1. Health Information Technology Connecting Patients, Providersand PayersHealth Care Information Exchange Strategy andRoadmap

2. About mePatrick Mulrooney14 years providing successful delivery of Enterprise Strategy Programs andsolutions that create and optimized IT & Business combined road-maps, whileensuring that the appropriate technologies are being utilized to maximize,Capitalize and support business strategies .Successful delivery of 50 + projects in a management role.Expertise: Global Solution Delivery IT Governance Enterprise Architecture Business Insight Information Management Business Value Analysis and Benefits Management Organizational DesignGroup Affiliation: Microsoft in Health, Enterprise Architecture Consultants, Microsoft BI & Datawarehouse Professionals, IT Governance & Outsourcing, Data Architect USA, Solution Architecture Workshop ofMicrosoft, Microsoft Amalga, Enterprise Management Architecture.Home: Buffalo New YorkLove GolfVeteran: United States Air Force 3. Scope of Engagement Deliver Business Foundation & Road Map strategies Nationwide Health Information Network (NHIN) Health Information Exchange (HIE) Integrate Health Information Technology (Health IT) Incorporate Medicaid Information Technology Architecture(MITA)Map Architecture FrameworkBusiness ArchitectureInformation & Data ArchitectureTechnical ArchitectureAssemble Architecture Development Model (ADM), Enterprise Continuum Architectural Assets (Building Blocks) Technical Designs Solutions Platforms Tools 4. Stakeholders Senior leadership (CFO, COO, CEO,CIO,CTO) Medical Professionals and Health careProviders; Clinic managers, Nursing staff, Billing andadministrative staff, Medical records staff. Patient advocates Government agencies, Federal & Local Health plan sponsors (employers / unions). Special Investigation (SIU) Corporate Sales & CRM executives. 550,000 members/beneficiaries 5. My RoleMultiple Hats Ensuring that the business and IT strategies were inposition. Accomplish Needs analysis and roadmapdevelopment. (IBM Blue Works) Architect Solutions that were in line with currentBusiness/IT environment. Align technology to business objectives. Business case development. Secure the active participation of key stakeholders. 6. My RoleMultiple Hats cont Drive common approaches and expose informationassets and processes across the enterprise.(EnterpriseContinuum) Link the business mission, strategy and processesof an organization to its IT strategy . Show how the current and future needs of theorganization will be met in an efficient, sustainable,agile, and adaptable manner. Allow both the Business and IT strategies to enableand drive each other. Making sure that there is a vision... 7. Value of my Contribution Successful alignment of IT strategy and planningwith companys business goals. Optimization of information managementapproaches. Integrated Long-term strategic responsibility for thecompanys IT systems. Promotion of shared infrastructure and applications. Reduce costs and improve information flows. Ensured that projects did not duplicate functionalityor diverge from each other. 8. Value of my Contributioncont. Mitigated the risks associated with information andIT assets through appropriate standards andsecurity policies. Built staff development, knowledge and skills. Transferred understanding of evolving businessneeds and technology capabilities. Direct involvement in the development of policies,standards and guidelines that express the selection,development, implementation and use ofInformation Technology within the enterprise. 9. Business Foundation & Road MapMission StatementOur GoalBusiness ValueBusiness & IT Alignment Eight IT Priority Areas of FocusEnterprise Road Map Required Data ExchangesBusiness Imperatives 10. To successfully institute a framework of business processes and technologies that support and improved program administration for theenterprise and stakeholders. Thinking Globally Acting Dynamically Focus on the individual 11. Our Goal Patient Centric Health Information ExchangeDiagnosticPharmacies Labs HospitalsBehavioral HealthPublic Provider &Health Physicians &PatientStaff 11 12. Business Value & Benefits Develop capabilities for standards-based,secure data exchange nationwide. Improve the coordination of care &information among hospitals, laboratories,physicians offices, pharmacies, and otherproviders. Ensure appropriate information is availableat the time and place of care. Ensure that members health information issecure and confidential. 