Connecting Communities for Better Health

1. Special Interest Group on Communities of Practice: LHII’sNHII 2004: Cornerstones for Electronic Healthcare Janet M. MarchibrodaChief Executive Officer, eHealth Initiative Executive Director, Foundation for eHealth InitiativeExecutive Director, Connecting for HealthJuly 22, 2004

2. Overview of Presentation • A Scan of the Needs of Community-Based Health Information Exchange Projects Across the Country • Common Issues and Challenges • National Initiatives that Can Help • Public Sector • Private Sector

3. Early Pioneers in Health Information Exchange* • Bellingham, WA • Delaware • Florida • Indianapolis, IN • Los Angeles, CA • Maine • Maryland • Massachusetts • Michiana Health Information Network, IN *Sample

4. Early Pioneers in Health Information Exchange* • Michigan • New York • North Carolina • Ohio • Pennsylvania • Rhode Island • Santa Barbara, CA • Tennessee • Utah Health Information Network • Washington, D.C. *Sample

5. What Problems are They Trying to Solve? • Improving Healthcare Delivery at Point of Care • Reducing Costs – Achieving Efficiencies • Biosurveillance/Public Health Initiatives • Quality Improvement Initiatives

6. Increasing Demand • Recent College of Healthcare Information Management Executives (CHIME) Survey Reveals: • One in five organizations currently participating in a data sharing arrangement w/other providers and payers in local region • 40% of responding organizations are either currently participating in or are considering participation in a regional data sharing initiative

7. Common Issues and Challenges • Organization and governance • Lack of upfront funding • Lack of sustainable business model – alignment of incentives • Competing entities reluctant to share information that would undermine competitive advantage • Technical issues: architecture, accurately linking patient data, applications, standards, security

8. Common Issues and Challenges • Engaging clinicians • Engaging payers and employers • Assuring privacy and security • Organizational and governance issues • Workflow and organizational change

9. Government Initiatives that Can Help • AHRQ $34 million HIT Demonstration Program • Additional $50 million for demonstration projects proposed for FY 05 in DHHS Secretary’s budget • AHRQ’s State and Regional HIT Demonstration Program • CMS launching four demonstration programs under Medicare; CMS “DOQ-IT” Program • CDC PHIN Program promotes integration and use of standards and leveraging data that already resides in the system – e.g. Biosense - $130 million in proposed FY 05 budget

10. Private Sector Initiatives that Can Help • A number of payment pilots and other incentive programs emerging from employer and plan communities, including Bridges to Excellence • HL7 develops a functional model for an electronic health record • The work of the EHR Collaborative and other private sector initiatives • Foundation for eHealth Initiative launches Connecting Communities for Better Health Program

11. Our Approach AGGREGATE AND DEVELOP KNOWLEDGE IN KEY ISSUE AREAS VET WITH AND DISSEMINATE TO STAKEHOLDERS PRIMARY DISSEMINATION VEHICLES CLINICIANS ONLINE RESOURCE CENTER FINANCING (Incentives, Funding) LEGAL (Data Use, Stark Issues) HOSPITALS AND OTHER PROVIDERS VIDEO, WEB, PHONE CONFERENCES CLINICIAN ADOPTION AND PROCESS CHANGE HEALTHCARE IT PHARMA AND DEVICE MFR FACE TO FACE CONFERENCES PRIVACY PUBLIC HEALTH TARGETED BRIEFINGS PAYERS EMPLOYERS, PURCHASERS CLINICAL KNOWLEDGE CHRONIC CARE PUBLICATIONS PATIENTS, CONSUMERS PARTNER ORGANIZATIONS TECHNICAL (STDS, SECURITY, ARCHITECTURE) POLICY-MAKERS

12. Connecting Communities for Better Health • Goal is to catalyze activities on a national, regional, and local basis that will lay the foundation for electronic connectivity and a health information infrastructure • Funded under Foundation for eHealth Initiative cooperative agreement with HRSA - $3.9 million in year one, $2.9 million in year two …augmenting funding through other contributions and grants • Provide seed funding to multi-stakeholder collaboratives within communities that are using electronic health information exchange and other IT tools to drive improvements in healthcare, with the goal of evaluating and widely disseminating lessons learned

13. Connecting Communities for Better Health • Gaining critical input from experts, “on-the-ground implementers”, and key stakeholders on key areas related to health information exchange: technical, organizational, financial and clinical • Disseminate and facilitate dialogue and learning • Through Community Learning Network and Online Resource Center: community profiles; resources and tools; electronic sharing of information and facilitation of dialogue

14. Connecting Communities for Better Health • Disseminate and facilitate dialogue and learning • Connecting Communities Learning Forum: June 2004 – Technical, clinical, financial and organizational experts came to Washington to share learning with community stakeholders on health information exchange – over 400 attended • Key partnering organizations • Center for Information Technology Leadership – Partners Healthcare System – John Glaser; Blackford Middleton • Regenstrief Institute – J. Marc Overhage • Ongoing audio, video and web conferences • Frequent meetings throughout the year

15. Connecting Communities for Better Health • Creating and widely publicizing a pool of “electronic health information exchange-ready” communities to facilitate interest and public and private sector investment in such initiatives • Building national awareness among policy-makers, healthcare leaders, and other drivers of change, regarding feasibility, value, barriers, and strategies • Collaborating and aligning with related activities both within the public and private sectors

16. Response to Request for Capabilities • What We Asked For in our 2003 Request for Capabilities Statements: • Multi-stakeholder initiatives involving at least three stakeholder groups • Matched funding • Use of standards and a clinical component • What We Received: • 134 responses representing 42 states and the District of Columbia proposing collaborative health information exchange projects across the country

17. Organization Types Involvement

18. Functions Provided

19. Data Types Involved

20. Communities to be Funded • Strategically focused on critical areas that need to be addressed to implement health information exchange • Replicable and sustainable technical architecture models • Alignment of incentive models • Use of replicable data exchange standards • Addressing ways to accurately link patient data • Multi-jurisdictional models • Electronic prescribing issues

21. Communities Being Funded • Connecting Colorado (Denver, CO) • Indiana Health Information Exchange (Indianapolis, IN) • MA-SHARE MedsInfo e-Prescribing Initiative (Waltham, MA) • MD/DC Collaborative for Healthcare Information Technology (Baltimore/Washington Metro Area) • Santa Barbara County Care Data Exchange (Santa Barbara, CA) • Taconic Health Information Network and Community (Fishkill, NY)

22. Communities Being Funded • Tri-Cities TN-VA Care Data Exchange (Kingsport, TN) • Whatcom County e-Prescribing Project (Bellingham, WA) • Wisconsin Health Information Exchange (National Institute for Medical Informatics – Midwest) (Milwaukee, WI)

23. What Does All of this Mean? “Never doubt that a group of thoughtful, committed people can change the world. Indeed it’s the only thing that ever has.” Margaret Mead

24. Closing • We are finally building momentum…the “stars and planets are aligning” which is due to leadership in public and private sectors • The focus has shifted from “whether we should” to “how will we do this?” • This work will create lasting and significant changes in the U.S. healthcare system…how clinicians practice…how hospitals operate….how healthcare gets paid for…how patients manage their health and navigate our healthcare system