Mike Dittemore, RN, BS, eMBA LACIE Executive Director

MOHIMA 2016 Annual Convention

Overview of Topics

•Status of interoperability between HIOs (KS – MO)

•Legislating “Good Behavior” To Improve Interoperability In Missouri

•House Bill 1579

•Senate Bill 636

•House Bill 2609

•Implementation of a Private Exchange: LACIE 2.0 HMS/ LACIE Private Health Information Exchange

Status of Interoperability of Public HIOs

•Tiger Network LACIE (Good Federated Connection)

•KHIN LACIE (Improving Federated Connection)

LACIE

•Missouri Health Connection Tiger Network

KHIN

National Health Exchange – great idea, limited technology/ standards for matching of patients between different HIOs

• eHealth Exchange – LACIE and Tiger evaluating value of participating. KHIN is participating. Unsure of MHC status.

Legislating “Good Behavior” of HIOs In Missouri

•House Bill 1579

Both Bills were prefilled in late November

•Senate Bill 636

•UPDATE – Neither Bill Will Pass Their Committees

• Both Bills in Current Form would:

• Do away with state designated entity status

• Require HIOs that want to be state approved to:

• Provide open financial records/ transparency

• In order to have access to state date (Medicaid/ Registries) would need to be an approved HIO

• Approved HIOs would need to connect to one another at no charge

• Set up unbiased commission to oversee HIO activity

Legislating “Good Behavior” of HIOs In Missouri

• For an HIO to receive any potential grants or funds from the state, or the Federal Government the HIO would need to be approved.

• Removes entitlement, requires interoperability by all approved HIOs

• If legislation does not pass there will be no significant improvement in interoperability in Missouri for the foreseeable future

• Primary concern of legislators was the implementation of a commission to oversee HIOs

• Next Steps:

• Possible Amendment to Bill(s) with high probability of passing

• Take issues to new Governor and Attorney General after this years elections

Whenever the attorney general has reasonable cause to believe that actions amounting to

health information blocking have occurred, the attorney general may bring a civil action in

a court of competent jurisdiction. Such court may order any appropriate relief, including a

fine of up to five thousand dollars for each occurrence of health information blocking.

Nothing in this subsection shall be deemed to limit the power or authority of the state or

attorney general to investigate and seek any other administrative, legal, or equitable relief

as allowed by law.

• Most likely this Bill will not pass, however, it has caused more discussion and the need to address state subsidized data blocking.

HB 2609 Filed in 2016

What Is A Private Exchange?

• Private Exchange is a more granular way of exchanging data/ enhancing participant control

• Must adhere to all HIPAA requirements for exchange, fully auditable data trail

• Organizations and Providers have full control over the data they choose to share/ PHIE has no rights to data

• Contractual agreements regarding:

• Type of data to be shared – patient cohorts/ alerts/ reporting

• Who data will be shared with – clinics/ payers/ hospitals/ ACOs/ research

• Frequency of sharing – daily/ weekly/ monthly/ quarterly

Why Private Health Information Exchange?

• “More than half of providers pointed a finger straight at their EHR vendors for existing connectivity defects, lacking interoperability and, perhaps worst, data blocking and silos.”

• “Overwhelming number of insurance companies are moving away from involvement with public health information exchanges in a move toward more regional exchange.”

• “63 percent of hospitals and networks are actively moving to replace their HIE system while 94 percent of payers “intend to totally abandon their involvement with public HIEs.”

• “Almost all of the responding hospitals also see private HIEs as the more sustainable and profitable option moving forward — while 88 percent of hospitals and 95 percent of payers said all stakeholders should pay a fair share in secure data exchange to maintain what Black Book described as a more collaborative, trusting relationship.”

April 6th 2016 http://www.hiewatch.com/news/providers-and-payers-blame-interoperability-issues-and-data-blocking-ehr-vendors-turn-private

Key Considerations

• Private Exchange is a service – no legal or technical requirements that an organization also has to be a member of public exchange

• Permissioned data is accessed and extracted through a virtual cloud based machine we refer to as a HIPAA Control Unit (HCU) that is connected directly to the participating organizations database(s) through a VPN connection that participant has full control over.