13. Business Value & Benefits cont Offer members new capabilities for managingand controlling their personal health records aswell as providing access to their healthinformation from Electronic Health Records(EHR) and other sources. Reduce risks from medical errors. Supporting the delivery of appropriate, evidencebased medical care. Lower healthcare costs by reducinginefficiencies, medical errors, and incompletepatient information. 14. Enterprise Road MapRequired Data Exchanges2013 Lab results delivery ePrescribing Claims and eligibility checking Quality & immunization reporting2014 Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Receive public health alerts Home monitoring Populate Personal Health Records (PHR)2015 Access comprehensive data from all available sources Experience of care reporting Medical device interoperability 15. Joint Business & IT Priority AreasRoad Map1.Incorporate technologies that protect the privacy of healthinformation and promote security in a qualified electronichealth record. Including for the segmentation and protection from disclosure, ofspecific and sensitive individual identifiable health information.2.A nationwide health information technology infrastructurethat allows for the electronic use and accurate exchange ofhealth information.3.The utilization of a certified electronic health record foreach person by 2014.4.Technologies that, as a part of a qualified electronic healthrecord, allow for the accounting/auditing of disclosuresmade by a covered entity. 16. Joint Business & IT Priority Areas(cont.)5.The use of certified electronic health records to improvethe quality of health care.6.Technology solutions that allow individually identifiablehealth information, to be rendered unusable, unreadable,to unauthorized individuals.7.The use of electronic systems to ensure thecomprehensive collection of patient demographic data,including at a minimum, race, ethnicity, primary language,and gender information.8.Technology solutions that address the needs of children,elderly and other vulnerable populations. 17. Business Benefits 18. Change the Way We Think Beneficiary & Member centric focus Public & private collaborations Dynamic synergy with theDepartment of Health 19. Change the Way Weinteract With Technology Develop & Require Best Practices Expand Project Management Disciplines Engage Enterprise Solution Architectures Integrate Testing & Quality Assurance Faster Time to Market Create successful business-technologyroadmaps 20. Change the Way We Work Learning & Growth Organize Around Strategy Align to Create Synergy Promote Process Innovation Mission Based Motivation 21. Change the Way We Govern Business Based Priority Setting Govern Based on Facts Goal & Objective Based Decision Making Execution Based Upon Value 22. Change the Way We lead Strategic Accountability Performance Accountability Operational Excellence Strategic Flexibility 23. Give us Strategic Advantage E-prescribe, MTM, Part D Electronic Health Records Linking our Health Community Business Agility Member Empowerment Improved Health of Members & BeneficiariesMTM=Medication therapy management, Part D = Medicare Prescription Drug Benefit 24. Make us a Better Company 25. Nationwide Health InformationNetwork (NHIN) 26. Health Information Distribution 27. Goals NHIN seeks to achieve Developing capabilities for standards-based, secure dataexchange nationwide. Improving the coordination of care information amonghospitals, laboratories, physicians offices, pharmacies, andother providers. (Amalga ) Ensuring appropriate information is available at the time andplace of care. Giving consumers new capabilities for managing andcontrolling their personal health records as well as providingaccess to their health information from Electronic HealthRecords (HER) and other sources. ( Health Vault ) Reducing risks from medical errors and supporting the deliveryof appropriate, evidence-based medical care. Lowering healthcare costs by reducing inefficiencies, medicalerrors, and incomplete patient information.NHIN =Nationwide Health Information Network 28. Health Information Exchange(HIE) 29. Health Information Exchange (HIE)is designed to: Improve individual patient care. Provide early detection of infectious disease outbreaks around the country. Improved tracking of chronic disease management. Provide quality measurements. ( HEDIS )HEDIS = Health Care Effectiveness Data for Information set 30. Patient Visit/Discharge Summary Exchange4Patient receives care and3details are noted in hospital medical record As a result of a referral,admission, or emergency,patient registers in hospitalHIE service checks 7 provider directory for 2routing instructions Consents and Standard formatprovider routing discharge summarypreferences are sentor ER report is to HIE service transmitted to HIE network6 Patient is discharged from hospitalPatient visits PCP or specialistHIE service routes and establishes trusteddischarge summary torelationship and consents for PCP, specialist or5release of dataother interested and 1trusted party (e.g.,health insurance caseHIE = Health Information Exchangemanager)PCP = Primary Care Provider 8 31. 