L. Philip Caillouet PhD FHIMSS Louisiana Center for Health Informatics

1. IABPAD Las VegasEvaluation ofHealth Information Exchange Deployment:Is Success in the Eye of the Beholder? L. Philip Caillouet PhD FHIMSS Louisiana Center for Health Informatics The University of Louisiana at LafayetteOctober 26-27, 2012

2. Outline of This Presentation • Introduction • Defining “Success” in Health Information Exchange • Who Benefits from Specific HIE Functionalities? • Defining “Success” for Each HIE Functionality • Conclusions • References

3. Introduction

4. HITECH, HIT, & EHRs • The Health Information Technology for Economic and Clinical Health (HITECH) Act, embedded as it was in the American Recovery and Reinvestment Act (ARRA) of 2009 – i.e., the “Stimulus Act” – seeks to encourage widespread deployment of health information technology (HIT) in the U. S. healthcare delivery sector. • Deployment means not merely installation of equipment and implementation of systems, but also full adoption of HIT by physicians and other healthcare providers – what has come to be known as “meaningful use” (MU). • Broadly defined, HIT employs computer and communication technologies for clinical, administrative, and financial applications thereof. • Electronic health records (EHRs) are a key aspect of HIT in that these provide the mechanism whereby healthcare providers can record and retrieve information about each patient in their care.

5. HIEs • Health Information Exchanges (HIEs) are another key aspect of HIT, focused on transmission of EHR-sourced data among healthcare providers, confidentially and only in preauthorized circumstances, for the benefit of their common patient. • HIEs might also be used to expedite the forwarding of patient-specific or aggregated de-identified information from a healthcare provider to payors, to regulators, or to government public health agencies as may be required by contract, rule, or law. • HITECH’s “encouragement” is managed by the U. S. Department of Health and Human Services (DHHS) through the Office of the National Coordinator for HIT (DHHS-ONCHIT) and is notably manifested in the form of incentive payments from the Centers for Medicare and Medicaid Services (DHHS-CMS) that may be claimed when MU can be documented.

6. After HITECH Seed Money Expires? • As CMS incentives expire, “encouragement” is anticipated to evolve into penalties for failure to show MU. • Measuring the overall effectiveness of these “encouragement” strategies will be a complex undertaking for public policy analysts who must rely on measurement of the relative success of each and every distinct regional HIE, itself a measure of the aggregate success of EHR adoption among providers within the HIE’s scope. • If success – like beauty – is in the eye of the beholder, then there are many eye exams and vision checks ahead.

7. Defining “Success” in Health Information Exchanges

8. A Vision for Success of HIE … a future in which information technology is employed to enable healthcare providers (i.e., professionals and institutions), patients, payers, regulators, and public health agencies to be in full and instantaneous communication with full access to all current and historical information (but only as authorized by the rightful owner – usually the patient), to suit the various purposes of each party in the provision of effective care efficiently, in the management of public policies regarding need and care patterns, and in the expeditious compensation of costs where risk sharing agreements exists. (Caillouet 2011)

9. Healthcare Information: A State of Confusion!?! Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services PHOs Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. IPAs Us! ASO TPAs Network & Care Mgrs. Credit Bureaus Claims Assistance Financial Services Insurers

10. Healthcare Information: Order from Chaos? Equip. Mfrs. Peer Review Orgs. Federal & State Gov’t. Hospitals Data Services Suppliers Fiscal Inter- mediaries Employers, Unions, & Assns. Drug Mfrs. Physicians Pharm. Benefit Mgrs. ASO TPAs Network & Care Mgrs. Credit Bureaus Claims Assistance Financial Services Color Key: Clinical (specific) Clinical (summary) Financial Administrative Patients Insurers

11. Will We Live Happily Ever After? Enter Healthcare Reform andHealth Insurance Reform Accountable Care Organizations? Coordinated Care Networks? National Health Information Infrastructure? Meaningful Use? … one more time ...

13. Who Benefits from Specific HIE Functionalities”

14. HIE Participant Classes • Providers • Physicians • Hospitals • Pharmacies • Payors • Insurers • Medicare & Medicaid • Patients • Regulators • Public Health Agencies

15. Use-Case Scenarios • Use-Case Scenarios for ambulatory care • Pre-Arrival • Point of Arrival • Point of Care • Point of Departure • Post-Departure • Use-Case Scenarios for acute care • Use-Case Scenarios for disaster evacuations

16. Ambulatory CareUse-Case Scenarios

17. Ambulatory CareUse-Case Scenarios(continued)

19. Table 1. “Pre-Arrival”Uses of Information Exchanged in an HIE

20. Table 2. “Point-of-Arrival”Uses of Information Exchanged in an HIE

21. Table 3. “Point-of-Care”Uses of Information Exchanged in an HIE

22. Table 4. “Point-of-Departure”Uses of Information Exchanged in an HIE

23. Table 5. “Post-Departure”Uses of Information Exchanged in an HIE

24. Defining “Success”for Each HIE Functionality

26. Conclusions

27. This study suggests that ... • Benefits may accrue in various distinct areas and in varying degrees to each of the HIE’s diverse participants. • Certain participants may have no direct interest whatsoever in any but a very few specific HIE functionalities. • Participants who receive HIE transmissions are the principal beneficiaries of the exchange – receiver receives “value” only if they perceive utility. • If an unsolicited request for information arrives, the receiving participant is obliged to respond – a new burden or “cost-of-doing-business” in the electronic age. • Some unsolicited transmissions may be requests for services – “orders” – and the receiver has an opportunity to benefit by turning the order into collectible revenue. • An HIE “succeeds” when it offers the proper mix of functionalities that can strike a successful balance of “value” for “value” exchange among its participants. • Under-contributing functionalities may still find a long-term niche, especially when these co-exist with other functionalities that can subsidize their continuance. • With HITECH-funded HIEs just coming on-stream in 2012, there is a significant opportunity for researchers to further develop and test HIE evaluation techniques.

28. References

29. References • Caillouet, L. P. (2012). Health Information Exchange – A Public Policy Challenge for Healthcare Professionals and Administrators [revised]. International Journal of Business and Public Administration (IJBPA), Vol.9, No.2, Spring 2012, pp. 28-41. • Caillouet, L. P. (2011). Health Information Exchange – A Public Policy Challenge for Healthcare Professionals and Administrators. International Academy of Business and Public Administration Disciplines (IABPAD), Conference Proceedings, ISSN 1547-4836, Volume 8, Number 4, Memphis TN, October 28, 2011, pp. 664-675. • Center for Medicare and Medicaid Services (CMS). EHR Incentive Programs, with detail.Retrieved May 22, 2012, from https://www.cms.gov/ehrincentiveprograms/. • Center for Medicare and Medicaid Services (CMS). Physician Quality Reporting System – formerly known as the Physician Quality Reporting Initiative (PQRI).Retrieved May 22, 2012, from https://www.cms.gov/PQRS/. • Louisiana Health Care Quality Form (LHCQF). Louisiana Health Information Exchange (LaHIE) Strategic and Operational Plans. Retrieved May 22, 2012, from http://lhcqf.org/images/stories/LaHIE%20State%20Plan.pdf. • Office of the National Coordinator for Health Information Technology (ONCHIT). Federal Health IT Strategic Plan. Retrieved May 22, 2012, from http://healthit.hhs.gov/portal/server.pt/community/fed_health_it_strategic_plan/1211/home/15583.

30. Questions, Comments,or Suggestions? <caillouet@louisiana.edu> Learn more at http://lchi.louisiana.edu