Factors in Selecting an HIE System. List of Factors 1. Architecture 2. Safeguards 3. Provider Portal 4. HIE Software Types 5. Use of MPI 6. HIO Staffing.

Factors in Selecting an HIE System

List of Factors

1. Architecture2. Safeguards3. Provider Portal4. HIE Software Types5. Use of MPI6. HIO Staffing Required7. Business Factors

HEALTHCARE – AN INDUSTRY IN TRANSITION: THE CASE FOR PRIVATE HIES

Dave MinchPresident and COO, HealthShare Bay AreaCo-chair, California Association of HIEs

ConnectHealthcare Community Webinar

7/18/2013

Healthcare – an Industry in Transition

• Healthcare corporations must look toward a future of less FFS and more capitation, shared risk, and competition:

What must your IT systems be capable of doing that they cannot do today?

What must your organization be capable of doing better than your competitors?

What will the industry look like 5 years from now, and how do I need to prepare for that vision today?

ConnectHealthcare Community Webinar

7/18/2013

Payment Reforms Create Opportunities

• Capitation, Shared Risk, Incentive Payments; require:• Analytics based on threaded patients

(patients that have longitudinal records with all ambulatory and acute care encounters recorded and maintained)

• Ability to perform analysis based on patterns of care – grouping of patients by disease and disease stage

• Ability to look into geographic regions and perform population analysis and trending

ConnectHealthcare Community Webinar

7/18/2013

More for Less – Working Smarter

• Capitation will limit funds and stimulate improved processes:• Individual PCP replaced by care team

which leverages lower-cost professionals• Increased reliance on EHRs and Registries

to track patients and determine required testing and interventions

• Increased use of care alerts and reminders to improve patient safety and decrease unnecessary testing and procedures

ConnectHealthcare Community Webinar

7/18/2013

Survival Trumps Cooperation

• Healthcare corporations decide to develop & pay for their own captive HIOs:• They can determine exactly how their

HIOs are formed and maintained;• They can use the HIOs to bind their

providers;• They can leverage the HIOs to attract and

keep patients;• They can perform their own analytics;• They can maintain referral patterns within

their own ACOs.

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7/18/2013

and… What Does the Future Hold?

• What will the industry look like 5 years from now, and how do I need to prepare for that vision today?• Fewer, larger capitated healthcare

organizations competing for small and large groups of patients…

• How many “Kaisers” will it take to satisfy California’s needs?

• Use modern analytic techniques to allow potential addition of other data sources.

ConnectHealthcare Community Webinar

7/18/2013

So… what is missing?

• Private HIOs can do a good job of analytics within their boundaries so long as they have data from all providers touching their patients.

• Public HIOs may or may not have adequate access to data for analytics and need to plan for patient consent.

ConnectHealthcare Community Webinar

7/18/2013

Connector Strategy

• Access to patient encounters outside of the ACO walls.

• Notifications of encounters when patients are seen in other facilities within the connector territory.

• Distribution channel for information out to the secondary provider network.

• Onramp to the California Trust Network (CAHIE).

• Onramp for providers outside the private HIOs to interoperate.

MARKET CHANGES

Robert Moore, MD, MPH, Chief Medical Officer, Partnership Health Plan of California

Market ChangesHealthcare TransformationAspiration for a Closed Delivery

SystemLead Time for Connected Care

Healthcare TransformationMore closed delivery systemsEmployer-provided healthcare in

California: 100% managed care beginning in 2012

45 ACOs in CAMedi-Cal: 100% managed care131 CMS incentive projects (plus P for P

and other already implemented incentive programs)

Role of hospitals: consultant quote re Tenet is “risk management”

Aspiration for Closed Delivery SystemAdvantages of Closed System

◦ Self-direction (no community board)◦ Keep referrals and data in the network◦ Ability to develop analytics without requiring

patient consent (part of operations)◦ Broader aggregation of data for treatment◦ Hub for interfaces

Negatives of Closed System◦ Cost of system borne entirely by owner◦ Lack of out-of-network data (connector HIE can

provide data for treatment, not for analysis)◦ May miss important clinical and behavioral health

data

Time to ConnectionLead Time to “Wire a Market”Connectivity Needed for New

Reimbursement Models Is Immediate

Rural HIE Incentive◦Offered through November 2013◦First-come, first-served to $1 million

WHAT HIE FUTURE DO YOU WANT?

