METROPOLITAN CHICAGO

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METROPOLITAN CHICAGO HEALTHCARE COUNCIL
Medical Trading Area Health Information
Exchange Kick-off Meeting
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MCHC

• Mission
• The Metropolitan Chicago Healthcare Council
  (MCHC) is a membership and service organization
  dedicated to helping members care for their
  communities through access to health care and
  improved delivery of services.
• Vision
• High quality, accessible healthcare for all
  communities.

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Goals for Today

• Provide Background and HIE Briefing
• Discuss the Work Ahead
• Help Define Your Involvement

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Agenda

• Welcome and Introductions
• Overview of Health Information Exchange
• Vision to Reality
• Stakeholder Engagement

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To Begin

• Please Introduce Yourself / Organization
• What brought you here?
• What is the number 1 question on your mind?

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• Overview of Illinois Health Information Exchange

IL Dept of Healthcare Family Services
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A Critical Time for Health Information Exchange
(HIE)

• In Illinois On February 4, 2009, Governor Pat
  Quinn signed Public Act 95-1030 into law,
  appropriating 3 million to the Department of
  Healthcare and Family Services to establish a
  program for health information exchange planning.
• Across the Country The American Reinvestment
  and Recovery Act (ARRA), signed into law on
  February 17th, dedicates more than 20 billion
  nationwide in federal funding to implement
  electronic health records and health data
  exchange by 2014.

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Federal Health IT Timelines

• State Health Information Exchange Cooperative
  Agreement Program, 2010 2014
• State of Illinois submitted an application to the
  Office of the National Coordinator (ONC) on
  October 16, 2009
• Application is currently under review by ONC
  awaiting feedback and further direction
• Illinois awarded 18,837.639.00 for the four year
  planning and implementation period
• Regional Extension Center Program (REC) 70
  awards nationally 3 applications from Illinois
• REC programs begin in early 2010

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Federal Health IT Timelines

• Rate incentives to providers through Medicare and
  Medicaid for Meaningful Use of EHR, beginning in
  2011
• Incentives are gradually reduced with penalties
  beginning in 2015
• Provider incentives range from 40,000 and
  65,000 over a 5 year period
• Hospital incentives are based on a formula that
  includes a 2 million base that takes bed days
  and discharges into account

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Goals of Illinois HIE

• Improve healthcare quality and outcomes
• Reduce medical errors and redundant services
• Improve patient safety
• Enhance coordination of patient care among
  providers
• Engage patients and their families by providing
  meaningful health care information at the point
  of care
• Reduce health disparities increase disease
  surveillance
• Control the cost of health care

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HIE Planning Grants

• With funding from PA 95-1030, HFS awarded 16
  grants across Illinois for HIE planning.
• The goals of HIE Planning Grants are to
• establish the governance structures
• promote provider collaboration
• develop the social capital necessary to sustain
  HIE
• develop a technical and operational framework
• develop a financially sustainable state-level HIE
• promote state-level interoperability

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16 Medical Trading Areas

• f

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MTA Analysis

• Captured the majority (75-85) of medical
  transactions within a geographic region in order
  to define a Medical Trading Area (MTA)
• Medical Transaction is defined as one of the
  following
• Hospital admissions
• Outpatient ER visits
• Physician office visits, consultations, specialty
  care referrals
• Diagnostic services
• OTC pharmacy prescribed by a physician

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MTA Analysis (continued)

• Medical transaction data will be used to identify
  data exchange partners
• Used Medicaid transactions, from State FY 2007,
  covering 2.5M enrollees
• Validated data by using data from State employee
  claims data

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Stakeholder Requirements

• Successful applicants provided a commitment to
  include a majority (gt50) of MTA stakeholders in
  their HIE planning efforts
• Stakeholders are representative of entire
  geography of the MTA including practicing
  physicians, nurse practitioners, hospitals and
  hospital associations, corporate and independent
  laboratories, chain and independent pharmacies,
  health plans and insurers, local health
  departments, consumers and consumer advocacy
  groups, quality improvement organizations,
  behavioral health providers and long term care
  facilities

