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Regional Health Information Organizations (RHIOs)

Regional Health Information Organizations (RHIOs) The Primary Vehicle for Achieving the National Health Information Network (NHIN) Presented by: Holt Anderson Executive Director, NCHICA. Presentation Outline. The National Framework The Request for Information (RFI) Speculative Definitions

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Regional Health Information Organizations (RHIOs)

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  1. Regional Health Information Organizations (RHIOs) The Primary Vehicle for Achieving the National Health Information Network (NHIN) Presented by: Holt Anderson Executive Director, NCHICA

  2. Presentation Outline • The National Framework • The Request for Information (RFI) • Speculative Definitions • Emerging Models for RHIOs • NCHICA as one possible RHIO model • Examples of Collaborative Activities and Challenges Incurred • Q & A

  3. Obstacles to a Universal EHR • the multitude of industry standards that have yet to be harmonized, • a lack of clear and unambiguous policies about data control, • differing security policies among organizations and states, • the risk that EHR products won't work as promised; and • the lack of a business model that creates incentives for physician investment and adoption. David Brailer, ONCHIT, AMIA Conference, April 2005

  4. Framework for Strategic Action • Inform clinical practice with use of EHRs • Interconnect clinicians • Personalize care with consumer-based health records and better information for consumers • Improve public health through advanced biosurveillance methods and streamlined collection of data for quality measurement and research

  5. Request for Information US Dept. of Health & Human Services Office of the National Coordinator for Health Information Technology Issued: November 15, 2004 Responses by: January 18, 2005

  6. Framework for Strategic Action • Inform clinical practice with use of EHRs • Interconnect clinicians • Personalize care with consumer-based health records and better information for consumers • Improve public health through advanced biosurveillance methods and streamlined collection of data for quality measurement and research

  7. The RFI • Addresses goal of interconnecting clinicians by seeking public comment and input regarding how widespread interoperability of health information technologies and health information exchange can be achieved.

  8. Why Interoperability • Interoperability is necessary: • for compiling the complete experience of a patient’s care • for maintaining a patient's personal health records, and • for ensuring that complete health information is accessible to clinicians as the patient moves through various healthcare settings.

  9. Why Interoperability(cont.) • Interoperability is needed for clinicians to make fact-based decisions so medical errors and redundant tests can be reduced. • Interoperability is also critical to cost-effective and timely data collection for biosurveillance, quality measurement and clinical research.

  10. NCHICA RFI Response Participants Duke Univ Hlth System Initiate Systems Internet2 Keane LabCorp MRNC NC DHHS NCHIMA Physicians EHR Robeson Co Med Soc RTI International Siemens Smart & Assoc Telumenous UNC SPH Western NC RHIO

  11. Disclaimer • The NHIN and RHIOs are a new but important concepts • Definitions are not firm at this time • Public input is being sought by the Office of the National Coordinator for Health Information Technology (ONCHIT)

  12. NHIN • National Health Information Network (NHIN) • A supportive, nation-wide, interoperable system with the capacity to exchange conveniently and securely healthcare information culminating in the improvement of consumer health and the reduction in healthcare costs.

  13. RHIO • Regional Healthcare Information Organizations (RHIO) • A collaborative, consumer-centric organization focused on facilitating the coordination of existing and proposed e-health initiatives within a region, state, or other designated local area.

  14. Types of RHIOs • Federations • Includes large, “self-sufficient” enterprises • Agreement to network, share, allow access to information they maintain on peer to peer basis • May develop system of indexing and/or locating data (e.g., state or region-wide MPI)

  15. Types of RHIOs (cont.) • Co-ops • Includes mostly smaller enterprises • Agreement to pool resources and create a combined, common data repository • May share technology and administrative overhead

  16. Types of RHIOs (cont.) • Hybrids • Includes combinations of Federations and Co-ops • Agreement to network, share, allow access to information they maintain on peer to peer basis • Allows aggregation across large areas (statewide or regional

  17. RHIO Structure • 501(c)(3) Nonprofit • Eligible for Federal and State Grants • Contributions may be tax deductible as charitable • Issues: • Limit of ~20% on income from “unrelated business” activities (i.e. not charitable and educational) • May need to subcontract or otherwise handoff operational aspects of activities

  18. Key Allies for a RHIO Include: • Covered Entities (Providers, Health Plans, Clearinghouses) • Medical Society • Hospital Association • Nurses Association • Health Information Management Assn. • Medical Group Managers Association • Healthcare Financial Management Association • Association of Local Health Directors • Association of Pharmacists • Long-term Care Association • Association of Health Plans • QIOs • Vendors • Etc., Etc.

