The Transformation of the U'S' Healthcare System Leveraging Health Information Technology HIT

1
The Transformation of the U.S. Healthcare
SystemLeveraging Health Information Technology
(HIT)

• Nick BonvinoNational Practice Leader,
  CTGRHIOs/Health Information Exchanges

Steve KotykAccount Executive, QuadraMed
Specializing in Identity Management
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National Agenda

• 2004Pres. Bush created the Office of the
  National Coordinator for HIT (ONCHIT) in HHS
• 2004HHS Sec. Thompson appointed the first ONCHIT
  DirectorDavid Brailer, MD, PhD
• 2004Dr. Brailer published a Framework for HIT
• 2004AHRQ awarded 100 grants and contracts for
  HIT planning, implementation, research,
  standards, and state and regional demonstrations,
  exceeding 29 Million, 139 M over 5 years
• 2004-05HHS (ONC AHRQ)4 major HIT contracts
• 2005Health Information Technology Standards
  Panel (HITSP) was formed by ANSIONC contract to
  ANSI with subcontract to Health Info. and Mgmt.
  Sys. Society (HIMSS)

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National Agenda

• 2005Americas Health Information Community
  chartered to advise HHS Secretary on
  interoperability
• 2005ONC published the public responses to an RFI
  on NHIN requirements
• 2006the 4 NHIN consortia delivered 977 NHIN
  functional requirements (June 2006), under
  contract to ONC
• 2006 (Aug 22)Pres. Bush signed Executive Order
• 2006NCVHS synthesized 11 major NHIN requirements
  out of the 977 (Sep 2006)
• 2006HITSP delivered 3 Interoperability
  Specifications (IS) of standards for the 3 AHIC
  use cases (Sep 2006) AHIC recommended the HHS
  Secy accept them (Oct 2006)

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National Agenda

• 2007Secy Leavitt accepted the ISs and will
  recognize them for federal use in Dec. 2007,
  after testing. Then, per Ex. Order, federal
  agencies must use them. (Jan 23, 2007)
• 2007AHIC proposed 4 more use cases (Jan 23)
• 2007 - ANSI HITSP- Oct target for naming
  standards
• 2007Robert Kolodner, MD, Dir., ONCHIT, announced
  a State Alliance for eHealth (Oct 10, 2006 Jan
  26, 2007)
• 2007---Secy Leavitt promotes 4 cornerstones to
  business
• "We need to reduce costs and medical errors with
  better information technology" "We will
  encourage price transparency."
• Pres. Bush, State of the Union Message. January
  23, 2007

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Basic National HIT Building Blocks

• Health data standards
• Nationwide Network of Networks
• Certification of HIT products
• Privacy

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Public-Private Standards Glossary

• AHICSeptember 13, 2005
• Americas Health Information Community,
• A Federal advisory committee to the HHS Secretary
  on national health information interoperability.
  It provides public input.
• ONC
• Office of the National Coordinator for HIT in
  HHS/OS
• ANSI HITSP
• American National Standards Institute s
• Health Information Technology Standards Panel
• IS
• HITSP Interoperability Specifications
• They name the standards and data elements that
  enable the AHIC use case functions
• Presidents Executive Order (Aug. 22, 2006)
• Directs federal agencies to use health data
  standards recognized by the HHS Secretary

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American Health Information Community Update

• AHIC--An Advisory Committee
• Inform and recommend to the Secretary specific
  actions to achieve a common interoperability
  framework for health information technology
• Serve as a public forum for participation from a
  broad range of stakeholders to provide input on
  achieving interoperability
• 18 members 9 private sector leaders, 9
  government leaders

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AHIC Breakthrough Use Cases-2006

• Consumer Empowerment To create a
  consumer-directed and secure
• Electronic health-care registration information
  and
• Medication history for patients
• For patients to exchange data with their
  caregivers
• Electronic Health Records To enable the
  interoperability between provider EHRs and
  laboratory systems
• with secure access and patient-centric
  interpretations
• Bio-surveillance To enable the electronic
  exchange of standardized and anonymized
  Biosurveillance data among providers and public
  health agencies within 24 hours

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AHIC Use Cases-2007

• Consumer Empowerment
• Extend previous use case
• Add lab results, problem list, allergies,
  encounter and Dx summaries describe in laymans
  terms
• Consumer access to clinical information,
  incorporation of data into PHRs, with portability
  among providers EHR software
• EHR (Care Delivery)
• eRx--Medication management
• Population Health
• Extend Biosurveillance use case
• Quality measure data from EHRs
• Emergency Responder
• Data exchange among emergency responders and
  providers
• Source AHIC-acceptance, Jan 23, 2007

