The valuable RHIO: Stunning interoperability, zones of exchange, and knowledge for action Jonathan Teich, MD, PhD Senior VP and CMO, Healthvision Asst. Prof. of Medicine, Harvard Univ. June 27, 2005

Agenda: Where is the value in interoperability? Connected communities and interoperable systems What is stunning interoperability and why is it needed? Current tools and examples

Save the US $337B over 10 years Save $78B in each year thereafter Value of Healthcare Information Exchange and Interoperability (HIEI): CITL Key Findings Standardized, encoded, electronic healthcare information exchange would Save the US $337B over 10 years Save $78B in each year thereafter Decrease unnecessary utilization Decrease re-testing Decrease errors and morbidity Improve disease management

Connected communities and interoperable systems

Connected communities: horizontal / people / places Connected communities, and RHIO’s, and the NHIN, refer to being able to share data from multiple sources in a region, or even across regions.

Connected Community core principles – clinical view Common (appropriate) access to data Common access to knowledge – to make the best decisions Access to services – to take action on those decisions Communication and collaboration

Zones model permits graded approach Low interaction: Federated data assembly High interaction: Close data integration

Interoperability: vertical / systems

Interoperability

CITL HIEI Taxonomy 1 2 3 4 Level Description Examples Non-electronic data Phone, US Mail 2 Machine-transportable data Fax/Email without categorization 3 Machine-organizable data Text reports, HL7 messages 4 Machine-interpretable data LOINC-based lab results from lab system; codified medication hx

10-Year Cumulative Net Return by HIEI Level $(200) $(100) $- $100 $200 $300 $400 1 2 3 4 5 6 7 8 9 10 Years in billions Level 1 Level 2 Level 3 Level 4

What is “stunning interoperability” and why is it important? More than just data exchange Systems act in concert Anyone-can-play adaptability Knowledge organized for action

“Stunning” interoperability – concerted action Data exchange with meaning Views with clinical organization Applications can affect each other Requires: standards, exchange agreements Example: allergy entered in pharmacy system gets missed by today’s CPOE systems Which means that systems and applications should really be able to play together, even if they come from different manufacturers. [Read] New data coming from one system might generate an alert in another system. Information entered in one EMR could be seen in the format of another EMR. A single view will combine information from multiple sources.

‘CCR-plus’ Keep records from diverging when multiple referrals or clinical threads are occurring (which is almost all the time) Include vocabulary/coding as well as transport

“Stunning” Interoperability – Anyone-can-play aspect Choice – Best-of-breed systems become a smooth integrated system Choose by price and functionality rather than nameplate Customers will know that the new app can work seamlessly with what they have Flexibility – customers take the functions they need from a wide range A new system could be purchased and added and would quickly work together with what you already have, because it exchanges information in a healthbase model that everyone understands. The major benefit of this is, that we can make buying decisions based on price and functionality, rather than being constrained to continue with a single vendor even if something is better out there.

Requirements Catalog of basic functions and data exchanges Remote/common services: Reporting, configuration, preferences, etc. Internet and other easily-available services with common API’s based on healthbase requests ASP services and systems Start simple and quick! Organize the data once you have it together

Knowledge for action: Using Information centers Where you go when you’re dealing with a healthcare issue or scenario A “mindset” – “right now, I’m thinking about my new pregnancy” Has all of the relevant data displays, information sources, and transaction handlers to deal with the many aspects of the scenario Applies to lay and professional users This really applies to the functional, scenario-based orientation of the healthbase that we described earlier.

Hospitalization center Infocenters model Sicken Home Patient Overview Wellness ctr Practice Overview Chronic condition ctr Reports center Visit center Practice day overview So, I see no reason why we can’t… Procedures center One-click tasks Hospitalization center

Classes Appointments Reference Forums Personal record Home monitoring The cardinal rule is: I don’t want my screens organized by data. I want them organized by scenarios. On one screen, I see everything I need to have when I’m thinking about my diabetes. Here, we have a patient, and from a single screen, she can handle her common status, transactions and processes, and also be informed of new information that may have emerged. Again, using a modular approach, large companies can build many of these components and put them into a big full-function center; and then small companies can come in and add small, hard-hitting features which drop right into the same information center. Home monitoring Medications

Summary The value in interoperability comes from communication among providers, and concerted action among systems Stunning interoperability includes: Concerted action Anyone-can-play Knowledge for action Simple, pretty-good-and-solid solutions are the way to begin

For questions: jteich@healthvision.com