Health Information Exchange HIE

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Health Information Exchange (HIE)

• A Regional Healthcare Information (exchange)
  Organization (RHIO) is the business that manages
  the exchange of healthcare information across all
  participating stakeholders

RHIOs HIEs exist and are forming today at the
local, regional and state levels. These
exchanges ideally will integrate and harmonize
with and as part of the future National Health
Information Network (NHIN).
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Virginia Health Information Exchanges
Virginias Health IT Grants awarded in 2007 and
2008 to expand the use of electronic health
records in Virginia
NOVARHIO Access to patient medical histories in
ERs comprehensive outreach campaign for a
voluntary web-based File for Life that could be
accessed by emergency responders
Centra Nations first outpatient EHR link with
ACCs outpatient cardiac registry to benchmark
adherence to practice guidelines and measures
MedVirginia EMR adoption by free clinics with
HIE interfaces for secure messaging, Rx history,
vitals, aligned with NHIN assessment of e-Rx for
mental health providers
CareSpark Comprehensive approach to regional HIE
aligned to NHIN goals specific attention to
rural health disparities in region
CCNV Fully funded EHR implementation at all
clinic sites (15 live today) with pilot
connectivity to public health services in
Southside
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Virginia Health Information Exchanges

• Centra - Terri Ripley
• Community Care Network of Virginia - David Selig
• Northern Virginia Regional Health Information
  Organization - Geoff Brown
• CareSpark - Liesa Jenkins
• MedVirginia - Michael Matthews

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Centras Health Information
Centra Provider Portal
Community Master Person Index
Inpatient Clinical Solutions
Documentation Orders Results
Document Imaging
Centra Lab
Centras Ambulatory EHR
Medical ImagingPACS
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Electronic Exchange of Results
Centra
Central Virginia Imaging
Ambulatory EHR
Transcribed Reports
Lab Results
Radiology Reports
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Outpatient EHR link with ACC

• As a patient visits Centras Cardiology
  physician, data is collected within an IC3
  template as part of the EMR.
• Hospital data is combined with the physicians
  EMR. For the first time inpatient and outpatient
  data is available to the physician and collected
  in the NCDR.
• Currently 113 data elements are captured
  electronically and sent to the ACC.
• The ACC compares data with benchmarked data and
  will return reports showing each physicians
  adherence to best practice guidelines and
  measures.

Heart House
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Next Steps

• Additional physician offices online with results
• Continued Roll-out of physician office EMR
• Case study for Cardiology Data Registry
• Expand data sharing
• CCD from Physician offices

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Virginia Health Information Exchanges

• Centra - Terri Ripley
• Community Care Network of Virginia - David Selig
• Northern Virginia Regional Health Information
  Organization - Geoff Brown
• CareSpark - Liesa Jenkins
• MedVirginia - Michael Matthews

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State IT CouncilInformation Technology Grant
Community Care Network of Virginia, Inc.
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Who We Are.

• Incorporated in 1996
• Owned by all of Virginias 23 Federally Qualified
  Health Centers
• Located in 85 offices across the Commonwealth

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Information Technology Focus

• Hosting, support and training for legacy practice
  management system, and new electronic health
  record system since 1999
• Statewide initiative to install electronic health
  record software application to be completed 1st
  QTR. 2009
• Created Center for Data and Informatics for data
  warehousing, reporting and to support Performance
  improvement
• Evaluating innovative technology - Kiosks

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The Medical Home and HIE
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The Medical Home and HIE

• Personal Relationship Each Patient has an
  ongoing relationship with a primary care
  physician
• Team Approach The Physician leads a team of
  individuals at the practice level who
  collectively take responsibility for the ongoing
  patient care.
• Comprehensive The physician is responsible for
  providing for all the patients health care needs
  at all stages of life
• Coordination Care is coordinated and integrated
  across all domains of the health care system,
  facilitated by registries, information
  technology, health information exchange and other
  means to assure that patient get the indicated
  care when and where they want it.
• Quality and Safety Quality and Safety are
  hallmarks of the medical home.
• Expanded Access Enhanced access to care is
  available through systems such as open
  scheduling, expanded hours, and new options for
  communication between patients, physicians, and
  practice staff.

