Health Information Exchange in a Community: The MidSouth eHealth Alliance

1. Health Information Exchange in a Community: The MidSouth eHealth Alliance September 2010

2. The MidSouth eHealth Alliance • What is the MidSouth eHealth Alliance? • History • Technical Architecture • Privacy and Security • System Walk-thru • Meaningful Use

3. Why Tennessee? • Late 2003/early 2004 - Governor Bredesen began planning process to reform TennCare program emphasizing cost-saving strategies • Ranked #1 in % of population covered by Medicaid - 22.3% • TennCare consumed 33% of entire State budget • February 2004 – asked Vanderbilt to work with The MED on evidence-based medicine initiative • May 2004 – Governor Bredesen decided broader informatics approach was needed • Began as a state-funded planning project in August 2004.

4. Now the real work begins… Awarded an AHRQ State & Regional Demonstration contract in September 2004 ($4.8 million) Also received state funding ($7.2 million) MidSouth eHealth Alliance received an additional $545,000 from the state for operational costs

5. Why Memphis? • 17% of State’s population- ~1.2 million • 25% of population - at or below the poverty line • 20% of State’s TennCare population • Universities – including UT School of Medicine • Diversity of health care settings • FedEx headquarters • Major postal hub • Emergency preparedness initiatives - New Madrid fault

6. Vanderbilt’s role • Vanderbilt Center for Better Health is subcontractor to the state and • Serves as the PMO • Provides the technical solution and support (i.e., donated the use of its EMR for the proof of concept) • Ensures compliance with AHRQ and State contracts • In addition, Vanderbilt receives strategic direction from the MSeHA Board

7. Background • MidSouth eHealth Alliance Board was founded in February 2005 • The MidSouth eHealth Alliance was incorporated in August 2005 and received 501(c)3 status in March 2006 • Initial Participants were and continue to be represented on the Board • Amerigroup/TLC (TennCare MCO) • Baptist Memorial Health Care Corporation (5 facilities including one in MS) • Christ Community Health Services (4 clinics) • Methodist Healthcare (6 facilities including LeBonheur Children’s Medical Center) • The Regional Medical Center (The MED) • St. Francis Hospital & St. Francis Bartlett (Tenet Healthcare) • St. Jude Children’s Research Hospital • Shelby County/Health Loop Clinics (11 primary care clinics) • UT Medical Group (400+ clinicians)

8. Background • Originally the “burning platform” was TennCare. • The issues related to TennCare and the uninsured were shared by all the participants – all had very active EDs. • There was an acknowledged lack of continuity of care following ED visits. • 11% of TennCare enrollees went to 2 or more different emergency departments in 2003. (Source: Amerigroup/TLC) • 19% of the all payer patients went to 2 or more different emergency departments in 2003. (Source: THA) • Very quickly the participants reframed the issue to “improve the quality of care for all the citizens of the Greater Memphis area at a lower cost” • Other goals for the project included: • Narrow initial focus to demonstrate success, prove value and build trust • Reduce unnecessary duplication of diagnostic tests • Not intended to displace current provider level information systems • Provide a view across disparate components of several provider systems • Must meet current and evolving Privacy and Security requirements

9. Background • Participants identified data elements to be available and agreed to provide clinical and demographic information from all encounters inpatient, outpatient and emergency department. • The board identified the first point of access to be the Emergency Department but is now expanding access point to the system. The primary concern with expanding access is privacy and confidentiality. • First emergency department began using the system on May 23, 2006 • Today we are live in 14 hospital emergency departments. • Hospitalists in 3 health systems began accessing the system in September 2007 with plans to add a hospitalist at a fourth health system • As of September 2010: • Christ Community Health Services • The Health Loop Clinics • Memphis Children’s Clinic • Memphis Health Center

10. Data available today • 20 data feeds submit IP, OP, ED and claims information • Patient identification/demographics • Encounter data: date of service, physician and reason • Lab results • Medication history through claims • Immunizations • Allergies • Dictated Reports • Imaging studies • Cardiology studies • Discharge summaries • Operative reports • Emergency room summaries • History and Physicals • Diagnostic Codes • Some medication history (TennCare Claims) • Etc.

11. A overview the data flow from sites and to sites Data is published from data source to the exchange Exchange receives data & manages data transformation Organizations will have a level of responsibility for management of data Data bank compiles and aggregates the patient Data at the regional level • Participation Agreement • Patient Data • Secure Connection • Batch / Real-Time • Mapping of Data • Parsing of Data • Standardization of Data • Queue Management • Compilation Algorithm • Authentication • Security • User Access • Issue Resolution • Data Integrity • Entities are responsible for managing their Data

12. Approach to Security • Security • Continuous monitoring of all users activities with alerts built into the auditing process when a business rule is potentially violated • Two factor authentication: • Something you know: User Name and Password • Something you have: Random number from token • System access is locked down to specific/approved IP addresses

13. Secure Access • The SecurID Token is an authentication device, the use of which is subject to the terms and conditions described in the VUMC Confidentiality Agreement and the VUMC Security Guidelines on Remote Access. • The SecurID token generates a simple one-time authentication code that changes every 60 seconds. • Dual-factor security: something you have, something you know

14. Approach to Privacy • Privacy • All privacy rules assume the relationship is between the patient and the provider organization NOT the patient and the MidSouth eHealth Alliance • All Participants are required to notify their patients that their data will be shared for the purpose of treatment • Most use the Notice of Privacy Practices to accomplish this • All Participants are required to allow patients to “opt out” if they choose to do so • All Participants use a “Fact Sheet” with FAQs to educate patients • Developed in conjunction with an adult literacy class • Also available to patients on the MidSouth eHealth Alliance website

29. Summary The MidSouth eHealth exchange is operational Although the results are preliminary, it is effective The Exchange is relatively low-cost The Exchange is scalable The power of such an Exchange is only beginning to be explored The true impact has been on the community-it is changing the way care is delivered This is a very real production system It is delivering as promised

30. Thank you. Rodney L. Holmes, MSHI, CPA Executive Director MidSouth eHealth Alliance rodney.holmes@mseha.org