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Utah Health Information Network . Jan Root, Ph.D. Assistant Executive Director June 2005, AHRQ Annual Meeting. UHIN: CHIN to RHIO. In operation since 1993 (CHIN) Community-based; inclusive Providers, payers, gov’t Statewide network Not-for-profit Self-sustaining - PowerPoint PPT Presentation
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Utah Health Information Utah Health Information Network Network
Jan Root, Ph.D.Jan Root, Ph.D.Assistant Executive Assistant Executive
DirectorDirector
June 2005, AHRQ Annual June 2005, AHRQ Annual MeetingMeeting
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UHIN: CHIN to UHIN: CHIN to RHIORHIO
In operation since 1993 (CHIN)In operation since 1993 (CHIN)Community-based; inclusiveCommunity-based; inclusive– Providers, payers, gov’tProviders, payers, gov’tStatewide network Statewide network Not-for-profit Not-for-profit Self-sustainingSelf-sustaining– Began with what members thought Began with what members thought
would bring the most value: claimswould bring the most value: claims
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UHIN DoesUHIN DoesMake e-exchange of Make e-exchange of healthcare data possible:healthcare data possible:– Neutral trusted third partyNeutral trusted third party– Develop the IT & Governance Develop the IT & Governance
infrastructureinfrastructure– Develop Standards Develop Standards – Reduce the cost of health careReduce the cost of health care
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Go ‘inside’ officeGo ‘inside’ office– No EMRNo EMR– No quality of care improvementNo quality of care improvement– No patient safetyNo patient safety
No centralized data baseNo centralized data base– Utah DOH holds this functionUtah DOH holds this function
UHIN is the pipelineUHIN is the pipeline
UHIN Doesn’tUHIN Doesn’t
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Salt Lake City- 724
Ogden – 149
Bountiful- 105
Logan- 59
Orem/Provo- 235
Vernal- 31Roosevelt- 17Heber36
Brigham City - 19
Tooele-17
Delta - 4
Fillmore-2
Richfield- 12
Bicknell-2Monticello-3
Blanding-7
Monument Valley- 4Kanab7St. George- 107
Cedar City- 39
Milford- 2
Beaver- 5Moab-10
Layton- 182
Gunnison-19
Price- 36Nephi-7
Tremonton - 3
Salina-3
33rdrd Party Payors’ Claims (450+ Party Payors’ Claims (450+ payers)payers)– Medicaid and MedicareMedicaid and Medicare
Hospitals (100%)Hospitals (100%)Physicians/Clinics (85-90%)Physicians/Clinics (85-90%)Laboratories (100%)Laboratories (100%)Local Health Department Local Health Department (100%) (100%) Mental health centers (100%)Mental health centers (100%)Chiropractics (90%)Chiropractics (90%)
~50 million transactions/year~50 million transactions/yearGateway is redundant and Gateway is redundant and mirroredmirrored
Current UHIN Coverage Current UHIN Coverage
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UHIN’s UHIN’s SuccessSuccess
1.1. Community decision-makingCommunity decision-making2.2. Pursue the value, non-profit Pursue the value, non-profit
business modelbusiness model3.3. Use standards from the Use standards from the
beginningbeginning4.4. Make available to allMake available to all
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1. Community, Community, 1. Community, Community, CommunityCommunity
Consensus building processConsensus building processEvery organization has ONE Every organization has ONE vote as an equal playervote as an equal playerValue-based operation brings Value-based operation brings partners togetherpartners togetherIf we work together, everyone If we work together, everyone will be rewardedwill be rewarded
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2. Value = Business 2. Value = Business ModelModel
Where is the money? Example:Where is the money? Example:– Claim transaction: cost to a payer to bring in a Claim transaction: cost to a payer to bring in a
claimclaimPaper claim = ~ $8Paper claim = ~ $8Electronic claim = < $1Electronic claim = < $1UHIN charges = 20¢UHIN charges = 20¢Payer saves ~ $6.80/e-claimPayer saves ~ $6.80/e-claim
Community savingsCommunity savings– As a Not-for-Profit RHIO, transaction volume As a Not-for-Profit RHIO, transaction volume
goes up, average cost per transaction goes goes up, average cost per transaction goes down for all stakeholders.down for all stakeholders.
