Southwestern VaMedical Technology SummitOct. 2, 2009
Presentation Overview
Background • Coordination of Care for Individuals• Regional Public Health Status Improvement
Current Status • Regional Participation and Capabilities• State-level initiatives• National
Future Plans • Support participants to achieve “Meaningful Use”• Expansion of cooperative efforts• Tracking and reporting of outcomes
Background: Regional Health Improvement
750,000 citizens
(2/3 in Tennessee, 1/3 in Virginia)
Disproportionately High Rates for
•Premature mortality
•Chronic Diseases
•Prescription Drug Overdose Uneven Access to Services
•18 hospitals•1400 physicians•18% uninsured
CareSpark’s Mission: to Improve the Health of People
in northeast Tennessee and southwest Virginia
through the Collaborative Use of Health Information
CareSpark’s Core Strategies
Provide patient information and decision supportat the point-of-
care
Provide patient information and decision supportat the point-of-
care
Align financial incentives for
patients, providers, purchasers
Align financial incentives for
patients, providers, purchasers
Empower patientsto make informed
decisions and healthy choices
Empower patientsto make informed
decisions and healthy choices
Compile and analyze aggregate data for population health improvement
Compile and analyze aggregate data for population health improvement
1.1. 2.2.
3.3. 4.4.
Community-Wide Collaboration
• Employers: Eastman Chemical Company, CGI, BAE Systems, City of Kingsport,
Food City, ntara, the Creative Trust, Steadman Corporate Design,
• Payors: Blue Cross Blue Shield of Tennessee, John Deere Health / United Healthcare, Cariten
PHP, Highlands Wellmont Health Network, CIGNA
• Hospitals: Mountain States Health Alliance, Wellmont Health System, Johnston Memorial
Hospital, Quillen V.A. Medical Center, Laughlin Memorial
• Physician Practices: Holston Medical Group, Highlands Physicians, Health Alliance PHO,
Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Frontier Health, Southwest Virginia Community Health System, Mountain Region Family Medicine, Medical Care PLLC
• Health Education: East TN State University School of Medicine / College of Nursing/ College
of Public and Allied Health, University of Appalachia College of Pharmacy, University of Virginia
• Public Health: Sullivan and Northeast Regional Health Departments in TN, Cumberland
Plateau and Lenowisco Health Districts in VA, Tennessee Department of Health, Virginia Department of Health and Human Resources
• Community Non-Profits: Kingsport Tomorrow, United Way of
Kingsport, Rotary Club of Kingsport, Kingsport Chamber of Commerce, Bristol Chamber of Commerce, NETWORKS Sullivan County Partnership
• Patient Advocacy Groups: American Cancer Society,
Minority Health Coalition, Mountain Empire Older Citizens, Savvy Patient
•Technology Companies: ActiveHealth, AllScripts, Anakam, BCTI, Cisco,
CGI, Deliberare, Healthvision, Holston Technology, Initiate Systems, Intellithought, Intel, LucentGlow, OnePartner, Oracle, Wellogic
Key Strategic Decisions
1. Enable voluntary participation by all patients and providers in region
2. Enroll patients through default Passive Enrollment (“opt-out”) with option for Active Enrollment (“opt-in”)
3. Hybrid Model, combining Federated Repositories and Centralized
Repository for limited clinical data- Enabling coordination of care decision support, monitoring and aggregate data analysis
4. Data Access and UsesPatient: view content of records, view access logProvider: payment, treatment, operations Public health: required reporting and authorized queriesPayers: de-identified aggregate dataResearch: IRB-approved studies
5. Fee-Based Revenue Model- Contracts with public agencies, insurers and employers- Transaction fees for data providers (labs, hospitals, large practices)- Contributions (cash and inkind)
6. Commitment to standards (ISO, IHE / HITSP / NHIN, other)
CareSpark Data-Sharing Options
Data Sharing Option Intended Data Use Data Sharing Result
Identified Data Patient Care and Treatment
All data sent to CareSpark will be identified data in order to match patient records from multiple providers. Identified data will be available to authorized providers for access of additional healthcare information about the patient.