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Medical Home and HIE
Hospitals
Specialists
Local Social Service Agencies
Medical Home Federally Qualified Health Center
Health Department
Payers
Pharmacy
Home Health
Hospice
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CCNV State IT Council Grant
Local Social Service Agencies
Medical Home Federally Qualified Health Center

• Patient demographics
• Family income and need
• Referral coordination

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David Selig Chief Executive Officer Community
Care Network of Virginia 6802 Paragon Place Suite
630 Richmond, VA 23230 804-237-7686 dselig_at_ccnva.c
om
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Virginia Health Information Exchanges

• Centra - Terri Ripley
• Community Care Network of Virginia - David Selig
• Northern Virginia Regional Health Information
  Organization - Geoff Brown
• CareSpark - Liesa Jenkins
• MedVirginia - Michael Matthews

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Inova Health System
Inova Continuum of Care Healthplex
Inova Alexandria Hospital
Inova Fairfax Hospital
HIMSS Virginia Chapter October 16, 2008
Inova Fairfax Hospital for Women Children
Inova Fair Oaks Hospital
Loudoun Healthcare
Inova Mt. Vernon Hospital
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NoVa RHIO

• Mission

...to improve the health status and health care
of the those who live and work in
Northern Virginia by facilitating the
availability of accurate and
timely electronic medical records when needed for
health maintenance and treatment
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Perspectives on Better Communication Better
HealthCare

• Critical information missing in 14 of primary
  care visits impact on care in 44 of these
  cases
• Patients agree to duplicate tests 50 of time
• Difficulties in information retrieval account for
  one in seven admissions

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Seeking Solutions NoVa RHIO
Benefits and Values

•  
• Safety
• Programs will improve the safety of medical
  care 
• Value
• Programs will improve the efficiency of medical
  care
• Convenience
• Programs will be user friendly and promote
  access to health and health care 
• Privacy and Integrity
• The protection of an individuals personal and
  private information is of critical importance

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NoVa RHIO Participants

• Major Area Hospitals and Healthcare Systems
• HCA Reston Hospital Center
• INOVA Fairfax Hospital
• Virginia Hospital Center (Arlington)
• Physicians and Clinics
• Labs and Pharmacy
• Patient Advocate Organizations
• Healthcare consumers
• NGOs

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NoVa RHIO Organization

• Local Governments
• Payors
• Businesses
• Universities
• Not-for-profits
• Diverse Board of Directors/Trustees
• Foundation funding through large employer
  contributions plan for sustainable business
  model

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Health Care Scenarios

• Getting information to the Point-of-Care
• Doctors, Dentists, Clinics and Hospitals
• Emergency Medical Technicians
• Future RHIO Goals
• Improving Public Health Response
• Supporting patients in a mobile society
• Consumer Empowerment

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Emergency Medical Technician Scenario
Suppose you have a medical emergency when the
ambulance arrives, do you want the Emergency
Medical Technicians searching your home, vehicle
or office for your hand-written health records or
would you prefer they press a few keys on a
computer in the ambulance and instantly have the
accurate and comprehensive information needed to
save your life?
Personal Health Record (PHR)
Electronic Patient and Provider Identification
EMT Portal
Patient Safety Data
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How does it work?
Query sent to GE HIE/Rx Hub
Request submitted by registration to Inova Data
Center
12 seconds
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Virginia Health Information Exchanges

• Centra - Terri Ripley
• Community Care Network of Virginia - David Selig
• Northern Virginia Regional Health Information
  Organization - Geoff Brown
• CareSpark - Liesa Jenkins
• MedVirginia - Michael Matthews

