HIEs and the American Dream

1. HIEs and the American Dream Challenges, issues and successes in State level initiatives By Mark Jacobs Wellspan Health January 15, 2008

2. Necessity never made a good bargain. • Benjamin Franklin (born Jan 17, 1706)

3. Sustainability took only 300 Years

4. The HIE Party “Fragile AGGLOMERATION of Patient needs and a need for Positive Results” AHIMA HHS Access HITSP Security & HIPAA NHIN AHRQ HIMSS Privacy RHIOS Regulatory State Efforts HIEs State and Federal Involvement PHR Governors NHIN Market Adoption CCHIT EHR AHIC Use Cases Vendors Interoperability Gartner iHE Standards ONC Identity Management Hospitals Patients Payers Providers Physicians Banks Public Health

5. Major Struggles in HC • Cost • Struggled to care for the the poor and chronically ill patients • Chronic Diseases – i.e. Diabetes, Asthma, Heart Disease, and some cancers can be managed and can have a positive impact on lifestyles • Finding ways to use Technology since it can do so much for care

6. Challenges to Define

7. All things are cheap to the saving, dear to the wasteful $2,000,000,000,000 Source: Congressional Budget Office

8. $2 Trillion Dollars Empire State Building The Patient

9. "An ounce of prevention is worth a pound of cure,"

10. States share many of the same challenges • Fragmented healthcare delivery and financing environment. • Historic economic pressures and restructuring serve as challenges and drivers • Geographic, service scope and diversity call for coordinated local solutions • Health Information Technology delivery • Privacy Protection

11. Connecting Pennsylvanians for Better Health Outcome of Collaborative Efforts Foundational Governance Focus of Efforts Nationwide Health Information Network (NHIN) • Reducing HC Cost • Improving Patient Quality • Patient Safety • Strategies for HIT Adoption • Document Evidence of Benefits • Document Current HIT • Adoption Office of National Coordinator for HIT (ONC) Strategic Framework Certification of EMR Products • Guidance Tools for State Level HIEs • HIE Steering Committee • eHI Technology Workgroup • eHI • AHIMA - FORE • HIMSS • Gartner • Use cases • eHealth Initiative’s ConnectingCommunities • Certification Commission on HIT • HIT Standards Panel • Health Information Security & Privacy Collaboration • Nationwide Health Information Network (NHIN) Architecture Projects Standards American Health Information Community (AHIC) Privacy & Security • HIMSS Dashboard • Technology Tools • Education Use Cases Report – Prototype Architecture Contracts • Opportunities to use IT and HIT • Educate providers on HIT • Assist in coordination of HIT for PA • Standards • Work with providers for business case for HIE • Multi-stakeholder collaboration • 9 member Not-for- Profit / Board • Defined Mission &Purpose • Connecting PA for Better HealthStrategic Plan • 6 Standing Committees • Committees (BAT/CEC/Policy) • E-Prescribing Discovery Group • Local HIE Special Interest Group • Gather Information • Define Through ConsensusBaseline • Identify Best Practices • Disseminate to Broad Spectrum • of HC and Gov’t. Organizations • Governor’s Office - HIT Representatives • Governor’s HIT Commission (Pending) • Survey of HIT Capabilities • Legislation (Pending) • House Bill 700 – Re-engineer HC • Senate Bill 8 – Funding for Physician EMRs • Senate Bill 934 – RHIO Funding • Electronic Prescribing • Insurance Commissioner. (Ins. Cost/Quality) Quality Insights (QIO)CMS Contract for Physician EMR Adoption • Assess Hospital EMR Capabilities • For Internet Connectivity • - Physicians • - Providers State Level • Private & Security Solutions for HIE • State Alliance for Leaders for eHealth • ConnectTheDocs Hospital/PhysicianBroadband Assessment (PA Med Soc) • Best Practices for State Level HIE • Central Penn Geisinger, Shamokin (AHRQ grant) • Central Penn Alliance Laboratory (CPAL) • Central Penn Health Information Collaborative (AHRQ grant) • Dubois (Northwestern Pennsylvania) • Mercy Circle of Care Exchange Model • Philadelphia Health Information Exchange • Pittsburgh Regional Health Information Network • Southern Allegheny Resource Alliance • Susquehanna Valley Rural Health Partnership • University of Pittsburgh Medical Center (UPMC) • Harrisburg Health Information Exchange Efforts • Statewide Immunization Info System – Registry • REAL Time Outbreak Disease Surveillance (RODS) • PA National Elect Disease Surveillance System (NEDSS) • Tech Council of Central PA • NEPSI • Highmark e-Prescribing Grants • Capital BC/Prematics e-Rx • HL7 Interface Project • eRadiology efforts HIE Efforts PA • AHRQ Grants • Central Penn – 3 year impact • Dubois RHIO Numerous Provider and EMR Adoption/Alignment Activities Federal Led/Facilitated Efforts State Level Efforts Pennsylvania eHealth Initiative (PAeHI) Led Efforts Legend Direct Relationship Indirect Relationship Provider/Private/Public Led Efforts Last Revised 8/23/07