De-Identified Data Anonomized – patient data can never be re-identified
Approved Population Health Improvement activities
Identified data available to CareSpark will be de-identified according to the approved requirements and stored separately.Pseudo-Anonomized –
Patient data can be re-identified, if necessary, but only by the party who provided the pseudo-anonoymized data
Limited Public Health Identified data available to CareSpark will be de-identified with the specified additional fields required for a limited dataset according to the approved requirements and stored separately.
CareSpark’s infrastructure
• We’ve Built a standards-compliant Clinical Document Exchange Network• Exchanges clinical documents between providers• Accepts patient demographic information from
Providers• Controls clinical data in accordance with patient
consent preferences• Supports direct integration and
access through provider EMRs (standard and non-standard)
• Allows access for providers without EMR
• High levels of security
Technical Architecture
Internet
Provider 1
Active Health
Data BaseServer
ApplicationServer
`
MPI ClientFilters and Encryptions
Application Server
Data BaseServer
CareSpark Secure & Redundant
Network A
CareSpark Secure & Redundant
Network B
Note 1: Patient access will be via the internet thorough Https Protocol (SSL)
LoadBalancer
AppFirewall
Note 2: Although not pictured, the Internet connectivity, the Application Firewall and the Load Balancer will all be redundant, to avoid a single point of failure.
See Note 2.
See Note 3
NHIN
Patient`
See Note 1.
Note 3: All non-patient connections to the Internet are secured connections, via SSL.
EMPIFilters and Encriptions
EMPIFilters and Encriptions
Data BaseServer
Data BaseServer
Router
Provider 2`
MPI ClientFilters and Encryptions
` Small Doctors Office
`Provider using
ASP
Application Server
Provider
MPI ClientFilters and Encryption
CareSparkCareSpark
OracleOracle
Health Information Exchange Infrastructure
XDS PatientIdentitySource(MPI)
XDS PatientIdentitySource(MPI)
CloverleafCloverleaf
CT TimeClient
CT TimeClient
ATNA AuditRepositoryATNA AuditRepository
XDSDocumentRepository
XDSDocumentRepository
XDSKey Store
XDSKey Store
InitiateEMPI
InitiateEMPI
PostGreSqlPostGreSql
ATNAWinSysLog
ATNAWinSysLog
Service Providers
DB Server
ConsentRepositoryConsent
RepositoryMPOP
ConsentMPOP
ConsentPatient Identity Feed
Patient Queries
Send Clinical Documents
Query For Clinical Documents
Retrieve Clinical Documents
Subscriber Identity Feed
Clinical Documents
CareSpark ProvidersCareSpark Providers
EMREMR
Patient Managemen
t System
Patient Managemen
t System
ActiveHealthActiveHealth
Subscriber Managemen
t System
Subscriber Managemen
t System
CareEngineCareEngine
XDS PIXServiceXDS PIXService
XDS PDQService
XDS PDQService
XDS RegService
XDS RegService
XDS RepService
XDS RepService
Two-Factor
Authentication
Two-Factor
Authentication
Clinician
Portal
Clinician
Portal
XDSDocumentRegistry
XDSDocumentRegistry
XDSRegistry
NIST
XDSRegistry
NIST
ADTService
ADTService
WellogicWellogic
HealthvisionHealthvision
CGICGI
OnePartner/BCTI
OnePartner/BCTI
AnakamAnakam
Car
eSp
ark
XD
S D
ata
Sto
re
-
F
or P
atie
nt C
are
Jan 06
CareSpark RHIO Timeline
Jun 08 Jan 10Jan 07 Jan 11Jan 09Jan 05
Tn non-profit org chartered
document registry andrepository
Build clinical data repository
Physician Portal,
authentication
Decision Support
delivered electronically
Data-sharing
agreements Claims-based
