIEI

Benefits Benefits •• Improve patient safety: access to complete medication lists Improve patient safety: access to complete medication lists

will reduce drug interactions and adverse drug eventswill reduce drug interactions and adverse drug events•• More convenient for clinicians: automatic refill alerts, accessMore convenient for clinicians: automatic refill alerts, access•• to adherence information, automated insurance forms, identify to adherence information, automated insurance forms, identify

patients for drug recallspatients for drug recalls•• Efficient formulary management between pharmacies and Efficient formulary management between pharmacies and

payers payers –– probably biggest financial impactprobably biggest financial impact•• Save time ordering, dispensing prescriptionsSave time ordering, dispensing prescriptions

Evidence re time and phone calls:Evidence re time and phone calls:•• 55% of prescriptions involve a phone call55% of prescriptions involve a phone call•• Each call + 2 provider minutes + 3 pharmacist minutesEach call + 2 provider minutes + 3 pharmacist minutes

Experts estimated HIEI impact on % callsExperts estimated HIEI impact on % calls

ProviderProvider--Pharmacy Annual BenefitPharmacy Annual Benefit$2.7B national $2.7B national

benefit at benefit at Level 4Level 4

$4,700 per MD in $4,700 per MD in freefree--standing standing office at Level office at Level 44

Probably most Probably most benefit from benefit from pharmacypharmacy--payer HIEIpayer HIEI

$0.0

$0.5

$1.0

$1.5

$2.0

$2.5

$3.0


PharmaciesProviders

in b

illio

ns


ProviderProvider--Provider HIEIProvider HIEI

Benefits Benefits •• Reduce fragmentationReduce fragmentation•• Reduce educated guesses in clinical careReduce educated guesses in clinical care•• Improve referral quality by making relevant information Improve referral quality by making relevant information

available to the consultantavailable to the consultant•• Save time responding to referralsSave time responding to referrals•• Save time responding to chart requestsSave time responding to chart requests

Evidence re referral rates, % visits missing Evidence re referral rates, % visits missing information, administrative costs of referrals and information, administrative costs of referrals and chart requestschart requests•• Experts estimated HIEI impact on administrative costsExperts estimated HIEI impact on administrative costs

ProviderProvider--Provider Annual BenefitProvider Annual Benefit$43,000 per office $43,000 per office

MD National MD National Benefit:Benefit:

Level 2:Level 2: $2.8$2.8billionbillion

Level 3:Level 3: $8.1$8.1billionbillion

Level 4: $13.2Level 4: $13.2billionbillion

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

SmallGroup

MediumGroup

LargeGroup

SmallHospital

MediumHospital

LargeHospital

JumboHospital

Level 2Level 3Level 4


ProviderProvider--Public Health HIEIPublic Health HIEI

BenefitsBenefits•• Earlier recognition of disease outbreaksEarlier recognition of disease outbreaks•• BiosurveillanceBiosurveillance: identify warning signs by aggregating data : identify warning signs by aggregating data

from many sourcesfrom many sources•• Increase % of disease reportedIncrease % of disease reported•• Save time reporting vital statistics and diseaseSave time reporting vital statistics and disease

Evidence re number of vital statistics and Evidence re number of vital statistics and disease reports, and time requireddisease reports, and time required•• Experts estimated HIEI impactExperts estimated HIEI impact

ProviderProvider--Public Health Annual BenefitPublic Health Annual Benefit$195 million national $195 million national

benefitbenefit

$0

$50

$100

$150

$200

$250


Public HealthProviders

in m

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ProviderProvider--Payer HIEIPayer HIEI

BenefitsBenefits•• Save timeSave time•• Reduce rejected claimsReduce rejected claims

Evidence re % of transactions already Evidence re % of transactions already automated due to HIPAAautomated due to HIPAA

Calculated impact of full automation at Level 4Calculated impact of full automation at Level 4•• Levels 2Levels 2--3 not allowed by HIPAA3 not allowed by HIPAA

ProviderProvider--Payer Annual BenefitPayer Annual Benefit$20.1B national net $20.1B national net

benefitbenefit

$10.3B to providers$10.3B to providers

$9.8B to payers$9.8B to payers

$0

$5

$10

$15

$20

$25

Level 4

MedicaidMedicareCommercialProviders

in b

illio

ns


Questions?Questions?

Becky J. CherneyBecky J. CherneyPresident/CEOPresident/CEOFlorida Health Care CoalitionFlorida Health Care Coalition4401 Vineland Road, Suite A104401 Vineland Road, Suite A10Orlando, FL 32811Orlando, FL [email protected]@flhcc.com

The Value of Interoperable Health Information Technology · NHIN compliance Central Florida RHIO....

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