2Provider refers patient to a Referralsspecialist, hospital or otherprovider for consultation or service43HIE service checks provider directory for routing HIE service submits instructions and sends referralreferral authorizationrequest with pertinent patient information / history, diagnosis request to payer forand service requested to approval and referral #consulting provider; businessrules can be stored in HIE service for elements of real- time decision support Patient visits PCP HIE service routes1or specialist andvisit summary to PCP,Patient visits consultingestablishes trustedspecialist or other Standard format provider, receivesrelationship andinterested and trusted visit summary with services, and details are consents for releaseparty (e.g., health consultation notesnoted in patient chart , of data; consentsinsurance case transmitted to HIEelectronic medical and provider routing manager) networkrecord or other result ispreferences are created (e.g., at lab) sent to HIE service7 6HIE = Health Information Exchange5PCP = Primary Care Provider 32. Laboratory Results 2Consents, labresults, and provider routing preferences are sent to HIE service3HIE service checks provider directory forrouting instructions andsends laboratory results to patients preferredprovider1 4Patient undergoes tests from his or her Authorized providers physician, establishescan access patientstrusted relationship andlaboratory resultsconsents for release of laboratory dataHIE = Health Information ExchangePCP = Primary Care Provider 33. Standardized Quality Data2 Consents, provider routing preferences and applicable data are sent to HIE serviceStandard format visit1summary or batch with data fordetermining quality metrics isPatient visits PCP,sent to payer, government specialist, hospital or agency or other quality metricsother provider and 3organization based on patientestablishes trustedconsent and business HIE relationship and service.consents for release ofdataHIE = Health Information ExchangePCP = Primary Care Provider 34. Community Provider Directory 3 HIE service consolidatesorganizational provider information into a single1 community provider4 directory ProviderProvider information Authorized HIEorganizations trackfrom each providerusers can accessand maintainsorganization is sent community provider internal provider to HIE service directory directory2HIE = Health Information ExchangePCP = Primary Care Provider 35. Health Information Technology (Health IT) 36. Health Information Technology (Health IT) Health Information Technology (Health IT) is the use of computerapplications to record, store, protect, retrieve, and transfer, clinical,administrative, and financial information electronically within healthcare settings. New Health Reform laws requires implementation of uniformstandards for electronic exchange of health information by 2013.36 37. Health IT Strategic Goals Develop the infrastructure for Electronic HealthRecords, including privacy, confidentiality, and datastandards. Provide incentives and create tools to facilitate theadoption of Health IT and EHRs. EHR = Electronic Health RecordsEHR = Electronic Health Records37 38. Benefits Associated withBroad use of HIT Improve health care quality Prevent medical errors Reduce health care costs Increase administrative efficiencies Decrease paperwork Expand access to affordable care 39. Benefits: Better Engaged Patients Electronic Health Record systems can connectpatients to community resources and support. Provides information that permits them toparticipate in shared decision-making with theirhealthcare provider. Supports home monitoring of reportedsymptoms related to chronic conditions with thegoal of preventing unnecessary hospitalization.HIT = Health Information Technology(Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)39 40. Benefits: Clinical Decision SupportSystems (CDS) Clinical Decision Support systems are seen as criticalcomponents in creating EHR-based learning systems CDS