Indiana Health Information Exchange The Indianapolis and Beyond ...
-
Upload
jared56 -
Category
Health & Medicine
-
view
462 -
download
0
Transcript of Indiana Health Information Exchange The Indianapolis and Beyond ...
Ind
ian
a H
ea
lth
Info
rma
tio
n E
xch
an
ge
Ind
ian
a H
ea
lth
Info
rma
tio
n E
xch
an
ge
Ind
ian
a H
ea
lth
Info
rma
tio
n E
xch
an
ge
Ind
ian
a H
ea
lth
Info
rma
tio
n E
xch
an
ge
Indiana Health Information ExchangeThe Indianapolis and Beyond Story
Presented to:South Dakota Health IT Summit
Sioux Falls, SDOctober 8, 2008
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 2
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Agenda
• HIE Landscape • IHIE Background and Governance • Services
– DOCS4DOCS® Clinical Messaging Service– Clinical Repository – Quality Health First
• Customer Support • Discussion
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 3
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Health Information Exchange Evolving Landscape
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 4
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
State of the Field• Health information exchange initiatives are continuing to mature.
– 130 included in the eHI annual survey (self report) – A lot more are getting started – 18 are new – Increased operation in number of HIEs (32 to 42) -
31% increase – DATA IS MOVING – Seeing impact – getting results – reducing costs and
improving care delivery as part of the care process – Business model still is the struggle – Financing – securing
upfront funding is the second largest challenge – 69% of the operational ones reported a positive ROI for
various stakeholders (reducing costs) – More than half of the operational HIEs – labs, radiology is
up this year – still supporting care delivery (CM and alerts) – increasing in population health; and public health surveillance
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 5
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Types of Data Exchanged
Types of Data 2007 2006
Labs 34% 26%
Outpatient Episodes 32% 21%
ED Episodes 30% 23%
Inpatient Episodes 28% 23%
Outpatient Lab Results 30% 22%
Radiology Results 26% 20%
Enrollment/Eligibility 26% 27%
Outpatient Prescriptions 25% 19%
From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 6
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Most Difficult Challenges (Moderately Difficult and Very Difficult)
Challenges 2007 2006
Developing Sustainable Business Model (56% said “very difficult” in 2007) 91% 80%
Addressing Privacy and Confidentiality Issues (34% said “very difficult” in 2007) 85% 79%
Accurately Linking Patient Data
(25% said “very difficult” in 2007) 81% 86%
Defining Value for Users of the HIE
(43% said “very difficult in 2007) 81% 99%
Securing Upfront Funding
(53% said very difficult in 2007) 80% 90%
From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 7
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Funding Sources Start-Up vs. Operating
Source Start-Up Operating
Hospitals 54 62
Federal government 44 38
State government 42 35
Payers 33 35
Philanthropic 31 23
Labs --- 21
Public health --- 23
Physician practices ---37
From: eHealth Initiative’s 2007 Fourth Annual Survey of Health Information Exchange at the State, Regional and Community Levels, http://www.ehealthinitiative.org/2007HIESurvey/default.mspx
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 8
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
What Does All this Mean?
• HIEs face substantial challenges, but are demonstrating steady and important progress– Development of a sustainable business model
• Operational HIE organizations have pursued pragmatic, incremental local strategies to engage data sharing partners to build and expand HIE
• Along with federal grants and contracts, state funding has played an important part in advancing early HIE development
• One solution, does not fit all…what is the “burning platform” for South Dakota?
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 9
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Courier just dropped off
moreenvelopes
Courier just dropped off
moreenvelopes
Prescription refill request on
fax machine (Right
behind the joke of the day)
Prescription refill request on
fax machine (Right
behind the joke of the day)
Unopened mail
Unopened mail
Printer with results from
one lab
Printer with results from
one lab
“Hey Sally! Where is
Mrs. Jones x-ray?”
“Hey Sally! Where is
Mrs. Jones x-ray?”
