Approaches to ImplementationSession 2

April 12, 2011

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Agenda• What is the emerging ecosystem of Direct players?

• What approaches can States take to enable Direct in their communities?

• In what situation is each approach appropriate?– When is an approach sufficient to meet HIE needs? – How does the approach fit into the State’s HIE strategy?– What are examples of pilots and States who have adopted a similar approach?

• Panelist Presentations– Gary Christensen, CIO/COO, Rhode Island Quality Institute– Christopher M. Henkenius, Program Director, NeHII, Inc.– Carol Robinson, Oregon State Coordinator for HIT, Oregon Health Authority

• Q&A

• Poll

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What is the emerging ecosystem of Direct players?• 50+ vendors have committed to roll-out Direct-enabled functionality,

and ~20 states include Direct in their approved State HIE plans*

EHRs4MedicaAprimaAllscriptsCare360CernereClinicalWorkse-MDsEpicGE HealthcareGreenway

Med3000MEDgleNextGenOpenEMRPolarisRelayHealth Sage HealthcareSiemensSunquestWorldVistA

PHRsDossiaMicrosoft HealthVaultNoMoreClipboard.comRelayHealth

HIEs & HIOsAAFPAbilityAkira TechnologiesApeniMedAtlas DevelopmentAxolotlCareEvolutionCovisintGarden State Health

Systems Inc.GSI HealthHarrisHINSTxHIO Shared Services/NeHIIIngenixInprivaIVANSKryptiq CorporationLifepoint Informatics

max.mdMedAlliesMedCommonsMEDfxMedicityMedPlusMirthMobileMDNational Health SvcsNetDirectorOrion HealthProviderDirectRedwoodMedNetSecure Exchange SolutionsSurescriptsTechsant TechnologiesThomson ReutersVerizonWellogic

StatesAlabama CaliforniaFloridaIllinoisIowaKentuckyMinnesotaMissouriMontanaNew HampshireNew JerseyNorth CarolinaOhioOregonRhode IslandSouth CarolinaTexasVermontWest VirginiaWisconsin

* Source: http://directproject.org/content.php?key=getstarted&sub=vendorsupport (as of April 2, 2011)

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What approaches can States take to enable Direct in their communities?1. Encourage market-based solutions by establishing parameters for trust

– Create a conducive environment for market-driven solutions through enabling policies, certification criteria, etc.

– Leverage other State HIE services, e.g., directories

2. Offer complete set of services to all community members– Can buy, build or contract HISP services to vendors to set up HISPs and CAs– Need to think through how market-driven solutions can participate, e.g.,

• Establish HISP functionality at State level, or do match-making with nationwide providers?

• Provider value proposition and benefits to State HIE from setting up a HISP in light of national services?

3. Fill in the gaps by providing services to under-served participants, e.g., rural and remote providers and labs

– Identify target participants– Work through similar set of considerations as in Options 1 & 2 above

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HIE strategy should drive the approach to implementing Direct

OrchestratorElevator Public UtilityCapacity-Builder

$ $

Rapid facilitation of directed exchange capabilities to support Stage 1 MU

Develops and bolsters local exchange capabilities

Connects local exchange activities with thin layer of statewide infrastructure

Directly connects providers into centralized HIE solution

Direct Approach #1: Market-based solns

Direct Approach #3: Fill in the gaps

Direct Approach #3: Fill in the gaps

Individual States may adopt multiple strategies

Direct Approach #2: Offer complete svcs

Direct Approach #2: Offer complete svcs

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Panelists and the approaches they adopted• Panelist 1: Rhode Island – RIQI

– Employed Approach #1: Encouraged market-based solutions, to establish HISPs

– Also employed other approaches to solve different HIE problems

• Panelist 2: Nebraska – NeHII – Employed Approach #2: Offer complete set of services to entire

community– Took this a step further to enable HISP services to other States

and communities

• Panelist 3: Oregon – OHA – Employed Approach #3: Fill in the gaps – Leveraged existing regional HIT investments and initiatives

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Panelist #1: Rhode Island – RIQI

KEY TENET IMPLICATION APPROACH

RIQI shouldn’t be a HISP

Be HISP-agnostic

Be value-add (or not)

Educate, facilitate, enable, but don’t “do”

Make “certificates” invisible

Enable “trust”

RIQI should facilitate introduction of “good” HISPs to providers

HISPs can differentiate themselves via price, service, or value-added services

(over and above vanilla)

Business relationships are between providers and HISPs

RIQI should develop a REC service to help providers adopt

RIQI should offer a certificate “product” (optional)

As a trusted 3rd party, RIQI will create and manage a “trust community”

Market-based Solution

Market-based Solution

Market-based Solution

Fill in the gaps

Offer service

Offer service

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Panelist #2: Nebraska – NeHII• Current HIE Environment

– Mature HIE in NeHII Offering Complete HIE Functionality

– VA, Medicaid, and External Demand

– National Focus Through HIO Shared Services

• Objectives

– Provide Value to Patients

– Provide Value to Participants

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Panelist #2: Nebraska – NeHII• Alternatives

– Buy

– Build

• Direction

– Enable HISP and Associated Services for:• NeHII Participants• Non-NeHII Participants• Other States and Communities

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Panelist #3: Oregon – Oregon Health Authority

Current HIE Environment• Numerous regional-based

Health Information Organizations (HIOs) at varying levels of maturity

• HIOs clustered around large population centers and patterns of referral

• Geographically, most of state unserved by HIOs

• Heterogeneous technology adoption

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Panelist #3: Oregon – Oregon Health Authority• Objective: Leverage existing investments in HIT and HIE to reach as many providers

and participants as possible and provide enough services to allow all qualifying providers and hospitals to meet Meaningful Use

• Approach: Provide flexible and common shared services, policies, and processes that are necessary for statewide HIE to occur while fostering growth in the market

– Support markets (i.e., HIOs and local/regional HIE) to reach as many providers as possible

– Knit markets into a statewide fabric of HIE by facilitating communication between them

• Common policy and qualification framework

• Common shared services – Trust, Provider Directories, Messaging (HISP)

– Fill the gaps – offer services to providers not served by HIOs

• Key Take-Aways:– All providers will have an option to participate in HIE regardless of HIO coverage

– Reliance on HIOs means “monitor and adapt” will be key to Oregon’s success

Q&A

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Poll