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Goals of HIE Planning Efforts

• To determine the level of EHR adoption and
  barriers to adoption through a state-wide survey
• To leverage federal incentives for EHR adoption
  and Meaningful Use (MU) as outlined in ARRA and
  the HITECH Act
• Plan for ability to share protected health
  information from disparate information systems
  and service providers within their MTA

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HIE Advisory Committee

• Membership reflects broad-based stakeholder
  involvement
• Governance Work Group formed to develop
  recommendations for structure of public-private
  entity to be established by legislation in early
  2010
• Sustainability Work Group formed to identify
  long-term funding options, including private
  sector and philanthropic contributions
• To increase e-prescribing throughout Illinois
• To connect to a health information exchange

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HIE Advisory Committee

• Privacy and Security Work Group is integrating
  Health Information Security and Privacy
  Collaboration (HISPC) efforts into HIE planning
• Consumer Education Work Group formed to research
  and develop HIE communication messages and
  strategies
• Technical and Business Operations Work Group is
  addressing the functions necessary for a
  successful HIE

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Coordination with Medicaid Program

• Current Medicaid Management Information System
  (MMIS) and Medicaid Medical Data Warehouse will
  provide significant foundation
• Strategic and Operational Plans will be
  consistent with the State Medicaid Health IT Plan
• Utilize Medicaid data to target high volume
  providers eligible for MU incentives

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Collaborative Efforts

• Working closely with the IL Department of Public
  Health and all local public health departments
• Coordinating efforts with the IL Department of
  Commerce and Economic Opportunity on health care
  workforce development strategies
• Coordinating HIE planning efforts with the IL
  Broadband Development Council
• Will work closely with the Regional Extension
  Centers that will be designated to provide
  technical assistance

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Illinois HIE Website

• http//hie.illinois.gov
• All MTA maps, details about counties, hospitals,
  and FQHC contained in each MTA
• Planning Grant resources, toolkits, wiki
• Educational webinars
• Best practices lessons learned from HIE projects
  and initiatives in Illinois and other states

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Questions?
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From Vision to Reality

• AHQR Demonstration Projects
• eHealth Initiative 2009 Study on HIE
• MCHC HIE

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AHRQ Demonstration ProjectsBefore ONC, HITECH,
Meaningful Use, ePrescribing

• Agency for Healthcare Research and Quality Five
  year project to support state-wide data
  sharing/interoperability aimed at improving
  quality, safety, efficiency and effectiveness of
  health care for patients and populations
• In 2004, awarded 5 year contracts to Colorado,
  Indiana, Rhode Island, Tennessee, Utah and later,
  Delaware
• Developed a variety of approaches with different
  technical, business and governance
• Clinical Messaging, Medications, Problem Lists,
  Results, Quality
• Handout for additional details or go to
  www.healthit.ahrq.gov

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AHRQ Demonstration Projects(continued)

• Some Thoughts from Demonstration Sites Leaders
• Level of alliance memo of understanding before
  signed contracts
• Must operate HIE with consensus building
• Drive value reduce cost per transaction
• Money and deadlines are huge incentives to get
  things done
• Exchange is both a verb and a noun

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State of HIE eHealth Initiative 2009 survey

• 193 HIE initiatives are pursuing exchange
  efforts 150 responded to the survey
• Number of initiatives involved in health
  information exchange is growing 67 new
  organizations have arisen since 2008
• All 50 states, Puerto Rico and District of
  Columbia
• Most commonly reported as a Multi-County coverage
  area (47), although there are also HIEs that
  cover an Entire State (39) Multi-State area
  (12) Metropolitan area (7) and National level
  (6)
• Source eHealth Initiatives 2009 Sixth Annual
  HIE survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Staging of Initiatives
Stage Description
Stage 1 Recognition of need for HIE among multiple stakeholders
Stage 2 Getting Organized defining vision, goals and objectives, identifying funding sources, setting up legal and governance structure
Stage 3 Transferring vision, goals and objectives to tactics and business plan defining requirements and secure funding
Stage 4 Implementation well-underway- technical, financial, legal
Stage 5 Fully operational HIE and transmission of data
Stage 6 Fully operational HIE and transmission of data used by stakeholders and have a sustainable business model
Stage 7 Expansion of the organization to encompass a broader coalition of stakeholders than present in the initial operational model
Source eHealth Initiatives 2009 Sixth Annual
HIE survey Migrating toward Meaningful Use The
State of Health Information Exchange
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Status of HIEs