Unsorted results
Unsorted results
About to ring with
stat results
About to ring with
stat results
Web portal (from one hospital)
Web portal (from one hospital)
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 10
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Indiana Health Information ExchangeGovernance and Services
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 11
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Who We Are…Over 36 Million Results Delivered
Indiana Health Information Exchange
• 35 FTEs– 24x7x365 Customer Support– Business Development– Technical/Programming– Physician Liaisons
We are a health information exchange that bridges the gap between paper-based and technology-based medicine to electronically provide patient-
specific, clinical information from various sources at the most critical time: the point-of-care.
Regenstrief Institute
• 95 FTEs– Research and Development– Application Support– Technical Support
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 12
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
IHIE and Regenstrief
Regenstrief Both / Either IHIE
Concepts / Ideas
Research
Grants
Business Models
Customer Support
Training
Marketing / Sales
Project Management
Data Use Agreements
Application Development
Operations
Implementation
Technology: Development Testing Production Maintenance
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 13
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Governance
• IHIE is governed by a Board of 16 organizations representing the major healthcare stakeholders in Indiana. The Board members are chosen to allow for multi-organizational representation of health care stakeholders and to draw upon industry experience.
• The hardest work was establishing trusted organizational models, consensus on goals and requirements, and crafting participation agreements that met the legal, clinical and ownership requirements of each party.
• We have advisory groups that provide guidance and expertise to assist with future development.
• Membership is multi-disciplinary including representation encompassing technical, clinical, customer service and users.
IHIE was founded as a non-profit 501(c)3 incorporated company on February 24, 2004 by a collaboration of fourteen institutions representing hospitals, healthcare providers, researchers, public health organizations, and economic development groups.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 14
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Governance IHIE Board
• BioCrossroads - CEO• City of Indianapolis - Mayor• Clarian Health Partners - CEO• Community Health Network -
CEO• Health and Hospital Corporation
– CEO • Indiana State Department of
Health - State Health Commissioner
• Indiana State Medical Association - President
• Indiana University School of Medicine - Dean
• The Indianapolis Medical Society - President
• Marion County Health Department - CMO
• Regenstrief Institute - CEO• St. Francis Hospital and Health -
CEO• St. Vincent Healthcare - CEO• At large (3)
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 15
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
GovernanceAdvisory Groups
Advisory Group Description Membership
Steering Committee
Provides general oversight of the clinical messaging project. Focus is on new functionality, issues, and problem resolution.
CIOs from the charter member hospitals and representatives from IHIE and Regenstrief Institute
Application Committee
Provides for the development of community standards, creation of acceptance testing plans, development of training materials, implementation of physician offices, and development of application enhancements.
Members from the interface teams at each of the charter hospitals who are involved in the day-to-day operations of clinical messaging from the service providers
Planning Committee
Identifies and evaluates potential research and other projects on which IHIE & Regenstrief can collaborate.
Executive staff from IHIE and Regenstrief, as well as key project personnel from both organizations
Security Committee
Provides updates as to the security enhancements of the clinical messaging systems, any HIPAA issues we see from this side. Any HIPAA issues are always reported back to these people as they happen.
