1. Health Information Exchange
September 14, 2018
Gijs van Oort, PHD
CEO
HASA
Emily Hartmann
Executive Director
PHIX

2. Agenda What are health information exchanges (HIEs)?
Overview of two HIEs in Texas
HASA – Healthcare Access San Antonio
PHIX - Paso del Norte Health Information Exchange
How do I choose the right network?

3. What are health information exchanges (HIEs)?

4. One Big Problem: Unreliable and inefficient health information sharing
Lack of medication management
Repeated lab and imaging studies
Preventable medical errors
Poor care coordination

5. Centralized hubs facilitate data exchange
Hospital
Primary Care Clinic
FQHC
Lab
Hospital
Health Information Exchange (HIE) Repository
Specialist ED
Urgent Care
Primary Care Clinic
Specialist
FQHC = Federally Qualified Health Center; HIE = Health Information Exchange, ED = Emergency Department

6. HIEs have the same goal but different approaches
Common goal: Improve health by ensuring the right information is in the right place at the right time.
HIEs can be structured differently:
Governance
Legal
Privacy and Security
Financial
Patient Consent
Functionality

7. National effort to connect HIEs
Source: SHIEC.

8. Future: Single on-ramp for interoperability
Trusted Exchange Framework and Common Agreement
There is no “magic bullet” for nationwide interoperability
The goal is to build networks that connect
Choose the right network(s) for your organization
Network serves as a single on-ramp for interoperability

9. Community Health Information Exchange Benefits and Value
HASA is community Health Information Exchange in full production since 2010 and with data contributors since 2012.
Gijs van Oort, PhD
CEO

10. Growing Demand for Health Care Federal Budget for HHSC is decreasing
Source: UTSA Demographics Center
Source: TX Medicaid and CHIP in Perspective - 11th Edition
Federal Budget for HHSC is decreasing

11. Increased Demand with Same or Lower Reimbursement
Rationing of Care or
Greater efficiency in care delivery
Triple Aim
Better care
Better health
Reasonable cost
Payment Reform (From Fee for Service to Pay for Performance)
Bundled payment
MIPS/APM
Patient Centered Medical Homes
Readmissions penalties
Need actionable, real-time, patient information
HIE

12. HASA Capabilities Aggregated patient lookup
Data push into customer systems (CCD, ADT)
Real-time, clinical reporting for quality, utilization, public health, care coordination
Electronic referral system
Alerts and discharge notification
Connection to TX HIEs and national HIEs
Connectivity to DoD & VA (in development)

13. Community Health/ Mental Health
HASA HIE Coverage Area to Date Nonprofit, with broad community participation
Physicians
1703
Hospitals 43
Waco Region
San Angelo Region
Community Health/ Mental Health 3
HASA’s initial coverage area spanned the greater San Antonio region, comprising 22 counties. The Corpus region currently uses HASA services as does the North Texas region. (this slide needs updated map…)
FQHC 7

14. HASA discussions with Western Plains hospitals

15. HASA HIE data exchange
HASA’s initial coverage area spanned the greater San Antonio region, comprising 22 counties. The Corpus region currently uses HASA services as does the North Texas region. (this slide needs updated map…)

16. HASA Landing Dashboard
HASA Data Elements:
Demographics
Encounters
Lab
Radiology
Discharge
Immunizations (some)
Medications (some)

17. From: Sugumar, Sophia (CMS/CCSQ) [mailto:Sophia. Sugumar@cms. hhs
From: Sugumar, Sophia (CMS/CCSQ) Sent: Wednesday, March 22, :08 PM To: Andrea Espinosa Vince Fonseca Phil Beckett Subject: Action Required: 2017 MIPS Qualified Registry Posting DRAFT: Healthcare Access San Antonio Importance: High
Congratulations! You’ve been approved to participate in the Merit-Based Incentive Program (MIPS) for 2017 as a qualified registry.

