Community Health Information Network (CHIN)

1. Community Health Information Network (CHIN) Medical Economics Data May 09, 1994 [draft] Author: Carol Sansone, Business Development Manager

2. Community Health Information Network (CHIN) • DefinitionIntegrated collection of computer and telecommunications capabilities that facilitates communication of clinical and financial patient information among multiple providers, payers, employers, pharmacies, and related healthcare entities • Variables • CHIN will live within a health plan • Ownership • Number of participants • Transaction volume • Level of integration with other systems • Range of applications • Model of CHIN • ARCHITECTURE

3. Community Health Information Network (CHIN) Migration Path • Transaction switching from station to station • Universal implementation of clinical communications linking hospitals and physicians • Payer communication offering electronic data interchange and insurance eligibility information • Creation of clinical information (virtual) repositories • Utilization of outcome database • ORGANZATION

4. Community Health Information Network Three Phases of CHIN Automation • Electronic Ordering – Single Institution • Electronic Medical Record – Multiple/Single Institutions • Lifetime Health Record/CHIN • Development – Multiple Encounters/Multiple Institutions

5. Community Health Information Network (CHIN) CLINTON’S HEALTHCARE INITIATIVES • Cut the cost of healthcare administration. • Govern healthcare administration simplification through Federal regulation. • Expressed interest in the CHIN marketplace by large Hospital Information Systems (HIS) vendors. • Drive outcome measurements through CHIN users (payers, government, research/education, providers, patients, employees, accreditation agents/regulators). • MARKET FORCES

6. ENVISIONED CHIN BENEFITS PATIENT BENEFITS • Reduce redundancy in forms, exams, tests • Facilitate continuity of care • Promote knowledgeable choice • Lower cost of care PROVIDER BENEFITS • Improve quality of care • Reduce isolation of rural physicians • Reduce litigation exposure • Manage total cost of therapy • Build a competitive marketplace advantage

7. ENVISIONED CHIN BENEFITS (CONT’D) • Employer Benefits • Evaluate plan benefit characteristics • Compare provider performance • Reduce costs of health benefits • Improve employer/employee satisfaction with selected healthcare service options

8. Potential CHIN Fee Structures • All participants will pay fees for installation, systems integration, transmission, maintenance, service charges such as flat fees, eligibility fees and transactions fees. • Current systems usually omit physician fees to encourage participation. • Longer term, physicians will be charged for incremental services. • The network is largely transparent to the patient, who pays nothing.

9. UNRESOLVED CHIN ISSUES • Data and image transmission standardization • Data standards are evolving (HL7/IEEE/MEDIX) • Industry imagery transmission standards are in their infancy stage of development

10. UNRESOLVED CHIN ISSUES (CONT’D) • Data ownership once (value-added) data is on the network • Data access role within a local network • Data security to both code and protect lifetime health records

11. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC (AMERITECH HEALTH CONNECTIONS, INC.) • Area of Service • 7 hospitals with 750 physician users targeted • 5 payers targeted for claims • 5 billing services • 3 labs and 4 clinics interested • MILWAUKEE AREA WITH COMMUNITY FOCUS

12. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC • Features • Open system architecture • Host systems include IBM, Tandem, HP, DEC, and Unisys • User interface with Windows, so all data can be presented on one screen • ARCHITECTURE DESIGNED FOR GROWTH

13. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC • Analysis • User functionality includes both payer and provider clinical communications • Specific applications include the following: • E-Mail • Bulletin board • Deferred results • Integrated with practice-management systems • STRENGTHS

14. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC Future Applications • Insurance enrollment • Eligibility Verification • Claim payment notifications • Radiology images • Rx notification • Pre-admit • Good financial stability • Security through a card with microchip-encoded password/ID • STRENGTHS

15. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC • Analysis • Future applications (continued) • Scheduling inquiry • Orders • Medical library • Credit histories • Insurance change notifications • Integrated community database • STRENGTHS

16. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC • Analysis • Limited payer functionality at present • Development of clinical database in early stage of development • Not fully proven line • WEAKNESSES

17. Community Health Information Network (CHIN) • AMERITECH/WHIN/AHC • Analysis • How and when all interfaces will be accomplished • Time to market concept • Proving cost-justification • Development of outcomes/utilization database • CHALLENGES

18. Community Health Information Network (CHIN) • CHMIS/HARTFORD FOUNDATION • Test site in Memphis • Comprehensive design created by New York based Benton International (consultants) • Features • User and payers ATM-style efficiency • Not-for-profit John A. Hartford foundation

19. Community Health Information Network (CHIN) • CHMIS/HARTFORD FOUNDATION • Analysis • Combine EDI/WEDI concept of electronic processing and transactional facilitation • Meeting shared information needs through community-controlled database • Focus on community/cost/quality as goals • Straight-forward design • Ride the back of existing claims structure and build on an embedded base rather than a perfect system concept • STRENGTHS (WEDI/Workgroup Electronic Data Interchange)

20. Community Health Information Network (CHIN) • CHMIS/HARTFORD FOUNDATION • Analysis • Unproven • Database issues of security and confidentiality because of size • Focusing on claims and insurance rather than larger vision • WEAKNESSES

