Factors for Creating a Successful RHIO / HIE

498DLWinter 2011

Beena JoyPaul Kuo

MariJo RughDavid Sumner

Examining Goals for RHIOs / HIEs

• 3 State review• Technical and non-technical

concerns– Structure and Governance– Data Security and Standards– Consent Management– Adoption

Provider Participation• Motivators

– Compliance with mandates (eg, e-prescribing)

– e-Billing mandates– Pay-for-performance incentives– Improved coding and direct links

to payers – Time savings from direct

electronic reporting – Increased payment if quality

goals are met– Cost savings to public and private

health plans– Altruistic goal to improve public

health– Quality of care and patient safety– Increased operational and clinical

efficiencies

• Barriers– Lack of interoperability– Lack of vision and goals– Security and privacy concerns– Cost– Creating a successful business

model– Limited technical support

Business Models• Membership/subscription • Transaction fees • Sales/revenue• Affiliate/revenue• Advertising revenue

• Greatest potential– Hybrid membership/subscription and

transaction model

Overview

Center for Health Transformation. (2010)

http://www.grrhio.org/about/~/media/HIE_For_A_New_Generation.ashx

Illinois HIE

Illinois Office of Health Information Technology, 2010http://www.hie.illinois.gov/assets/hiesop.pdf

Illinois HIE

• General Architecture- De-centralized, federated, 3-layer

• Financial Model- ARRA plus public-private partnership; mechanism ??

Illinois HIE• Clinical Messaging Future• Clinical Summary Exchange for Care Coordination (CCD/CCR

Standards) Future• Delivery of Structured Lab Results Operational (61%)• Electronic Order Entry Future• ePrescribing and Refill Requests Operational (89%)• Quality Reporting Future• Patient Portal Future• Repository Services Future• Eligibility and Claims Operational (44%)

Illinois HIE

• Connectivity to NHIN– 2012 – 2014 ?

Illinois HIE

Illinois Office of Health Information Technology, 2010http://www.hie.illinois.gov/assets/hiesop.pdf

Indiana HIE

• Five existing independent, private-sector, regionally-based HIOs

• Each of which has been operational and sustainable for at least five years

• Accounts for more than 12 million patient records and 12,000 physicians

Indiana HIE Mission/Vision

VanZee, 2010www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf

Indiana HIE Services• Clinical Messaging and Electronic Results Delivery (HL7

Standard)• Clinical Summary Exchange for Care Coordination

(CCD/CCR Standards)• Electronic Order Entry• ePrescribing and Refill Requests• Quality Reporting• Patient Engagement (Patient Portal)• Repository Services• Interoperability / Shared Provider Directories / Master

Patient Indexes• Eligibility and Claims

Indiana HIE StandardsTerminology Standards ICD, CPT, NDC, LOINC©, RxNorm, and SNOMED, and

HITSP constructs such as C32, C37

Data Transport and Protocol Standards

Web Services, LLP, HTTPS, Standard Object Access Protocol (SOAP), HTTPS,

SSH, SFTP, SQL, ODBC, IHE, electronic business Extensible Mark-up Language (ebXML),

Secure Socket Layer (SSL), and Transport Layer Security (TLS).

ePrescribing standards NCPDP, NCPDP SCRIPT v8.1, NCPDPFormulary and Benefit v1.0, NCPDP SCRIPT v8.1

RXHREQ, RXHRES

Image Transfer standards DICOM

EHR standards CCHIT certified

Indiana HIE – Moving Forward

• Connectivity to NHIN – existing HIOs have established connectivity

Indiana Infrastructure

VanZee, 2010www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf

• Mission• Overview of the WI

• Demographics• 4 Operational HIEs

• WHIE• OCHIN, Inc• CHIC• UNIVERSATA, Inc

• State-Level HIE Planning and Design• Phase 1 • Phase 2

Wisconsin HIE

Wisconsin HIE

• Clinical Summary Exchange for Care Coordination (CCD/CCR Standards) Operational (Epic)

• Delivery of Structured Lab Results Operational • Electronic Order Entry Operational• ePrescribing and Refill Requests Operational • Public Health Reporting Operational

• Electronic Lab Reporting of notifiable conditions• Syndromic Surveillance• Immunization Data

• Eligibility and Claims Operational

HIE Strategic & Operational Plan Profile

Wisconsin HIE Architecture

Wired for Health Board, 2010

http://wiredboard.wisconsin.gov/SOP01.25.11Posted.pdf

State Contrasts

• IL, IN Federated – WI Hybrid models

• IN, WI Clinical Messaging - Operational• IN, WI Electronic Order Entry – Operational• IN, WI Quality Reporting - Operational• IN Patient Portal – Operational

• Technical standards - Essentially matching

HIE Functionality Required for Meaningful Use

2011• Electronically capture health information in a coded format• Use that information to track key clinical conditions• Communicate that information for care coordination purposes2013• Encourage the use of HIT for continuous quality improvement at the point

of care• Exchange HIT information in the most structured format possible.2015• Promote improvements in quality, safety and efficiency• Focus decision support for national high priority conditions• Enable patient access to self management tools• Access to comprehensive patient data• Improving population health

Recommendations for new RHIOs

• Commitment to the RHIO is a process

• Don’t give away services• Vendor-neutral architecture• Understand requirements• Encourage adoption• Plan for consent management• Base the solution on HIT and IT

standards

Conclusion: On Our Way to Sustainable HIE

• Early failures and successes have laid the road bed for the future

• State strategies further the construction• Advancements in technologies and standards

are removing the barriers• Additional opportunities/gaps to be addressed

Feedback Welcomed!

• Questions?