Lyman Dennis, PhD, Executive Director, ConnectHealthcareSuzanne Ness, Regional Vice President, Hospital Council of Northern & Central California

What HIE Future DoYou Want?: Factors1. Architecture2. Safeguards3. Provider Portal4. Fixed HIE vs. HIE Tool Kit5. MPI6. Staffing Required7. Business Factors

1 Systems ArchitectureHIE ConnectorFederated Model

◦Data at provider locations◦Data at HIO location

Clinical Data Repository

2 SafeguardsParticipants Agree to Use Data

only for Patient Treatment Queries

System Has Safeguards to Detect Data Trolling and Disable Offender Access Immediately

Any Population Health Analysis Will Be Done by a Third Party with Deidentified Results Available to All

3 Provider PortalUsed by Provider to Assess Data

Received and Decide What to Add to EHR

Sent Data May Vary Significantly in◦Amount of data provided◦Type of data (fields, coding schemes,

time span,…)◦Quality of data

Trust of Sender

4 Type of HIETurnkey Product

◦RespectedHIE Toolset

◦Respected tool elements◦Product of known or unknown

quality, validity

5 MPIWith -- mostWithout – iCA, Relay Health

6 HIO Staffing RequiredAdministrative

Roles◦ Project Manager◦ Technical Lead◦ Clinical Lead◦ Training Specialist◦ Help Desk

Data Cleaning & Matching◦ Medical Records

Tech

0.5 to FT0 to FTTBD0.5 to 1.00 to 2 FT

0 to 2

7 Business Factors

1. Vendora. Financial stabilityb. Managementc. Vendor and project staffing

2. Assessment of Vendor and Product

a. Functional profile of softwareb. Proposal scorec. Scripted demo scored. References score

7 Business Factors (cont’d)3. Price for Services

a. License or SaaSb. Implementationc. Interfaces (some charge, some

free)d. Supporte. Expansion to other counties

4. Provision of Custom Features5. Provisions for Failure to Perform

PROS & CONS OF ARCHITECTURES

Mitch Wippern, Deputy Director – Operations, Napa County Health and Human Services Agency

Private HIEs (Connector)

Private HIEs (Connector)

Pro Con

Data security. Owner of private HIE controls data sharing.

Portal duplication. Too many portals if private HIE and community HIE.

Single interface. Can connect any unit in private HIE to trading partner.

Usefulness. Allows queries to private HIE.

Data is not accessible to the community HIE for disease management, population health, public health.

If parties agree to share, community HIE should have more complete data.

Interfacing is not the purpose of private HIE.

Does not populate community HIE.

Federated HIE with Data at Each Provider’s Data Center

Federated HIE with Data at Each Provider’s Data Center

Pro Con

Data security. Keeps provider data in edge servers at provider data center. Appears very secure.

Query reliability. Not the best.

Usefulness. Workable. A few organizations do this.

According to a leading HIE attorney, the data are no more secure than in other HIE models.

Queries are performed “just-in-time” across many servers. A network disturbance and drop data.

Slower query-response. Data loss possible.

Federated with Data at HIE

Federated HIE with Data at HIE

Pro Con

Data security. Keeps data in proxy servers which store sharable data at the HIE. Providers control what data is sharable.

Query reliability. Queries run in the HIE server facility are fast and reliable. No latency or down-connection issues.

Usefulness. Good for query-response. Can be used to populate at CDR for analysis. Widely used approach.

Although data security can be identical to “data at provider,” to the uninitiated it seems less secure.

Somewhat better performance in a single database (CDR).

Repository HIE

Repository HIE

Pro Con

Data security. All data on a single server (or farm) organized by patient. Secure as any other approach so long as well-managed.

Query reliability. Highest. No latency or data loss.

Usefulness. Best overall for all uses including clinical studies across the community, DM, and public health.

The uninitiated may worry about others access to data on their patients.

None

None

RealityManagers of many of the prominent HIEs

say they use a “federated model.”Most mean “federated at the HIE” if you

to ask.When one asks where the HIE stores

laboratory and pharmacy data, these HIE managers generally say “in a repository.”

This represents two types of hybrid architecture:◦Proxy servers at the HIE location and◦A mix of federated and CDR solutions.

SUMMARY

Lyman Dennis, PhD, Executive Director, ConnectHealthcare

Summary: Health ReformAptly named: incentives rulePrivate HIEs: real considerationTiming important

◦Time to wire community◦Connectivity crucial for incentive

reform models◦Rural HIE incentive time-limited

Summary: Our Future

1. HIE Architecturea. HIE connectorb. Federated modelc. Repository model

2. Safeguards Advised3. Provider Portal4. Turnkey vs Tool Kit Solution5. MPI6. Staffing7. Business Factors

Next Steps1. Bids including Private HIEs2. Reference Checks3. Participants Select Approach4. Select Two Finalists5. Scripted Presentations to Board and

Procurement Team6. Finalize Budget7. Negotiate Terms and Execute Agreement8. Execute Participant Agreements9. Set Up System10. Begin Adding Users

Discussion