continually incorporate clinical advances, applyingthem to ever-growing and more detailed patientdatabases CDS increase the providers abilities to predict (based onpatient data and demographics) which interventions willoffer the best outcome.EHR = Electronic Health RecordsSources: Grantham, D. (November/December 2010) CDS systems seek real life data. Behavioral Healthcare. pp. 35-39;Moore, J. (January/February 2011) CDS: more signal, less noise. Government Health IT, pp. 25-27EHR =Electronic Health Records, Vitamin D deficiencies40 41. Strategic Outcomes for Health IT Adoption Strategic HIT Performance HIT Strategic Focus AreasOutcomesPerformance Metrics Meaningful Use ofReduced Unnecessary EHR to reduceCost/Utilization =CostReduced PMPM & Duplication, Errors ContainmentStrategic Planning Logic Map and improveLower % Admin Cost Admin Efficiency Meaningful Use ofImproved Quality Quality EHR to betterAgainst HEDIS and Improvement coordinate care andOther Benchmarks Quality Performance Meaningful use ofHigher Provider AdministrativeEHR to ReduceSatisfaction & EfficiencyAdmin. Process Reduction in Admin. Cycle TimesCostPublic Meaningful Use ofPublic Health EHR to build Health & Responsiveness Population Reduction in ResearchHealth Mgmt. & Health Disparities Research 01/05/13 Barrier USE MeaningfulPERFORMANCE Management Barrier 42. Advantage: A Connected Health IT SystemHospital CareDiagnosticsSpecialist ReferralCoordinationPrimaryOrderCareEntry LabMedicalResultHomeReporting EHR/HIE ProviderResearch &E-PrescribingComparative Remote Patient Medical Mgmt. & Effectiveness Self MonitoringAdministrativeEHR = Electronic Health Records DataHIE= Health Information Exchange 43. Medicaid InformationTechnology Architecture(MITA) 44. Medicaid Information Technology Architecture (MITA)MITA represents a business-driven enterprisetransformation.MITA is firmly grounded in enterprisearchitecture principles.MITA defines a business transformation over a5-year and long-term (10 years and greater)timeframe, and defines a technical architectureand a transition strategy to enable the businesstransformation. 45. MITA Objectives Promote reusable components through modularity. Adapt data and industry standards. Promote secure data exchange. Promote efficient data sharing. Beneficiary centric focus. Integration of clinical and administrative data to enable better decision making. Breakdown artificial barriers between systems, geography, and funding within the Title 19 program.The Medicaid Title 19 program is designed to help persons who are age 65 years or older, or persons with disabilities between theages of 18 and 65, who are blind or who receive public assistance to pay medical expenses 46. MITA Goals Develop seamless integrated systems that effectively communicate through interoperability and standards. Provide an environment that supports flexibility, adaptability, and rapid response to changes in programs and technology. Establish a national framework of enabling technologies and processes that support improved program administration for the Medicaid enterprise. Dedicated to improving healthcare outcomes for Medicaid beneficiaries. 47. Nation Wide Framework 48. Partnerships Business and IT AlignmentMITA is intended to foster integrated business and ITtransformation across the Medicaid enterprise to improve theadministration of the Medicaid program.It is a common business and technology vision for state Medicaid organizations.MITA is conceived in the context of: E-Gov Federal Enterprise Architecture Office of the National Coordinator for Health Information Technology (ONCHIT). The Centers for Medicare and Medicaid Management (CMS) National Health Infrastructure Initiative (NHII). 49. Architecture Framework(MITA) Business Architecture Information Architecture Technical Architecture 50. Business Architecture Concept of OperationsThe Concept of Operations is a methodology used to describe current business operations and to envision a future transformation that meets the needs of stakeholders. Definition of As-Is operations. Identification of current and future stakeholders. Identification of major business and data exchanges between stakeholders. Description of To-Be operations. Listing of key enablers required to meet the To-Be transformation. 51. Business Architecture Maturity ModelA maturity model can be viewed as a set of structured levels that describe how well the behaviors, practices and processes ofan organization can reliably and sustainably produce required outcomes. 