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Details of the 3 New Use Cases

• Medication Management
• Includes medication reconciliation,
  pharmacy/allergy, monitoring of medications,
  ordering, transmission, dispensing,
  administering, patient lookup and matching
• Consumer Access to Clinical Information
• Includes laboratory results, as needed by
  patients, list of conditions and allergies,
  health problems, diagnosis codes, list of
  providers, and portability of PHR data
• Quality
• Includes inpatient quality measures, ambulatory
  measures, clinicians access, public reporting,
  data sharing rights and responsibilities, storage
  and management of data sets, augmenting clinical
  data

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Basic National HIT Building Blocks

• Health data standards
• Nationwide Network(s)
• Certification of HIT products
• Privacy

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NHIN contracts

• Were awarded in 2005 to four consortia led by
• Accenture
• Computer Science Corporation,
• International Business Machines
• Northrop Grumman
• Each specify their architectures for 3 geo. areas
• Delivered 1157?977 NHIN functions to ONC (June
  2006)
• Delivered their potential prototypes (sample
  information architectures) for an NHIN to ONC and
  AHIC and the public in January 2007
• Next phase Connect the prototypes to state and
  regional health information exchange programs in
  an effort to create a secure national network
• Working with States, AHRQ, Markle Foundation

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11 NCVHS High-Level NHIN Requirements (Oct, 2006)

• Certification
• Authentication
• Authorization
• Person Identification
• Location of Health Information
• Transport and Content Standards

• Data Transactions
• Auditing and Logging
• Time-sensitive Data Access
• Communications
• Data Storage

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State Alliance for eHealth

• State Alliance for eHealth formed
• Contract with Nat. Gov. Assn. Was announced by
  Rob Kolodner, MD, Director ONC, on Oct 10, 2006
• State AHICsstate advisory panels
• Co-chaired by Tennessee Gov. Phil Bredesen and
  Vermont Gov. Jim Douglas,
• Will establish state-based forums for discussing
  ways to build interoperability among states to
  improve healthcare
• Will be a vehicle for evaluating and possibly
  resolving issues including
• Privacy -- State law barriers
• State-level HIE governance
• Sustainable financial models

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Basic National HIT Building Blocks

• Health data standards
• Nationwide Network(s)
• Certification of HIT products
• Privacy

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National HIT Building Block

• Compliance Certification
• Certification Commission for Healthcare
  Information Technology (CCHIT) was awarded 7.5 M
  over 3 years by ONCHIT, plus an optional 1.2 M
  extension
• To develop, create prototypes for, and evaluate
  the certification criteria and inspection process
  for electronic health records (EHRs)
• The contract addresses certification of
• Ambulatory EHRs
• Inpatient EHRs, and
• The infrastructure components through which they
  interoperate

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Compliance Certification

• Certification of EHRs is expected to accelerate
  HIT adoption by
• Reducing the risk of EHR investment by providers
• Protecting the privacy of health information
• Ensuring the interoperability of EHRs
• Facilitating the availability of purchaser and
  payer incentives for provider adoption of EHRs

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National HIT Building Block

• Health data standards
• Nationwide Network(s)
• Certification of HIT products
• Privacy

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One of 4 NHII Contracts

• Privacy and Security (AHRQ-ONCHIT)
• Research Triangle Institute for 11.5 M
• National Governors Association, a partner
• To identify privacy and security
• Barriers and restrictions, (State privacy laws
  and practices) and
• Enablers to the development of interoperable
  systems at the state and regional levels.
• Draft reports from 35 states are being summarized
  by RTI

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To Summarize

• Standards are being named for breakthrough use
  cases
• Federal agencies will have to use them
• Certification of HIT products has begun
• Federal contracts will insist on certified HIT
  products
• NHIN architectures are available for use,
  particularly by states
• State privacy laws and practices are being
  illuminated
• A forum exists for interoperability issues for
  State health information exchanges

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Texas - Emerging Health Information Exchanges

• MiRHIO Goliad
• Digital City Corpus Christi
• Healthcare Access San Antonio (HASA)
• ICare Connection Austin
• Critical Connection Austin
• Dallas Fort Worth RHIO
• North Texas Specialty Physicians (Sandlot),
  Tarrant County
• DFW Hospital Council Data Initiative