12. CalRHIO California Outcome of Collaborative Efforts Foundational Governance Focus of Efforts Nationwide Health Information Network (NHIN) • Strategies for HIT Adoption • Document Evidence of • Benefits • Document Current HIT • Adoption *Reducing HC Cost * Improving Patient Quality * Patient Safety Office of National Coordinator for HIT (ONC) Strategic Framework Certification of EMR Products * Certification Commission on HIT * HIT Standards Panel * Health Information Security & Privacy Collaboration * Nationwide Health Information Network (NHIN) Architecture Projects • Guidance Tools for • State Level HIEs • HIE Steering Committee • eHI Technology Workgroup • eHI • AHIMA • HIMSS • Gartner • Use cases • eHealth Initiative Connecting • Communities American Health Information Community (AHIC) Standards FORE Privacy & Security • HIMSS Dashboard • Technology Tools • Education Use Cases Report – Prototype Architecture Contracts • Other views available: • Core functions • State of maturity • Funding method ARC Grants (**) * * HIE efforts shown by type of governance: Statewide HIE Virtual Backbone CA Community Clinics & Health Centers Patient Registry Efforts California Statistics: Population: 36.4 Million Physicians: 71,500 Hospitals: acute: 453 psych: 55 Other Facilities: 1,400 CA/CalRHIO Efforts Provider Sponsored Efforts County/Public Efforts Consortia Efforts CA: 7/25/07

13. Illinois Driver Outcome Focus Nationwide Health Information Network (NHIN) • Strategies for HIT Adoption • Document Evidence of • Benefits • Document Current HIT • Adoption *Reducing HC Cost * Improving Patient Quality * Patient Safety Office of National Coordinator for HIT (ONC) Strategic Framework Certification of EMR Products * Certification Commission on HIT * HIT Standards Panel * Health Information Security & Privacy Collaboration * Nationwide Health Information Network (NHIN) Architecture Projects • Guidance Tools for • State Level HIEs • HIE Steering Committee • eHI Technology Workgroup • eHI • AHIMA • HIMSS • Gartner • Use cases • eHealth Initiative Connecting • Communities American Health Information Community (AHIC) Standards FORE Privacy & Security • HIMSS Dashboard • Technology Tools • Education Use Cases Report – Prototype Architecture Contracts • Registries • Illinois I-NEDSS – Disease Surveillance • Cornerstone • Illinois (ICARE) • Tracking Our Toddlers' Shots (TOTS) Electronic Health Records Taskforce Illinois • 2004 AHRQ • (EQUIP) Project - Erie Family Health Center • Linking Rural Prov. to Improve PC & Health - Katherine Shaw Bethea Hos. • Sharing Pat.Record Access in Rural Health Settings- S.Bush Lincoln HC • Toward an Optimal Patient Safety Information System -(JCAHO) • Value of Technology to Transfer Discharge Information - University of ILL. • 2005 • Implementing Amb. EMR & Improving Shared Access- Sarah Bush Lincoln • Caterpiller, Inc • Association of Community Mental • Health Authoriities of Ill Local Funds Initiative • Illinois Health Network - Illinois Hospital Research & Educational Foundation • Northern Illinois Physicians for Connectivity (NIPFC) • KCHAIN (Kane Community Health Access Integrated Network) AHRQ Grants (**) Federal Led/Facilitated Efforts State Efforts Statewide RHIO Efforts Provider/Private/Public Led Efforts – Catalysts toward HIE & EMR Adoption

14. The RHIO World View ~ Bringing Order to the Chaos: ~ The National RHIO HIE View ~ Components: Policies Practices Architecture Standards Certification Privacy / Security Standards Organizations HL7 ; ANSI National Health Information Network (NHIN) FUTURE NHIN Regional/State HIE-Led Efforts Regional Provider/Private/Public Led Efforts (Largest Catalyst toward HIE & EMR Adoption) Regional/State HIE-Led Efforts Regional/State HIE-Led Efforts

15. The Information Age should be a period of great glory for the US Health System and the American Dream Never leave that "till tomorrow which you can do today.