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Virginia HIMSS 10-16-08
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750,000 patients in multi-state region
2/3 of patients live in Tennessee 1/3 live in
Virginia 5 in other states

• Health Disparities (compared to rest of Va)
• Mortality rates 42-100 higher for adults ages
  25-64
• 5 times the rate of death from prescription drug
  overdose
• High rates of chronic diseases heart disease,
  diabetes, hypertension, lung disease, cancers
• 18 uninsured

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Background of CareSpark

• CareSparks mission is to improve the health
• of people in NE Tennessee and SW Virginia through
  the collaborative use of health information

• Initiated in 2003, chartered in 2005
• Community-based, regional not-for-profit
• Aligned with federal and state (Tennessee,
  Virginia) initiatives
• Recognized leadership as model for
• Collaborative governance and broad-based
  participation
• Standards-based approach
• Commitment to data-driven performance excellence
• Business model for sustainability

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CareSparks Strategic Outcomes

• Population Health Clinical
• Premature Mortality Adult Diabetics, Rx filled,
  vision / foot, HBA1Clt7
• New Diabetes Cases
• Lipid Panel LDL lt 100
• Flu Vaccines for 65 Pneumo Vax for ages 65, lt2
• ER Visits for Health Attack Stroke Therapy
• Post- MI followup Cancer Screenings (PAP,
  Mammogram, colorectal)
• Financial Savings -- ROI
• Patient
• Clinician
• Facilities
• Purchaser (health plan, employer, taxpayer,
  individual)

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Community-Wide Collaboration

• Active, representative participation, including
• Employers Eastman Chemical Company, CGI, BAE
  Systems, City of Kingsport,
• Payors Blue Cross Blue Shield of Tennessee,
  John Deere Health / United Healthcare, Cariten
• PHP, Highlands Wellmont Health Network, CIGNA
• Hospitals Mountain States Health Alliance,
  Wellmont Health System, Johnston Memorial
• Hospital, Quillen V.A. Medical Center,
  Laughlin Memorial
• Physician Practices Holston Medical Group,
  Highlands Physicians, Health Alliance PHO,
• Cardiovascular Associates, ETSU University
  Physicians, Clinch River Health Services,
  Frontier Health,
• Southwest Virginia Community Care Network,
  Blue Ridge NeuroScience, C-Health
• Health Education East TN State University
  School of Medicine / College of Nursing/ College
• of Public and Allied Health, University of
  Appalachia College of Pharmacy, University of
  Virginia
• Public Health Sullivan and Northeast Regional
  Health Departments in TN, Cumberland
• Plateau and Lenowisco Health Districts in VA,
  Tennessee Department of Health, Virginia
  Department
• of Health and Human Resources
• Community Non-Profits Kingsport Tomorrow,
  United Way of
• Kingsport, Rotary Club of Kingsport,
  Kingsport Chamber of Commerce,
• Bristol Chamber of Commerce, NETWORKS
  Sullivan County Partnership
• Patient Advocacy Groups American Cancer
  Society,

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CareSpark RHIO Consortium Partners

• National / International Local / Regional
• BCTI
• ActiveHealth the Creative Trust AllScripts D
  eliberare
• Anakam Holston Technology
• Cisco Intellithought
• CGI LucentGlow
• Dell OnePartner
• GE Healthcare
• Healthvision / Quovadx State
• Initiate Systems Tennessee
• Intel Virginia
• Misys
• Oracle Federal
• Siemens DHHS / ONC Wellogic

Market / thought leaders committed to
interoperability, collaboration and results
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Revenue Sources July 2005 June 2008

• Employers
• Eastman Chemical Company 600,000
• King Pharmaceuticals 60,000
• Cariten PHP 8,000
• Johnston Memorial Hospital 10,000
• Contracts
• State of TN 1,016,900
• Accenture (NHIN prototype) 308,000
• Commonwealth of Virginia 250,000
• NHIN Trial Implementation 3,988,622
• Consortium Partners
• cash and inkind 2,225,000
• Enrollment Fees (CareEngine Services) 431,640
• Transaction Fees 0