• Where is the US at with regard to HIE Staging?
• 57 operational (Stages 5, 6, 7)
• 79 implementation (Stages 2, 3, 4)
• 9 early planning (Stage 1)
• 5 unknown
• We are Stage 2 Moving to Stage 3 in 2010
• Source
• eHealth Initiatives 2009 Sixth Annual HIE
  survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Key Findings

• The Services most offered are
• Results delivery (e.g. laboratory or diagnostic
  study results) (44 initiatives).
• Connectivity to electronic health records (38).
• Clinical documentation (34).
• Alerts to providers (31).
• Electronic prescribing (26).
• Source
• eHealth Initiatives 2009 Sixth Annual HIE
  survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Key Findings

• More health information initiatives are
  exchanging data, with increases in the type of
  data exchanged nearly across the board.  
• The number of initiatives currently exchanging
  data
• Laboratory data increased to 49 initiatives, up
  from 26 in 2008.
• Medication data (including outpatient
  prescriptions) 48 initiatives are currently
  exchanging.
• Outpatient laboratory increased to 45, up from 25
  in 2008.
• Outpatient episodes increased to 43, up from 23
  in 2008.
• Radiology results increased to 39, up from 23 in
  2008.
• Emergency Department episodes increased to 36, up
  from 27 in 2008.
• rce eHealth Initiatives 2009 Sixth Annual HIE
  survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Key Findings

• Positive Impact on Physicians
• Health information exchange has had a positive
  impact on physician practices allowing them to
  become more efficient without disrupting care.
  Operational initiatives report the following
  impacts
• Improved access to test results and resultant
  efficiencies on practice (28 operational
  initiatives).
• Improved quality of practice life (i.e., less
  hassles looking for information, getting home
  sooner at the end of the day, etc) (24).
• Reduced staff time spent on handling lab and
  radiology results (23).
• Reduced staff time spent on clerical
  administration and filing (22).

Source eHealth Initiatives 2009 Sixth Annual
HIE survey Migrating toward Meaningful Use The
State of Health Information Exchange
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Key Findings

• Positive Physician Impact Quality and Efficiency
  (continued)
• Reduction of duplicate tests (14)
• Improved compliance with chronic care and
  prevention guidelines (12)
• Reduce time spent on handling prescriptions (12)
• Improve care outcomes (11)
• Fewer prescription errors (10)
• Reduced med errors (10).

Source eHealth Initiatives 2009 Sixth Annual
HIE survey Migrating toward Meaningful Use The
State of Health Information Exchange
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Key Findings

• HIEs can help Reduce Costs
• In 2009, operational initiatives most often
  reported ROI from hospitals (21) and physician
  practices (19) could see the greatest return on
  investment (ROI).
• Operational health information exchange
  initiatives are helping cut health care costs in
  a number of areas.
• Primary reported areas of cost-cutting include
• Reduced staff time spent on handling lab and
  radiology results (26 operational initiatives).
• Reduced staff time spent on clerical
  administration and filing (24).
• Decreased dollars spent on redundant tests (17).
• Decreased cost of care for chronic care patients
  (11).
• Reduced medication errors (10).
• Source eHealth Initiatives 2009 Sixth Annual
  HIE survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Key FindingsOther HIE Services

• Implementation Support
• Tech Assistance for Implementation
• Workflow Guidance
• Advice on Purchasing Decision
• Dissemination Best Practices
• Coordinating Financial Incentives
• Supporting Quality Improvement / Performance
  Reporting
• Liaison between Public and Private Health IT
  efforts

