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Community Health Information Network (CHIN)
Medical Economics Data May 09, 1994 [draft]
Author: Carol Sansone, Business Development Manager
Community Health Information Network (CHIN) Definition Integrated collection of computer and
telecommunications capabilities that facilitates communication of clinical and financial patient information among multiple providers, payers, employers, pharmacies, and related healthcare entities
Variables CHIN will live within a health plan Ownership Number of participants Transaction volume Level of integration with other systems Range of applications Model of CHIN ARCHITECTURE
Community Health Information Network (CHIN) Migration Path
Transaction switching from station to station Universal implementation of clinical communications linking
hospitals and physicians Payer communication offering electronic data interchange and
insurance eligibility information Creation of clinical information (virtual) repositories Utilization of outcome database ORGANZATION
Community Health Information Network
Three Phases of CHIN Automation Electronic Ordering – Single Institution Electronic Medical Record – Multiple/Single
Institutions Lifetime Health Record/CHIN
Development – Multiple Encounters/Multiple Institutions
Community Health Information Network (CHIN)
CLINTON’S HEALTHCARE INITIATIVES Cut the cost of healthcare administration. Govern healthcare administration simplification through
Federal regulation. Expressed interest in the CHIN marketplace by large
Hospital Information Systems (HIS) vendors. Drive outcome measurements through CHIN users
(payers, government, research/education, providers, patients, employees, accreditation agents/regulators).
MARKET FORCES
ENVISIONED CHIN BENEFITS
PATIENT BENEFITS Reduce redundancy in forms, exams, tests Facilitate continuity of care Promote knowledgeable choice Lower cost of carePROVIDER BENEFITS Improve quality of care Reduce isolation of rural physicians Reduce litigation exposure Manage total cost of therapy Build a competitive marketplace advantage
ENVISIONED CHIN BENEFITS (CONT’D) Employer Benefits
Evaluate plan benefit characteristics Compare provider performance Reduce costs of health benefits Improve employer/employee satisfaction with
selected healthcare service options
Potential CHIN Fee Structures
All participants will pay fees for installation, systems integration, transmission, maintenance, service charges such as flat fees, eligibility fees and transactions fees.
Current systems usually omit physician fees to encourage participation.
Longer term, physicians will be charged for incremental services.
The network is largely transparent to the patient, who pays nothing.
UNRESOLVED CHIN ISSUES
Data and image transmission standardization Data standards are evolving
(HL7/IEEE/MEDIX) Industry imagery transmission standards are
in their infancy stage of development
UNRESOLVED CHIN ISSUES (CONT’D) Data ownership once (value-added) data is
on the network Data access role within a local network Data security to both code and protect
lifetime health records
Community Health Information Network (CHIN)
1) AMERITECH/WHIN/AHC
(AMERITECH HEALTH CONNECTIONS, INC.) Area of Service
7 hospitals with 750 physician users targeted 5 payers targeted for claims 5 billing services 3 labs and 4 clinics interested MILWAUKEE AREA WITH COMMUNITY
FOCUS
Community Health Information Network (CHIN)
1) AMERITECH/WHIN/AHC Features
Open system architecture Host systems include IBM, Tandem, HP,
DEC, and Unisys User interface with Windows, so all data can
be presented on one screen ARCHITECTURE DESIGNED FOR
GROWTH
Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Analysis
User functionality includes both payer and provider clinical communications
Specific applications include the following: E-Mail Bulletin board Deferred results Integrated with practice-management systems STRENGTHS
Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Future Applications Insurance enrollment Eligibility Verification Claim payment notifications Radiology images Rx notification Pre-admit Good financial stability Security through a card with microchip-encoded password/ID STRENGTHS
Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Analysis Future applications (continued)
Scheduling inquiry Orders Medical library Credit histories Insurance change notifications Integrated community database STRENGTHS
Community Health Information Network (CHIN)
1) AMERITECH/WHIN/AHC Analysis
Limited payer functionality at present Development of clinical database in early
stage of development Not fully proven line
WEAKNESSES
Community Health Information Network (CHIN)
1) AMERITECH/WHIN/AHC Analysis
How and when all interfaces will be accomplished
Time to market concept Proving cost-justification Development of outcomes/utilization
database CHALLENGES
Community Health Information Network (CHIN)
2) CHMIS/HARTFORD FOUNDATION Test site in Memphis Comprehensive design created by New
York based Benton International (consultants)
Features User and payers ATM-style efficiency Not-for-profit John A. Hartford foundation
Community Health Information Network (CHIN)
2) CHMIS/HARTFORD FOUNDATION Analysis
Combine EDI/WEDI concept of electronic processing and transactional facilitation
Meeting shared information needs through community-controlled database
Focus on community/cost/quality as goals Straight-forward design Ride the back of existing claims structure and build on an
embedded base rather than a perfect system concept
STRENGTHS(WEDI/Workgroup Electronic Data Interchange)
Community Health Information Network (CHIN)2) CHMIS/HARTFORD FOUNDATION Analysis
Unproven Database issues of security and
confidentiality because of size Focusing on claims and insurance rather
than larger vision
WEAKNESSES
Community Health Information Network (CHIN)2) CHMIS/HARTFORD FOUNDATION Analysis
Community support because of size Operational complexity Time to market System integration and interface issues
CHALLENGES
Community Health Information Network (CHIN)3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS) Area of Service
Approximately 22 networks are growing reaching more than 40 percent of Colorado hospitals.