  19. RHIO Management VIDEO CLIP

  20. NCHICA as One Possible RHIO Model

  21. NCHICA Background • Established in 1994 by Executive Order of Governor • 501(c)(3) nonprofit - research & education • 250 members including: • Providers • Health Plans • Clearinghouses • State & Federal Government Agencies • Professional Associations and Societies • Research Organizations • Vendors and Consultants • Mission: Improve healthcare in NC by accelerating the adoption of information technology

  22. Terms of Membership A fundamental purpose of NCHICA is to: • facilitate the development of a statewide healthcare information network incorporating • open architecture • interoperable systems, and • reconfigured information systems.

  23. Terms of Membership (cont.) Applicant agrees to support the following principles: • to foster interoperability and open-systems architecture • to work in good faith to integrate existing healthcare information systems • to provide expert personnel to support the activities of NCHICA in the spirit of collaboration • to support policies adopted by NCHICA to protect intellectual property • to encourage a competitive environment for the development of the information, telecommunications, and telemedicine industries in North Carolina consistent with NCHICA's purposes.

  24. Successes and Challenges Raised in NCHICA Projects

  25. Characteristics of Projects • All have evolved from earlier efforts • All are statewide efforts • All involve public and private sector • All build toward a North Carolina “Local Health Information Infrastructure” and are positioned to connect into national PHIN and NHIN efforts • Expectation is for continued evolution and refinement

  26. Statewide Master Person Index • 1994 Goal: • Develop Voluntary Patient Information Locator (VPIL) so that records could be accessed for care • Business / Policy: • Shared “customer lists” • Legal: • Privacy & Liability • No State or Federal Laws covering electronic health info • Consumer: • Privacy • Technical: • Availability of standardized MPIs from all providers and sectors • Synchronizing databases • Standards for data

  27. Statewide Master Person Index • Lessons Learned: • Technology is the easy part • Business and Policy Considerations are much harder and “Show Stoppers” • Develop clinical leadership for project with technologists in support role

  28. HIPAA Efforts • 1995-1999 Privacy & Confidentiality Focus Group • Model Privacy Legislation • 1998-2003 HIPAA Implementation Planning Task Force • 1998-Present • Privacy Work Group • Security Work Group • Transactions, Code Sets and Identifiers Work Group • Privacy & Security Officials Work Group • Deliverables: Compliance tools, model documents, education and training programs • and, method of building community consensus

  29. Statewide Immunization Registry • 1998 Goal: • Combined registry of public and private children’s immunization records from multiple sources available via secure Internet • Business / Policy: • Internet access to public health database • Legal: • Privacy and Security • Non-stigmatizing data • Consumer: • Well understood need • Technical: • Data quality and matching entries from different sources • Move from mainframe to server with SSL Web technology and authentication

  30. Statewide Immunization Registry

  31. Statewide Immunization Registry Status • Combined Database • Public Health • BCBSNC • Kaiser Permanente (historical) • ~ 2M Children • ~ 20M doses • 425 sites; 2250 authenticated users • 90 Local Public Health Departments • 335 Private Providers, Schools, State of TN

  32. New Statewide Immunization Registry

  33. Statewide Immunization Registry • Lessons Learned: • Choose project with clear benefits • Find clinical champions • Enlist CEO-level champions • Share the load • Celebrate success • PKI is not like falling off a log • Proof is in the utility of the project and user demand for sustaining it past pilot stage

  34. Statewide Emergency Dept. Database • 1999 Goal: • Standardize and electronically collect clinical data from emergency departments for: • Best Practice Development & Community Assessments • Public Health Surveillance (2001) • Business / Policy: • Participation Agreement covering access and use of data • Legal: • Privacy and Security • No state mandate for collection of certain data elements with identifiers (Limited Data Set and Data Use Agreement) • Consumer: • Collected and transmitted to aggregation point as deidentified data • Technical • Standards for data elements (CDC’s DEEDS Standard) • Mapping of systems so extracts could be transformed into DEEDS • No standards for coding of Chief Complaint and First Report of Injury

  35. Status as of 1-31-2005: Statewide Emergency Dept. Database • Data from 24+ hospitals • 4000+ visit records per day on average • Total Number of Visits: 1.6M + • Total Number of Patients: 875K + • Total Number of Final Diagnosis Codes: 4.2M + • Total Number of Cause of Injury Codes: 478K + • NCHA now involved to accelerate collection from all 124 hospitals with EDs across NC

