overview of health information exchange in the u.s

Kate Berry

CEONational eHealth Collaborative (NeHC)

Overview of Health Information Exchange in the U.S.

www.nationalehealth.org

Discussion Topics

• Introduction to NeHC

• Current landscape for HIT and HIE • Examples of leading HIE organizations

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About NeHC

National eHealth Collaborative (NeHC) is a public-private partnership that works collaboratively with

healthcare stakeholders to tackle barriers and accelerate progress in achieving secure,

interoperable electronic exchange of health information nationwide, to improve American health

and healthcare.

NeHC is a cooperative agreement partner of the Office of the National Coordinator for Health IT (ONC) in the U.S. Department of Health and Human

Services (HHS).






NeHC Board of DirectorsSimon Cohn, MD, MPHChair, 2011 Board of DirectorsKaiser Permanente

Laura AdamsRhode Island Quality Institute Holt AndersonNorth Carolina Health Information and Communications Alliance, Inc.

David Baker, MD, MPHNorthwestern University

Lori Evans Bernstein, MPHGSI Health

Kate BerryNational eHealth Collaborative

Alice Brown, JDNational Partnership for Women and Families

Pamela Cipriano, PhD, RN, FAANInstitute of Medicine

Janet Corrigan, PhD, MBANational Quality Forum Arthur Davidson, MD, MSPHDenver Health Steven Findlay, MPHConsumers Union

Thomas Fritz, MA, MPAInland Northwest Health Services

Kevin HutchinsonFormer CEO of Prematics

Michael Lardiere, LCSWNational Council for Community Behavioral Healthcare

Patricia MacTaggart, MBA, MMAGeorge Washington University Chuck ParkerContinua Health Alliance

Paul Uhrig, JDSurescripts

GOVERNMENT LIAISONS: Mary Jo Deering, PhDOffice of the National Coordinator for Health Information Technology

Douglas Fridsma, MD, PhDOffice of the National Coordinator for Health Information Technology Linda Fischetti, RN, MSU.S. Department of Veterans Affairs Seth Foldy, MD, MPHCenters for Disease Control and Prevention

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NeHC Mission, Vision and Strategy

MAJOR INITIATIVES

VISION

STRATEGIC GOALS

MISSION

A transformed U.S. healthcare system that ranks #1 worldwide in health and healthcare through innovative access, sharing and use of

health information in every community and across the nation.

NeHC is a public-private partnership that enables secure and interoperable nationwide health information exchange to advance health and improve healthcare.

Promote Nationwide HIE

Engage with Stakeholders

on HIE

Achieve Sustainability

for NeHC to AccomplishOur Goals

Ensure NeHC’s Vitality and Relevance

Develop and Disseminate HIE Leader Profiles

Support NwHIN Exchange

Convene Consumer Consortium on eHealth

Accelerate HIE Progress Through Collaborative Forum and Programs

Create Online Communities and Knowledge Base

Operate NeHC University

Develop and Communicate a National HIE Roadmap






Overview of HITECH ProgramProvider incentives• $34B incentives to providers under Medicare and

Medicaid• For physicians and hospitals using certified EHRs

and achieving “meaningful use”• Up to $44,000 per physician under Medicare or

$60,000 under Medicaid• Beginning in 2011 spread over four years with

disincentives beginning in 2015

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Overview of HITECH Program (continued)

Infrastructure and support for HIE and other programs• $564M for statewide HIEs ($4M-$40M per state)• $250M for 17 Beacon Community HIEs ($10M-$20M each)• $598M for Regional Extension Centers for implementation support• $1.5B for Federally Qualified Community Health Centers • $112M for training at community colleges and universities for

workforce development• $60M for SHARP, research in security, patient-centeredness, new

architectures, secondary use• $4.3B for broadband• $2.5B for distance learning/telehealth grants

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National Health Information Exchange Programs

• Nationwide Health Information Network Exchange• A group of federal agencies, local, regional and state-level

HIEs and integrated delivery networks demonstrating live health information exchange using the Nationwide Health Information Network standards and specifications






Current Participants on NwHIN Exchange• Centers for Disease Control and Prevention (CDC)• Department of Defense (DoD)• Social Security Administration (SSA)• Department of Veterans Affairs (VA)• Kaiser Permanente• HealthBridge• MedVirginia• Regenstrief Institute• Inland Northwest Health Services• North Carolina Healthcare Information and Communications Alliance• Many more organizations in the queue…. Including state HIEs,

Beacons, health systems

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• The Direct Project• The Direct Project specifies a simple, secure, scalable,

standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet






Examples Pilot Projects Using Direct

• Hennepin County Medical Center – sending immunization records to MN Department of Health using Direct

• MedAllies in Hudson Valley, NY – launching a Direct pilot project to demonstrate the delivery of critical clinical information across transition of care settings in a "push" fashion that supports existing clinical workflows

• Rhode Island Quality Institute – using Direct to exchange data between primary care providers and specialists and between EHR users and the state HIE

• CareSpark in Tennessee – demonstrating the routing of mammography referrals from the VA to the private sector provider using Direct

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• The Standards & Interoperability Framework• The S&I Framework is a set of integrated functions,

processes and tools being guided by the healthcare and technology industry to achieve harmonized interoperability for healthcare.






The Standards and Interoperability Framework

• Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system.