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MiRHIO Goliad, TX

• Southeast Texas Health System, or STHS, was
  developed in 1994 as a regional response to
  changes in managed care
• STHS Owned by 7 Hospitals
• Victoria
• Lake Jackson
• Bay City
• Port Lavaca
• Edna
• Hallettsville
• Columbus
• www.MiRHIO.org

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MiRHIO Goliad, TX

• Centralized data repository in located in Austin
• Connectivity, hardware, software
• in 7 hospitals in 7 counties
• For up to 200 physicians via web portal
• Issued Smart Cards for 35,000 patients
• Demographics
• Clinically Relevant Information,
• Insurance,
• Past Family Medical History
• Web based patient portal

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Digital City - HIECorpus Christi, TX

• Corpus Christi awarded Most Wired City for the
  last two years
• City initiated HIE to link Emergency Medical
  Services to Hospital ED
• Partnering with Christus Health to design
  deploy throughout Corpus Christi
• Long term goal is to evolve into a full service
  HIE
• Using a pure opt-in model through City ad
  campaign

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Digital CityCorpus Christi, TX

• HIE to enhance the effectiveness of the Emergency
  Medical Services
• EMS Wireless patient data collection with
  data/video connectivity to Hospital ER
• Centered on the Personal Health Record
• Demographic
• Allergies
• Medications
• Chronic Diseases
• DNR Authorization
• Manages own Care Team for authorizations
• Launch to occur in January 2008

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HASA San Antonio, TX

• Improving healthcare access for the uninsured
• Serving 14 hospitals and 40 clinical
• Reaching out to approximately 514,000 uninsured

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HASA San Antonio, TX

• Initially provided on-line financial assistance
  intelligent surveys to identify possible patient
  funding sources (Medicaider)
• Reduced survey time from 30 minutes to 2 minutes
• Most funding sources are identified at point of
  care
• Currently deploying Secure Share
• Hybrid EHR to maintain data providence
• Electronic Health Summary Record (no
  codification)
• Using Open Source Software
• 300K patients with 1M encounter records
• Pre-populated EMPI from members systems
• Using e-signature to authorize and validate
  consent

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ICare Connect Austin, TX

• Improving access to healthcare for the uninsured
  population in Austin surrounding counties
• Serving over 60 locations 13 hospitals, 50
  clinics, Mental Health Authority, 2 physician
  networks
• Member Organizations
• Austin/Travis County HHS Department
• Austin Travis County MHMR Center
• Austin Women's Hospital
• Central Texas Medical Center
• Austin Community Care Services Department
• El Buen Samaritano
• Johns Community Hospital
• Lone Star Circle Of Care
• People's Community Clinic

• Planned Parenthood Of The Texas Capital Region
• Round Rock Health Clinic
• St. David's Health Care
• Seton Family Of Hospitals
• Travis County Healthcare District
• Travis County Medical Society
• UT School Of Nursing
• Volunteer Healthcare Clinic
• Williamson County And Cities Health District

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ICare Connect Austin, TX

• Serving over 550K patients with 2.9M encounters
  and 510K prescriptions since 2002
• Continuity of Care Record
• Demographics
• Allergies
• Medications
• Therapy treatment summaries
• Lab orders/results
• Progress notes
• ICD-9 CPT-4

Improves coordination of care across healthcare
delivery region Proven to reduce ED Access and
hospitalization Increases payment receipts with
Medicaider eligibility automation
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Critical ConnectionAustin, TX

• Originated from the Travis County Medical Society
  in 1997
• 60 doctors have developed the specifications
• Currently deployed at 18 clinics with 54 doctors
  servicing 50K patients, with data feeds from
• Austin Radiological Association
• Clinical Pathology Lab
• Quest Diagnostics
• EHR contains
• Demographics
• Allergies
• Medications
• Encounter notes
• Lab Radiology reports

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Critical ConnectionAustin, TX

• 2009 rollout to 85 clinics, 178 physicians
• Introduce additional functionality
• Electronic referral system
• E-Prescribing
• Inpatient Hospital Data
• Intake HP
• Discharge Summary
• Procedure Notes
• Surgical Notes
• Lab Reports
• Radiology Reports

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D/FW RHIO - North Texas RMPIDallas / Fort Worth,
TX

• Launched as a result of the Texas Health
  Information Technology Advisory Committee (HITAC)
  report
• Member Organizations
• UT Southwestern Medical Center
• Texas Health Resources
• Baylor Health System
• John Peter Smith Health System
• Methodist Health System
• Parkland Health Hospital System
• Dallas County Medical Society
• Tarrant County Medical Society
• Dallas/Fort Worth Hospital Council
• ProPath
• UT Health System Provided a Grant to create a
  North Texas Regional MPI (NTRMPI) Demonstration
  Project