• Administrative
• Services that reduce interfaces from EMR vendors
• Distribution services (e.g.,
  Reports to Physicians)
• Data load services
• Hosting Electronic Medical Records (EMRs)
• Charges for Database Access
• Routing Personal Health Records (PHRs)
• Source eHealth Initiatives 2009 Sixth Annual
  HIE survey Migrating toward Meaningful Use The
  State of Health Information Exchange

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Health Information Technology for Economic
and Clinical Health Act of
2009 (HITECH Act)
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• One Consortium
• A Unified Plan
• MTA 7 Southern Suburbs
• MTA 8 Northern Suburbs
• MTA 12 Central Cook
• MTA 13 Northern Cook
• MTA 16 DuPage

Regional and State-wide Collaboration
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DRAFT For Discussion
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Planning Factors

• Vision for the HIE
• Collaboration
• Trust and Commitment
• Stakeholder Benefits
• Privacy/Security issues
• Clinical and Public Health priorities

• HIE Clinical and Financial expectations
• HIE cost and value
• Sustainability
• Technical Infrastructure
• Technological capabilities
• Implementation Plan

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Current HIE Initiatives

• Hosting Webinars to learn from other states (AHA,
  Wisconsin, Indiana)
• Convening stakeholders by provider type (FQHCs,
  PCPs, etc)
• Chicago Community Trust FQHC/CBHO Summit
• Convening MTAs on a local level (beginning the
  week of November 9th)
• Develop populate regional organization
  structure
• Plan for the future HIE Implementation

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HIE Planning Building Blocks
June 30, 2010
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Questions?
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Stakeholder Involvement
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MCHC HIE PLANNING STRUCTURE
MTA Stakeholders will Populate Committees
Committees collaborate on a unified plan across
MTAs
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Committee Selected Planning Considerations
Governance Set goals, objectives and performance measures Oversight and accountability Account for the flexibility needed to align with emerging statewide and nationwide HIE governance Recommend choice of legal entity, governing structure and approach to transparency Recommend design and management of data-sharing agreements Recommend audit trail and monitoring access Determine handling for breach of confidentiality complaints Recommend Personal Health Record capabilities
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Committee Selected Planning Considerations
Stakeholder Collaboration and Engagement Part A Provider and Consumer Education, Engagement, Communication Conduct focus groups and/or surveys Enlist patient/consumer buy-in to the HIE while addressing privacy concerns Recommend mechanisms for handling complaints compliments Develop a multi-facetted communication plan Identify champions EHR HIE Identify triggering events, calls to action, or drivers of progress Keep state legislators and other interested parties apprised of progress Engage clinicians in determining how systems will be used
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Committee Selected Planning Considerations
Stakeholder Collaboration and Engagement Part B Legal/Policy activities Identify federal and state legal and policy requirements Establish a MTA-wide policy framework Implement enforcement mechanisms Minimize obstacles in data sharing agreements, Review relevant laws and regulations affecting HIE in Illinois Determine who needs to have access to what data need to know Determine if changes are needed to Notice of Privacy Practices Review regulations and address policy and procedure needs for sensitive records Legal/Policy Reporting considerations 
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Committee Selected Planning Considerations
Information Exchange and Meaningful Use Identify key classes of information that will improve clinical processes and outcomes Recommend which data gets exchanged first consider which data is of high value and already available in electronic format Consider how the medically-underserved will be addressed Explore clinical data standards common terminology decisions about what data to include in the HIE
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Committee Selected Planning Considerations
Information Exchange and Meaningful Use (continued) Recommend how specific data should be handled, such as Duplicates, overlays, merges, etc. Sensitive data Snapshot view Payer information Advance directives (healthcare proxy, organ donation) Quality indicators and how to measure Review Meaningful Use guidelines and consider how they will factor into decisions about what data to include in the HIE
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Meaningful Use Objectives Requiring Health
Information Exchange HIE-related requirements
rise significantly by 2013
Lab results delivery ePrescribing Claims and
Eligibility checking Quality and immunization
reporting
2011

