Improving Patient Care W ith Health Information Exchange

1. Improving Patient Care With Health Information Exchange Shannon Vogel Texas Medical Association Director, Health Information Technology Tiffany Champagne Director of Business Development Greater Houston HealthConnect Jim Langabeer, PhD CEOGreater Houston HealthConnect

2. CME The TMA designates this educational activity for a maximum of 1 AMA PRA Category 1 creditTM. Physicians should only claim credit commensurate with the extent of their participation in this activity. This activity has been designated as 1 hour of ethics and/or professional responsibility education.

3. CME Please fill out your CME form! White copy – TMA Yellow copy – Keep for your records Please fill out evaluation form – anonymously!

4. CME Disclosure Policies and standards of the Texas Medical Association, the Accreditation Council for Continuing Medical Education, and the American Medical Association require that speakers and planners for continuing medical education activities disclose any relevant financial relationship they may have with commercial entities whose products, devices or services may be discussed in the content of the CME activity. The content of this material does not relate to any product of a commercial interest; therefore, there are no relevant financial relationships to disclose.

5. Objectives • Define a health information exchange (HIE); • Describe ways a health information exchange can enhance quality of care; and • Determine if a health information exchange meets criteria to increase patient safety.

6. The Health Information Technology for Economic and Clinical Health (HITECH) Act has HIT provisions. HITECH Act

7. $38 million – regional extension centers $28.8 million – health information exchange $15 million – SHARP grant (Strategic Health IT Advanced Research Projects) $5.4 million – HIT workforce education $4.5 million – Medicaid health IT planning $91.7 million total HITECH Act – Texas Funding

8. Texas in Context • 254 counties • 268,581 square miles • 773 miles east to west; 790 miles north to south • 221x the size of Rhode Island (1.5 million residents) • 25.7 million residents • 25 metropolitan areas more than 100,000 residents; four more than a million • 40,000 direct patient care physicians • 630 hospitals

9. What is an HIE?

10. HIE Defined The secure electronic movement of health information among treating physicians and other health care providers and related organizations according to national and state laws and nationally recognized standards.

11. Benefits of HIE • HIEs improve care coordination. • Silos of information are broken. • Authorized physicians and other providers have access to patient information quickly and securely. • It’s about having the right information at the right time to enhance clinical decision making.

12. Benefits of HIE • Information about your patient may include: • Recent labs • Current medications • Radiology images • Recent hospitalizations This is not always complete. The amount of information available is as good as the number of health organizations participating within the community. Helps reduce duplicate testing!

13. Private Versus Public HIEs • Private HIEs typically operate under the governance of a single health care system. • Public HIEs are usually community-based and receive grant funding from sources such as the Office of the National Coordinator.

14. Private Versus Public HIEs • Twelve Texas public HIEs; the Texas Health and Human Services Commission (HHSC) funds them with support from the Texas Health Services Authority (THSA) • Multiple private HIEs through hospital systems

15. Public HIEs • Texas public HIEs are in various stages throughout the state. • Texas received $28 million from the Office of the National Coordinator for HIE infrastructure. • HHSC and THSA oversees grants to regional HIEs in Texas. • Details about Texas HIEs available at http://hietexas.org/.

16. Public HIEs in Texas www.hietexas.org

17. HIE Participation Ideally physicians should use an electronic health record (EHR), but physicians do not have to have an EHR to participate in an HIE. Internet access is necessary!

18. HIE Models • Centralized — Patient information is stored in a centralized database. • Federated (decentralized) — Patient information is gathered from sources upon a query but not stored anywhere centrally. • Hybrid — Some data is stored, and some is not.

19. Protecting the Patient • Four consent models exist for patient information: • Opt-in: Every patient is out of the HIE unless the patient indicates wanting in — affirmative authorization needed. • Opt-in with restrictions: allows patients to agree to make all or some data available. • Opt-out (no-consent): A predetermined set of data is automatically included in the HIE, but any patient may opt out of participation. • Opt-out with exceptions: allows protected health information (PHI) to be included but may exclude some data. This is sometimes referred to as data segmentation.

20. Protecting the Patient • HIPAA does authorize a physician to share information directly for purposes of: • Treatment • Payment • Health care operations • If the HIE model is at any time to monetize the data or use it for any other reason than stated above, patient consent (authorization) is required!

21. Secondary Use of PHI • Secondary use of PHI may include: • Medical research • Public health surveillance • Compilation for registry use • Marketing

22. Protecting the Patient • There is a delicate balance between the physician having all information, and the patient’s right to determine what information is shared. • Notice the source of the information. • Information received from the HIE should be verified with the patient.

23. HIE Governance • Important for physicians to be involved in HIE governance • Public HIEs are required to have multi-stakeholder boards. Find out who the physician representatives are and become involved! • Attend meetings if possible. Ask questions! • Private HIEs may not have multi-stakeholder boards.

