Me hi hie-landscape-webinar-2014-june

HIE Perspectives and Understanding National, State, and Local Initiatives

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Learning objectives

Recognize and differentiate national HIE efforts

Indicate the current level of HIE adoption

Describe drivers of HIE at the national and Massachusetts levels

Delineate challenges inherent in HIE

Characterize emerging HIE trends

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Agenda

The “apples” and “oranges” of HIE

HIE Facts and Figures

HIE drivers, challenges and trends

eLINC HIE and the Salter/Winchester Hospital use case

Use Case for a regional HIE: Wellport HIE

About Us

Sean Kennedy, MPH, MS, PMPHealth Information Exchange DirectorMassachusetts eHealth Institute at the Massachusetts Technology Collaborative

Eddy RospideEMR/HIE DirectorWinchester Highland Management, LLCeLINC Health Information Exchange

Joe Heyman, MDChief Medical Information OfficerWellport Health Information Exchange

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The “apples” and “oranges” of HIE

Collaborations

• Care Connectivity Consortium• CommonWell Health Alliance• Carequality

Trust

• Direct Trust• National Association for Trusted

Exchange (NATE)

HIEs

• eHealth Exchange (federal)• Mass HIway (public, state)• eLINC & Wellport HIE(private,

regional)

Certification / Accreditation

• Federal Bridge Certification Authority (FBCA)

• Electronic Healthcare Network Accreditation Commission (EHNAC)

HIE Facts and Figures National

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How many HIEs are there?

Although estimates vary depending on the data source, there are as many as 280 health information exchanges (HIEs) in the United States that enable the electronic sharing of health-related information.

Source: 2012 CapSite U.S. Health Information Exchange (HIE) Study

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Adoption of HIEs is on the rise

One-half of the nation’s hospitals are now participating in a regional, State, or private HIE, and 71 percent plan to buy new HIE technology in the next 2 years.1

Furthermore, nearly one-half of the nation’s physicians plan to join an HIE.2

Source: 1 2012 CapSite U.S. Health Information Exchange (HIE) Study 2 McCann E. HIEs see rise in physician enrollment; demonstration of Stage 1 gains similar traction. PhysBizTech. 2012 Oct.

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4 in 10 hospitals report an exchange capability for PHI

Percent of Hospitals Able to Send and Receive Secure Electronic Messages Containing Patient Health Information to and from External

Sources

Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement.

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51 percent of hospitals can query from external sources

U.S. Hospitals' Capability to Electronically Query Patient Health Information from Outside Their Organization or System

Source: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement.

HIE Facts and Figures Massachusetts

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HIE Participation (% among all MA practices)

26%

16%

18%

2%

32%

7%

Overall HIE Current and Future Participation

Currently participate in HIE

Will participate in next 12 months

Will participate in 1 - 2 years

Will participate in 3+ years

Unsure of participation date

Will not participate in HIE

Source: Massachusetts eHealth Institute Practice Health IT Study 2014

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HIE Use (among the 26% MA practices participating in HIE)

Public Health and Quality Measures

Requests for Referral

eRX

Lab &Test Ordering

Eligibility Verification

Transitions of Care

None of these

Anything else

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

77%

75%

74%

45%

39%

28%

11%

2%

HIE Users: What information are they exchanging?

Source: Massachusetts eHealth Institute Practice Health IT Study 2014

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The HIway works and delivers value!

219,931 Transactions exchanged during April 29

2,450,425 Total Transactions (inception to date)

April Transaction Activity

HIway Status (organizations)

Count

Contracted 200

Connected 105

SOURCE: Health Information Technology Council slides, May 2014

Mass HIway Status Map - IN DEVELOPMENT

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as of March 2014

Organization Name:Milford Regional Medical CenterHIway Status: TransactingBilling City:

MILFORDBilling Street: 14 PROSPECT STUse Cases:

Discharge summaries from acute

care to skilled nursing facility and

home health in the form of a CCDA

HIE drivers, challenges and trends

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Drivers

Alignment to Meaningful Use objectives and CEHRT criteria - specifically, MU2 requires HIE – to gain incentive payments

ONC grant funding to promote adoption of HIE and EHRs

Emerging value-based payment models and ACOs

Patient safety and patient care

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Drivers from the Commonwealth Fund Report - “Getting it Right…”

“Physicians sharing the same patient ordered duplicate tests and therapies. The same drug and radiology exam were ordered 11 percent of the time. Half of the time, patients followed the duplicate instructions.

Physicians did not know what other physicians were doing to their patients. Primary care physicians were not aware of one of four prescriptions taken by patients.

Uncertainty and hassle reduction drove decisions. One of seven admissions resulted from missing information in EDs or primary care settings. One of five lab and X-ray tests were duplicates because of retrieval barriers.”

