2013

1. Is HIE the New EHR? 2013 Julie A. Dooling, RHIT Senior Project University of Cincinnati Bachelor of Science in Health Information Management

2. Learning Objectives • Examine the history and definitions behind health information exchange (HIE). • Compare and contrast various types of HIEs operating in the industry today. • Explain the technology choices being used to transport data and information between healthcare providers. • Describe “meaningful choice” and identify potential changes to use and disclosure of protected health information (PHI). • Discuss the future of HIE and what it means to the HIM professional in terms of challenges and opportunities.

3. Audience Poll

4. History of HIE • Institute of Medicine (IOM) report: • To Err is Human – 1999 • Crossing the Quality Chasm - 2001 • National Committee on Vital and Health Statistics (NCVHS) • Information For Health - 2001 • The Office of the National Coordinator (ONC) established in May, 2004. • Coordinates a variety of programs to implement HITECH and support several initiatives to foster nationwide adoption of health IT. • Nationwide Health Information Network or the NwHIN is one of those initiatives. http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc_initiatives/1497

5. What is HIE and Why? Health Information Exchange Refers to the process of reliable and interoperable electronic health-related information sharing conducted in a manner that protects the confidentiality, privacy and security of the information. http://www.ahima.org/resources/hie.aspx

6. HIE is a Verb… • HIE is a verb, not a noun” • FarzadMostashari, National Health IT Coordinator • “.. Sustainable HIE.. Focuses on verbs – the actual exchange – not nouns – the organizations set up to facilitate the exchange”. Aneesh Chopra, former U.S. Chief Technology Officer • Verb: The electronic sharing of health-related information among organizations • Noun: An organization that provides services to enable the electronic sharing of health-related information http://www.healthit.gov/providers-professionals/health-information-exchange?utm_source=google&utm_medium=cpc&utm_campaign=technology http://www.healthcare-informatics.com/blogs/jennifer-prestigiacomo/aneesh-chopra-sustainable-hie-focuses-verbs-not-nouns?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+healthca-�informatics+%28Healthcare+Informatics%29

7. Why?

8. Current Drivers To Change • More Data Please…..

9. Current Drivers to Change • Meaningful Use • Improve quality safety and efficiency of health care • Making information available to support patient care where ever the patient is located • > 40% of all outpatient visits involve a transition * Rudin R, Salzberg C, Szolovits P, Volk L, Simon S, Bates D. Care transitions as opportunities for clinicians to use data exchange services: how often do they occur? J Am Med Inform Assoc. 2011;18(6):853–8

10. Current Drivers to Change Meaningful Use Stage 2 Emphasizes importance of HIE

11. Pop Quiz! • Q: Who is the National HealthIT Coordinator? • A: Farzad Mostashari Courtesy of www.hhs.gov

12. Data and Information • “..for information to follow a patient where and when it is needed, across organizational, vendor, and geographic boundaries”.

13. Data and Information • “Accurate Data, Excellent Care” • AHIMA HIP Week March 17-23 • Emphasis on Data: • Big Data • Dark Data • Data, Data, and More Data

14. Data and Information • There will be an increased need for accurate and available health information

15. Pop Quiz! • Fill In The Blank: There will be an increased need for accurate and _________ health information. • A: Available Courtesy of www.hhs.gov

16. Changes to Health Information Exchange (HIE) Timeline • Federated Model • Non-federated • Centralized • Health Data Banks • Clinical data Exchange Cooperative • Direct Project Pilots • Health Information Organization (HIO) • PCAST reports begins discussion of metadata for P&S • HIE, RHIO, Private or IDN HIE • Government-Led HIE • HIE Public Utility • Private Sector led HIE • ARRA/HITECH Act 2007 2008 2009 2010 2011 2012 • State Level HIE • Regional Health Information Organization (RHIO) • HIEs • Health Record Banks • Noun Vs. Verb moved focus of discussions • Data Segmentation for Privacy (DS4P) • **3 Key Forms of HIE • ONC awarded grants to State Designated Entities (SDEs) • HIE with emphasis on opt-in/opt-out

17. Structure, Types and Models • Directed Exchange: • Ability to send and receive secure information electronically between care providers to support coordinated care • Query-based exchange: • Ability for providers to find and/or request information on a patient from other providers, often used for unplanned care • Consumer Mediated Exchange: • Ability for patients to aggregate and control the use of their health information among providers

18. Structure, Types and Models • Private, Enterprise or Integrated Delivery Network HIE • May share same electronic health record (EHR) technology or • May contract with HIE technology vendor to provide integration services to link local, regional or state HIEs.