Security/privacy officers from each of the charter hospitals
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 16
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Indiana Health Information ExchangeState Borders Do Not Exist
Crown Point
Dyer
Hammond
Michigan City
Lafayette
West Lafayette
Crawfordsville
Kokomo
Beech Grove
Carmel
Elwood
Indianapolis
Martinsville
Mooresville
Plainfield
Avon
Fishers
Evansville
Michiana Health Information Exchange
Medical Informatics Engineering
Healthbridge
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 17
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Three Things to Remember
1. Don’t make it complicated• “Free” the data – get it out of the silos
and establish trust in your community • Aggregate the data and do something
with it
2. Don’t Boil the Ocean
3. Data re-use is the killer application
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 18
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
DOCS4DOCS Results Delivery
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 19
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Health Information Exchange Services
Health Information Exchange
Hospital
Data Data repositoryrepository
Health Health Information Information ExchangeExchange
Network Network applicationsapplications
Server
Labs
Outpatient RX& PBMs
Physician officeAmbulatory
centers (e.g. imaging)
Public health
Services
Hospitals
Physicians
Labs
Publichealth
Payer
• Clinical Messaging• Medication Reconciliation• Shared EMR• Credentialing• Eligibility checking
• Results delivery• Secure document transfer• Shared EMR• Clinical Decision Support• Credentialing• Eligibility checking
• Clinical Messaging• Orders
• Needs Assessment• Surveillance• Reportable conditions• ADE detection
• Clinical Quality Measurement• Claims Ajudication• Secure document transfer
• De-identified, longitudinal clinical dataResearchers
Negotiated Negotiated AccessAccess
Payers
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 20
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
“One…two…three Strikes You’re Out!”
• There were three times where the IHIE project was down on its knees:– Hospital CIO’s – “IHIE competes with individual hospitals IT strategies
to link to physician offices”• How Resolved – Individual hospitals computer system (Cerner, GE,
Eclypsis, Siemens, McKesson) is hospital workflow but all can participate in the city-wide network to reduce cost - PROCEED
– Hospital CFO’s – “I do not see any significant ROI and recommend to CEO’s not to proceed”
• How Resolved – ROI study shows hard dollar costs about the same as current cost, many tangible (soft) cost savings. Hospital CEO vision is that IHIE is the infrastructure for future healthcare initiatives and cost savings – PROCEED
– IHIE – “Funding – Have plan, have community buy-in, no money”• How resolved – join Bio Crossroads and Regenstrief Initiative to obtain
initial grant funding - PROCEED
Almost
^
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 21
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
DOCS4DOCS Service (Push)
• IHIE’s DOCS4DOCS clinical messaging service takes text reports (e.g. lab, pathology, radiology, transcription, cardiology) from their source information systems and delivers those results to physicians associated with the source organization (medical staff or non-medical staff) via any of three methods: – Into “DOCS4DOCS”, a web-based “inbox” that is accessible via
the hospital portal or other IHIE portal – Via fax (if they insist)– Directly into the physician practice EHR
• We deliver only what the customers tell us they want us to deliver.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 22
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 23
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Results Delivery History
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
Q1 20
05
Q2 20
05
Q3 20
05
Q4 20
05
Q1 20
06
Q2 20
06
Q3 20
06
Q4 20
06
Q1 20
07
Q2 20
07
Q3 20
07
Q4 20
07
Q1 20
08
Q2 20
08
Q3 20
08
Fax
IHIE Poral
EMR
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 24
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Sustainable With Results Delivery
• Basic Conceptual Principles of HIE Sustainability– HIE is a business– Leveraging of High-cost, High-value assets– No Loss Leaders– Independent Local Sustainability– Natural Monopoly– The Need for Scale– Avoidance of Grants for Operational Cost
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 25
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Interdependency of HIE Components
Layer I: Including Interface Engine, Community Trust, …
Layer II: Including Mapped/Normalized Data…
New Value-added
ServiceLayer III: Including Repository Services…
New Value-added
ServiceMedication Profile
Public HealthSurveillance
Clinical Messaging
Clinical Quality
Services
Ambulatory Results Review
ED Abstract and Results
ReviewNew
Value-added
Service
Inpatient Results Review
Value-added services that can be built upon the HIE investment
A layer of necessary investment
In the beginning, HIE assets are interdependent and how assets, once created, can be leveraged to deliver additional services.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 26
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Community-Wide Clinical Repository Indiana Network for Patient Care
Page 27
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Clinical Repository Background (Pull)
• Securely aggregates and connects patient information electronically outside an individual healthcare organization. Provides an abstract that contains the most accurate, up-to-date information available a patient, regardless of treatment location.