decision support
Clinical documentExchange
MPI build
begins
Strategic Planning
Revenue-generating
services (med hx, results delivery)
Immunizationregistry
Funding Sources – Planning Phase
BlueCross BlueShield of Tennessee $162,125Foundation for eHealth Initiatives $100,000
(Office for Advancement of Telehealth, HRSA, DHHS)AllScripts HealthCare Solutions $ 25,000John Deere Health $ 41,500Eastman Chemical Company $ 50,000Mountain States Health Alliance $ 50,000Wellmont Health System $ 50,000Novartis Pharmaceuticals Corporation $ 15,000Frontier Health $ 10,000Health Alliance PHO $ 10,000Highlands Physicians Inc. $ 10,000Holston Medical Group $ 10,000United Way of Greater Kingsport $ 10,000Rotary Club of Kingsport $ 10,000East TN State University / Medical Education Assistance Corp. $ 5,000Laughlin Memorial Hospital $ 2,500Johnston Memorial Hospital $ 2,500Kingsport Tomorrow $ 1,500Cardiovascular Associates $ 250
Total funds contributed: $562,875
Revenue Sources July 2005 – July 2009
Local Support $4,185,120 Employer contributions: $ 678,000State grants / contracts $1,600,000Technology Partners $2,250,000CareEngine enrollment fees $1,257,120
State contracts $1,669,600Tennessee $1,369,600Virginia $ 250,000
Federal contracts $4,917,098NHIN Prototype $ 308,000NHIN Trial Implementation $3,609,125
NHIN Option year 1 $ 999,973
Total Funding: $10,771, 818
Participation and Capabilities
July 2009 July 2010 July 2011
Patients 175,000 2,500,000 5,000,000
Data Sources
5 25 100
Clinician users
75 500 3000
Record types
LabsMedsAllergiesRadiology reportsDiagnosisImmunizations
ClaimsDischarge summariesAuthorizationse-PrescriptionsSecure messagingReal-time decision support
Patient accessBiosurveillance
CareSpark’s Strategic Objectives
Population Health ClinicalPremature Mortality Adult Diabetics, Rx filled, vision / foot, HBA1C<7
New Diabetes CasesLipid Panel LDL < 100Flu Vaccines for 65+ Pneumo Vax for ages 65+, <2ER Visits for Health Attack Stroke TherapyPost- MI followup Cancer Screenings (PAP, Mammogram, colorectal)Deaths from Rx Overdose Pain Medication
Financial Savings -- ROI• Patient• Clinician• Facilities• Purchaser (health plan, employer, taxpayer, individual)
Convergence of Interests
Administrative
Billing & Claims
Clinical
Consumer / Personal
Health Record
Research
Best Practices
Patient-Centered
Care
Technical InfrastructureFinancial Incentives
Privacy & Confidentiality
Governance and Policy
Patient-Centered
Care
Nationwide Health Information Network: “network of networks”
NHIN Prototype Demonstration 2006-07
design for exchange between
CareSpark, West Virginia, Kentucky providers
NHIN Trial Implementation 2008
* Core Services:
Consumer permissions
Security exchange
Standardized interfaces
Summary medical record
* Medication Management
eRx, med history, decision
support
* Consumer Empowerment
personal health record, registration
and medication history
Health Information Exchange in Tennessee
Tennessee Roadmap for Health IT
Tennessee eHealth Council: seed funds for RHIO’s, grants for eRx, broadband
Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework• Standards• Interoperability• Transparency• Value• Quality/Cost
Framework for trust and collaboration
Broadband % of Access, Stakeholders, Automation
EMR / EHR/PHR implementation
Structured notes & paper records
Administrative transactions (claims…)
E-prescribing roll out
Secure clinical messaging (labs, imaging, email….)
H.I.E.
