Demonstrating The Value OfLocal Exchanges

Connecting to the PC-EHR & Health Information Exchanges July 19th, 2011

Ted KremerExecutive Director, Rochester RHIO

© Ingenix, Inc. 2

Rochester RHIO

One of several regional New York Health Information Exchanges Rochester RHIO covers 1.3 million patients in 13 countiesOutside of Rochester predominantly rural

Roughly 3000 physicians, both independent and hospital practices

20% EHR adoption in ambulatory care setting

Hospital Clinical information systems all automated

20 Hospitals across 13 counties

Well defined medical trading area

Rural and Urban mix with referrals coming into larger urban hospitals

Three health plans with 70% of market share

Large employer self ensured based

Regional and community history of collaborative care improvement projects

Market dynamics still using information access as competitive advantage

Medical delivery area landscape

Exploring how a small regional exchange can become a trusted value partner

Core Value Propositions:1) Improving the Quality of Care

• Lower risk of mistakes

• Fewer unnecessary tests

• Easier second opinions

• Better emergency care

• Greater convenience for patients

• Reduced hospital readmissions

• Smoother transitions of care

• More effective patient coaching and community prevention efforts

Core Value Propositions:2) Enhancing System Efficiency

• Lower risk of mistakes

• Fewer unnecessary tests

• Easier second opinions

• Better emergency care

• Greater convenience for patients

• Reduced hospital readmissions

• Smoother transitions of care

• More effective patient coaching and community prevention efforts

Emerging Value Propositions: Supporting Health Reforms & Care Improvements

• Support for meaningful use requirements

• Accountable care organizations

• Medical home grants

• Hospital readmission reduction program

• Quality care reporting requirements

• Administrative simplification

• Independence at home pilot programs

• Federal healthcare innovation efforts

Rochester RHIO Timeline

2006 2007 2008 2009 2010

• Initial Grant• Incorporation• Stakeholder

collaboration

• Policy development

• Technology foundation

• Consumer focus groups

• Pilot RHIO services

• Increase in quantity & types of data

• Full-scale deployment

• Increase in physician adoption

• Consumer Marketing

• HIE growth• EHR

adoption & integration

Growth in Numbers

Physicians

Total users

Connected EHR Systems

Consented Patients

133

450

6

42,00

2009 2010 Today

866

2,500

115

225,00

1,222

3,985

145

482,788

Sources of data51 million records+ million each monthFrom over 70 sources

ServicesSetupConfigurationMonitoringData qualitySupport

Users419 organizations3,985 users1222 physicians

Information = Adoption & Value

Maturing Revenue Streams

Initial Startup Phase Transitional Phase Mature Phase

Grants  2006 2007 2008 2009 2010 2011 2012 2013+

Heal NY 1 (start HIE)                

Heal NY 5 (HIE & EHR)                

Heal NY 17 (medical home)                

 Revenue                

RHIO Contribution Plan                

Hospital Subscription Plan                

Fees                

                 

Sustainability

From Grant Fundingto Sustainability

RHIO 1.0 – A Clinical Exchange

RHIO 1.0 Our initial exchange focus was between Hospitals, Labs, Radiology practices and Physicians

With initial start up funding based on a 2 year grant we sought to build services quickly

Took an opportunistic build approach

Met participants and vendors where they were with an eye to where we wanted to go

Leveraged standards wherever possible (HL7-> IHE)

Started with a vision of supporting2 HIE modalities:

1)Query services Using Virtual health Record (VHR)(requires consent)

2)Results servicesSupporting 14 EHR vendors systems (does not require consent)

With only 20% initial EHR adoptionVHR services trended up first.

With more EHRs connected, VHR use has dropped butdelivery volumes have trended up

Moving into CCD exchange

Privacy & Consent

As of 6/30/11Total Consents: 682579Total Unique Patients Consented: 482788

Consent to view model Consent per covered entityConsent controls query use

Consumer marketing & education

All household mailings to 400,000 households

Movie theatre advertising

Radio & print advertising

Advertising and article space bank for hospital & health plan newsletters to include patient education in their materials

Communications group with PR professionals from multiple organizations

PR firm active in getting newspaper and radio coverage

PR firm assists rural and regional facilities to get local coverage

Patients now often ask for the HIE consent form when it is not presented to them

Tools to assist providers with consent

Patient tri-fold brochure

Commonly asked questions

Consent forms

Counter cards

Clipboards

Chart stickers

Practice scripts

Practice guidelines

Optional scanning

Consumer & Provider web site

Patient Portal live in April

PHR Gateway pilot in June

RHIO 2.0 – A Community Care Exchange

• Care Coordinationo New

communication patterns

o Additional sources of care information

• Patient Engagement

• Health Analytics

Care Coordination: Communication Patterns

Electronic Health Record (EHR) interoperability • Initial model was results delivery (push)

• Improved filtering & turning off paper• Dual routing to both EHR and ACO care engines

• Moving to 2-way EHR interoperability• EHR requesting a CCD from the exchange• Send CCD from an EHR

o Send to RHIO (event based, manual)o Send to other provider (CCD & C62)

Care alerts (subscriptions & notification) • Configure per provider subscription sources• Capability of EHR to consume sources

Mobile HIE application support (iPhone, iPad)

Care Coordination:Additional Sources of Information

Additional types & Sources of Data•More complete hospital transcribed/clinical reports •More complete Admissions and Discharges information•Office of the Aging information•Eligibility information•Emergency medical services information•Mobile image providers•Advance directives•Care engines updates (problems, communications)•Patient submitted data from PHRs•Kiosks/Home monitoring (vitals)

Patient Engagement

• Patient marketing & education• Patient portal services

• Consent management• Audit requests• Advance directives

• PHR gateway with 2 way PHR connectivity • Consumer/Retail health kiosks• Home monitors• Linking communications from care engines

RHIO 2.0 – A Connected Community of Health

Your Info Goes Where You Go

Our initial HIE efforts focused on quick value creation to build a track record and a foundation for future efforts

The bigger opportunities are ahead