• Data can be filtered to a specific payer and plan level as well as filtering out patient information that was not submitted as a claim to insurance; information can be shared in bi-directional manner

Key Considerations Cont.

• Eliminates need of interfaces from EMR vendor (Pull versus Push data gathering)

• Data can be normalized prior to being shared with selected participant(s) and can be sent to Public Exchange if requested

• Data can be shared as identified, de-identified, aggregated

• Currently vast majority of HIOs do not share PT/OT, Dietary, Respiratory, Social Worker or Nursing notes limiting the value of the HIO for Long Term Care, Skilled Nursing Facilities, Outpatient Rehab, Home Health. Private Exchange can share notes from anywhere within the EMR with permission.

• Private Exchange can also be used to provide information from non-EMR sources such as registration systems.

Flexibility with Private Exchange

• Data can be provided to contracted receiving organization(s) in various methods

• HL7

• CCD

• CCDA

• PDF

• Flat Files

• Primary Barrier to Exchange is permission, not technology do to the ability to normalize data prior to exchanging

HIPAA Control Unit (HCU)

Use Case of Private Exchange - Standardization

• Consensus is that for HIOs to be sustainable and keep participants costs as low as possible payers need to be engaged and contribute to exchange, both financially and with data.

• To simply ensure that all participants in the current exchange were sending at least the same minimum amount of information in an Admission Discharge and Transfer (ADT) message it was estimated it would take 18-24 months for all participants to comply to standardize ADT and push to HIO. Approximately 20 different EMRs/ versions.

• With Private Exchange ADT standardization is approximately 1-2 weeks. (Pull versus push, not dependent on EMR vendor work queue/ priority)

Use Case of Private Exchange - Alerts

• Community Mental Health Centers (CMHC) not aware when patients in their care present to local acute care hospitals.

• Master Patient Index (MPI) created by Private Exchange regarding CMHC patients

• Acute Hospitals “listen” for ADT activity on CMHC MPI through their HIPAA Control Unit

• Alerts are provided to applicable CMHC/ Crisis Center

• Ability to direct patient to more suitable care if applicable/ keep CMHC providers updated while maintaining confidentiality

• Ability to provide same type of service between ACOs/ hospitals, providers and hospitals

Use Case of Private Exchange - Analytics

• Private Exchange has capacity to provide analytics at individual organizational level, or between multiple organizations providing data to centralized HCU.

• Independent hospitals able to share information on patients both have treatment relationship with to assist in reducing 30 day readmissions

• Care gaps can more easily be uncovered – Private Exchange can has ability to identify patient cohort based on diagnosis and or problem. Diabetes/ CHF/ etc. Then review data to see if applicable care has been documented and alert if not. Also aid to ensure physician agreement with assigned patients.

• Analytics can be broken down to Organizational/ Group/ Provider/ Support Staff level and assignments made

ACO View

In Summary

Not dependent on what Electronic Medical Record can “PUSH” to the exchange.

Ability to “Pull” permissioned/ contractual information from participants database.

Organizations have full control over the data they share, with whom, frequency and length of time sharing will take place, as well as how they disseminate data internally.

Information exchanged can be very specific/ granular compared to Public Exchange where information is “all in” or “all out”.

Information can be exchanged in a variety of different formats based on what is best for the receiving organization.

A variety of use cases have been identified for Private Exchange/ “Granular Exchange”:Data Liquidity/ Exchange between contracted organizations based on permissionAnalytics- Ability to perform in-depth analysis internal to one organization or between organization to identify care gaps/ opportunities. Can also be used to provide reporting measures such as HEDIS/ STARS.Payers – Information can be provided to payers in electronic format including alerts/ payers can also share information back to provider. Multiple payers can receive information from and provide information back through organizations HCU

Thank You For The Opportunity!

Questions?

Mike Dittemore RN, BS, eMBAExecutive Director

Lewis And Clark Information Exchange(LACIE)

12200 NW Ambassador Drive Suite 232Kansas City, MO 64163

O: 816-287-8725mike.dittemore@lacie-hie.com