Source: Electronic Medical RecordsGetting It Right and Going to Scale, W. Edward �Hammond, The Commonwealth Fund, January 2004

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Drivers prompted locally - in MA

All Providers able to access an EHR networked through the statewide HIE - January 2017

C.224 cost containment provisions

20 Source: MA Cost Trends Report, 2013

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Opportunity for HIE

Source: MA Cost Trends Report, 2013

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Challenges

Little implementation guidance

Establishing convincing value proposition

HISP-HISP and directory sharing

Compatibility of exchanged data sets

“You can’t draw a border, and say ‘patients stop here.’”

– J. Marc Overhage, MD, PhD, Chief Medical Informatics Officer at Siemens Healthcare, Health Services on HIEs ending at state borders

“Ecosystem maturity and workflow changes represent the two main challenges for vendors and providers as they implement two Meaningful Use (MU) Stage 2 requirements related to health information exchange: transition of care (ToC) and view, download and transmit (VDT) requirements.”

Micky Tripathi, CEO, Mass eHealth Collaborative

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Challenges from the eHealth Institute 2013 Survey

Interoperability – without steep technical interface costs, more plug n play

Financial sustainability – private vs public financing

Competitive concerns

Patient engagement remains low

Source: eHealth Institute, 2013 Survey on Health Data Exchange http://www.ehidc.org/resource-center/surveys/view_document/333-survey-results-results-from-survey-on-data-exchange-2013-data-exchange

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Trends

From exchange to interoperability

Quality over quantity incentives being implemented– Shifting payment models – from fee for service to value-based

Faster adoption of EHRs than HIEs

Consumerism of healthcare

– Majority (52%) of consumers want to access tools, websites rankings for quality, patients’ reviews of doctors and hospitals

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What’s ahead

HIE gets easier – EHRs get there, experience in the market grows, trust established

Exchanges show value

Capturing social and behavioral domains in electronic health records

Distributed analytics

Interoperability - “ONC’s 10-year plan”

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The rise of private HIEs

“In general, privately funded HIEs are growing at a much faster rate than publicly funded HIEs. From 2010 to 2011, the number of live public HIEs in the United States rose from 37 to 67, whereas the number of live private HIEs more than tripled from 52 to 161.”

Source: Prestigiacom J. Private HIEs on the upswing. Healthc Inform. 2012;29(3):24, 26.

Governed and managed by Winchester Highland Management,

LLC.

eLINC Heath Information Exchange (HIE)

• Our eLINC HIE was formed by Winchester Hospital and the IPA under Highland Management. More info can found at http://elinc.businesscatalyst.com for now. eLINC stands for:– electronically Leveraging information – Improving care – Networking providers, and – Communicating with each other

• eLINC a vehicle for our stakeholders to message each other, and share or exchange health information in a safe, secure, and non-competitive manner

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eLINC Participant Services• The same folks that implemented the HM supported EMRs in the

community also make up the eLINC implementation and support Team. They provider the following services:– EMR implementation– Meaningful Use Attestation assistance– Secure direct messaging accounts which can communicate with any EMR

vendor who uses a HISP that participates and implemented the direct trust framework and certificate bundles respectively.

– Hospital admission and discharge notifications for PCPs and ACOs– Clinicians access to patient clinical information (delivered directly in the EMR) ,

aggregated from many organizations (eLINC HIE), for use at the point of care• Central Data Repository (CDR) services for aggregation of patient data from HIE participant EMR

systems (Deploying in June 2014)

– Results delivery from Winchester Hospital laboratory, radiology, and other departments (Current)

– Business Intelligence(BI) services for network and provider quality performance reporting (TBD)

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Winchester Community - Current Environment

• Community of close to 400 physicians and Winchester Hospital– 182 out of 208 eligible providers have attested for MU

Stage 1.– There are a total of 81 interfaces between Winchester

Hospital and physician practices• 23 Different EMRs but mainly 11 supported

– eClinicalWorks, AthenaHealth, Allscripts Professional, NexTech, GE Centricity, Origin, Practice Partners, MDIntellesys, Vitera, Nexgen, and Amazing Charts.

• 23 Practices or 27 physicians are still on paper.30

Supported Use Cases and Activities

• Care Transitions across healthcare organizations– Excel Orthopedics Winchester Homecare– Excel Orthopedics Winchester Hospital surgical preadmission and testing– Salter Healthcare Winchester Hospital ED and Medical Records department

• Upcoming Activities– Deploy secure messaging across the community– Work with physicians to attest for MU 2– Pilot HIE Clinical repository with 2 pilot eCW practices– Integrate Athena, Practice Partner EMR products as well

as all your EMR vendor products to the HIE clinical repository

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Clinical Data Repository – eCW eEHXFeatures and Capabilities:

– Integrated directly with the EMR as an IHE compliant cross enterprise document repository

– Access may also be through secure web login– Aggregates data from all contributing organizations– Supports C32 CCD integration– Document may only uploads only through eCW– Patient consent flows directly from ADT integrated EMRs

