Factors for Creating a Successful RHIO / HIE

1. Beena Joy Paul Kuo MariJo Rugh David Sumner Factors for Creating a Successful RHIO / HIE 498DL Winter 2011

2. Examining Goals for RHIOs / HIEs • 3 State review • Technical and non-technical concerns • Structure and Governance • Data Security and Standards • Consent Management • Adoption

3. Motivators Compliance with mandates (eg, e-prescribing) e-Billing mandates Pay-for-performance incentives Improved coding and direct links to payers Time savings from direct electronic reporting Increased payment if quality goals are met Cost savings to public and private health plans Altruistic goal to improve public health Quality of care and patient safety Increased operational and clinical efficiencies Barriers Lack of interoperability Lack of vision and goals Security and privacy concerns Cost Creating a successful business model Limited technical support Provider Participation

4. Business Models • Membership/subscription • Transaction fees • Sales/revenue • Affiliate/revenue • Advertising revenue • Greatest potential • Hybrid membership/subscription and transaction model

5. Overview Center for Health Transformation. (2010) http://www.grrhio.org/about/~/media/HIE_For_A_New_Generation.ashx

6. Illinois HIE Illinois Office of Health Information Technology, 2010 http://www.hie.illinois.gov/assets/hiesop.pdf

7. Illinois HIE • General Architecture- De-centralized, federated, 3-layer • Financial Model- ARRA plus public-private partnership; mechanism ??

8. Illinois HIE • Clinical Messaging Future • Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) Future • Delivery of Structured Lab Results Operational (61%) • Electronic Order Entry Future • ePrescribing and Refill Requests Operational (89%) • Quality Reporting Future • Patient Portal Future • Repository Services Future • Eligibility and Claims Operational (44%)

9. Illinois HIE • Connectivity to NHIN • 2012 – 2014 ?

10. Illinois HIE Illinois Office of Health Information Technology, 2010 http://www.hie.illinois.gov/assets/hiesop.pdf

11. Indiana HIE • Five existing independent, private-sector, regionally-based HIOs • Each of which has been operational and sustainable for at least five years • Accounts for more than 12 million patient records and 12,000 physicians

12. Indiana HIE Mission/Vision VanZee, 2010 www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf

13. Indiana HIE Services • Clinical Messaging and Electronic Results Delivery (HL7 Standard) • Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) • Electronic Order Entry • ePrescribing and Refill Requests • Quality Reporting • Patient Engagement (Patient Portal) • Repository Services • Interoperability / Shared Provider Directories / Master Patient Indexes • Eligibility and Claims

14. Indiana HIE Standards

15. Indiana HIE – Moving Forward • Connectivity to NHIN – existing HIOs have established connectivity

16. Indiana Infrastructure VanZee, 2010 www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf

17. Mission Overview of the WI Demographics 4 Operational HIEs WHIE OCHIN, Inc CHIC UNIVERSATA, Inc State-Level HIE Planning and Design Phase 1 Phase 2 Wisconsin HIE

18. Wisconsin HIE • Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) Operational (Epic) • Delivery of Structured Lab Results Operational • Electronic Order Entry Operational • ePrescribing and Refill Requests Operational • Public Health Reporting Operational • Electronic Lab Reporting of notifiable conditions • Syndromic Surveillance • Immunization Data • Eligibility and Claims Operational

19. HIE Strategic & Operational Plan Profile

20. Wisconsin HIE Architecture Wired for Health Board, 2010 http://wiredboard.wisconsin.gov/SOP01.25.11Posted.pdf

21. State Contrasts • IL, IN Federated – WI Hybrid models • IN, WI Clinical Messaging - Operational • IN, WI Electronic Order Entry – Operational • IN, WI Quality Reporting - Operational • IN Patient Portal – Operational • Technical standards - Essentially matching

22. HIE Functionality Required for Meaningful Use 2011 • Electronically capture health information in a coded format • Use that information to track key clinical conditions • Communicate that information for care coordination purposes 2013 • Encourage the use of HIT for continuous quality improvement at the point of care • Exchange HIT information in the most structured format possible. 2015 • Promote improvements in quality, safety and efficiency • Focus decision support for national high priority conditions • Enable patient access to self management tools • Access to comprehensive patient data • Improving population health

23. Recommendations for new RHIOs • Commitment to the RHIO is a process • Don’t give away services • Vendor-neutral architecture • Understand requirements • Encourage adoption • Plan for consent management • Base the solution on HIT and IT standards

24. Conclusion: On Our Way to Sustainable HIE • Early failures and successes have laid the road bed for the future • State strategies further the construction • Advancements in technologies and standards are removing the barriers • Additional opportunities/gaps to be addressed

25. Feedback Welcomed! • Questions?