52. Business ArchitectureBusiness Process Model Medicaid Business ProcessModelMember ProviderContractorOperations Management ManagementManagementManagement Program BusinessProgramCareIntegrity Relationship Management ManagementManagementManagementThe Business Process Model is a repository of businessprocesses common to most Health Care programs. TheBPM consists of a hierarchy of business areas that lead to individual business processes. 53. Business ArchitectureBusiness Self AssessmentThe Business Self Assessment is used to determine current businesscapabilities and document their plans for transformation to achieve a higher level of business prowess. 54. Business ArchitectureStrategy & Governance Prioritize business capability needs. Formal plan for implementing capabilities. Establish technical standards. Solidify strategic approach. 55. Business ArchitectureProcess Innovation Best practices in requirements gathering, project management,architecture and software development. Governance process & portfolio management. 56. Architecture Framework(MITA) Business Architecture Information Architecture Technical Architecture 57. Information ArchitectureThe Information Architecture describes a logical architecture for theHealth Care enterprise. It provides a description of the information strategy, architecture, and data that may be used to define the needs that will enable the future business processes of the enterprise. 58. Information ArchitectureRational for Building a Clinical &Administrative information Architecture Facilitates Cost and Quality Transparency Essential for Continuity of Care Records Facilitates Population Health Management Improves Medical Management Improve Program Evaluation and DecisionMaking 59. Information Architecture Data Management Strategy Provide a structure that facilitates the development of data that can be effectivelyshared across a States Medicaid enterprise boundaries to improve missionperformance. Provides a mechanism for the agency to better understand data and how it fits in thetotal realm of Medicaid information. Addresses fundamental areas necessary to enable information sharing opportunities. Positions the Medicaid agency to operate in an environment of global information. 60. Information ArchitectureKey Components to Data Management Strategy Data Governance defines the governance processes for making enterprise-wide decisions regarding MITAs information holdings. Data Architecture establishes standard data-management procedures for the MITA data models. Data-Sharing Architecture describes technology considerations for Medicaid enterprises to participate in information-sharing communities. 61. Information ArchitectureConceptual Data ModelThe conceptual data model is usedprimarily as a communication tool betweenthe business user and IT architect toobtain agreement on the overalldescription of entities and theirrelationships in business terms. It alsorepresents the beginnings of an overalllogical structure of the data. 62. Information ArchitectureLogical Data Model Derived from the conceptual data model, the logical datamodel defines aspects of the business, broken down intodata classes and attributes associated with each businessprocess. The model identifies all of the data elements that are inmotion within the system or shared throughout the Medicaidenterprise. It also shows relationships between aspects ofbusiness. The logical data model is the foundation for creating aphysical data model. 63. Enterprise Level Data Repository and Decision Support Infrastructure Methods/AnalyticsDecisionEpisodes of Care SupportExternal Data / Profiles Performance MeasuresReportingPublic Health Disease StagingApplications Evidence-BasedMedical Management MedicineComparativeFraud DetectionData Sets Data DataDataBeneficiary DataWarehouse Architecture Architecture Performance AnalysisData ManagementAndAndSourcesProcess DataDataClaims/Encounter Cubes Eligibility Analysis Security Protection Cubes Clinical Data SetsIntegration Cost and Quality Translation AnalysisDemographic Data StandardizationPrescription DrugData Validation Profile and Screens ChronicChronic EHR DataIllness IllnessEligibility Data Health Plan &Sub-databases Sub-databasesHealth Plan &Registries RegistriesProvider DecisionProvider DecisionProgram DataSupport Support Information Architecture 64. Architecture Framework (MITA) Business Architecture Information Architecture Technical Architecture 65. Technical ArchitectureThe MITA technical architecture includes Data Architecture Application Architecture Technology ArchitectureCollectively, they define a set of technical services and standardsthat can be used to plan and specify future systems. 