Health Information Exchange Meaningful Use and Beyond

1. Health Information ExchangeMeaningful Use and Beyond Bob Hoyt MD Haas Center University of West Florida

2. Learning Objectives • After completion of the presentation, participants should be able to: • Explain how health information exchange is part of the national HIT strategy • Describe how HIE is part of meaningful use • Enumerate the newest HIE features • List the significant challenges facing HIE today

3. Disclaimer • I have no conflicts of interest to report • I am working with Dr. Rick Harper of the Haas Center for Business Research and Economic Development, under an ONC grant to study health information exchange in Pensacola, Florida

4. Definitions • HIE: “electronic movement of health related information among organizations according to nationally recognized standards” • HIO: “overseas and governs the exchange of health related information among organizations according to nationally recognized standards” • RHIO: “brings together healthcare stakeholders within a defined geographic area and governs HIE among them for the purpose of improving healthcare in that community”

5. Why is HIE an important topic? • Part of Meaningful Use and the $29 billion EHR reimbursement program • $548 million from ARRA spent to support the State HIE Cooperative Agreement Program • Promoting HIE is one of the goals of the 60 Regional HIT Extension Centers • Health information exchange is integral to the Nationwide Health Information Network (NHIN)

6. Multiple Sources + Uses of Data

7. The HIT Trifecta

9. State HIE Cooperative Agreement Program • ARRA program to support statewide and interstate HIE • In 2010 $548 million funded 56 state designated entities (SDEs) • Four year grants with requirement for states to match a portion of grant awards by the second year. By Oct 1 2012 states must match $1 for $3

10. FHIE • Florida received $20.7 million in 2010 • Federated model with shared record locator service (RLS) • Vendor to be selected by Nov 1 2010 • Early limited go-live date March 2010 • Eventually will establish subscription model for all participants

11. FHIE • Services (matches meaningful use): • Eligibility and claims • E-prescribing and refill requests • Lab ordering and results delivery • Public health reporting • Quality reporting • Prescription fill status reports • Clinical summary exchange • Disaster preparedness

12. Florida HIOs • 20 HIOs exist in Florida but none are at an advanced level (stage 6 or 7)

13. What is the status of HIOs in 2010?

14. 2010 HIE eHealth Initiative Survey • An annual self-reported survey • According to the report approximately 250 HIOs exist in US • 73 are said to be operational (exchanging something) • 18 are sustainable (operational, no federal support in last year and at least broke even)

15. Stages of Development { Operational }

16. Stages 5-7 (operational)

17. Operational Status

18. Stakeholders

19. Revenue Sources

20. Revenue Sources

21. Federal Funding

22. Helping to meet Meaningful Use

23. Operational Initiatives

24. Other Functionalities

25. Other Functionalities

26. Opt-in/Opt-out Policies • 61 HIOs have global level policies • 36 HIOs have organizational level policies • 34 HIOs have provider level policies • 14 HIOs have emergency level policies • 13 HIOs have individual data element level policies

27. HIE Basic (>50%) Features • Clinical messaging (electronic test results delivery) • Lab and radiology results • Medication data • Outpatient visits • ER visits • EHR connectivity • Clinical documentation • Alerts to Physicians

28. HIE Advanced (<50%) features • E-prescribing • Electronic health record-HIE combo • Public health reporting • Telemedicine: teleradiology and telehomecare • Medication reconciliation • ER utilization data • Transcription • Voice recognition • Business analytics/intelligence • Value-based reimbursement (P4P) • Credentialing • Research • Clinical decision support • Consumer portal • Claims clearing house • Care coordination

29. Perceived Benefits

30. Case Study:HealthBridge

31. HealthBridge www.healthbridge.org • Not-for-profit HIO that began in 1997 • Located in Cincinnati, Ohio and now covers four states • They partner with three other HIOs: HealthLINC, Collaborating Communities Health Information Exchange and Northeast Kentucky Regional Health Information Organization

32. HealthBridge www.healthbridge.org • Also a Regional HIT extension center and a Beacon Community • Did not require initial federal funding • Does not charge physicians to use the exchange or EMR Lite™ • Nationwide Health Information Network (NHIN) participant

33. HealthBridge • HealthBridge provides connectivity for more than 28 hospitals, 5500 physician users, 17 local health departments,  700 physician offices and clinics, as well as nursing homes, independent labs, radiology centers • They deliver approximately 3 million clinical messages (laboratory, radiology, transcription and ADT) to more than 5500 physicians EACH MONTH. • HealthBridge represents nearly 95% of the hospital sector activity in the Cincinnati region.

34. HealthBridge • Connectivity to 26 different ambulatory EHR systems • Access to 60+ hospital based images, fetal heart monitoring data and inpatient EHRs • Since 2000 has used push technology • Uses Mirth Mux to connect to the NHIN

35. Health Bridge

37. EMR Lite • HealthBridge offers a very low cost web-based EMR that is part of the HIO which means data can be pushed or pulled • They also interface with multiple other EHRs • If a physician doesn’t have an EHR, they can dynamically create a virtual health record (VHR) which means data is pulled from all sources to create a summary (< 2 seconds)

39. Mirth MUx • Open Source integration engine, CDR, MPI and CONNECT software to connect to the NHIN • Much faster and cheaper alternative

40. HIO Challenges

41. Future HIE/HIO Trends • Look for more partners to share the load such as chronic care facilities, home health, hospice, etc. • Combine clinical data with administrative and financial data: Utah Health Information Network, New England Health Exchange Network and NaviNet

42. NaviNet SaaS Model

43. Future HIE/HIO Trends • Look for more consumer oriented functionality • 44 HIOs allow patients to view data • 31 HIOs allow patients to contribute data

44. What might a future HIO look like? Complete System Fully Integrated in the Cloud NHIN Payers Research Claims Financial HIO Business Analytics Public Health Patient Portal Practice Management System EHRs

45. Conclusions • The US has invested heavily in HIT; primarily to support EHRs and HIE • Based on prior experiences we will see many successes and failures • Under the right circumstances (e.g. HealthBridge) HIE becomes the glue that ties together disparate HIT into a cohesive system • Too soon to say HIE will improve patient outcomes • Less expensive/complex alternatives are probably necessary (e.g. Mirth MUx)