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Regional Health Information Organizations (RHIOs)

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Title: Regional Health Information Organizations (RHIOs)


1
  • Regional Health Information Organizations (RHIOs)
  • The Primary Vehicle for Achieving the National
    Health Information Network (NHIN)
  • Presented by Holt Anderson
  • Executive Director, NCHICA

2
Presentation Outline
  • The National Framework
  • The Request for Information (RFI)
  • Speculative Definitions
  • Emerging Models for RHIOs
  • NCHICA as one possible RHIO model
  • Examples of Collaborative Activities and
    Challenges Incurred
  • Q A

3
(No Transcript)
4
Obstacles to a Universal EHR
  • the multitude of industry standards that have yet
    to be harmonized,
  • a lack of clear and unambiguous policies about
    data control,
  • differing security policies among organizations
    and states,
  • the risk that EHR products won't work as
    promised and
  • the lack of a business model that creates
    incentives for physician investment and adoption.

David Brailer, ONCHIT, AMIA Conference, April 2005
5
Framework for Strategic Action
  • Inform clinical practice with use of EHRs
  • Interconnect clinicians
  • Personalize care with consumer-based health
    records and better information for consumers
  • Improve public health through advanced
    biosurveillance methods and streamlined
    collection of data for quality measurement and
    research

6
Request for Information
  • US Dept. of Health Human Services
  • Office of the National Coordinator for Health
    Information Technology

Issued November 15, 2004 Responses by January
18, 2005
7
Framework for Strategic Action
  • Inform clinical practice with use of EHRs
  • Interconnect clinicians
  • Personalize care with consumer-based health
    records and better information for consumers
  • Improve public health through advanced
    biosurveillance methods and streamlined
    collection of data for quality measurement and
    research

8
The RFI
  • Addresses goal of interconnecting clinicians by
    seeking public comment and input regarding how
    widespread interoperability of health information
    technologies and health information exchange can
    be achieved.

9
Why Interoperability
  • Interoperability is necessary
  • for compiling the complete experience of a
    patients care
  • for maintaining a patient's personal health
    records, and
  • for ensuring that complete health information is
    accessible to clinicians as the patient moves
    through various healthcare settings.

10
Why Interoperability (cont.)
  • Interoperability is needed for clinicians to make
    fact-based decisions so medical errors and
    redundant tests can be reduced.
  • Interoperability is also critical to
    cost-effective and timely data collection for
    biosurveillance, quality measurement and clinical
    research.

11
NCHICA RFI Response Participants
  • Duke Univ Hlth System
  • Initiate Systems
  • Internet2
  • Keane
  • LabCorp
  • MRNC
  • NC DHHS
  • NCHIMA
  • Physicians EHR
  • Robeson Co Med Soc
  • RTI International
  • Siemens
  • Smart Assoc
  • Telumenous
  • UNC SPH
  • Western NC RHIO

12
Disclaimer
  • The NHIN and RHIOs are a new but important
    concepts
  • Definitions are not firm at this time
  • Public input is being sought by the Office of the
    National Coordinator for Health Information
    Technology (ONCHIT)

13
NHIN
  • National Health Information Network (NHIN)
  • A supportive, nation-wide, interoperable system
    with the capacity to exchange conveniently and
    securely healthcare information culminating in
    the improvement of consumer health and the
    reduction in healthcare costs.

14
RHIO
  • Regional Healthcare Information Organizations
    (RHIO)
  • A collaborative, consumer-centric organization
    focused on facilitating the coordination of
    existing and proposed e-health initiatives within
    a region, state, or other designated local area.