21. Community Health Information Network (CHIN) • CHMIS/HARTFORD FOUNDATION • Analysis • Community support because of size • Operational complexity • Time to market • System integration and interface issues • CHALLENGES

22. Community Health Information Network (CHIN) • INTEGRATED MEDICAL SYSTEMS, INC. (IMS) • Area of Service • Approximately 22 networks are growing reaching more than 40 percent of Colorado hospitals. • First alpha site at St. Anthony, Denver • EXPANSION THROUGH ACQUISITION STRATEGY FOR NATIONAL COVERAGE

23. Community Health Information Network (CHIN) • INTEGRATED MEDICAL SYSTEMS, INC. (IMS) • Features • For-profit corporate venture • Batch system in the works for approximately 3 years • Mature clinical messaging capability • Transmits voice, data and image • Store and forward technology to send messages • ARCHITECTURE

24. Community Health Information Network (CHIN) • INTEGRATED MEDICAL SYSTEMS, INC. (IMS) • Analysis • Proven capability • Simplicity of use • Low costs with batch interfaces means less worry about data loss • STRENGTHS

25. Community Health Information Network (CHIN) • INTEGRATED MEDICAL SYSTEMS, INC. (IMS) • Analysis • Limited payer capacity • Batch architectural design • Limited system integration • Costs can be high depending on service and transaction volume • WEAKNESSES

26. Community Health Information Network (CHIN) • INTEGRATED MEDICAL SYSTEMS, INC. (IMS) • Analysis • Transaction switch in development stage • Company growing rapidly so resources may be stretched • Clinical and outcomes databases planned for the future • CHALLENGES

27. Community Health Information Network (CHIN) • SMS/HDX • Area of Service • Community focus and open to all participants • Total view is national in scope • CURRENTLY DIFFERENT STAGES OF DEVELOPMENT IN OHIO, NEW HAMPSHIRE, NEW YORK, AND CALIFORNIA

28. Community Health Information Network (CHIN) • SMS/HDX • Features • For-profit effort by subsidiary of major HIS system vendor with extensive client list nationwide • ARCHITECTURE

29. Community Health Information Network (CHIN) • SMS/HDX • Analysis • Extensive design with proven capability in payer-clinical communications • Transaction switch scope to be expanded over 4 to 6 years • Includes new captive membership, utilization monitoring, payment settlement, and eventually, managed-care functionality • STRENGTHS

30. Community Health Information Network (CHIN) • SMS/HDX • Analysis • Data processed from national center in Malvern, PA, rather than regionally • Not fully proven in concept • Database ownership issues exist for proprietary vendor • WEAKNESSES

31. Community Health Information Network (CHIN) • SMS/HDX • Analysis • Developing clinical/outcomes database • Physicians want a range of functions • How proprietary vendors will interface to foreign systems • CHALLENGES

32. Community Health Information Network (CHIN) • UNITED HEALTHCARE • Area of Service • Minnesota is test site • REGIONAL GEOGRAPHY

33. Community Health Information Network (CHIN) • UNITED HEALTHCARE • Features • Payer-focus called Providerlink • Sponsored by Minnesota-based managed-care company for EDI claims • ARCHITECTURE

34. Community Health Information Network (CHIN) • UNITED HEALTHCARE • Analysis • Proven system processing more than 40 million claims from United’s 18 plans and more than 500 hospitals with 2 million vendors ? • Architectural design is good for growth and flexibility • Users have flexibility in hardware and workstation devices • Substantial savings have been shown (more than $1 per claim) • STRENGTHS

35. Community Health Information Network (CHIN) • UNITED HEALTHCARE • Analysis • Limited clinical capability • Payer owned, so participation by others may be guarded • WEAKNESSES

36. Community Health Information Network (CHIN) • UNITED HEALTHCARE • Analysis • Not currently a database repository for clinical data • Data ownership issues • Plan lab and results reporting • CHALLENGES

37. Community Health Information Network – Other Emerging Chins • Inova Health Systems of Falls Church, VA • San Antonio Healthcare Partnership • NO/HIN in New Orleans • Henry Ford Health Alliance Plan in Southeastern Michigan • Metropolitan Chicago Healthcare Council • Praxis, based in Nashville • 6 states now receive funding from the Hartford Foundation, with another 9 states applying in the coming months. • POPULATION SAMPLING OF CHIN(S) NATIONWIDE

38. Community Health Information Network (CHIN) • Topology Models • STRATEGIC ALLIANCES • INTEGRATION • (demonstrate access points) • (demonstrate linkages)

39. Community Health Information Network (CHIN) • B2B Linkages • Banker, • Hospital, • Physician’s Office or • Community Health Center • Other Chins

40. Community Healthcare Information Network (CHIN) • B2B Applications • Computerized Patient Record • Case Management Results Reporting Physician Direct Order Entry • Alerts • Nursing Documentation • Physician Documentation

41. Community Health Information Network (CHIN) • B2B Applications (cont’d) • Scheduling • Patient Accounting • Radiology • Laboratory • Cardiology • Anesthesia • Pharmacy • Medical Records Abstracts

42. Community Health Information Network (CHIN) • B2B Applications (cont’d) • Corporate Financials • Network • ADT • Interface Engine • E-mail/EDI • Imaging • Forms Automation • Master Patient Index

43. Community Health Information Network (CHIN) • What next!