• Available at over 130 locations in Indianapolis area, including ED and ambulatory
• Data on over 6 million patients.• Used by approximately 15,000 active users.• One study indicated the repository results in $26 savings per ED
visit. • Other participants include:
– National and regional laboratories– Local imaging centers– All four homeless care systems– Public health departments (county and state)
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 28
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Clinical Repository Data
• 16 million registration events
• 41 million orders
• 1 billion coded results
• 25 million text reports
• 9 million radiology reports
• 12 million drug orders
• 750,000 EKG tracings
• 140 million radiology images
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 29
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Indiana Network for Patient Care Data Sources – Growing Beyond Central Indiana
• Hospitals – Over 20 hospitals including the 5 major hospital systems and
other hospitals in the Indianapolis-area
• Payors
• Labs and local imaging centers
• Public health departments (county and state)
• Ambulatory Physician Practices – Approximately 1/3 of ambulatory physicians
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 30
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Participants’ AgreementThe Participant Controls the Use of Their Data
• How can participants share health data to treat patients?
• Who may have access to personal health information for treatment purposes?
• What information is to be stored on the network?
• How may the personal health information be used for research purposes?
http://www.regenstrief.org/medinformatics/inpc
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 31
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Silos of Information
Electronic Medical Electronic Medical Record SystemRecord System
Data delivered Data delivered to to
immunization immunization registryregistry Jane Receives Jane Receives
Immunizations and other Immunizations and other care (measurements, labs, care (measurements, labs, diagnoses, etc) @ Clinical diagnoses, etc) @ Clinical
PracticePracticeData delivered Data delivered to EMRto EMR
ImmunizatioImmunization Registryn Registry
Jane Receives Jane Receives Immunizations @ Health Immunizations @ Health
DepartmentDepartment
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 32
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Silos of Information
ImmunizatioImmunization Registryn Registry
Electronic Medical Electronic Medical Record SystemRecord System
Registry Web Registry Web InterfaceInterface
EMR EMR InterfaceInterface
??????????????????????
“Amid all the discussion, Indiana may be mentioned more often than any other state as a model for how to develop a successful HIE.”– For the Record, September 2007
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 33
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Consolidating the Silos
ImmunizatioImmunization Registryn Registry
Electronic Medical Electronic Medical Record SystemRecord System
Patient ID: 123LMNOPPatient ID: 123LMNOPName: Jane Doe Name: Jane Doe DOB: 01/01/04DOB: 01/01/04SSN: N/A SSN: N/A Address: 555 Johnson RoadAddress: 555 Johnson RoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202
Patient ID: 6789XYZPatient ID: 6789XYZName: Jane Ellen DoeName: Jane Ellen DoeDOB: 01/01/04DOB: 01/01/04SSN:123-45-6789SSN:123-45-6789Address: 555 Johnson Address: 555 Johnson RoadRoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202
Global Global Patient IndexPatient Index
Concept Concept DictionaryDictionary
Global ID:Global ID: 4567845678Name: Name: Jane Ellen Doe Jane Ellen Doe Lots of Demographics..Lots of Demographics..MRF1 ID: MRF1 ID: OU81247OU81247MRF2 ID: MRF2 ID: 45643564564356PH MRF ID: PH MRF ID: 123LMNOP123LMNOPMRF3 ID:MRF3 ID: 6789XYZ6789XYZ
DTaP Dose Count:DTaP Dose Count: 30936-930936-9HIB Dose Count:HIB Dose Count: 30938-530938-5IPV Dose Count:IPV Dose Count: 33555-433555-4VZV Dose Count:VZV Dose Count: 30943-530943-5MMR Dose Count:MMR Dose Count: 30940-130940-1HepB Dose Count:HepB Dose Count: 30937-730937-7
Jane Doe’s Immunizations:Jane Doe’s Immunizations:
3/1/043/1/04 DipTetaPurDipTetaPur3/1/043/1/04 HemInfBHemInfB3/1/043/1/04 PolioVirPolioVir3/1/043/1/04 HepaBHepaB
Jane Ellen Doe’s Shots:Jane Ellen Doe’s Shots:
5/1/045/1/04 DTaP ImmDTaP Imm5/1/045/1/04 HIB ImmHIB Imm5/1/045/1/04 IPV ImmIPV Imm7/9/047/9/04 DTaP ImmDTaP Imm7/9/047/9/04 IPV ImmIPV Imm
30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30937-30937-77
30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30936-30936-9 9 33555-33555-44
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 34
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Consolidating the Silos
ImmunizatioImmunization Registryn Registry