16. How much can we save? • Rand Study : $162 Billion per year • $2.2 Million Adverse Drug Events Annually • 1 avoided ADE saves $1,000-$2,000 • EHRs instrumental in Managing Chronic Diseases • Reduces incidence of chronic disease and hospital visits due to long-term prevention BY $147 billion per year. • Widespread use of HIT also will lead to more short-term preventive care routinely. Show me the Money

17. Savings with EMRs SOURCE: “Can Electronic Medical Record Systems Transform Healthcare? An Assessment of Potential Health Benefits, Savings, and Costs,” Health Affairs, Vol. 24, No. 5, September/October 2005, pp. 1103–1117, Richard Hillestad, James Bigelow, Anthony Bower, Federico Girosi, Robin Meili, Richard Scoville, Roger Taylor.

18. 2005 Rand Study :HIT Savings and Cost

20. Savings with HIEs? • Looks promising • Fully standardized HIEI could yield a net value of $77.8 billion per year once fully implemented. • Non-standardized HIEI offers smaller positive financial returns – no estimates. • Clinical impact of HIEI for which quantitative estimates cannot yet be made would likely add further value. • A compelling business case exists for national implementation of fully standardized HIE.

22. Is there a Sustainability model when Chronic Care Management, EMRs and HIEs work together? While we may not be able to control all that happens to us, we can control what happens inside us. Ben Franklin

23. Challenges Bridging the Tools Health Information Exchanges Ambulatory EMR w/ePrescribe Acute Care EMRs CDMS Health Information Exchange Interoperability, Standards, Governance

24. Technology – Which way Source : IT Tools for Chronic Management: July 2006 : Calf HC Foundation

25. The HIE Positioning Compass Supporters (Those who believe the change will occur) HIEs Hospitals Business Leaders Visionaries or Ideologists Conservatives Generalists Specialists (Those involved HIEs Strategic Framework) Crossing the Chasm (Those with a wide array of knowledge where HC exists today Technology Enthusiasts Pragmatists Technology HC Market Skeptics "For the want of a nail, the shoe was lost; for the want of a shoe the horse was lost; and for the want of a horse the rider was lost, being overtaken and slain by the enemy, all for the want of care about a horseshoe nail." (Those challenged with care delivery or care recovery) MJJ – 1/08

26. HIE SustainabilityAchieving the Dream • Envision success for HIE • Different providers, Common HIT Challenges • Split differences Can Dilute Opportunities • Identify providers with high marks on a Risk Scorecard • Identify and provide “on-demand” services to support the EHR

27. Moving forward with HIEs • Move beyond the initial target niche. • Select strategic target market segments. • Create an entry point into a larger segment. • Take control of a mainstream market

28. Think Organically • Assess your Environment • Assess your RHIO as an organization • Assess what you can achieve within- current state • Develop a simple and easy strategy • Develop your plan around a time-line • Execute the plan with Administrative oversight • Measure and Monitor everything • Probe and test • Assess and Aggregate Success

29. How can Information Management Help in Chronic Disease Management • HIT will play an important role in the successful implementation of these chronic disease initiatives through tools such as: age, sex, disease registers; recall and reminder systems. • EHRs together with other decision support tools which can assist general practice in the systematic approach to Chronic Disease Management. • Technology can assist in General Practice through improving the availability and Health Information Exchange (HIE) of secure electronic clinical and patient data; such as: online pathology/radiology ordering and reporting; use of electronic referrals; and discharge summaries.

30. HIEs and the American Dream • Leverage the collaboration, planning and resources of RHIOs • Leverage the EHR through interoperability for the objective of Chronic Disease Management within states • Commit as a priority EMR adoption and use of standards • Develop a tactical plan to implement the HIE between providers • Utilize current technology, privacy and security standards to be employed

31. "can do nothing easy."