HIEs and the American Dream

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HIEs and the American Dream
Challenges, issues and successes in State level
initiatives

• By Mark Jacobs
• Wellspan Health
• January 15, 2008

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Necessity never made a good bargain. Benjamin
Franklin (born Jan 17, 1706)
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Sustainability took only 300 Years
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The HIE Party
Fragile AGGLOMERATION of Patient needs and a
need for Positive Results
AHIMA
HHS
Access
HITSP
Security HIPAA
NHIN
AHRQ
HIMSS
Privacy
RHIOS
Regulatory
State Efforts
HIEs
State and Federal Involvement
PHR
Governors
NHIN
Market Adoption
CCHIT
EHR
AHIC
Use Cases
Vendors
Interoperability
Gartner
iHE
Standards
ONC
Identity Management
Providers
Payers
Hospitals
Patients
Physicians
Banks
Public Health
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Major Struggles in HC

• Cost
• Struggled to care for the the poor and
  chronically ill patients
• Chronic Diseases i.e. Diabetes, Asthma, Heart
  Disease, and some cancers can be managed and can
  have a positive impact on lifestyles
• Finding ways to use Technology since it can do so
  much for care

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Challenges to Define
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All things are cheap to the saving, dear to the
wasteful
2,000,000,000,000
Source Congressional Budget Office
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2 Trillion Dollars
Empire State Building
The Patient
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"An ounce of prevention is worth a pound of
cure,"
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States share many of the same challenges

• Fragmented healthcare delivery and financing
  environment.
• Historic economic pressures and restructuring
  serve as challenges and drivers
• Geographic, service scope and diversity call for
  coordinated local solutions
• Health Information Technology delivery
• Privacy Protection

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California
Focus of Efforts
Foundational Governance
Outcome of Collaborative Efforts
Nationwide Health Information Network (NHIN)

• Strategies for HIT Adoption
• Document Evidence of
• Benefits
• Document Current HIT
• Adoption

Reducing HC Cost Improving Patient Quality
Patient Safety
Office of National Coordinator for HIT (ONC)
Strategic Framework
Certification of EMR Products
Certification Commission on HIT HIT
Standards Panel Health Information Security
Privacy Collaboration Nationwide
Health Information Network (NHIN)
Architecture Projects

• Guidance Tools for
• State Level HIEs
• HIE Steering Committee
• eHI Technology Workgroup

American Health Information Community (AHIC)

• eHI
• AHIMA
• HIMSS
• Gartner
• Use cases
• eHealth Initiative Connecting
• Communities

Standards
FORE
Privacy Security

• HIMSS Dashboard
• Technology Tools
• Education

Use Cases
Report Prototype Architecture Contracts

• Other views available
• Core functions
• State of maturity
• Funding method

ARC Grants ()
HIE efforts shown by type of governance
Statewide HIE Virtual Backbone
CA Community Clinics Health Centers
Patient Registry Efforts
California Statistics Population 36.4
Million Physicians 71,500 Hospitals acute
453 psych 55 Other
Facilities 1,400
CA/CalRHIO Efforts
Provider Sponsored Efforts
County/Public Efforts
Consortia Efforts
CA 7/25/07
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Illinois

Driver
Focus
Outcome
Nationwide Health Information Network (NHIN)

• Strategies for HIT Adoption
• Document Evidence of
• Benefits
• Document Current HIT
• Adoption

Reducing HC Cost Improving Patient Quality
Patient Safety
Office of National Coordinator for HIT (ONC)
Strategic Framework
Certification of EMR Products
Certification Commission on HIT HIT
Standards Panel Health Information Security
Privacy Collaboration Nationwide
Health Information Network (NHIN)
Architecture Projects

• Guidance Tools for
• State Level HIEs
• HIE Steering Committee
• eHI Technology Workgroup

American Health Information Community (AHIC)

• eHI
• AHIMA
• HIMSS
• Gartner
• Use cases
• eHealth Initiative Connecting
• Communities

Standards
FORE
Privacy Security

• HIMSS Dashboard
• Technology Tools
• Education

Use Cases
Report Prototype Architecture Contracts

• Registries
• Illinois I-NEDSS Disease Surveillance
• Cornerstone
• Illinois (ICARE)
• Tracking Our Toddlers' Shots (TOTS)

Electronic Health Records Taskforce
Illinois

• 2004 AHRQ
• (EQUIP) Project - Erie Family Health Center
• Linking Rural Prov. to Improve PC Health -
  Katherine Shaw Bethea Hos.
• Sharing Pat.Record Access in Rural Health
  Settings- S.Bush Lincoln HC
• Toward an Optimal Patient Safety Information
  System -(JCAHO)
• Value of Technology to Transfer Discharge
  Information - University of ILL.
• 2005
• Implementing Amb. EMR Improving Shared Access-
  Sarah Bush Lincoln
• Caterpiller, Inc
• Association of Community Mental
• Health Authoriities of Ill Local Funds Initiative
• Illinois Health Network - Illinois Hospital
  Research Educational Foundation