• Increasing volume
• Lab Provider
• Provider Pharmacy

• Provider to Lab
• Pharmacy to Provider
• Office Hospital
• Office to Office
• Hospital / Office Public Health
  Hospital / Office Reporting Entities
• Office Patient

Registry reporting and reporting to public
health Electronic ordering Health summaries for
continuity of care Public Health Alerts Home
Monitoring Populate PHRs
2013
Routing availability of relatively rich exchange
transactions Anyone to Anyone Patient to
Reporting Entities
Accessible comprehensive data for all available
sources Experience of care reporting Medical
device interoperability
2015
Source C. Delany regarding ONC HIT, Policy
August 14, 2009
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Committee Selected Planning Considerations
Technical Infrastructure and Operations Develop a MTA-wide technical infrastructure. HIE services to be developed Leverage existing MTA-level resources that can advance HIE, such as master patient indexes Develop or facilitate the creation and use of shared directories Determine if specific support functions Help Desk, Implementation Guides, EHR consulting Monitor and plan actual performance of HIE Document how the HIE efforts within the MTA are enabling meaningful use.
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Committee Selected Planning Considerations
Technical Infrastructure and Operations (continued) Recommend the overall technology requirements/data-sharing process Recommend how data match/patient ID can be achieved Determine likelihood of a single vendor or multiple vendors Recommend how system will leverage other health registry efforts Recommend security protocols Make recommendations for interoperability Address scalability increase in network traffic, geographic expansion, sharing with entities outside the HIE Assess what MTA shared services or other statewide technical resources are developed and implemented to address business and technical operations
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Committee Selected Planning Considerations
Sustainability Develop the capability to effectively manage funding necessary to implement the MTA Plan Develop a path to sustainability including a business plan Determine who will benefit from the system and make recommendations for a business model Review initial funding and long-term funding options, including Membership / Subscription Fee Model Transaction Fees to Data Provider or User Information Intermediary Model / Sale of De-identified Data Combination Models Determine how ROI can/should be calculated Explore possible services which could be delivered Finance Reporting considerations
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Committee Selected Planning Considerations
Public Health  Public Health requires surveillance data, registries, vital statistics, quality reporting, plus an interface with laboratory and diagnostic data to insure the collection of population data. Considerations Ensure the coordination, integration, and alignment of efforts with Medicaid and public health programs. Plan for interoperability with public health data systems Ensure that EMR systems adopted and adapted by labs, physicians, medical groups and hospitals, are able to automatically and bi-directionally interact with public health surveillance and reporting systems Ensure that the HIE policies and memoranda of understanding include secure and aggregated data for public health as a priority
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Phasing and Deadlines
DRAFT
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stakeholders

• Clinicians
• Hospitals
• Public Health Departments
• FQHCs
• Behavioral Health
• Long Term Care
• Home Care
• Medical Societies Hospital Associations
• Accreditation
• Laboratories
• Pharmacies
• Health Plans Insurers
• Major Employers
• Local Government
• Patient Groups
• Consumers Consumer Advocacy Groups
• Quality Improvement Organizations

Volunteers Needed!
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HIE Planning Committees
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DRAFT For Discussion
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Next Steps

• Volunteer Profile Completion (today)
• Follow-up with committee kick-off
• Begin convening committees

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Closing Thought

• By focusing on meaningful use we recognize that
  better healthcare does not come solely from the
  adoption of technology itself, but through the
  exchange and use of health information to best
  inform clinical decisions at the point of care
• Dr. David Blumenthal, October, 2009

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Volunteer Profile Sheets

• Please complete today
• Demographic and Contact Information
• Areas of Expertise
• Committee Preferences
• Other Stakeholder GroupsIdeas?

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METROPOLITAN CHICAGO HEALTHCARE COUNCIL
Thank You for Your Participation!

Terri Jacobsen, Director 312-906-6037
tjacobse_at_mchc.com Jose Lopez, Program
Manager 312-906-6022 jlopez_at_mchc.com