A Parents Journey to a creating a Higher Quality, Safer, More Efficient Health Care system through H

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A Parents Journey to a creating a Higher
Quality, Safer, More Efficient Health Care
system through HIT
Presented by Amy Zimmerman, MPH Director, RI HIE
Rhode Island Department of Health
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A Parents view of KIDSNET

• Decided it was time
• Gestation felt long had some indigestion and
  sleepness nights during that time
• During infancy it kept me up at night, especially
  when it was burping
• There was sibling rivalry, Josh and Shayna
  sometimes competed with it for my time and
  attention
• It would get sick and have to go the the HLN
  doctor
• It did not always listen it was stubborn at
  times

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A Parents view of KIDSNET

• Over the years I have
• gotten grey worrying about it
• laughed and cried with it
• Asked myself at times, did I do the right thing?
• Seen it grow, develop many friendships become
  popular it is having a hard time deciding who
  to hang out with
• Adolesence resulted in lots of transitions

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A Parents view of KIDSNET

• As it enters into Adulthood
• It has become independent, but still seeks some
  guidance form me
• Has has new responsibilities
• Wants to provide community service
• Choices to make about its future what to do with
  its life, what direction to go in given the
  changing world, trends, the economy?

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Our Destination A health care system that

• Focuses on health promotion and prevention in
  addition to care delivery
• Is driven by patient needs in addition providers
  needs
• Provides Anytime, Anywhere access to ones health
  information (Not reliant on paper or patients
  memories or ability to transport)
• Allows for easy access to best practices/care
  standards to support decision making
• Is affordable and accessible to all

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Current Navigation Status
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Future Navigation Status
Patients
Laboratories
Specialty Providers
Primary Care Specialists
Hospitals
Patient information
Health Plans
Pharmacies
Radiology Centers
Department of Health
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In Three Parts

• Health care data becomes electronic at the source
  (EHR adoption)
• Build the connectivity between all the individual
  sources (HIE)
• Provide Patient Access to the HIE
• All while assuring proper oversight and community
  governance

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Working through a Public Private Partnership
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Private Side Rhode Island Quality Institute and
Its Critical Partners

• Serve as the convener, facilitator collaborator,
  and identifier of projects, and as appropriate
  the manager of projects to
• Build statewide HIE and interoperability and
  ensure adoption of EHR as foundation for improved
  quality care
• Provide the governance for the HIE and
  coordination for HIT efforts

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Public Side Governors Health Care Agenda

• From The Directors Group on Health
• The Wellness Initiative
• Anywhere, Anytime Health Information
• Balanced Health care Delivery System
• Affordable Small Business Insurance
• Smart Public Sector Purchasing

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Anywhere Anytime Health Care

• HIT Issues Team Agenda
• Utilize the public private partnership developed
  by RIQI to lead and manage a statewide health
  exchange
• Increase provider adoption of E-prescribing and
  laboratory data exchange as a first step
• Reduce administrative costs by increasing
  electronic information transfer
• Ensure electronic health data is used
  appropriately and kept both private and secure

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Anywhere Anytime Health Care

• HIT Issues Team Agenda cont.
• Contribute State Agencies Health information to
  the statewide health exchange system
• Pursue federal funds to support the
  implementation of a statewide health information
  exchange
• Performance measures E-prescribing and KIDSNET

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Anywhere Anytime Health Care

• Proposed Public Funding
• Certificate of Participation (COP) for 9
  different Capitol IT improvements
• Improvements in health, education, govt
  operations, public safety economic development
• Total 65 million over 5 years
• 20 million for HIE and patient access

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Core Functions of RIsHIE Project

• Create database which unique identifies patients
  across health care settings and indicates where
  patient has information stored
• Allow data from various sources to be viewed in
  an integrated and uniform manner
• Allow data from various sources to be integrated
  into EHRs, allow EHR data to be shared
• Allow consumer control over who can access their
  data  
• Provide decision support (i..e. immunization
  algorithm)
• Create the ability to utilize the data for
  public health purposes evaluation,
  surveillance, research,etc

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Health Information Exchange Activities to Date
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Established A Governance Structure
Rhode Island Quality Institute Board of Directors
Consumer Advisory Committee
HIT Committee of Chairs
Statewide RI HIE Project (AHRQ)
Incentives and Sustainability
Admin. Data Sharing
EHR of Rhode Island
Care Model and Cultural Change
Electronic Prescribing
Clinical IT Leadership
Policy and Legal
Consumer Engagement
Technical Solutions
Provider Engagement
Data Sharing Partners
Evaluation
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Key Issues/Lessons Learned Governance

• Define role community partners/ leverage strength
• Start with Governance focused (HIE) and then
  expand as needed (RIHO)
• Balance of committee structure (enough not too
  much)
• Align work of multiple inter-related Committees
  and workgroups

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Data Prioritization Plan

• Two-Track Data Prioritization Plan The RI/AHRQ
  Health IT Project will evaluate and implement a
  top clinical priority data set (which includes
  laboratory information) and pursue feasibility of
  the administrative track with Rhode Island
  Quality Institute Board-level action.
• Clinical Track (in priority order)
• Lab Information
• Medication Information
• Reports (discharge, procedure, operative)
• Phone numbers/contact info.
• Administrative Track Insurance Eligibility and
  Coverage Information

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Key Issues/Lessons Learned Data Sharing

• Value Critical to ask those who will use the
  system whats of value
• Be prepared for the unexpected use the
  governance system to address issues that are may
  seem out of scope

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Developing Technical Approach

• Convened Technical Solution Workgroup
• Assessed initial data sharing partners
  capabilities
• Developed draft lab data standard implementation
  guide
• Developed Technical Strawman Concept for RFP
• MPI links decentralized repositories of
  centralized clinical data categories (Lab,
  Medications, Reports, child health , etc.)
• Defined core minimum data set for matching
  patient records
• Developed and Release technical RFP
• Evaluating 13 responses

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Key Issues/Lessons Learned Technical Aspects
and Procurement

• Build HIE that is locally accepted and in line
  nationally
• Build HIE that meet needs of initial data sharing
  partners but anticipates needs of all other data
  sharing partners in state
• Developing new ways of doing business if working
  in partnership (i.e. build to transition to
  community, state procurement, community review
  process )
• Assure sustainability with plan that could
  include a model which places most of costs in
  the middle
• Need simultaneously build capacity (, time,
  staff) at project and RIHO level

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Other Activities

• Legal and Policy Group
• Provider Engagement/Professional Advisory Panel
  (PAP)
• Consumer/Advisory Committee
• Sustainability

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Key Issues/Lessons Learned Data Sharing

• Assure sustainability with plan that could
  include a model which places most of costs in
  the middle
• Need simultaneously build capacity (, time,
  staff) at project and RIHO level
• Structure the Legal and Policy discussions- stay
  focused
• Consumer Advisory Approach- individual consumers
  vs. advocacy organizations

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Preparing HEALTHs Data For HIE

• Develop community consensus on which data
  standards to use for lab and immunizations (RWJ
  Informationlinks)
• Currently working with two dominate EHR vendors
  to develop bidirectional data transfer and
  connectivity between KIDSNET and EHRs
• Possibly use KIDSNET to test out direct patient
  access

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Reality of this Journey
Long and whindy Road
Watch for Potholes
Make a few wrong turns
Watch for consumer input
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Contact Information

• Amy Zimmerman, MPH
• Director, RI HIE
• Rhode Island Department of Health
• 401-222-5942
• amyz_at_doh.state.ri.us