health information exchange (hie)

Health Information Health Information ExchangeExchange

Ed DonaldsonInteroperability Product Manager, SuccessEHS

Justin CopelandPresident, Triggerfish Corporation

1

Health Information Health Information ExchangeExchange• Verb– Exchange of the information within an

EHR to other entities with the goal of improving care, treatment and outcomes

• Noun– An organization that facilitates the

exchange of health information using various data, methods and messages to do so

2

Meaningful UseMeaningful Use

• Electronic Exchange of Clinical Information Core requirement

– Capability to exchange key clinical information (for example: problem list, medication list, medication allergies and diagnostic test results) among providers of care and patient authorized entities electronically.

3

Meaningful UseMeaningful Use

• Electronic Exchange of Clinical Information Core requirement

– Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.

4

Benefits of Health Information Benefits of Health Information ExchangeExchange• Provides a vehicle to support improved

patient care quality and safety

• Provides a mechanism to reduce duplication of services and reduce health care costs

• Enables the integration of sick-care (illness) with well-care

Source: Health Information and Management Systems Society (HIMSS)

5

Benefits of Health Information Benefits of Health Information ExchangeExchange• Facilitates operational and administrative

efficiencies resulting in reduced operational costs

• Stimulates consumer education and involvement with the health care process

• Promotes transparency of service and cost

Source: Health Information and Management Systems Society (HIMSS)

6

Health Information ExchangesHealth Information Exchanges

• History– Regional Health Information Org.

(RHIOs)• A health information organization (HIO) that

brings together health care stakeholders within a defined geographic area and governs health information exchange (HIE) among them for the purpose of improving health and care in that community.-National Health Alliance for Health Information Technology

– Effort begun in 20077

Health Information ExchangesHealth Information Exchanges

• History– HIEs• Taking RHIOs to the next step• Still issues with privacy, security,

sustainability and dependability of the HIE• No standards yet mandated by ONC

8

Current State of HIEsCurrent State of HIEs

• Many in beginning stages of formation

• Still working on sustainability– Beacon Grants:15 grants awarded in May

2010 to develop interoperability in areas that already have high EHR adoption rates and to use that information to help inform efforts tosupport meaningful use of EHRs

9

Current State of HIEsCurrent State of HIEs

• State Health Information Exchange Program– http://healthit.hhs.gov/portal/server.pt?

open=512&mode=2&objID=1834

• Various standards being used– Standards haven’t been mandated in

HITECH Act like labs, CCD, etc.

10

Types of HIEsTypes of HIEs

• Public Entity – Geographic– Statewide: funding possibly through

federal grants and state or local initiatives

• Private Entities – Coalition– Regional entity (hospital, physician

groups) drives creation of HIE

11

Directional Flow of DataDirectional Flow of Data

• Methods of dataflow– Push• Example: Demographic Message• Send information one way – initiated by

sender

– Bi-directional Push• Example: Laboratory Interface• Send and receive information – each way

initiated by sender

12

Directional Flow of DataDirectional Flow of Data

• Methods of dataflow– Pull• Example: Send request for CCD• Receive information by requesting it

– Full Bi-directional• Push information• Send information on request• Receive information on request

13

StandardsStandards

• Messages: What information is being

sent

– HL7: Health Level Seven

• Machine readable

14

StandardsStandards

• CCD: Continuity of Care Document

• Human & Machine readable

15

StandardsStandards

• Transport: How information is being sent–MLLP: Minimum Lower Layer Protocol• IP Address and Port

– IHE – Integrating the Health Care Enterprise• XDS – Cross Enterprise Document Sharing• Connectathon • HIMSS Interoperability Showcase

16

StandardsStandards

• Transport: How information is being sent

– NHIN – National Health Information Network

• CONNECT

• DIRECT Project

17

Surescripts Network for Clinical Surescripts Network for Clinical InteroperabilityInteroperability

18

Surescripts Network for Clinical Surescripts Network for Clinical InteroperabilityInteroperability

• PUSH method• CCD• Directory of participants (email

address)• Cost• Availability• Will provide means to do one test

19

Connecting with an HIEConnecting with an HIE

• Find out which one serves you best• Resources– HIMSS HIE Toolkit

• http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=142

– HIMSS State HIT Dashboard• http://www.himss.org/statedashboard/

– Regional Extension Centers• http://healthit.hhs.gov/portal/server.pt?

open=512&objID=1495&mode=2

20

Connecting with an HIEConnecting with an HIE

• Find out which one serves you best• Resources– State Health Information Exchange

Program (ONC)• http://statehieresources.org/state-plans/• http://statehieresources.org/contacts/

21

HIE Customer Case StudyHIE Customer Case Study

• Northwest Health Services, Inc.

22

BackgroundBackground

• In May of 2008, Northwest HealthServices began a collaborative effort with Heartland Health, a regional health center, to develop a regional health information exchange now know as the Lewis and Clark Information Exchange, or LACIE.

23

Who is LACIE?Who is LACIE?

• 501(c)(3) with a public Board of Directors

• Formed by collaborative effort of Heartland Health and Northwest Health Services (NHS) and using Cerner as the technology provider

• Provider led24

Who is LACIE?Who is LACIE?

• Current, live transmission of databetween members

• Wholly owned entity of Heartland Health– IDN Serving 4 State Area of NW Missouri– 2009 Recipient of Malcolm Baldrige

Quality Award

25

Who is LACIE?Who is LACIE?

26

LACIE LACIE TodayToday

Heartland

NWMC

NWHS

EMR1

EMR2XDS Document

Registry

XDS Document

RegistryPatient Registry

(MPI)

Patient Registry

(MPI)

AuditingAuditing User

Mgmt

User

MgmtNode

Reg.

Node

Reg.AnalyticsAnalytics

LACIE Network (HIE)

EMR3

NHIN GatewayNHIN GatewayHarrison

County

Atchison

St. Francis

Saint

Luke’s

Shawnee

Mission

Bethany

Rural

Health

PHR

EMR4

27

LACIE TodayLACIE Today

28

Built

Pending

Tiger Institute Network

Tiger Institute Network

BuildingBuildingLACIELACIE

29

ONC Direct Project Pilot

Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:

• Demonstrate how Direct Project standards can be used as a viable method to improve coordination of care across communities.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

30

ONC Direct Project Pilot

Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:

• Replace traditional unsecure ad hoc communication methods (e.g. fax, phone, paper) with secure email.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

31

ONC Direct Project Pilot

Partnership between Heartland, LACIE and Cerner; representing one of only a handful of Direct Project pilots across the country with the primary goal to:

• Meet community providers where they are today, by providing simple solutions to create instant interoperability, with a path toward more advanced methods.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

32

Benefits to PatientsBenefits to Patients

• Test results and medical recordsavailable to specialists and referral providers.

33

Benefits to HIE MembersBenefits to HIE Members

• Improved access to information will enhance the quality of patient care.

34

ChallengesChallenges

• Accessing multiple systems

• Master Patient Index (MPI) matching

• Provider buy-in

• How much should I rely on this

information

35

OpportunitiesOpportunities

• Leverage Direct Project to add

secure communication

• Patient Health Record portal

36

Click here to learn more about

Health Information Exchange.

37