15
Types of RHIOs
  • Federations
  • Includes large, self-sufficient enterprises
  • Agreement to network, share, allow access to
    information they maintain on peer to peer basis
  • May develop system of indexing and/or locating
    data (e.g., state or region-wide MPI)

16
Types of RHIOs (cont.)
  • Co-ops
  • Includes mostly smaller enterprises
  • Agreement to pool resources and create a
    combined, common data repository
  • May share technology and administrative overhead

17
Types of RHIOs (cont.)
  • Hybrids
  • Includes combinations of Federations and Co-ops
  • Agreement to network, share, allow access to
    information they maintain on peer to peer basis
  • Allows aggregation across large areas (statewide
    or regional

18
RHIO Structure
  • 501(c)(3) Nonprofit
  • Eligible for Federal and State Grants
  • Contributions may be tax deductible as charitable
  • Issues
  • Limit of 20 on income from unrelated business
    activities (i.e. not charitable and educational)
  • May need to subcontract or otherwise handoff
    operational aspects of activities

19
Key Allies for a RHIO Include
  • Covered Entities (Providers, Health Plans,
    Clearinghouses)
  • Medical Society
  • Hospital Association
  • Nurses Association
  • Health Information Management Assn.
  • Medical Group Managers Association
  • Healthcare Financial Management Association
  • Association of Local Health Directors
  • Association of Pharmacists
  • Long-term Care Association
  • Association of Health Plans
  • QIOs
  • Vendors
  • Etc., Etc.

20
RHIO Management
VIDEO CLIP
21
  • NCHICA as One Possible RHIO Model

22
NCHICA Background
  • Established in 1994 by Executive Order of
    Governor
  • 501(c)(3) nonprofit - research education
  • 250 members including
  • Providers
  • Health Plans
  • Clearinghouses
  • State Federal Government Agencies
  • Professional Associations and Societies
  • Research Organizations
  • Vendors and Consultants
  • Mission Improve healthcare in NC by
    accelerating the adoption of information
    technology

23
Terms of Membership
  • A fundamental purpose of NCHICA is to
  • facilitate the development of a statewide
    healthcare information network incorporating
  • open architecture
  • interoperable systems, and
  • reconfigured information systems.

24
Terms of Membership (cont.)
  • Applicant agrees to support the following
    principles
  • to foster interoperability and open-systems
    architecture
  • to work in good faith to integrate existing
    healthcare information systems
  • to provide expert personnel to support the
    activities of NCHICA in the spirit of
    collaboration
  • to support policies adopted by NCHICA to protect
    intellectual property
  • to encourage a competitive environment for the
    development of the information,
    telecommunications, and telemedicine industries
    in North Carolina consistent with NCHICA's
    purposes.

25
Successes and Challenges Raised in NCHICA Projects
26
Characteristics of Projects
  • All have evolved from earlier efforts
  • All are statewide efforts
  • All involve public and private sector
  • All build toward a North Carolina Local Health
    Information Infrastructure and are positioned to
    connect into national PHIN and NHIN efforts
  • Expectation is for continued evolution and
    refinement

27
Statewide Master Person Index
  • 1994 Goal
  • Develop Voluntary Patient Information Locator
    (VPIL) so that records could be accessed for care
  • Business / Policy
  • Shared customer lists
  • Legal
  • Privacy Liability
  • No State or Federal Laws covering electronic
    health info
  • Consumer
  • Privacy
  • Technical
  • Availability of standardized MPIs from all
    providers and sectors
  • Synchronizing databases
  • Standards for data

28
Statewide Master Person Index
  • Lessons Learned
  • Technology is the easy part
  • Business and Policy Considerations are much
    harder and Show Stoppers
  • Develop clinical leadership for project with
    technologists in support role

29
HIPAA Efforts
  • 1995-1999 Privacy Confidentiality Focus Group
  • Model Privacy Legislation
  • 1998-2003 HIPAA Implementation Planning Task
    Force
  • 1998-Present
  • Privacy Work Group
  • Security Work Group
  • Transactions, Code Sets and Identifiers Work
    Group
  • Privacy Security Officials Work Group
  • Deliverables Compliance tools, model documents,
    education and training programs
  • and, method of building community consensus