• An S&I Initiative focuses on a single challenge with a set of value-creating goals and outcomes, and the development of content, technical specifications and reusable tools and services.

• Call for Participation: The overall success of the S&I Framework is dependent upon volunteer experts from the healthcare industry and we welcome any interested party to get involved in S&I Framework Initiatives, participate in discussions and provide comments and feedback by joining the Wiki: http://wiki.siframework.org

http://wiki.siframework.org/






Examples of 12 Leading HIEs from a Soon to be Released NeHC Report

• Availity• Business and clinical exchange between payers and

providers through a national network• Savings include 10-12% fewer calls to health plans, 60%

cleaner claims, 10% fewer paper claims• Big Bend RHIO --Physicians and hospitals sharing

information on patients in Tallahassee, Florida region• HealthBridge

• Hospitals and physicians sharing information on patients in Greater Cincinnati-Northern Kentucky tri-state area

• Estimates more than $20 million annual savings• HealthInfoNet – statewide HIE in Maine with 16 hospitals

and 2,000 clinicians currently participating, goal is to have all hospitals and 80% of physicians connected by 2015






Examples of 12 Leading HIEs from a Soon to be Released NeHC Report (continued)

• Inland Northwest Health Services• Diversified healthcare services company connecting 38

hospitals and 450 ambulatory organizations including 4,000 physicians

• Provides 47,000 end-users with secure access to community-wide EHR with records for 3.5 million patients in Washington, northeast Oregon, northern Idaho, western Montana

• One hospital system estimated $1.3 million in savings• Participating hospitals spend less than 2% on health IT

infrastructure compared to national average of 3+%• MedVirginia

• Provide system for community-wide clinical information exchange in Central Virginia to improve clinical workflow, achieve meaningful use, create PCMHs

• Partners with DoD, SSA, VA via NwHIN Exchange







• Quality Health Network• Clinical data exchange collects and distributes data to and

from diverse healthcare providers including acute care, urgent care, long-term care, reference labs, surgical centers, behavioral health, public health, pharmacies, physician practices

• Colorado west of the Continental Divide and eastern Utah• Organized in “medical neighborhoods” based on referral

patterns• Rochester RHIO (Ted will cover)• Sandlot

• HIE driving EMR adoption and connectivity and exchange among practices, labs, and hospitals

• 12 hospitals, 350 physicians, 2 national labs across 7 counties for 1.7 million patients







• SMRTNET• Network of networks in Oklahoma exchanging data between

hospitals, Native American tribes, community health centers, labs, universities, practices, first responders, public health, etc.

• 3,000 users and 3.1 million individuals in MPI in 2011• Taconic Health Information Network and Community (THINC)

• Community-wide initiative in Hudson Valley, NY to advance HIT, HIE, EHRs

• 363 providers 4 (soon to be 8) hospitals using the HIE• U.S. Department of Veterans Affairs

• Develop virtual lifetime electronic record (VLER) for every service member and veteran and enable HIE between VA and private sector health systems driving need for HIE

• Leverage NwHIN Exchange – 11 regional pilots by September 2011 and nationwide deployment summer 2012






Critical Success Factors

• Aligning stakeholders with HIE priorities is an ongoing and intensive effort

• Establishing a brand in the community that conveys their role as a trusted, neutral entity protecting the interests of participants

• Achieving and maintaining alignment requires making difficult strategic choices

• Market structure and dynamics, especially in early stages, are important determinants of success

• Understanding clinical workflows and managing change are core competencies






Ongoing Challenges

• Policies and procedures designed to meet complex privacy requirements tend to impede an HIE’s efforts to achieve the critical mass of patient records needed to accelerate adoption

• Gaps in interoperability standards and lack of rigor in adhering to existing standards are drains on HIE resources






Business Models

• All but 3 of the 11 receiving funding from private sector are currently self-sustaining with fees from participants covering operating expenses

• A prevalent philosophy is to charge all private sector participants for using the HIE

• Despite a minority of the HIEs presently receiving financial support from payers (3), several more believe that this source of revenue is essential to long-term sustainability of the HIE






Portfolio of Services

• These leading HIEs are incubators of innovation

• The role of HIEs in providing healthcare consumers/ patients with access to their data is a work in progress, with most organizations either testing strategies with pilot projects or refraining from making investments in this area

• Reduced data distribution costs and increased staff productivity are currently the major reasons why participants are willing to pay for the services offered by these HIEs






Strategies to Create Value

• Interest in the NwHIN spans the continuum, with HIEs participating in Beacon Community initiatives or motivated to connect to the U.S. Department of Veterans Affairs leading the way

• 5 are currently connected to NwHIN Exchange• 3 more plan to connect to NwHIN Exchange• Those same HIEs are also implementing Direct

standards and services

• Leaders of these HIEs are cautiously optimistic about the emergence of accountable care organizations, seeing potential opportunities but also concerned about their potential impact on market dynamics






Future Outlook

• Raising capital to steadily grow the HIE organization’s connectivity footprint and portfolio of services is key to long-term sustainability

• As the HIE grows, its stakeholder community becomes more heterogeneous, making governance more challenging and complex





overview of health information exchange in the u.s

Documents

national health

department of health

development of health

american health

health reform incentive

national coordinator

national hie roadmapwww

healthcare system