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Participation Agreements

• Data Exchange for Patient Care / Treatment
  (7-31-08)
• Holston Medical Group
• Sullivan County Regional Health Department
• Southwest Virginia Community Health Services
• Cardiovascular Associates
• Bristol Surgical Associates
• Clinch River Health Service
• Mountain States Health Alliance
• Wellmont Health System
• C-Health
• Johnston Memorial Hospital
• Tennessee Dept of Health (immunization registry)
• Virginia Dept of Health (immunization registry)
• University of Virginia (cancer center)
• Johnson City Downtown Clinic
• Veterans Affairs
• East Tennessee State University (Physicians
  Practice Group)
• Labcorps
• Data Exchange for Quality Improvement (7-31-08)

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Standards-Based Technology
Data Participants Clinicians Facilities
Ancillary Services Public
Health / Research Payers
Patients Other RHIOs
CareSpark Data Store (as of
4-30-08) (as of
6-30-09)
Hospital 1 Phys Portal
XDS PatientIdentitySource (MPI)
Portal
XDS PIXService
IHE DocConsumer
Physician Practice w/EMR
XDS PDQService
XDS Key Store (access controls)
CareSpark XDS Data Store - For Patient Care
XDS DocumentRegistry
Document Repository
IHE DocSource/ DocConsumer
MPOP consent mgmt
ATNA Audit Repository
CT TimeService
Hospital
Document Repository
Data Transformation
Interface Engine
IHE DocSource/ DocConsumer
Other Data Participants
FILTER
Document Repository
Clinical Data Repository - For Public
Health Improvement
IHE DocSource/ DocConsumer
Clinical DataRepository
NHIN data participants
Public HealthData Mart
De-IdentifiedData Mart
Document Repository
IHE DocSource/ DocConsumer
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Convergence of Data
Clinical
Patient-Centered Care
Administrative Billing Claims
Personal Health Record
Research Best Practices
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Nationwide Health Information Network network
of networks
NHIN Prototype Demonstration 2006-07 design
for exchange between CareSpark, West
Virginia, Kentucky providers
NHIN Trial Implementation 2008 Core
Services Consumer permissions Security
exchange Standardized
interfaces Summary medical record
Medication Management eRx, med history,
decision support Consumer
Empowerment personal health record,
registration and medication
history
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Technical/Financial Timeline
Claims-based Decision support implemented
Physician Portal, authentication
Real-time Decision support integrated with HIE
document registry and Repository
Clinical document Exchange
Build clinical data repository
MPI build
Jun 08
Jun 09
Jan 08
Dec 09
Jan 09
Jun 07
Jan 07
Enrollment 50,000 members
Data-sharing agreements
Enrollment of 25,000 members
Enrollment 35,000 members
NHIN Trial Implementation
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Future Initiatives

• National connect with V.A., CDC and personal
  health records
• Tennessee connect with state agencies (public
  health immunization registry, Tn eHealth Council
  efforts)
• Virginia connect with immunization registry,
  prescription management program
• Local / Regional support aggregation and
  analysis of data to address public health issues
  for region (chronic disease, prescription drug
  overdose)

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Better Health for Central Appalachia

• www.carespark.com
• Liesa Jenkins, Executive Director
• 423-963-4970
• ljenkins_at_carespark.com

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Virginia Health Information Exchanges

• Centra - Terri Ripley
• Community Care Network of Virginia - David Selig
• Northern Virginia Regional Health Information
  Organization - Geoff Brown
• CareSpark - Liesa Jenkins
• MedVirginia - Michael Matthews