First alpha site at St. Anthony, Denver
EXPANSION THROUGH ACQUISITION STRATEGY FOR NATIONAL COVERAGE
Community Health Information Network (CHIN)3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)• Features
• For-profit corporate venture• Batch system in the works for approximately 3 years• Mature clinical messaging capability
• Transmits voice, data and image• Store and forward technology to send messages ARCHITECTURE
Community Health Information Network (CHIN)
3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)
• Analysis• Proven capability• Simplicity of use• Low costs with batch interfaces means less
worry about data loss
STRENGTHS
Community Health Information Network (CHIN)
3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)
• Analysis• Limited payer capacity• Batch architectural design• Limited system integration• Costs can be high depending on service and
transaction volume WEAKNESSES
Community Health Information Network (CHIN)
3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)
• Analysis• Transaction switch in development stage• Company growing rapidly so resources may
be stretched• Clinical and outcomes databases planned for
the future CHALLENGES
Community Health Information Network (CHIN)
4) SMS/HDX• Area of Service
• Community focus and open to all participants• Total view is national in scope
CURRENTLY DIFFERENT STAGES OF DEVELOPMENT IN OHIO, NEW HAMPSHIRE, NEW YORK, AND CALIFORNIA
Community Health Information Network (CHIN)
4) SMS/HDX• Features
• For-profit effort by subsidiary of major HIS system vendor with extensive client list nationwide
ARCHITECTURE
Community Health Information Network (CHIN)
4) SMS/HDX• Analysis
• Extensive design with proven capability in payer-clinical communications
• Transaction switch scope to be expanded over 4 to 6 years
• Includes new captive membership, utilization monitoring, payment settlement, and eventually, managed-care functionality
STRENGTHS
Community Health Information Network (CHIN)
4) SMS/HDX• Analysis
• Data processed from national center in Malvern, PA, rather than regionally
• Not fully proven in concept• Database ownership issues exist for
proprietary vendor
WEAKNESSES
Community Health Information Network (CHIN)
4) SMS/HDX• Analysis
• Developing clinical/outcomes database• Physicians want a range of functions• How proprietary vendors will interface to
foreign systems
CHALLENGES
Community Health Information Network (CHIN)
5) UNITED HEALTHCARE• Area of Service
• Minnesota is test site
REGIONAL GEOGRAPHY
Community Health Information Network (CHIN)
5) UNITED HEALTHCARE• Features
• Payer-focus called Providerlink• Sponsored by Minnesota-based managed-
care company for EDI claims
ARCHITECTURE
Community Health Information Network (CHIN)5) UNITED HEALTHCARE• Analysis
• Proven system processing more than 40 million claims from United’s 18 plans and more than 500 hospitals with 2 million vendors ?
• Architectural design is good for growth and flexibility• Users have flexibility in hardware and workstation
devices• Substantial savings have been shown (more than $1
per claim) STRENGTHS
Community Health Information Network (CHIN)
5) UNITED HEALTHCARE• Analysis
• Limited clinical capability• Payer owned, so participation by others may
be guarded
WEAKNESSES
Community Health Information Network (CHIN)
5) UNITED HEALTHCARE• Analysis
• Not currently a database repository for clinical data
• Data ownership issues• Plan lab and results reporting
CHALLENGES
Community Health Information Network – Other Emerging Chins Inova Health Systems of Falls Church, VA San Antonio Healthcare Partnership NO/HIN in New Orleans Henry Ford Health Alliance Plan in Southeastern Michigan Metropolitan Chicago Healthcare Council Praxis, based in Nashville 6 states now receive funding from the Hartford Foundation, with
another 9 states applying in the coming months. POPULATION SAMPLING OF CHIN(S) NATIONWIDE
Community Health Information Network (CHIN) Topology Models
STRATEGIC ALLIANCES INTEGRATION
(demonstrate access points) (demonstrate linkages)
Community Health Information Network (CHIN) B2B Linkages
Banker, Hospital, Physician’s Office or Community Health Center Other Chins
Community Healthcare Information Network (CHIN) B2B Applications
Computerized Patient Record Case Management Results Reporting
Physician Direct Order Entry Alerts
Nursing Documentation Physician Documentation
Community Health Information Network (CHIN) B2B Applications (cont’d)
Scheduling Patient Accounting Radiology Laboratory Cardiology Anesthesia Pharmacy Medical Records Abstracts
Community Health Information Network (CHIN) B2B Applications (cont’d)
Corporate Financials Network ADT Interface Engine E-mail/EDI Imaging Forms Automation Master Patient Index