1. 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

2. 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

3. 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

4. Connected communities and interoperable systems

5. 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.

6. 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

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

8. Interoperability: vertical / systems

9. Interoperability

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

11. 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

12. 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

13. “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.

18. ‘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

19. “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.

20. 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

21. 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.

23. 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

24. 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

25. 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

26. For questions: jteich@healthvision.com