30
Statewide Immunization Registry
  • 1998 Goal
  • Combined registry of public and private
    childrens immunization records from multiple
    sources available via secure Internet
  • Business / Policy
  • Internet access to public health database
  • Legal
  • Privacy and Security
  • Non-stigmatizing data
  • Consumer
  • Well understood need
  • Technical
  • Data quality and matching entries from different
    sources
  • Move from mainframe to server with SSL Web
    technology and authentication

31
Statewide Immunization Registry
32
Statewide Immunization Registry Status
  • Combined Database
  • Public Health
  • BCBSNC
  • Kaiser Permanente (historical)
  • 2M Children
  • 20M doses
  • 425 sites 2250 authenticated users
  • 90 Local Public Health Departments
  • 335 Private Providers, Schools, State of TN

33
New Statewide Immunization Registry
34
Statewide Immunization Registry
  • Lessons Learned
  • Choose project with clear benefits
  • Find clinical champions
  • Enlist CEO-level champions
  • Share the load
  • Celebrate success
  • PKI is not like falling off a log
  • Proof is in the utility of the project and user
    demand for sustaining it past pilot stage

35
Statewide Emergency Dept. Database
  • 1999 Goal
  • Standardize and electronically collect clinical
    data from emergency departments for
  • Best Practice Development Community Assessments
  • Public Health Surveillance (2001)
  • Business / Policy
  • Participation Agreement covering access and use
    of data
  • Legal
  • Privacy and Security
  • No state mandate for collection of certain data
    elements with identifiers (Limited Data Set and
    Data Use Agreement)
  • Consumer
  • Collected and transmitted to aggregation point as
    deidentified data
  • Technical
  • Standards for data elements (CDCs DEEDS
    Standard)
  • Mapping of systems so extracts could be
    transformed into DEEDS
  • No standards for coding of Chief Complaint and
    First Report of Injury

36
Status as of 1-31-2005
Statewide Emergency Dept. Database
  • Data from 24 hospitals
  • 4000 visit records per day on average
  • Total Number of Visits 1.6M
  • Total Number of Patients 875K
  • Total Number of Final Diagnosis Codes 4.2M
  • Total Number of Cause of Injury Codes 478K
  • NCHA now involved to accelerate collection from
    all 124 hospitals with EDs across NC

37
Statewide Emergency Dept. Database
  • Lessons Learned
  • Provide neutral table for collaboration
  • Make it easy for IT Departments to provide data
  • Keep it simple and cheap
  • Expect new opportunities for data use
  • Professional associations are better at policy
    issues than technology implementation
  • While HIPAA is permissive, providing information
    voluntarily (e.g. without safe harbor) makes
    legal counsel very uncomfortable

38
NC Public Health Initiatives
  • NC-PHIN
  • North Carolina Public Health Information Network
  • NC-HAN
  • North Carolina Health Alert Network

39
Vision Framework for the Future
NC-PHIN
  • Automated electronic reporting of data
  • Secure Internet pipeline for reporting
    information
  • Consistent user interfaces
  • Common data definitions
  • Reusable software components
  • Shared analysis and dissemination methods, e.g.,
    outbreak detection algorithms
  • Secure, HIPAA-compliant data warehouse
  • Established set of technical standards acceptable
    and adopted by preparedness partners

40
NC-PHIN Components
  • Health Alert Network NC-HAN
  • Epi-X (secure interactive communications with CDC
    and other states)
  • Enhanced Public Health Surveillance
  • Electronic Disease Reporting
  • Hospital Data (ICD-9, UB92 Admin. Data)
  • Syndromic Surveillance
  • Hospital Clinical Data
  • Poison Control Center
  • PreMIS
  • Aberrancy Detection
  • Medical Examiner Data
  • Program Area Modules
  • TB
  • Hepatitis
  • Meningitis
  • HIV/STD
  • Vaccine Preventable Diseases
  • Immunization Registry
  • Multi-Hazard Threat Database
  • GIS
  • Electronic Laboratory Results (LRN)
  • Vital Records Automation

