Utah Health Information Network

Utah Health Information Network Jan Root, Ph.D. Assistant Executive Director June 2005, AHRQ Annual Meeting

UHIN: CHIN to RHIO • In operation since 1993 (CHIN) • Community-based; inclusive • Providers, payers, gov’t • Statewide network • Not-for-profit • Self-sustaining • Began with what members thought would bring the most value: claims

UHIN Does • Make e-exchange of healthcare data possible: • Neutral trusted third party • Develop the IT & Governance infrastructure • Develop Standards • Reduce the cost of health care

UHIN Doesn’t • Go ‘inside’ office • No EMR • No quality of care improvement • No patient safety • No centralized data base • Utah DOH holds this function • UHIN is the pipeline

Logan- 59 Tremonton - 3 Brigham City - 19 Ogden – 149 Layton- 182 Bountiful- 105 Salt Lake City- 724 Vernal- 31 Heber36 Roosevelt- 17 Tooele-17 Orem/Provo- 235 Nephi-7 Price- 36 Delta - 4 Gunnison-19 Fillmore-2 Salina-3 Richfield- 12 Milford- 2 Moab-10 Beaver- 5 Bicknell-2 Monticello-3 Blanding-7 Cedar City- 39 St. George- 107 Monument Valley- 4 Kanab7 Current UHIN Coverage • ~50 million transactions/year • Gateway is redundant and mirrored • 3rd Party Payors’ Claims (450+ payers) • Medicaid and Medicare • Hospitals (100%) • Physicians/Clinics (85-90%) • Laboratories (100%) • Local Health Department (100%) • Mental health centers (100%) • Chiropractics (90%)

UHIN’s Success • Community decision-making • Pursue the value, non-profit business model • Use standards from the beginning • Make available to all

1. Community, Community, Community • Consensus building process • Every organization has ONE vote as an equal player • Value-based operation brings partners together • If we work together, everyone will be rewarded

2. Value = Business Model • Where is the money? Example: • Claim transaction: cost to a payer to bring in a claim • Paper claim = ~ $8 • Electronic claim = < $1 • UHIN charges = 20¢ • Payer saves ~ $6.80/e-claim • Community savings • As a Not-for-Profit RHIO, transaction volume goes up, average cost per transaction goes down for all stakeholders.

3. Standards, Standards, Standards • Use standards from the beginning • UHIN Standards Committee has been the key IT designing body • Community has donated ~ 1 million hours towards creating standards • Open standards-setting process for Utah standards • Actively participated in HIPAA standards development

4. Adoption for ALL • Goal: Bring value to everyone • Get everyone on board (low cost) • Everyone can play the same game (use standards) • Approach: low-tech and simple • Technical requirements are minimal • Baseline software offered to providers • Free product • Simple send/receive reports

Moving into Clinical • UHIN vision always included clinical exchanges • From the RHIO’s perspective: Health data is health data is health data • Goal: Bring value driven, non-profit business model to clinical exchanges

RHIOs • What should a RHIO be? • Only clinical exchanges? • Following slides are UHIN’s vision of a RHIO

Hospital Hospitals RHIO – Clinical X Hospital – Hospital RHIO Clinicians Clinics NHIO RHIO Clinics Integrated health care system Payers Providers Clinicians Provider Billing Services Payers Clearinghouse Payers Clearinghouse RHIO PBM Pharmacies Other orgs RxHub Pharm Hub Laboratories PBM Pharmacies DOH Banks

Hospitals Integrated health care system Hospitals Payers PBM RxHub PBM RHIO – Clinical X Hospital – PBM RHIO Clinicians Clinics NHIO RHIO Clinics Payers Providers Clinicians Provider Billing Services Payers Clearinghouse Clearinghouse RHIO Pharmacies Other orgs Pharm Hub Laboratories Pharmacies DOH Banks

Clinicians Clinics Hospitals Clinics Integrated health care system Hospitals Clinicians Pharmacies Pharm. Hub Pharmacies RHIO – Clinical X E-Prescribing RHIO NHIO RHIO Payers Providers Provider Billing Services Payers Clearinghouse Payers Clearinghouse PBM RHIO Other orgs RxHub Laboratories DOH PBM Banks

RHIO Clinicians Clinics NHIO Hospitals Clinics Hospitals Clinicians Pharmacies Pharm Hub Laboratories Pharmacies DOH CSDB RHIO Public Health Reporting RHIO Integrated health care system Payers Providers Provider Billing Services Payers Clearinghouse Payers Clearinghouse PBM RHIO Other orgs RxHub PBM Banks

Clinicians Clinics Hospitals Clinics Payers Providers Hospitals Clinicians Provider Billing Services Payers Payers DOH + UHIN Administrative Exchanges RHIO NHIO RHIO Integrated health care system Clearinghouse Clearinghouse PBM UHINet Pharmacies Other orgs RxHub Pharm Hub Laboratories Pharmacies PBM Banks

One connection gets you all needed messages RHIO Clinicians Clinics NHIO Hospitals RHIO Clinics Payers Integrated health care system Providers Hospitals Clinicians Provider Billing Services Payers Clearinghouse Payers Clearinghouse Other orgs PBM Pharmacies Pharm Hub RxHub Laboratories Pharmacies DOH PBM Banks RHIO (UHINet)

Physician to Hospital Medical necessity; Admissions; pre-natal reports current drugs; CCR Hospital to Physician Results; Discharge notes; lab results, ED admissions; ED labs and prescriptions transcription; dictation; CCR Doing It All Health Care Providers to Payers Claims, eligibility inquiries; claim status; lab results; CCR Public Health Reportable diseases Real-time; reduce public health burden; notice of disease outbreaks Pharmacy/PBMs E-Prescriptions; Formularies

UHIN and DOH • Goal: Create a single pipeline for health care entities to move many kinds of data including public health data to ease burden of reporting.

Major Challenges • Public perception of loss of privacy / control • Physician concerns about privacy • Building a business case • No killer app for clinical • Must build a collection of messages • Need uniform privacy law across the nation

Major Challenges • Competition • Community doesn’t compete on exchanging information • Compete on core services • Standards • RHIOs adopt community message and connectivity standards • Builds trust • RHIOs participate in national message and connectivity standards setting process

Utah Health Information Network