  36. Statewide Emergency Dept. Database • Lessons Learned: • Provide neutral table for collaboration • Make it easy for IT Departments to provide data • Keep it simple and cheap • Expect new opportunities for data use • Professional associations are better at policy issues than technology implementation • While HIPAA is permissive, providing information voluntarily (e.g. without safe harbor) makes legal counsel very uncomfortable

  37. NC Public Health Initiatives • NC-PHIN • North Carolina Public Health Information Network • NC-HAN • North CarolinaHealth Alert Network

  38. Vision: Framework for the Future NC-PHIN • Automated electronic reporting of data • Secure Internet pipeline for reporting information • Consistent user interfaces • Common data definitions • Reusable software components • Shared analysis and dissemination methods, e.g., outbreak detection algorithms • Secure, HIPAA-compliant data warehouse • Established set of technical standards acceptable and adopted by preparedness partners

  39. NC-PHIN Components Health Alert Network NC-HAN Epi-X (secure interactive communications with CDC and other states) Enhanced Public Health Surveillance Electronic Disease Reporting Hospital Data (ICD-9, UB92 Admin. Data) Syndromic Surveillance Hospital Clinical Data Poison Control Center PreMIS Aberrancy Detection Medical Examiner Data Program Area Modules TB Hepatitis Meningitis HIV/STD Vaccine Preventable Diseases Immunization Registry Multi-Hazard Threat Database GIS Electronic Laboratory Results (LRN) Vital Records Automation

  40. Public Health Initiatives • Lessons Learned: • HAN starts us on the path to connectivity • Connectivity drives additional opportunities • Use immunization registries to drive public-private connections • EHRs have potential of improving surveillance capabilities and improving population and public health

  41. North Carolina Healthcare Quality Initiative Improving Healthcare in North Carolina by Accelerating the Adoption of Information Technology

  42. NC Healthcare Quality Initiative • Goal: • Phase I - Provide list of medications at point of encounter to save time, improve accuracy of treatment and avoid medication errors • Include ability to automate refills, e-Rx, and access to formularies • Phase II – Electronic handling of Lab and Radiology data • Business / Policy: • Access to data from health plans, PBMs, pharmacies and other providers • Cost of operation; Sustainability • Legal: • Privacy and Security (limit use to Treatment) • Rights to data; Liability • Consumer: • Who has been looking for and at my information? • Drugs for behavioral health, communicable diseases, etc. • Technical • Accessing records from multiple sources and linking same patient data

  43. Medications Management • Key attributes: • Saves clinician’s time (10%-40% of encounter) • Improves patient safety • Leads to automating medication refills • Leads to e-Prescribing • Example: Medicare Population • 20% have 5 or more chronic conditions • Those 20% see on average 13.5 different physicians per year • Potential for prescribing errors, duplication of orders, tests, etc. • Chronic Care accounts for 70%-80% of expenditures

  44. Medications Management Initiative • Important data in emergent cases • Frequently not available • Identifies current medical conditions • Avoids inappropriate drug-drug interactions • Currently kept by different repositories • Pharmacy claims • Health Plans • Patients • Requires policy and technology solutions • Privacy and Security considerations • Business and collaboration considerations • Technology issues: • Data Quality • Networked databases • Data repository vs. Portal technology

  45. Medications Management Initiative IdentityHub/Repository Administration Inquiry History Database Patient Data Sources PBMs Pharmacies Health Plans, including NC Medicaid Regional Hospitals Regional Clinics Community Database Medicare Community Medication History Portal Electronic Prescriptions & Refills Presentation Web portal eRx EHR EAI Data Integration IDENTITYHUB INQUIRY HISTORY DATABASE Transaction Services RxHUB SureScripts Direct

  46. NC HC Quality Initiative - Project Management

  47. Proposal Development Teams • Technology • Technical approach, diagrams • Clinical Integration • Clinician role and adoption and consumers role, adoption, satisfaction • Business / Finance • Business Model, budgets and justification • Policy • Role of patients, agreements • Metrics • Assess value of project • Coordination • Executive Summary, letters of commitment, etc.

  48. Values for the Transition • Keep the health and safety of the individual as the core objective. • Use RHIOs as an opportunity and vehicle to transform healthcare into a more effective and efficient system. • Promote clinical and business benefits of information technology and secure communications .

  49. Generating RHIO Proposals for Funding • Lessons Learned: • Understand the requirements from the funder e.g.: • Contract or Grant • WMOB Subcontracting • Principal Investigator • Cognizant Auditing Agency • Time commitment of team to develop proposal: • Limited capabilities of volunteers with primary responsibilities elsewhere • Technical & Clinical Expertise • Policy and Business Requirements • Privacy & Security • Shared information among competitors • Commitments from top executives (private and government) • Educate and Obtain Commitment

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