41
Public Health Initiatives
  • Lessons Learned
  • HAN starts us on the path to connectivity
  • Connectivity drives additional opportunities
  • Use immunization registries to drive
    public-private connections
  • EHRs have potential of improving surveillance
    capabilities and improving population and public
    health

42
North Carolina Healthcare Quality Initiative
Improving Healthcare in North Carolina by
Accelerating the Adoption of Information
Technology
43
NC Healthcare Quality Initiative
  • Goal
  • Phase I - Provide list of medications at point of
    encounter to save time, improve accuracy of
    treatment and avoid medication errors
  • Include ability to automate refills, e-Rx, and
    access to formularies
  • Phase II Electronic handling of Lab and
    Radiology data
  • Business / Policy
  • Access to data from health plans, PBMs,
    pharmacies and other providers
  • Cost of operation Sustainability
  • Legal
  • Privacy and Security (limit use to Treatment)
  • Rights to data Liability
  • Consumer
  • Who has been looking for and at my information?
  • Drugs for behavioral health, communicable
    diseases, etc.
  • Technical
  • Accessing records from multiple sources and
    linking same patient data

44
Medications Management
  • Key attributes
  • Saves clinicians time (10-40 of encounter)
  • Improves patient safety
  • Leads to automating medication refills
  • Leads to e-Prescribing
  • Example Medicare Population
  • 20 have 5 or more chronic conditions
  • Those 20 see on average 13.5 different
    physicians per year
  • Potential for prescribing errors, duplication of
    orders, tests, etc.
  • Chronic Care accounts for 70-80 of expenditures

45
Medications Management Initiative
  • Important data in emergent cases
  • Frequently not available
  • Identifies current medical conditions
  • Avoids inappropriate drug-drug interactions
  • Currently kept by different repositories
  • Pharmacy claims
  • Health Plans
  • Patients
  • Requires policy and technology solutions
  • Privacy and Security considerations
  • Business and collaboration considerations
  • Technology issues
  • Data Quality
  • Networked databases
  • Data repository vs. Portal technology

46
Medications Management Initiative
Community Medication History Portal
Electronic Prescriptions Refills
Presentation
Web portal
eRx
EHR
EAI
Data Integration
INQUIRY HISTORY DATABASE
IDENTITY HUB
Transaction Services
RxHUB
SureScripts
Direct
47
NC HC Quality Initiative - Project Management
48
Proposal Development Teams
  • Technology
  • Technical approach, diagrams
  • Clinical Integration
  • Clinician role and adoption and consumers role,
    adoption, satisfaction
  • Business / Finance
  • Business Model, budgets and justification
  • Policy
  • Role of patients, agreements
  • Metrics
  • Assess value of project
  • Coordination
  • Executive Summary, letters of commitment, etc.

49
Values for the Transition
  • Keep the health and safety of the individual as
    the core objective.
  • Use RHIOs as an opportunity and vehicle to
    transform healthcare into a more effective and
    efficient system.
  • Promote clinical and business benefits of
    information technology and secure communications .

50
Generating RHIO Proposals for Funding
  • Lessons Learned
  • Understand the requirements from the funder e.g.
  • Contract or Grant
  • WMOB Subcontracting
  • Principal Investigator
  • Cognizant Auditing Agency
  • Time commitment of team to develop proposal
  • Limited capabilities of volunteers with primary
    responsibilities elsewhere
  • Technical Clinical Expertise
  • Policy and Business Requirements
  • Privacy Security
  • Shared information among competitors
  • Commitments from top executives (private and
    government)
  • Educate and Obtain Commitment

51
The Race Goes to the Swift
VIDEO CLIP
52
Thank You
  • Holt Anderson, Executive Director
  • Holt_at_nchica.org (919) 558-9258 ext. 27
  • North Carolina Healthcare Information and
    Communications Alliance, Inc. www.nchica.org

53
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