66. Technical ArchitectureTechnical Principles (MITA ) MITA is a business driven, implementation neutral, platform independent and is adaptable, extendible and scalable. The technical architecture is based on current and proven open technology. Security, privacy, interoperability and reliance on quality data are built-in. Technical principles shape MITAs definition and the States implementation of the Medicaid Enterprise Architecture. 67. Technical Architecture Technical Principles cont. Guiding principles support flexibility, adaptability rapid response and will promote an enterprise view. The result should be less duplication while providing timely, accurate and usable data. The technical architecture must support performance measurement and effective communication. Provide for the adoption of data and technical industry standards and the promotion of reusable components (modularity). 68. Technical ArchitectureTechnical Architecture Defined Business Driven Design of IT processes. The adoption and use of common industry and IT standards and bestpractices. Identification of business specific processes, data and technicalsolutions. Built in security and delivery of data. Scalability, interoperability and extendibility of IT components. Performance metrics common to the various Business/ IT operations. 69. Programmatic ApproachesEnterprise ContinuumTechnical DesignsSolutionsPlatformsBusiness IntelligenceToolsArchitectural Assets 70. Basic Health Information Exchange with DataRepositoryHealth Plan Adm.. Sys Clinical HIE Data Repository Record and Results Delivery Clinician Data RepositoryProvider EHRInterfacesMaster Patient IndexLaboratoriesBasic Patient Health SummaryPharmacies Web Portal ServerWeb Browser HIE Utility Applications 71. Health Information Exchange PlatformArchitectureCollaborative Knowledge ManagementValueSecurity and Consent PolicyAddedWeb Services ApplicationWebServicesData Analysis Applications Health Data Integration and Translation LayerPlatformServicesHealth Data Management Layer Health Data Publication LayerData Sources RadiologyRx History Administrative EHRClinical Lab 72. HIT Infrastructure Platform Design 73. Architecture Overview Local Gateway ParticipantLocal Gateway Participant PublishedPublishedPatient Data Patient Data EMRs and OtherInterface Interface EMRs and OtherEnterprise SystemsEngineEngineEnterprise Systems or PortalLocal ProviderLocal Provider or PortalDirectory DirectoryHIE ApplicationHIE Application Server / Gateway Server / GatewayStandard Messages,e-mail or fax encapsulationSecondary Local E-MailWeb Server Fax Server Fax ServerWeb Server E-Mail Secondary LocalSystemServer Server SystemLocal gateway users control integration, etc.Summary / ResultsSummary / ResultsCan leverage infrastructure for internal integrationViewerViewerInterfaces can be direct or use interface engine or similar toolsInternet / Network E-mail, fax orCCD Standard Messages, HTTP HTTP encapsulation encapsulationNetwork Subscriber Hosted PortalSummary / Published Patient Data Results ViewerWeb Server E-Mail FaxServer External Community Provider Directory NetworksHIE ApplicationPrinter Server / Gateway Hosted by service provider (MA-SHARE) No infrastructure support requirement just Internet connection, fax or e-Provides document / data storage, HTTP viewing for subscribers, and mailcommon provider index for dissemination to local gateway participants 74. Mapping Data Partners and Data Utilities 75. Enterprise PlatformArchitecture Examination 76. Business Platform Review 77. Business Intelligence Stack 78. Business Intelligence Tool Set 79. Clinical Decision Support Systems (CDS)Amalga frees the data locked in disparate systemsacross the health enterprise to fuel discovery,change, and innovation.Amalga empowers users to drive improvements innear-real time, as well as accelerate continuousimprovement over time.Amalga links data from different departments sothat it can be shared more easily, which helps thecaregiver see the whole patient, not justsnapshots. 80. Clinical Decision Support Systems (CDS) 81. Microsoft HealthVault is a web-based platform from Microsoftthat stores and maintainshealth and fitness information. 82. Cloud Approach Research 83. To successfully institute a framework of business processes and technologies that support and improved program administration for theenterprise and stakeholders. Thinking Globally Acting Dynamically Focus on the individual 84. Thank You Q&A