AAFP Southeast Family Medicine Forum Lessons Learned About Health Information Exchange

2. AAFP Southeast Family Medicine ForumLessons Learned About Health Information Exchange Michele Grinberg Flaherty Sensabaugh & Bonasso PLLC

3. Technology-Not to Create Problems-

4. Technology-To Solve Problems-

5. WV’s Personal Health Issues WV’s Health Care System Issues WV’s Technology Issues WV’s Geography State-of-the-art communication among all providers and patients Viable, affordable technology that meets all providers at any stage Lack of Access to Care Problems Answers

6. West Virginia’s Health Problems • The 2nd oldest population – with all the co-morbidity problems of aging • Chronic disease management • Patient compliance • Medication and drug management • High ER usage • All-age obesity • Low birth weight babies

7. West Virginia’s Health CareSystems Problems • Continuity and Coordination of Patient Care • Lack of complete patient data at the time and place of care delivery: accepting this as an inevitable part of the system • Extensive patient histories; multiple providers • Limited Private Payers

8. West Virginia’s Tech Problems • Limited broadband connections • 17 percent adoption of EMR systems - multiple EMR brands - varying levels of satisfaction - slow uptake among all providers - High costs • Multiple portals • More than one interface • “Wait and See” philosophy

9. -Technology –The Easy Part

10. Technology Solutions - • Limited broadband connections WV Telehealth Alliance FCC grant • Low and Slow EMR Adoption Top HIN vendor companies offer lower cost, less complex entry point systems. Can connect almost all EMR systems • High Costs WVHIN = 1 portal 1 interface 1 format

11. O -T - T - C!

12. Health Information Network in a Box

13. HIN in a Box HealthBridge Delaware Health Information Network

14. Delaware Health Information Network (DHIN) • Public/Private Partnership • First Statewide Health Information Network. DHIN went live Spring 2007 • Secure network for distributing clinical results and reports from the hospital, lab or radiology center to the treating physician • Data is managed by those who order and perform the tests • Supported by Medicity

15. Cited extensively in the health information literature as a sustainable, replicable and successful HIN HealthBridge

16. HealthBridge – Since 1997 Serves 2.2 million patients Connects 4,400 physicians More than 1.7 million clinical messages per month Connects 17 Health Departments Quest, Labcorp, Proscan Imaging, KY Diagnostic St. Elizabeth’s; St. Luke’s; The Health Alliance; TriHealth; Mercy Health Partners; Children’s; Deaconess; McCullough Hyde; Christ Hospital and Adams County

17. HealthBridge • Working with independent exchanges including • eHealth Collaborative, Bloomington, Indiana • Clark and Campaign County HIE, Springfield, Ohio • Built on pushing out clinical results • Upcoming additions to include disease registry and biosurveillance

18. Touch –The Hard Part

19. Touch Issues • Scorched Earth reactions to HIT • Change - work habits work flow staffing patterns and job descriptions • Fear of the New • Wait and See Philosophy • Cost • ROI

20. Touch Issues • Enabling a new paradigm of patient care where complete, timely and accurate information can be expected by both providers and consumers at the time and place where care is delivered via a private and secure electronic network.

21. How?

22. Meeting the Challenges Through WVHIN • Creating a community of a sufficient mass of data users and senders who can “converse” with each other electronically • Provide the most viable technology solutions for our state and for all providers • Maintain technology to optimize ease of entry, use and minimize costs • Coordinate with related projects

23. Technology • RFI and RFP Process • Staggered Roll-out of Services • Substantial Input from Users • Lessons Learned from NHIN Projects

24. National NHIN CareSpark, TN Delaware HIN Indiana University Long Beach Network for Health, CA Lovelace Clinic, NY MedVirginia New York eHealth Collaborative NC Healthcare Information & Communications Alliance WVHIN WVHIN Providers Cabin Creek Health Systems Appal. Regional Healthcare, Beckley and Summers County Amer. Medical Facilities Management WVU Physicians of Charleston Charleston Area Medical Center NHIN Lessons

25. NHIN 2- Lessons • Varying state practices & laws • Varying HIE/RHIO governance • Varying development stages • ALL PARTICIPANTS COMMITTED

26. LEGAL ISSUES • Consent/authorization laws vary from state to state, and state vs. HIPAA – What governs when data sent across state lines? • Liability & Insurance – States cannot indemnify others while private corps can. • Dispute resolution – States cannot agree to binding alternatives while private corps can.

27. NHIN2-WVHIN Lessons • Demonstration accomplished between June 15 -- July 30! • Privacy and Security Policies confirmed • Legal agreements in place • Incident procedures in place • Opt-out Consent process used with success BUT….. • Registration process critical (The Touch)

28. WVHIN’s Financial Benefits • 1 portal, 1 interface to maintain • 1 call for support • Low-cost or no-cost entry • Reasonable subscriber fees for those benefiting from the Network • Inclusion of all providers with respect to ability to pay • ROI evaluation statements

29. Reduce the Paper Chase • Paper Storage • Paper Cost • Paper Retrieval • Paper Organization • Paper Handlers • Paper Reading • Paper Damage • Paper Lost Forever

30. A Day in the Life of One Doctor’s Fax Machine 1 day 1 doctor 115 faxes 10 ads 55 lab results 30 consult reports 19 pharmacy renewals 1 stat abnormal mammogram that needs immediate attention

31. Touch • Extensive Community Outreach • Hand holding Installation and support • Vendor must demonstrate current ability to connect all but the most obscure EMR systems • Scheduled, staggered roll-out of services • Serving as a “hook-up” to link providers for informal help

34. “WVHINs” for Practices • HIE diminishes the hassle of patient handoff • One interface! One portal! • Low cost ease of entry via an electronic inbox with workflow tools • Can meet practices at any stage of electronic readiness • Less paper!

35. Easier Patient Handoff • Electronic Messages for • Referrals, ED Visits, Hospital Discharges • Accompanied by Labs / Meds / Allergies • Prior Authorizations • Insurance Information

36. Physician Benefits Phase I Real-Time Access to Information Better Organization of Information Order, Result, and Referral Tracking Improved Communication Office Efficiencies Low Cost Entry Point BETTER, MORE EFFICIENT PATIENT CARE

37. Staff Benefits • Far fewer games of telephone tag • Appropriate routing of routine requests • Audit trails • Less handwriting to decipher • Tailor to each provider’s work habits • Less paper!

38. Community Benefits • Phase II • Disease Registries • Automated Public Health Reporting • Quality Indicator Measurements Easier • Sharing Clinical Data is Easier and Controlled by Physicians • Reduce duplication in all areas – payers benefit

39. www.wvhin.org