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Health Information Exchange Meaningful Use and Beyond

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Health Information Exchange Meaningful Use and Beyond Bob Hoyt MD Haas Center University of West Florida HealthBridge Connectivity to 26 different ambulatory EHR ... – PowerPoint PPT presentation

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Title: Health Information Exchange Meaningful Use and Beyond


1
Health Information ExchangeMeaningful Use and
Beyond
  • Bob Hoyt MD
  • Haas Center
  • University of West Florida

2
Learning Objectives
  • After completion of the presentation,
    participants should be able to
  • Explain how health information exchange is part
    of the national HIT strategy
  • Describe how HIE is part of meaningful use
  • Enumerate the newest HIE features
  • List the significant challenges facing HIE today

3
Disclaimer
  • I have no conflicts of interest to report
  • I am working with Dr. Rick Harper of the Haas
    Center for Business Research and Economic
    Development, under an ONC grant to study health
    information exchange in Pensacola, Florida

4
Definitions
  • HIE electronic movement of health related
    information among organizations according to
    nationally recognized standards
  • HIO overseas and governs the exchange of health
    related information among organizations according
    to nationally recognized standards
  • RHIO brings together healthcare stakeholders
    within a defined geographic area and governs HIE
    among them for the purpose of improving
    healthcare in that community

5
Why is HIE an important topic?
  • Part of Meaningful Use and the 29 billion EHR
    reimbursement program
  • 548 million from ARRA spent to support the State
    HIE Cooperative Agreement Program
  • Promoting HIE is one of the goals of the 60
    Regional HIT Extension Centers
  • Health information exchange is integral to the
    Nationwide Health Information Network (NHIN)

6
Multiple Sources Uses of Data
7
The HIT Trifecta
8
(No Transcript)
9
State HIE Cooperative Agreement Program
  • ARRA program to support statewide and interstate
    HIE
  • In 2010 548 million funded 56 state designated
    entities (SDEs)
  • Four year grants with requirement for states to
    match a portion of grant awards by the second
    year. By Oct 1 2012 states must match 1 for 3

10
FHIE
  • Florida received 20.7 million in 2010
  • Federated model with shared record locator
    service (RLS)
  • Vendor to be selected by Nov 1 2010
  • Early limited go-live date March 2010
  • Eventually will establish subscription model for
    all participants

11
FHIE
  • Services (matches meaningful use)
  • Eligibility and claims
  • E-prescribing and refill requests
  • Lab ordering and results delivery
  • Public health reporting
  • Quality reporting
  • Prescription fill status reports
  • Clinical summary exchange
  • Disaster preparedness

12
Florida HIOs
  • 20 HIOs exist in Florida but none are at an
    advanced level (stage 6 or 7)

13
What is the status of HIOs in 2010?
14
2010 HIE eHealth Initiative Survey
  • An annual self-reported survey
  • According to the report approximately 250 HIOs
    exist in US
  • 73 are said to be operational (exchanging
    something)
  • 18 are sustainable (operational, no federal
    support in last year and at least broke even)

15
Stages of Development
Operational
16
Stages 5-7 (operational)
17
Operational Status
18
Stakeholders
19
Revenue Sources
20
Revenue Sources
21
Federal Funding
22
Helping to meet Meaningful Use
23
Operational Initiatives
24
Other Functionalities
25
Other Functionalities
26
Opt-in/Opt-out Policies
  • 61 HIOs have global level policies
  • 36 HIOs have organizational level policies
  • 34 HIOs have provider level policies
  • 14 HIOs have emergency level policies
  • 13 HIOs have individual data element level
    policies

27
HIE Basic (gt50) Features
  • Clinical messaging (electronic test results
    delivery)
  • Lab and radiology results
  • Medication data
  • Outpatient visits
  • ER visits
  • EHR connectivity
  • Clinical documentation
  • Alerts to Physicians

28
HIE Advanced (lt50) features
  • E-prescribing
  • Electronic health record-HIE combo
  • Public health reporting
  • Telemedicine teleradiology and telehomecare
  • Medication reconciliation
  • ER utilization data
  • Transcription
  • Voice recognition
  • Business analytics/intelligence
  • Value-based reimbursement (P4P)
  • Credentialing
  • Research
  • Clinical decision support
  • Consumer portal
  • Claims clearing house
  • Care coordination

29
Perceived Benefits
30
Case StudyHealthBridge
31
HealthBridge www.healthbridge.org
  • Not-for-profit HIO that began in 1997
  • Located in Cincinnati, Ohio and now covers four
    states
  • They partner with three other HIOs HealthLINC,
    Collaborating Communities Health Information
    Exchange and Northeast Kentucky Regional Health
    Information Organization

32
HealthBridge www.healthbridge.org
  • Also a Regional HIT extension center and a Beacon
    Community
  • Did not require initial federal funding
  • Does not charge physicians to use the exchange or
    EMR Lite
  • Nationwide Health Information Network (NHIN)
    participant

33
HealthBridge
  • HealthBridge provides connectivity for more than
    28 hospitals, 5500 physician users, 17 local
    health departments,  700 physician offices and
    clinics, as well as nursing homes, independent
    labs, radiology centers
  • They deliver approximately 3 million clinical
    messages (laboratory, radiology, transcription
    and ADT) to more than 5500 physicians EACH MONTH.
  • HealthBridge represents nearly 95 of
    the hospital sector activity in the Cincinnati
    region.

34
HealthBridge
  • Connectivity to 26 different ambulatory EHR
    systems
  • Access to 60 hospital based images, fetal heart
    monitoring data and inpatient EHRs
  • Since 2000 has used push technology
  • Uses Mirth Mux to connect to the NHIN

35
Health Bridge
36
(No Transcript)
37
Community Standard Lab Result
38
HealthBridge Clinical Inbox
Results sorted by abnormal lab values
39
Final View- To Access All Electronic Results for
a Practice
40
EMR Lite
  • HealthBridge offers a very low cost web-based EMR
    that is part of the HIO which means data can be
    pushed or pulled
  • They also interface with multiple other EHRs
  • If a physician doesnt have an EHR, they can
    dynamically create a virtual health record (VHR)
    which means data is pulled from all sources to
    create a summary (lt 2 seconds)

41
(No Transcript)
42
Mirth MUx
  • Open Source integration engine, CDR, MPI and
    CONNECT software to connect to the NHIN
  • Much faster and cheaper alternative

43
HIO Challenges
44
Future HIE/HIO Trends
  • Look for more partners to share the load such as
    chronic care facilities, home health, hospice,
    etc.
  • Combine clinical data with administrative and
    financial data Utah Health Information Network,
    New England Health Exchange Network and NaviNet

45
NaviNet SaaS Model
46
Future HIE/HIO Trends
  • Look for more consumer oriented functionality
  • 44 HIOs allow patients to view data
  • 31 HIOs allow patients to contribute data

47
What might a future HIO look like?
Complete System Fully Integrated in the Cloud
NHIN
HIO
Patient Portal
Business Analytics
Claims Financial
Research
Public Health
Payers
EHRs
Practice Management System
48
Conclusions
  • The US has invested heavily in HIT primarily to
    support EHRs and HIE
  • Based on prior experiences we will see many
    successes and failures
  • Under the right circumstances (e.g. HealthBridge)
    HIE becomes the glue that ties together disparate
    HIT into a cohesive system
  • Too soon to say HIE will improve patient outcomes
  • Less expensive/complex alternatives are probably
    necessary (e.g. Mirth MUx)
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