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D/FW RHIO - North Texas RMPIDallas / Fort Worth,
TX

• NTRMPI Demonstration Project to bring together
  independent health system MPI records into a
  regional MPI
• NTRMPI Participating Institutions
• UT Southwestern
• Texas Health Resources
• Baylor Health System
• ProPath
• Final stage of EMPI selection process
• Initial stage of funding organization and
  establishing governance model

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North Texas Specialty PhysiciansSandlot
Tarrant County, TX

• North Texas Specialty Physician (NTSP) IPA is
  funding a physician led HIE
• NTSP has approximately 600 physicians in Tarrant
  County servicing over 15,000 patients per day
• Selected two EMR vendors for their physician
  practices
• Selected an EHR Clinical Repository vendor
• Integrating with reference labs, e-prescribing,
  Texas Health Resources, and negotiating with
  other large DFW based Health Systems

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North Texas Specialty PhysiciansSandlot
Tarrant County, TX

• Sandlot is an independent IPA funded organization
  formed to provide EMR and HIE services to the
  Physician Community
• Sandlot HIE will support web based
• Medical history via the Continuity of Care Record
  (CCR)
• Known allergies
• Orders/Results
• Medications
• Online Referrals
• Scheduling
• Initial roll out to 300 physicians by the end of
  the year
• Second phase roll out to an additional 300
  physicians in the first quarter of 2008

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DFW Hospital Council Irving, TX

• Provides services to over 70 member hospitals
  throughout North Texas
• Since 1999 DFW Hospital Council has collected
  over 6M inpatient encounter records

Expanding services to receive 1.5M outpatient
encounters on a quarterly basis in addition to
the current 250K quarterly inpatient
encounters Currently all records are identified
only at the encounter level Implementing
probabilistic technology to link each patients
encounter information create a patient centric
view of provided services
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DFW Hospital Council Irving, TX

• DFW Hospital Council Objectives
• Link Inpatient to Outpatient Hospitalization
  Encounters
• Link Multiple Outpatient Encounters
• Calculate 30, 60. and 90 day Re-admission Rates
• Develop episodic metrics analytic capability to
  evaluate chronic illness models for congestive
  heart failure, pneumonia, and other identified
  chronic illnesses.
• Link cardiovascular, stroke, and chronic disease
  research data to our Inpatient and Outpatient
  databases
• Support research activity to improve healthcare
  delivery
• Improve patient safety and quality efforts
• Track complication rates
• Track infection rates
• Evaluate ability to use the technology to address
  physician data integrity issues (Issues with
  UPIN, State Lincense s, Multiple Federal IDs)

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Texas InitiativesAustin, TX

• 2005 - 79th Legislature Formed Texas Health
  Information Advisory Committee (HITAC)
• September 2006 HITAC Released the Roadmap for
  the Mobilization of Electronic Healthcare
  Information in Texas
• 2007 80th Legislature passed HB1066 authorizing
  the formation of the non-profit Texas Health
  Services Authority
• H.B. 1066 establishes the planning and
  coordination framework for the development of a
  seamless and interoperable EHR system and lays
  the groundwork by bringing together public and
  private stakeholders in a partnership to foster
  common data standards, cooperative arrangements,
  and interoperability.
• Eleven Directors to be appointed by Governor
  Perry in the fall of 2007

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Recommended Reading

• Journal of Healthcare Information Management
• Volume 21, Number 3 / Summer 2007
• Health Information Exchange Projects
• What Hospitals and Health Systems Need to Know
• http//www.aha.org/aha/content/2006/pdf/AHARHIOfin
  al.pdf
• Privacy Security and the Regional Health
  Information Organization
• http//www.chcf.org/documents/chronicdisease/RHIOP
  rivacySecurity.pdf
• Evolution of State Health Information Exchange/A
  Study of Vision, Strategy, and Progress
• http//www.avalerehealth.net/research/docs/State_b
  ased_Health_Information_Exchange_Final_Report.pdf

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Questions Discussion
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The Transformation of the U.S. Healthcare System

• Nick BonvinoNational Practice Leader, CTG(972)
  250-1956 nick.bonvino_at_ctg.com

Steve KotykAccount Executive, QuadraMed (972)
691-4215 skotyk_at_quadramed.com