AHRQ Grants ()
Federal Led/Facilitated Efforts
State Efforts
Statewide RHIO Efforts
Provider/Private/Public Led Efforts Catalysts
toward HIE EMR Adoption
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The RHIO World View Bringing Order to the
Chaos The National RHIO HIE View
Components Policies Practices Architecture Standa
rds Certification Privacy / Security
Standards Organizations HL7 ANSI
National Health Information Network (NHIN)
FUTURE NHIN
Regional/State HIE-Led Efforts
Regional Provider/Private/Public Led Efforts
(Largest Catalyst toward HIE EMR Adoption)
Regional/State HIE-Led Efforts
Regional/State HIE-Led Efforts
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The Information Age should be a period of great
glory for the US Health System and the American
Dream
Never leave that "till tomorrow which you can do
today.
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How much can we save?

• Rand Study 162 Billion per year
• 2.2 Million Adverse Drug Events Annually
• 1 avoided ADE saves 1,000-2,000
• EHRs instrumental in Managing Chronic Diseases
• Reduces incidence of chronic disease and hospital
  visits due to long-term prevention BY 147
  billion per year.
• Widespread use of HIT also will lead to more
  short-term preventive care routinely.

Show me the Money
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Savings with EMRs
SOURCE Can Electronic Medical Record Systems
Transform Healthcare? An Assessment of Potential
Health Benefits, Savings, and Costs, Health
Affairs, Vol. 24, No. 5, September/October 2005,
pp. 11031117, Richard Hillestad, James Bigelow,
Anthony Bower, Federico Girosi, Robin Meili,
Richard Scoville, Roger Taylor.
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2005 Rand Study HIT Savings and Cost
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Savings with HIEs?

• Looks promising
• Fully standardized HIEI could yield a net value
  of 77.8 billion per year once fully implemented.
  
• Non-standardized HIEI offers smaller positive
  financial returns no estimates.
• Clinical impact of HIEI for which quantitative
  estimates cannot yet be made would likely add
  further value.
• A compelling business case exists for national
  implementation of fully standardized HIE.

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Is there a Sustainability model when Chronic
Care Management, EMRs and HIEs work together?
While we may not be able to control all that
happens to us, we can control what happens inside
us.
Ben Franklin
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Health Information Exchanges
Challenges Bridging the Tools
Ambulatory EMR w/ePrescribe
Acute Care EMRs
CDMS
Health Information Exchange
Interoperability, Standards, Governance
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Technology Which way
Source IT Tools for Chronic Management July
2006 Calf HC Foundation
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The HIE Positioning Compass
Supporters
(Those who believe the change will occur)
Hospitals Business Leaders
HIEs
Visionaries or Ideologists
Conservatives
Generalists
Specialists
Crossing the Chasm
(Those involved HIEs Strategic Framework)
(Those with a wide array of knowledge where HC
exists today
Pragmatists
Technology Enthusiasts
Technology
HC Market
Skeptics
"For the want of a nail, the shoe was lost for
the want of a shoe the horse was lost and for
the want of a horse the rider was lost, being
overtaken and slain by the enemy, all for the
want of care about a horseshoe nail."
(Those challenged with care delivery or care
recovery)
MJJ 1/08
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HIE SustainabilityAchieving the Dream

• Envision success for HIE
• Different providers, Common HIT Challenges
• Split differences Can Dilute Opportunities
• Identify providers with high marks on a Risk
  Scorecard
• Identify and provide on-demand services to
  support the EHR

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Moving forward with HIEs

• Move beyond the initial target niche.
• Select strategic target market segments.
• Create an entry point into a larger segment.
• Take control of a mainstream market

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Think Organically

• Assess your Environment
• Assess your RHIO as an organization
• Assess what you can achieve within- current
  state
• Develop a simple and easy strategy
• Develop your plan around a time-line
• Execute the plan with Administrative oversight
• Measure and Monitor everything
• Probe and test
• Assess and Aggregate Success

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How can Information Management Help in Chronic
Disease Management

• HIT will play an important role in the successful
  implementation of these chronic disease
  initiatives through tools such as age, sex,
  disease registers recall and reminder systems.
• EHRs together with other decision support tools
  which can assist general practice in the
  systematic approach to Chronic Disease
  Management.
• Technology can assist in General Practice through
  improving the availability and Health Information
  Exchange (HIE) of secure electronic clinical and
  patient data such as online pathology/radiology
  ordering and reporting use of electronic
  referrals and discharge summaries.

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HIEs and the American Dream

• Leverage the collaboration, planning and
  resources of RHIOs
• Leverage the EHR through interoperability for the
  objective of Chronic Disease Management within
  states
• Commit as a priority EMR adoption and use of
  standards
• Develop a tactical plan to implement the HIE
  between providers
• Utilize current technology, privacy and security
  standards to be employed

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"can do nothing easy."