Co
mm
on
Po
rtal
Virginia RHIO initiatives
Virginia Health IT Council
Health Information Exchange
Stages of Evolution
Pre-operational
1: Recognize need
2. Organizing and planning
3. Securing resources
4. Developing and implementing
Operational
5. Transmitting data
6. Sustainable business model
7. Expanding participation
In August 2008, 57 report being operational, 88 pre-operational
HIT-Enabled Health ReformAchieving Meaningful Use
2009 2011 2013 2015
HIT-Enabled Health Reform
HITECH PoliciesProtect
privacy and security,
2011 Meaningful Use Criteria
(Capture/share data
electronically) 2013 Meaningful Use Criteria
(Advanced care processes with
decision support, patient access)
2015 Meaningful Use Criteria (Improved Outcomes)
23
24
Overview of Federal HIT Programs
States
Providers
Fed
eral
Gov
ernm
ent C
oord
inat
ion
State Grants - ONC
MU Incentive Payments - CMS
Health Center/Health Center Controlled Networks Funds - HRSA
Medicaid HIE Administrative Funding - CMS
Extension Centers - ONC
State & Regional Demonstrations -AHRQ P
rom
otin
g H
IEP
rom
otin
g M
U o
f E
HR
Tec
hnol
ogy
NHIN - ONC
Standards/Certification - ONC
Medicaid Technical Assistance -AHRQ
Federal Stimulus Funds
HITECH legislation in February 2009• Increased privacy and security requirements• Funding for health information exchange (State
HIE Cooperatives)• Funding for National Research Center
(“comparative effectiveness”) and Regional Health IT Extension Centers
• Funding for Healthcare Workforce Development• Incentives for adoption and “meaningful
use” of health information technology
+ + +EMR eRx
HIE Quality Reporting
Patient Access =
$$$$$$$$
2011-2015
State HIE Cooperatives
Health Improvement Partnership of Tennessee (HIP-TN) not-for-profit entity formed to facilitate and oversee application and distribution of ARRA funds
workgroups: Technical, Privacy & Security, Clinical,Governance / Policy, Financial Sustainability
Board members from this region: Doug Varney, David Sensibaugh
Virginia Health IT Interoperability Commission established under Virginia Department of Health by executive order
priorities to be addressed: childhood immunizations, infant mortality
Local appointee: Liesa Jenkins
Regional Health IT Extension Centers
Virginia: statewide collaboration with regional variation, led by
Va Health Quality Center
Tennessee: statewide proposal submitted by QSource, contracting with
regional partners for delivery of services
Letters of intent submitted Sept. 8Full proposals due Oct. 16, if requested
Future Plans for CareSpark
Local
Increased participation: Enhanced capabilities Sustainability
Providers Secure messaging for users Fees for services
Patients Clinical data repository Regional Extension Centers
Knoxville / Danville Population Health Improvement
Virginia
Public health Other
Immunization telemedicine
Rx Monitoring HIT Commission
VHEN
Tennessee
Public health Other
Immunization HIP-TN
Rx Monitoring
National
NHIN Gateway Other
Federal agencies (VA, SSA) Benchmarking
Other HIE’s (NC, KY, WV) Sharing best practices
Next Steps for YOU
1. Begin planning for EMR Assess your organization’s business requirements, including functionality, cost,
privacy and security protection Evaluate, select certified, standards-based solution, contract, train users and
implement (assistance from Regional Health IT Extension Center or other) Consider modularity for future needs: eRx, decision support, analytics and reporting,
patient access
2. Participate in Health Information Exchange Enter into Data-sharing agreements Access broadband services and network(s) Train users Inform patients Shared costs for infrastructure and services
3. Monitor your results Measure your own results (efficiency, cost, patient outcomes) Report outcomes to access incentives payments Benchmark with peers, share best practices Participate in research to improve effectiveness
4. Take pride in your success!
Better Health for Central Appalachia
www.carespark.com
Liesa Jenkins, Executive Director423-963-4970
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