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3. Standards, Standards, 3. Standards, Standards, StandardsStandards
Use standards from the beginningUse standards from the beginningUHIN Standards Committee has been UHIN Standards Committee has been the key IT designing bodythe key IT designing body– Community has donated ~ 1 million Community has donated ~ 1 million
hours towards creating standardshours towards creating standards– Open standards-setting process for Utah Open standards-setting process for Utah
standardsstandardsActively participated in HIPAA Actively participated in HIPAA standards developmentstandards development
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4. Adoption for ALL4. Adoption for ALLGoal: Bring value to everyoneGoal: Bring value to everyone– Get everyone on board (low cost)Get everyone on board (low cost)– Everyone can play the same game (use Everyone can play the same game (use
standards)standards)Approach: low-tech and simpleApproach: low-tech and simple– Technical requirements are minimalTechnical requirements are minimal– Baseline software offered to providersBaseline software offered to providers
Free productFree productSimple send/receive reportsSimple send/receive reports
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Moving into ClinicalMoving into ClinicalUHIN vision always included clinical exchangesUHIN vision always included clinical exchangesFrom the RHIO’s perspective:From the RHIO’s perspective:
Health data is health data is health dataHealth data is health data is health data
Goal: Bring value driven, non-profit business model to Goal: Bring value driven, non-profit business model to clinical exchangesclinical exchanges
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RHIOsRHIOsWhat should a RHIO be?What should a RHIO be?– Only clinical exchanges?Only clinical exchanges?
Following slides are UHIN’s vision of a Following slides are UHIN’s vision of a RHIORHIO
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PBM
RHIO – Clinical X
DOH
Payers
Other orgs
Clinicians
Clearinghouse
Providers Hospitals
Clinics
Provider
Payers
Laboratories
RxHub
Banks
RHIO Clinics
Hospital
Payers
Clinicians
PBM
Billing Services
Pharmacies
NHIORHIO
RHIO
Hospital – Hospital
Pharmacies
Pharm Hub
Integrated health care system
Clearinghouse
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DOH
Payers
Clearinghouse
Other orgs
Clinicians
Clearinghouse
Providers Hospitals
Clinics
Provider
PBMPayers
Laboratories
Banks
RHIO Clinics
Payers
Clinicians
RxHub
PBM
Billing Services
Pharmacies
NHIORHIO
RHIOPharmacies
Pharm Hub
Hospitals
Integrated health care system
RHIO – Clinical X Hospital – PBM
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DOH
Payers
Clearinghouse
Other orgs
Clearinghouse
Providers Hospitals
Clinics
Provider
PBMPayers
Laboratories
Banks
RHIO
Payers
Clinicians
RxHub
PBM
Billing Services
NHIORHIO
RHIOPharmacies
Pharmacies
Pharm. Hub
Clinicians Clinics
Hospitals
Integrated health care system
RHIO – Clinical X E-Prescribing
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RHIO
DOH
Payers
Clearinghouse
Other orgs
Clearinghouse
Providers Hospitals
Clinics
Provider
PBMPayers
Laboratories
Banks
RHIO Clinicians Clinics
Payers
Clinicians
RxHub
PBM
Billing Services
NHIORHIO
RHIO
Public Health Reporting
Pharmacies
Pharmacies
Pharm Hub
Hospitals
Integrated health care system
CSDB
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PBM
UHIN
DOH
Clearinghouse
Payers
Other orgs
Clearinghouse
Providers Hospitals
Clinics
Payers
Laboratories
RxHub
Banks
RHIO Clinicians Clinics
Hospitals
Payers
Clinicians
PBM
ProviderBilling Services
Pharmacies
NHIORHIO
UHINet
Administrative Exchanges
Pharmacies
Pharm Hub
Integrated health care system
+
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Clinics
One connection gets you all needed messages
DOH
Payers
Clearinghouse
Other orgsPBM
Payers
Banks
Pharmacies
Providers Hospitals
Laboratories
Clinicians
RxHub
PBM
ProviderBilling Services
Pharmacies
Pharm Hub
Payers
Clinicians Clinics
Hospitals
Integrated health care system
NHIORHIO
RHIO
Clearinghouse
RHIO(UHINet)
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TO FROM
Physicians Hospitals Health Plans Public Health
Pharmacies Laboratories
Consumers
Physicians Referrals and consultationsCCR
Admissions information; pre-natal reports;CCR
Medical nec; Workers Comp notes; P4P Claims; claim status; eligibility, prior authsFormularies, current drugs; pharm. ben.
