Getting HIT Right

1. Getting HIT Right Advice and Challenges 11 September 2013

2. 6 Steps to Health Information Superiority By Jeffrey Edgell Chief Technologist at DHA Group

3. 1. Avoid single-purpose solutions • Every interface comes at a cost. It is expensive to design, build and maintain each unique solution. • Even minor changes can mandate a redesign, and these costs can be significant. • Interoperability solutions relying on neutral models minimize expenses, allowing government to do more with less.

4. 2. Allow operational language autonomy • Forcing conformity creates resistance and often results in inefficiencies, such as requiring an organization to re-learn entire processes. • Allowing entities autonomy in the language they use allows them to retain their identity, eliminate training requirements and avoid the delays created by transitioning to a common language.

5. 3. Adopt a global perspective • Building an information enterprise requires a global perspective, understanding not just what information I produce, but also thinking outside the box and identifying other consumers that might benefit from this information. • Rather than focusing on what is relinquished in order to build an information enterprise, look at what is gained. • An information enterprise allows an organization to satisfy deficits, perhaps even unrecognized ones, through other information sharers.

6. 4. Select an appropriate neutral model • There are universal models available containing taxonomies of information for virtually every subject. • Adopting one model does raise concerns similar to those discussed in #2 above. • Highly federated and distributed organizations might even consider developing their own neutral model.

7. 5. Map to specific elements • Understand how each organization collects information and the differences that exist. • Areas lacking direct alignment with the neutral model must be identified, as they could create informational holds. • Many elements in the neutral element may not pertain to an organization. • Strategies for dealing with “pockets of non-information” that may exist should be developed.

8. 6. Be mindful of legal and security mandates • Individual pieces of information may be unclassified or not subject to privacy considerations on their own, yet in combination could be considered classified or confidential. It is important to be mindful of how combinations of elements might change parameters. • The information superiority that allows us to make better decisions and imparts greater knowledge can also be used against us, should unauthorized persons gain access to information unwittingly. • Understand that different organizations may apply stricter standards when it comes to determining what is and is not classified, private or confidential.

9. Public-Private HIE ‘Incredibly Disruptive' Says ONC's Hunter Blair By Anthony Brino Associate Editor,Government Health IT

10. “This is a big experiment we’re conducting,” The ONC’s Principal Advisor for State HIT-enabled Care Transformation Hunt Blair said at the CMS eHealth Summit, talking about the confluence of public-private investments in EHR adoption and health information exchange, “And we’re going to get negative results, that’s what happens in an experiment.”

11. Challenges to Healthcare Reform Without mentioning any specific negative impacts of health IT or medicine, his point was that meaningful use, health information exchange, value-based payments and care delivery redesign are challenging, with varying results so far across the states and localities.

12. Incredibly disruptive… • To the traditional business model of medicine and the last outside of government to move to interoperable data exchange • Vermont’s early foray into information technology-supported health reform included: • gradual EMR adoption • HIE participation assistance, • care coordination and medical home models, • and planning to have the state government become a value-based payer, as the primary-insurer for most Vermonters after 2017.

13. Buy-in is essential • You can’t do the kind of value-based payments we want to do without provider and payer attribution • Providers from different affiliations and payers, both publicly- and privately-financed, inevitably will have to share data

14. Getting the horse in front of the cart “This is about the transformation of healthcare delivery and payment that is enabled by technology, and not vice versa,” said Rob Tagalicod, director of CMS’s Office of eHealth Standards and Services

15. Regulations important, but not nimble • CMS consolidated reporting systems, will really lower the burden during Meaningful Use Stage 2, if newer software iterations become more clinician- and physician-friendly. • While moving toward MU Stage 3, CMS is attuned to the concerns of small and rural providers who may have missed the crest of the wave. We can’t leave them behind. • HIT is not a solution, it is a tool, immediate results are not going to be seen, and there are those that will feel the slow progress is somewhat of a shortcoming.

16. Standards are key • One need for HIEs is standardization at the state level for data like tumor registries, to help come up with cost estimates and provider connectivity timelines • Standards, such as Continuity of Care Documents, are not necessarily implemented in the same way which drags out the time it to connect a provider

17. Resources • 6 steps to health information superiority • ONC's Blair says public-private HIE 'incredibly disruptive'