Work in progress:– Encrypted CCD download– Patient consent capture by participant front staff in cases where no ADT

interface with consent exists between participant EMR– Monitoring report on performance of live eCW EMRs when tightly integrated

with eEHX– Performance report on nightly sweep of patient data from eCW EMRs where

patients have opted into the eLINC HIE– Workflow concerns related to consent capture– Proper education and training of participants

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eLINC High Level End State Diagram

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HL7 ADT, Results

Patient Results

Ambulatory Orders

Ambulatory Orders

Secure Messaging

MA State HIway

Secure Messaging

Clinical Encounter Data

Expanding Concentric CircleNEQCASNFs

RehabsWinchester HomecareTufts Medical Center

Lahey Health

TBD

RLS Query/Response

Health Information Exchange

Joe Heyman, MD

Chief Medical Information Officer

June 12, 2014

The GenesisThe Whittier IPA

The need to provide services and products for members without attaching requirements

The need for clinical integration for contracting and avoiding antitrust issues

The opportunity (2004-2008)

The importance of physician independence

Improving quality and efficiency of care

MAeHC

Early history after the

● Discontinuation of the minimal system● Four years of coming close to signing

– No references of a major vendor– Change the deal about hospital sign-on – on the last day– Quadruple the price on the last day– Finally signing last summer

MaeHC

After Signing

● Clinician Commitments (marketing)● Access to databases● Reformatting● 17 different vendors● Mission and Vision● Committees

– Policy, Usage, Technology

Documents● Mission and Vision Statements

● Operating Principles

● Policies and procedures

● Consent and assent

● FAQs

● Trifold for marketing

● Education for clinicians about proper use and legitimate access

● Internal HIPAA required security documents

● Business Associate Agreement

● Service Agreements

● Mass HIway agreements (HISP to HISP)

● Vendor SOW and contract

● EMR vendor interface agreements

Vision and MissionOUR VISION

The widespread use of the Wellport Health Information Exchange will improve the quality and efficiency of healthcare for all patients in the lower Merrimack Valley and beyond -- in an atmosphere of trust.

OUR MISSION

The Wellport Health Information Exchange (HIE) will provide the communication vehicle to improve the quality and efficiency of healthcare for its subscribers and their patients and clients by developing and providing services for managing and exchanging health information in an atmosphere of trust. The HIE will be guided by its Operating Principles which may evolve over time.

Operating Principles● Patients always come first.

● Patient privacy, security and confidentiality are paramount.

● We dedicate our services to the entire community of medical institutions and patients regardless of affiliations.

● Clinical data are not shared for purposes other than treatment, quality measurement and improvement, and public health.

● We will not share confidential business data among institutions or physicians unless requested by the contributor of that information.

● We will not sell clinical data.

●Advantages of an IPA ownership

● Physicians are stewards of the patients’ data

● Ethical use of data for improvement of quality and efficiency

● Instantaneous access to aggregated data

● No physician imprisonment

● Potential income stream for the IPA

● Private Direct addresses

● Helps with MU achievement

●Advantages of Regional HIE● Clinicians can see ALL patients’ data

● No silos

● Improves health of entire community

● Improves efficiency for entire community

● Ease of referrals

– You can easily attach other clinical information (that does not come from your own practice) to a direct message over the Mass HIway

● Single patient portal

Long term advantage of regional physician owned HIE

● Quality measurement for entire community

● Quality measurement for any subset of the community

● Potential addition of new innovative services (billing, third party applications, mobile, analytics)

Where are we now?● How many clinicians on production

platform? 43● How many patients on the system?

101,027 ● How many progress notes? 794,233● How many patients have opted in? 0● Platform is live and running● Patient opt-in about to begin

  Health Information ExchangeOwned and Operated by the Whittier IPA, Inc.

Joe Heyman, MDChief Medical Information Officer

255 Low StreetNewburyport, MA 01950(978) 462-2345 Office(978) 807-5365 Cell

[email protected] 

Questions & Discussion

Sean Kennedy, MPH, MS, PMPHealth Information Exchange DirectorMassachusetts eHealth Institute at the Massachusetts Technology Collaborative

Eddy RospideEMR/HIE DirectorWinchester Highland Management, LLCeLINC Health Information Exchange

Joe Heyman, MDChief Medical Information Officer

Wellport Health Information Exchange

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NEXT WEBINAR!

Meaningful Use Stage 2 & Health Information Exchange (HIE)Thursday, July 17 at 12:00pm-1:00pm

Join the Massachusetts eHealth Institute (MeHI) for an educational webinar on health information exchange (HIE) and Stage 2 Meaningful Use (MU). Sean Kennedy, Health Information Exchange Director and Al Wroblewski, a Meaningful Use subject matter expert will lead this important session and discuss how using an HIE can assist eligible participants in meeting Stage 2 Meaningful Use measures. Important Meaningful Use topics will include transitions of care, the submission of public health measures, and patient engagement.

Register

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[email protected]@MassEHealth

www.mehi.masstech.org