Case reporting;Queries to Controlled Substance Data Base
E-prescriptions;refills, renewals,Prior auth notice;
Questions about tests and results
Lab results, reminders disease mgt reminders refill/renewal reminders,
Hospitals Results,; Discharge notes; lab results, Rx, admissions; ED labs and Rxs transc.; dictation; CCR
Patient transfers; CCR Claims, claim status, eligibility, prior authorizationsDrug look-ups
Case reporting;RODSVital recordsTumor registries
Drugs reconciliation; E-prescriptions;
Questions about tests and results
Health Plans
Pharmacy eligibility, formularies, current drugs ; pharmacy benefits; remits; claim status; eligibility, prior auth responses
Medical necessity;remits; claim status; eligibility, prior authorizations responses
Subrogation, coordination of benefits
Case reporting? Eligibility resp; medication history; medical history remits;
Questions about tests and results
Benefits information
Public Health
Notices of disease outbreaks;Notices of changes in reportable diseases
Notices of disease outbreaks;Notices of changes in reportable diseases
Notices of disease outbreaks
Reports of disease outbreaks (to CDC); bioterrorism
Response to controlled substances data base queries
Notices of changes in reportable diseases
Pharmacies E-prescriptions;refills, renewals,Prior auth requests; questions about prescriptions; fill status
Drug reconciliation; fill status?
Pharmacy eligibility; claims; medication history; medical history
Reporting and queries to Controlled Substance Data Base
Prescription transfers
Questions about tests and results
Refill and renewal management
Laboratories
Results, responses to queries, test status updates
Results, responses to queries, test status updates
Answers about tests and results
Reportable diseases reporting
Results, responses to queries, test status updates
Q/A re: tests and results; test status updates
Results
Consumers eVisits, appointment scheduling, refills & renewals
Admission/ appointment scheduling
Benefits questions, complaints
Refills & renewals
Physician to HospitalMedical necessity;
Admissions; pre-natal reports
current drugs;CCR
Hospital to PhysicianResults; Discharge notes;
lab results, ED admissions; ED labs and prescriptions
transcription; dictation; CCRPublic Health
Reportable diseasesReal-time; reduce public health burden; notice of
disease outbreaks
Pharmacy/PBMsE-Prescriptions;
Formularies
Health Care Providers to Payers
Claims, eligibility inquiries; claim status; lab results;
CCR
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UHIN and UHIN and DOHDOH
Goal: Create a single pipeline for health Goal: Create a single pipeline for health care entities to move many kinds of data care entities to move many kinds of data including public health data to ease including public health data to ease burden of reporting.burden of reporting.
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Major Major ChallengesChallenges
1.1. Public perception of loss of privacy / Public perception of loss of privacy / controlcontrol
1.1. Physician concerns about privacyPhysician concerns about privacy2.2. Building a business caseBuilding a business case
1.1. No killer app for clinicalNo killer app for clinical2.2. Must build a collection of messagesMust build a collection of messages
3.3. Need uniform privacy law across the Need uniform privacy law across the nationnation
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4.4. Competition Competition • Community doesn’t compete on exchanging Community doesn’t compete on exchanging
informationinformation• Compete on core servicesCompete on core services
5.5. Standards Standards • RHIOs adopt community message and RHIOs adopt community message and
connectivity standardsconnectivity standards• Builds trustBuilds trust
• RHIOs participate in national message and RHIOs participate in national message and connectivity standards setting process connectivity standards setting process
Major ChallengesMajor Challenges
