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The Community Health Record: Beyond Interoperability

The Community Health Record: Beyond Interoperability. February 15, 2006. Dan Soule Director, Provider & National Health Strategies. Presentation Topics. Overview of the National Agenda Health Information Exchange and interoperability Community Health Record, going beyond interoperability

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The Community Health Record: Beyond Interoperability

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  1. The Community Health Record: Beyond Interoperability February 15, 2006 Dan Soule Director, Provider & National Health Strategies

  2. Presentation Topics • Overview of the National Agenda • Health Information Exchange and interoperability • Community Health Record, going beyond interoperability • Case Study: TennCare Benefits

  3. National agenda…in summary • Support for Health Care IT is Growing • Federal Focus and Coordination • Bi-partisan Support • Funding Sources Emerging • Pay-for-Performance Demonstrations • CMS • DOQ-IT • Others (Bridges to Excellence) • RHIOs are Underway… • Acute & Ambulatory EHRs • Personal Health Records • Health Information Exchange “RHIOs” • Brailer’s office gets structure from HHS • Office of Health Information Technology adoption • Office of Interoperability and Standards • HITSP, CCHIT, HSPC, NHIN contracts

  4. Types of electronic health record (EHR) • Provider Electronic Health Record • CPOE, ePrescribing, used in multiple venues of care, administrative management, billing, reporting, etc. • Personal Health Record • Personal health status • Community Health Record “RHIO” • Serves a geography and/or health system network • Ties into a national infrastructure • Derives summary record derived from multiple sources • Serves the population • Enables biohealth, public health, outcomes management • Pay for performance

  5. Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Dx/Tx Providers Basic Community Health Information Exchange (HIE) IHE Patient Identity (PIX, PDQ) IHE Document Registry (XDS) Person Directory (CMPI) Community Health Record IHE Document Repository (XDS) Distributed or centralized IHE Document Repository (XDS) Distributed or centralized Interoperable Document Sources & Consumers (XDS)

  6. CHR Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Dx/Tx Providers Helping Non-EHR Enabled Clinicians Current and near term state: Large number of non-EHR clinicians (cost, complexity, trust, etc.) Person Directory Clinicians without an EHR Community Health Record

  7. Health Plans\ (claims) Health Plans (claims) CHR Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Dx/Tx Providers Improving Data with Health Plan Claims Person Directory Clinicians without an EHR Community Health Record Claims data can be a reasonable substitute in the absence of original clinical data

  8. Health Plans\ (claims) Health Plans (claims) CHR Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Dx/Tx Providers Hybrid Architecture (distributed & centralized) Person Directory Clinicians without an EHR Community Health Record Minimal patient safety data set: medications, allergies, problems, etc. Comprehensive data set

  9. Provider Payer PBM Payer and State Registry Reference Labs CHR Viewer for Non-EHR Clinicians

  10. Health Plans\ (claims) Health Plans \ (claims) CHR Payer Payer PBM PBM Prescription Processing Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Pharmacy Pharmacy Pharmacy Dx/Tx Providers E-Prescribing Adds Sustainable Value Patient Safety Data Set enables ePrescribing benefits Person Directory Clinicians without an EHR Community Health Record

  11. CHR e-Prescribing Treatment map for Hypertension. Drug classes with medications approved to treat the condition displayed along with formulary and drug-drug, drug-allergy indicators (if applicable)

  12. Clinical Research Analytics Public Health • Clinical Trials Enrollment • Protocol Management • Life Sciences Discovery • Outcomes • Utilization • Fraud and Abuse • Biosurveillance • Disaster Management • Immunization Registry Health Plans\ (claims) Health Plans \ (claims) CHR Payer Payer PBM PBM Prescription Processing Personal Health Record (PHR) Personal Health Records (PHR) D.I. Lab Provider Electronic Health Records (EHR) Pharmacy Pharmacy Pharmacy Dx/Tx Providers Additional Stakeholder Benefits Additional “RHIO” stakeholders and functionality Person Directory Clinicians without an EHR Community Health Record

  13. Community Health Record: Beyond Interoperability ic • Helping non-EHR enabled providers: with a light-weight EMR • Hybrid architecture combines benefits of centralized and distributed models • Filling in the clinical data gaps with Health Plan data • Adding sustainable value with ePrescribing • Benefits for other stakeholders: Public Health, Outcomes, Clinical Research

  14. TennCare – Early Adopter • TennCare Medicaid population • TennCare coverage: 1.1 million out of 5 million (~25%) • BCBST is MCO for 55% of TennCare. (Six other MCO cover 45%) • TennCare funding issues • Relatively generous benefits (“as medically necessary”) • Large waiver population above Federal Medicare limits • Average TennCare patient gets 30 prescriptions/year, compared to national average of 12 • McKinsey Report: “Unconstrained, TennCare will consume 90% of each new state tax dollar in the year 2008” • Funded by State • Per month / per month basis • Immediate positive return for the state

  15. Tennessee - Early Adopter • Population • TennCare lives - 1,100,000 • BCBST commercial lives - 2,000,000 (targeted Q2, 2006) • Medicare lives - 870,000 (targeted Q4, 2006) • Services • Phase 1 “Core” – community health record (CHR), EMPI, and lightweight documentation (EPSDT) • ePrescribing pilots in process, broad physician roll-out targeted Q2, 2006 • Current progress • All 1,100,000 TennCare lives with a CHR • Approximately 2,500 unique users (400 plus sites) • Adding ~ 100 new users a week

  16. Details Of Expected Benefits • Improve care coordination and/or reduce clinical waste • Reduce inpatient admissions due to incomplete data in the ED • Reduce repeat outpatient visits due to incomplete patient data • Decrease wasteful diagnostic tests • More efficient use of medications • Reduce adverse drug events (ADEs) • Increase formulary-driven savings (generics) • Promote evidence-based prescribing (stepped care & therapeutic switch) • Reduce medication waste (redundant orders; over-utilization) • Reduce fraud and abuse • Improve health maintenance compliance • Increase participation rates for EPSDT and immunizations • Reduce costs around EPSDT (monitoring and legal liability)

  17. Thank You Dan Soule Director, Provider & National Health Strategies dsoule@cerner.com

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