19. Data Transport

20. Transport • Direct Project • Requirement in Stage 2 • Push technology; one-directional electronic messaging • Exchange at local and less complex level among trusted providers in support of Meaningful Use

21. Transport • CONNECT software solution • Free open source software solution that supports both local and national level exchange • Coordinated through the Federal Health Architecture program under the ONC • Patient consent obtained • Patient Lookup (PLU) is performed via EHR or HIE portal • Continuity of Care document (CCD) is retrieved from list

22. Transport • What is the CCD? Continuity of Care Document • Includes: • Patient Summary • Core data sets containing demographics and clinical information • Allow for aggregation to enable sharing, especially when patients transition from one care setting to another http://www.fortherecordmag.com/archives/121911p14.shtml

23. Pop Quiz • Q: What does CCD stand for … • A: CCD stands for Continuity of Care Document.

24. Challenges and Opportunity • KCHIMA Audience Responds: • Opportunities/Positives: • Information available during disaster • Sharing same accurate data • Enhance patient outcomes • Decrease costs/duplication/retrieval • Verify allergies immediately • Challenges: • Data Integrity with MPI • Corrections • Facilities are asking for more than the CCD • Privacy and Security • Hackers and Viruses

25. Top 5 Barriers • Privacy and Security • Direct Project • Meaningful Use • Competition and Fear • Harnessing Big Data for practical use

26. Meaningful Choice • ONCs Patient Consent Standardization Project Objectives: • Educate and inform individuals of their option to give individual choice in a clinical setting to share their health information electronically • Ensure that individuals are knowledgeable participants in decisions about sharing their electronic health information in a clinical environment

27. Meaningful Choice • Program Information Notice (PIN) • Outlines Privacy and Security for exchanging health information • Outlines designation of family member, caregiver, domestic partner or legal guardian to make decisions on their behalf.

28. Meaningful Choice • Choice is made with advance knowledge/time • Not used for discriminatory purposes or as a condition for receiving medical treatment • Choice is made with full transparency and education • Commensurate with circumstances for why individually identifiable health information (IIHI) is exchanged • Consistent with patient expectations • Revocable at any time

29. Integrity • Data Integrity: • What are the practices for timeliness, exchange, matching/linking, use and reuse, disclosure and re-disclosure, privacy protections, update corrections, amendment, quality control, retention, destruction…? • Must include a strong strategies of governance and stewardship

30. Integrity • The Ability to Accurately Link (match) multiple, disparate records relating to a single individual Identity Management • 2008 Rand Report • “avoiding adverse drug events, which are often the result of incomplete linking information about a patient’s medications or allergies, could save the healthcare system in the US about $4.5 billion per year”.

31. Integrity Master Patient Index Error Rates • Enterprise duplicate rates were reported to be as high as 39.1% • Often the result of unresolved duplicate records from contributing MPI files.

32. The Future of HIE Strategy and Governance Changing Market Needs Technology and Process Consumer Driven Healthcare Analytics and Managing the Data

33. Summary • HIE is an evolving territory • Growth tied to various initiatives • Structure and landscape continually changing • Strong governance and stewardship needed • Data integrity, identity management and meaningful choice is critical to ensure accurate and complete information

34. Questions? Thank you. Julie A. Dooling, RHIT juliedooling@ymail.com

35. Resources • AHIMA. (2013). Understanding the HIE Landscape . Journal of AHIMA, 56-63. • AHIMA. (2013) Segmenting Data Privacy: Cross-industry Initiative Aims to Piece Out Privacy Within the Health Record. Journal of AHIMA, 34-38. • AHIMA. (2012). Ensuring Data Integrity in Health Information Exchange. Chicago : AHIMA. • AHIMA/HIMSS Trends in Health Information Exchange Organizational Staffing • Julia Adler-Milstein, P. A. (2012). Sharing Clinical Data Electronically, A Critical Challenge for Fixing the Health Care System. The Journal of the American Medical Association, 1695-1696.