Factors for Creating a Successful RHIO / HIE 498DL Winter 2011 Beena Joy Paul Kuo MariJo Rugh David Sumner

Examining Goals for RHIOs / HIEs 3 State review Technical and non-technical concerns – Structure and Governance – Data Security and Standards – Consent Management – Adoption

Provider Participation Motivators – Compliance with mandates (eg, e-prescribing) – e-Billing mandates – Pay-for-performance incentives – Improved coding and direct links to payers – Time savings from direct electronic reporting – Increased payment if quality goals are met – Cost savings to public and private health plans – Altruistic goal to improve public health – Quality of care and patient safety – Increased operational and clinical efficiencies Barriers – Lack of interoperability – Lack of vision and goals – Security and privacy concerns – Cost – Creating a successful business model – Limited technical support

Business Models Membership/subscription Transaction fees Sales/revenue Affiliate/revenue Advertising revenue Greatest potential – Hybrid membership/subscription and transaction model

Overview Center for Health Transformation. (2010)

Illinois HIE Illinois Office of Health Information Technology,

Illinois HIE General Architecture- De-centralized, federated, 3-layer Financial Model- ARRA plus public-private partnership; mechanism ??

Illinois HIE Clinical MessagingFuture Clinical Summary Exchange for Care Coordination (CCD/CCR Standards)Future Delivery of Structured Lab Results Operational (61%) Electronic Order Entry Future ePrescribing and Refill RequestsOperational (89%) Quality ReportingFuture Patient Portal Future Repository Services Future Eligibility and Claims Operational (44%)

Illinois HIE Connectivity to NHIN – 2012 – 2014 ?

Illinois HIE Illinois Office of Health Information Technology,

Indiana HIE Five existing independent, private-sector, regionally-based HIOs Each of which has been operational and sustainable for at least five years Accounts for more than 12 million patient records and 12,000 physicians

Indiana HIE Mission/Vision VanZee,

Indiana HIE Services Clinical Messaging and Electronic Results Delivery (HL7 Standard) Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) Electronic Order Entry ePrescribing and Refill Requests Quality Reporting Patient Engagement (Patient Portal) Repository Services Interoperability / Shared Provider Directories / Master Patient Indexes Eligibility and Claims

Indiana HIE Standards Terminology StandardsICD, CPT, NDC, LOINC©, RxNorm, and SNOMED, and HITSP constructs such as C32, C37 Data Transport and Protocol Standards Web Services, LLP, HTTPS, Standard Object Access Protocol (SOAP), HTTPS, SSH, SFTP, SQL, ODBC, IHE, electronic business Extensible Mark-up Language (ebXML), Secure Socket Layer (SSL), and Transport Layer Security (TLS). ePrescribing standardsNCPDP, NCPDP SCRIPT v8.1, NCPDP Formulary and Benefit v1.0, NCPDP SCRIPT v8.1 RXHREQ, RXHRES Image Transfer standardsDICOM EHR standardsCCHIT certified

Indiana HIE – Moving Forward Connectivity to NHIN – existing HIOs have established connectivity

Indiana Infrastructure VanZee,

Mission Overview of the WI Demographics 4 Operational HIEs WHIE OCHIN, Inc CHIC UNIVERSATA, Inc State-Level HIE Planning and Design Phase 1 Phase 2 Wisconsin HIE

Clinical Summary Exchange for Care Coordination (CCD/CCR Standards)Operational (Epic) Delivery of Structured Lab Results Operational Electronic Order Entry Operational ePrescribing and Refill RequestsOperational Public Health Reporting Operational Electronic Lab Reporting of notifiable conditions Syndromic Surveillance Immunization Data Eligibility and Claims Operational

HIE Strategic & Operational Plan Profile GovernanceSecurityStandards and Architecture

Wisconsin HIE Architecture Wired for Health Board,

State Contrasts IL, IN Federated – WI Hybrid models IN, WI Clinical Messaging - Operational IN, WI Electronic Order Entry – Operational IN, WI Quality Reporting - Operational IN Patient Portal – Operational Technical standards - Essentially matching

HIE Functionality Required for Meaningful Use 2011 Electronically capture health information in a coded format Use that information to track key clinical conditions Communicate that information for care coordination purposes 2013 Encourage the use of HIT for continuous quality improvement at the point of care Exchange HIT information in the most structured format possible Promote improvements in quality, safety and efficiency Focus decision support for national high priority conditions Enable patient access to self management tools Access to comprehensive patient data Improving population health

Recommendations for new RHIOs Commitment to the RHIO is a process Don’t give away services Vendor-neutral architecture Understand requirements Encourage adoption Plan for consent management Base the solution on HIT and IT standards

Conclusion: On Our Way to Sustainable HIE Early failures and successes have laid the road bed for the future State strategies further the construction Advancements in technologies and standards are removing the barriers Additional opportunities/gaps to be addressed

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