Interoperability FramingJoint HITPC and HITSC MeetingOctober 15, 2014

Erica GalvezInteroperability Portfolio Manager

ONC

Office of the National Coordinator for Health Information Technology

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Interoperability

• Formally: The ability of a system or product to work with other systems/products without special effort on the part of the customer. Interoperability is made possible by the implementation of standards. (Institute for Electrical and Electronics Engineering )

• In simple terms: All individuals, their families, and their health care providers have appropriate access to health information that facilitates informed decision-making, supports coordinated health management, allows patients to be active partners in their health and care, and improves the overall health of our population.

Office of the National Coordinator for Health Information Technology

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Health IT Adoption in the Care Delivery System

2001 02 03 04 05 06 07 08 09 10 11 12 20130

20

40

60

80

100

18 17 1721 24

2935

4248 51

57

7278

10.5 11.816.9

21.827.9

33.939.6

48.1

Perc

ent

Any EHR system

Basic system

2001 02 03 04 05 06 07 08 09 10 11 12 20130

20

40

60

80

100

9.4 12.215.6

27.6

44.4

59.4

71.9

85.2

94

Perc

ent

Certified EHR

Basic system

NOTES: EHR is electronic health record. “Any EHR system” is a medical or health record system that is either all or partially electronic (excluding systems solely for billing). Data for 2001–2007 are from in-person National Ambulatory Medical Care Survey (NAMCS) interviews. Data for 2008–2010 are from combined files (in-person NAMCS and mail survey). SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey, Electronic Health Records Survey.

NOTES: Basic EHR adoption requires the EHR system to have a set of EHR functions defined in Appendix 1. A certified EHR is EHR technology that has been certified as meeting federal requirements for some or all of the hospital objectives of the CMS EHR Incentive Program. Possession means that the hospital has a legal agreement with the EHR vendor, but is not equivalent to adoption.SOURCE: ONC/American Hospital Association (AHA), AHA Annual Survey Information Technology Supplement

Office-Based Physicians Non-Federal Acute Care Hospitals

EHR Adoption

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In 2012, 5 in 10 received discharge summaries routinely; half of those received it electronically

Physician Adoption of HIE

ONC-NCHS analysis of NEHRS 2012-2013

• Lab results: 36%• Imaging reports: 34%• Problem lists: 33%•Medication lists: 34%•Med allergy lists: 34%

In 2013, about one-third of physicians exchange different types of data

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Hospital Adoption of HIE

51% able to query patient health information electronically

41% able to send and receive secure messages containing patient

health information to and from external sources

SOURCE: Office of the National Coordinator for Health Information Technology. 'U.S. Hospitals' Capability to Electronically Query Patient Health Information from Outside Their Organization and System,' Health IT Quick-Stat, nos. 25 & 27. April 2014.

Hospital Exchange With…

2008

Any provider outside the organization

Other hospitals outside the organization

Ambulatory providers outside the organization

Other hospitals inside the organization

2012

58%41%

47%

36%

15%

65%

51%

36%

Source: ONC/AHA, AHA Annual Survey Information Technology Supplement, 2012

7Office of the National Coordinator for Health Information Technology

Office of the National Coordinator for Health Information Technology

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Community and State-based Exchange Infrastructure & Services

State HIE Program: Operational CoreInfrastructure Services

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90%

At least 1 operational Health Information

Service Provider

73%

At least 1 operational master patient index

69%

At least 1 operational provider directory

67%

At least 1 operational provider authentication

service

Q4 2013

*N = 51 states and DC; territories excluded.*

Q2 2012

59%

At least 1 operational Health Information

Service Provider

33%

At least 1 operational provider directory

At least 1 operational master patient index

29%

43%

At least 1 operational provider authentication

service

Office of the National Coordinator for Health Information Technology

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Public Health

• Most state* health departments accept electronic data aligned with MU measures:– 48 states are electronically receiving data for immunizations– 47 states are electronically receiving data for electronic lab

reporting– 43 states are electronically receiving data for syndrome

surveillance– 36 states are electronically receiving data for cancer

As of October 8, 2014*N=51 (all states + District of Columbia)

Office of the National Coordinator for Health Information Technology

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Transactions

State HIE Program:Quarterly Directed Exchange Transactions

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Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 20130

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

72,766,216

70,719,991

147,433,270

168,111,802

155,067,622

157,588,707

236,639,280

Total number of directed exchange transactions per quarter

Reporting period

Dire

cted

tran

sacti

ons

CA, IN, MN and UT reported a decrease > 100 from Q2 ‘12 to Q3 ‘12.

AR, HI, ME, MI, MS, NE, PA, TX and WY reported a decrease > 100 from Q1 ‘13 to Q2 ‘13.

State HIE Program:Quarterly Patient Record Queries

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Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 20130

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

1,621,749

2,648,397

5,250,223

4,276,042

5,051,047

6,469,248

7,030,659

Total number of patient record queries per quarter

Reporting period

Patie

nt re

cord

que

ries

MI, MN, NE, NJ, NC, OK, UT, and WV reported a decrease > 100 from Q4 ‘12 to Q1 ‘13.

Office of the National Coordinator for Health Information Technology

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Sample EHR Technology DeveloperTransactions

Company one:• Total C-CDA transactions in July 2014: 2.7+ million• C-CDA transactions to other vendors in July 2014: 2.5+ million

Company two:• CCDAs exchanged using MU2 standards: 20 million per month• Web service calls: 75 million per month• Interface messages (HL7 v2, HL7 v3 (XML), NCPDP (XML), CDA

(HL7 v3 XML), ANSI (X12), DICOM): 5-7 billion per month• Messages sent to public health: 15.1 million per month• Immunizations only (also included in public health number above):

5.1 million per month

Office of the National Coordinator for Health Information Technology

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Expanding Ecosystem

Office of the National Coordinator for Health Information Technology

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New Technologies, Data Sources, Data Users

Office of the National Coordinator for Health Information Technology

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Governance

Office of the National Coordinator for Health Information Technology

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Varied Landscape

Office of the National Coordinator for Health Information Technology

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Discussion