24. HIE Sustainability • There are various models for HIE sustainability. • Grants (limited) • Taxpayer (not likely in Texas) • Subscription fees • Transaction fees • Payer participation • Many times determined by who directly benefits from HIE information

25. HIE Sustainability • There may also be start-up fees. • Physicians should inquire about HIE sustainability plans. • What happens to patient data if the HIE closes?

26. Information Sharing • It is important to know what information will be shared from your EHR and how it will be shared. • When receiving the information from the HIE, will it go directly into the EHR? Is it a PDF? This may depend on the EHR specifically. • Know which hospitals and labs are participating.

27. White Space • Counties where HIEs do not exist are considered white space. • THSA qualified five health information service providers to provide basic connectivity.

28. White space • Direct email, which is secure, encrypted, and HIPAA-compliant, is used to directly connect physicians. • Computer with Internet access required • No long-term contracts • Allows physicians to achieve meaningful use

29. White Space • Physicians practicing in white space counties are eligible to participate in a voucher program that covers initial connection fees. • More information about white space and the voucher program is available at www.hietexas.org/white-space.

30. Intelligence is the ability to increase efficiency; Wisdom is the ability to increase effectiveness. — R.L. Ackoff

31. HIEs in Texas Country road or super highway?

32. Thank you! CONTACT INFORMATIONShannon VogelDirector, Health Information Technology 401 West 15th StreetAustin, Texas 78701-1680(800) 880-1300, ext. 1411 shannon.vogel@texmed.orgwww.texmed.org

33. Jefferson County Medical Society Jim Langabeer, PhD CEO Tiffany Champagne, PhD ABD Director of Business Development August 21, 2013

34. What is an HIE? A health information exchange moves patient information electronically among physician offices, hospitals and other health professionals directly involved in a patient's care, such as pharmacies and labs.

35. Our Geographic Reach • Southeast Texas region represents nearly 25% of the entire Texas population • 6.9 million population • 14,000 physicians • 1,402 pharmacies • 133 hospitals of all types

36. Southeast Texas Trading Partners • Harris County (Ben Taub) • Texas Children’s Hospital • Methodist Hospital • MD Anderson CC • CHRISTUS • Kelsey-Seybold • Houston Fire/EMS • Baptist Hospital • Beaumont Family Eye • CHRISTUS (St. Elizabeth, St. Mary, Jasper Memorial) • Legacy Health • SETMA • Med Center of SE TX • SE TX ENT • Advanced Cardiovascular • UTMB • Galveston County Health District

37. Go-Live Timeline SETMA SE Texas ENT SW OBGYN Beaumont Family Eye CHRISTUS Health: -St. Mary -St. John -St. Catherine -Jasper Memorial -St. Elizabeth • UTMB Galveston • MHMRA – Houston • The Methodist Hospital System Houston Medical Imaging • Texas Children’s Hospital • Quest Labs 2013 April June August October December 2014 February Kelsey – Seybold Clinic Spring Branch CHC Good Neighbor HC Harris Health Legacy Community Health Services Baptist Hospital System Galveston Co. EMS Houston Fire Department

38. Technical Model A secure “pipeline” between providers that allows certain patient information to be securely accessed electronically by authorized physicians and providers. • Opt-In Model: Every patient is out of the HIE until they express affirmative authorization. • Federated (decentralized): Patient information is gathered from source areas upon a query but not stored centrally. • Access limited to purposes of treatment, payment, and operations (TPO).

39. Board Members • Ruthanne Mefford – Executive Director, Child Advocates of Fort Bend • Osama Mikhail, Ph.D. – Senior VP, University of Texas Health Science Center • Ivo Nelson – Founder and former Chair, Encore Health Resources • Lamar Pritchard, Ph.D. – Dean, University of Houston College of Pharmacy • Ben Raimer, M.D. – Senior VP, University of Texas Medical Branch at Galveston • Tim Tindle– Executive Vice President and Chief Information Officer, Harris Health System • Mark Toups, M.D. – Physician executive, CHRISTUS Health- Beaumont • Umesh Verma– CEO, Blue Lance • Greg Bernica– CEO, Harris County Medical Society • Marc Boom, M.D – CEO, The Methodist Hospital System • Chris Born – CEO, Texas Children's Health Plan • George Conklin – CIO, CHRISTUS Health • Paul Frison – Exec Vice Chairman, Houston Technology Center • William Gilmer, M.D. – Neurologist, private practice • Bernard Harris, Jr., M.D.- CEO, Vesalius Ventures • Gilbert Herrera – CEO, Herrera Partners • Michael Jhin – Former CEO, St. Luke’s Episcopal Health System • Kelly B. Lobley, M.D.– Co-Managing Physician for Clinical Information Technology, Kelsey-Seybold Clinic • Chris McKee– AVP for Business Affairs, MD Anderson Cancer Center

40. SharingClinical Information • Encounters • History and Physical • Vitals • Plan of Care • Lab Result Data • Images and Scans • Patient Demographics • Alerts • Advanced Directives • Problems • Procedures • Providers • Medications • Hospital Discharge Summary

41. Demonstration

42. Thank you