20. Social Determinants of Health Target 2018
Develop an intake platform for CMS five categories for personal risk:
Food insecurity
Utility needs
Housing instability
Interpersonal violence
Transportation needs
Implement intake capability for geographic risk:
Categorize zip code and census tract by vulnerability status
Create holistic patient view for providers to include:
Clinical risk
Social/personal risk
Geographic risk

21. HASA Virtual Health Record – Social Risks

22. HASA VHR – Geospatial Risks

23. HIE Collaboration during Harvey
GHH and HASA decided to collaborate by providing temporary access to each other’ HIEs as most of the affected area was accessible through one or the other:
GHH supporting evacuees in Houston
HASA supporting coastal residents cared for outside the region
HASA reached out to ICC for assistance in Austin shelter
HASA established a connection with Louisiana HIE as evacuees reached the Dallas shelter
HIETexas was reactivated for an additional 30 days

24. Emily Hartmann
Executive Director

25. Non-profit based in El Paso region
Mission to improve health through collaboration and data technology.
PHIX Board includes representatives from each of PHIX’s major partners.
Changed name in 2017 to better reflect broader region.

26. Provide centralized community health records
HIE = health information exchange

27. Connected to VA and Dept. of Defense Nationally
User Story: Active duty soldier and his family recently moved to Texas from Washington, DC. When his child visited a community specialist for a chronic health need, the specialist used PHIX to review the child’s full care record from the Dept. of Defense in Washington, DC. As a result, they avoided repeating several lab and imaging tests.

28. Value of PHIX: Stories from our users
Improved safety
Hospitalist planned to perform a cardiac catheterization for their patient. Prior to the procedure, they queried PHIX and found that a cardiac catheterization had been performed at another hospital. As a result, the patient received better care and avoided an unnecessary procedure.
Improved efficiency
Primary care physician queried PHIX before doing a stroke assessment for their patient. They found results from a stroke assessment performed the previous week at a hospital. As a result, the patient avoided several repeated imaging and lab tests.
Improved quality
Emergency Medicine physician had a patient in cardiac arrest who could not speak to her care history. Through PHIX, they found information on her cardiac conditions and medications from other providers. Based on this additional information, her treatment was adjusted.

29. Recognized for innovation and collaboration in public health
National Association of County and City Health Officials (NACCHO) selected the City of El Paso Department of Public Health as a Promising Practice for its Paso del Norte Electronic Network for Linkage to Preventive Health Services in 2018.
“This project offers a holistic approach to patients using a medical data hub to evaluate a person’s needs. We are able to use the system by cross referencing our clients’ information to make sure if they need further services such as cancer screenings or vaccinations, then they are either provided the care or are directed to the proper venues.”
Robert Resendes, Public Health Director

30. Data exchange partners
Hospitals (6)
Outpatient Clinics (6)
Veterans Administration*
Department of Defense*
Texas Tech University Health Sciences Center of El Paso
Local Mental Health Authority
Federally Qualified Health Centers (3)
City of El Paso Department of Public Health
PHIX is actively recruiting partners throughout west Texas and southern New Mexico.
*National connections through the eHealth Exchange.

31. Support and engage small physician practices
The physician community in our region consists primarily of small practices with one to four physicians.
PHIX supports practices in navigating complex federal regulations, quality reporting requirements, and privacy and security standards.
PHIX has an internal technical team to develop HIE interfaces with small practices rather than relying on third-party vendors.
HIE = health information exchange

32. PHIX Structure Patient Consent Governance
Generally, patients must opt out to prevent data from being shared.
There are exceptions. Patients at mental health and substance abuse facilities must opt in.
Governance
PHIX Board of Directors includes representatives from PHIX’s partners.
PHIX Committees provide feedback on how PHIX should operate and grow.
Privacy and Security Committee
Physician Advisory Committee
Strategic Planning Committee
Governance Committee

33. Exploring additional services to benefit PHIX’s partners
Real-time notifications to care managers when patients are admitted, discharged, and transferred
Image exchange
Connectivity to other HIEs

34. How do I choose the right network?

35. Choose the right front door for your community
Choose the “front door” to interoperability that is the best fit for your community.
Technology: What functionality do we need to meet our goals today and in the future?
Network: Who do we need in our data sharing network locally? Nationally?
Cost: What type of investment would be required?
Governance: Who is making decisions on how data is managed?
Legal: What can the data be used for?
Privacy and Security: What controls are in place? Who is making sure it runs properly?
Consent: Would our community prefer an opt-in or opt-out patient consent model?
Your front door will serve as a connection point across Texas and nationally.
HIEs in Texas are committed to working together.

36. Thank you Emily Hartmann, Executive Director, PHIX
Office: |Cell:
Gijs van Oort, PhD, CEO, HASA