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Organizational Purpose

• Collaboration in HIT
• Clinical data exchange
• Practice automation

Vision the most electronically integrated
medical community in the U.S.
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Development Timeline
Value-added Services
Launch of Solution
Major Milestones
NHIN II
Prototype
AHRQ
2001 - 2004
2004
2005
1Q06
4Q08
3Q07
1Q07
Mar 05
Product development begins
System Enhancements
VA HIT Council
600,000 charts / 115 practices / 330 physicians
/ 1200 users
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Features and Functions

• Current
• Clinical inbox
• Clinical messaging
• Community e-chart
• Demographic summary
• Clinical summary
• Electronic prescribing
• Integrated practice notes
• Rounds list
• PM interfaces

• 4Q08
• PACS interface
• E-signatures

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Stepping Stones

• Basic
• Results delivery
• Secure messaging
• E-chart
• PM interface/schedule view
• Integrated e-RX
• Integrated office transcriptions
• Integrated electronic chart
• Data integration with existing EMR

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Focus on Safety Net Providers

• Clinical data
• Hospital results
• Labs
• Medications
• Secure messaging
• Practice management
• Interfaced with MedVirginia
• Clinical documentation
• Meds, allergies, problem lists, vitals
• E-prescribing
• Eligibility screening tool

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Reports
Support to the Safety Net
Free Clinic Pharmacy
MedVirginia Health Information Exchange
E-Scripts
Retail Pharmacy
Updated Meds

• Demographics
• Eligibility
• Clinicals
• Medications
• Allergies
• Problems
• Immunizations
• Vitals
• Hospital results
• Lab results
• Practice notes

Demographics Schedule
Results Discharge Meds
Hospitals
Referrals
Eligibility Data Clinicals
Specialists
(Optional)
Care Coordination Monitoring of Sentinel Events
Referral Back to Medical Home
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Community Service Boards / Community Resource
Pharmacy

• Technical plan for connectivity
• Community Resource Pharmacy
• Retail pharmacies
• Access to community medications
• Clinical decision support
• Integration with interoperability assessment and
  pharmacy procurement

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NHIN Core Services and Use Cases

• NHIE Core Services
• Data Services
• Including summary record exchange
• Consumer Services
• User and Identity Management Services
• Management Services

• Breakthrough / Use Cases
• Medication Management
• EHR Labs
• Emergency Responder
• Consumer Empowerment
• Biosurveillance
• Consumer Access to Clinical Information
• Quality
• SSA

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Gunnery Sergeant William Ozzies Treatment History

• Iraq William Ozzies sustains injuries to head,
  body and left foot.

Bethesda, MD Receives care at National Naval
Medical Center for mild head trauma, surgery on
left foot and is evaluated for traumatic brain
injury (TBI).
Richmond, VA Transferred to St. Marys Hospital,
a Not for Profit Hospital within the Bon Secours
Health System and a data supplier to MedVirginia.
Physician prescribed pain medication and an
anti-inflammatory to address continued pain in
left foot.
Kingsport, TN Incurs injury to right ankle and
treated at the Holston Medical Group Urgent Care
of Sapling Grove, a provider that participates in
CareSpark. Physician accesses records from DoD
and MedVirginia. Diagnosed with sprained ankle
and prescribed Acetaminophen.
Pinehurst, NC Begins experiencing headaches
while on vacation. Visits FirstHealth of the
Carolinas, a member of NCHICA. Doctor reviews
records from DoD, MedVirginia, CareSpark and
diagnoses an analgesic overuse headache.
Richmond, VA After honorable discharge, William
begins treatment at Hunter Holmes McGuire VA
Medical Center.
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CMS EHR Demonstration

• Purpose Drive adoption of EHRs in primary care
• MedVirginia selected as convener for Virginia
• One of only 12 sites awarded in U.S.
• Small-medium PCP practices lt20 MDs
• Need 200 practices in VA (100 control, 100 study)
  
• Incentives (additional Medicare reimbursement)
  provided for
• Year 1 Adoption of CCHIT-certified EHR
• Year 2 Reporting of quality measures
• Year 3-5 Clinical improvements (P4P)
• Up to 29M in funding available

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