Electronic Medical Electronic Medical Record SystemRecord System
Global Global Patient IndexPatient Index
Concept Concept DictionaryDictionary
St. Vincent St. Vincent MRFMRF
Clarian Clarian MRFMRF
Wishard Wishard MRFMRF
Community MRFCommunity MRF
Public Health Public Health MRFMRF
Global Global Patient IndexPatient Index
IUMG MRFIUMG MRF
Concept Concept DictionaryDictionary
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 35
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
The clinical repository can tell the story when the patient cannot…
Dr. Watson
Dr. Thomas’ office
ED visit data (free-text chief complaint)
Registration Records (demographics)
Radiology Reports
Discharge Summaries
Operative Notes
Pathology Reports
Medication Records
EKG Reports
Laboratory Data
Inpatient and outpatient hospital encounter data demographics
Coded diagnoses and procedures for hospital admissions and ED visits
Ambulatory encounter (visit) data
• Patient presented at emergency department complaining of ‘having trouble’ with his heart.
• Standard treatment for heart attacks: blood thinners.
• Before embarking on treatment path, physician checked the repository for additional information on patient.
• Repository showed head scan performed at another hospital 3 weeks ago. Patient recovering from head injury.
• Repository helped physician determine best course of care to avoid complications.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 36
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Abstract Example
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 37
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Results Review Example
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 38
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Quality Health First® Program
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 39
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Quality Health First
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 40
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Quality Health First ® Program Background
A disease management, preventive care and reporting service providing pt-specific and population-based management reports, clinical alerts and reminders, as appropriate either participating physicians and health plans.
• Enables improved clinical decisions by combining clinical data, medical and drug claims and point-of-care data to monitor patients’ health and wellness.
• Employers Forum of Indiana instrumental in program design.
• Involves physicians, employers, and health plans and implemented and managed by IHIE
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 41
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
QHF Quality Improvement Measures
• Asthma Treatment• Children’s Health• Diabetes Care• Heart Health• Mental Health• Women’s Health
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 42
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 43
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 44
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 45
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Customer Support
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 46
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
IHIE Customer Service & Application Specialists
• Support of DOCS4DOCS application - 24x7x365 Customer Support– Implementation
• Acceptance Testing and Piloting• Workflow review and analysis
– Communications • Marketing• Practice Verification
– Training • Initial and on-going physician office and hospital training• Follow-up • Account maintenance for Data Providers and Practice Locations
– Operations / Maintenance • Help Desk (for example, password resets and result delivery issues• Scrub provider files and maintain.
– Provides the most accurate and up-to-date provider and practice information
• Monitor non usage of inboxes• Monitor inactive end user accounts
One-stop Issue Resolution / Seamless One-Call Policy Physician Offices Call IHIE, Not the Data Providers.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 47
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Customer Support Team
9 FT Employees• 1 FT Customer Service Manager• 4 FT Customer Service/Help Desk• 4 FT Application Specialists
Supporting • 10,000 providers = 3,400 offices• 37 data providers• 6,000 application users• Average 20 incoming call per day; most common
– “forgot my password”– “why didn’t I get this result”
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 48
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Customer Support – Time Spent
% of time
38%
28% 2%
15%
10%
Provider File: clean up, marketing, verification
Training
Travel
Follow up
Help Desk
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 49
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Provider File Maintenance
• The average provider file from a facility has 3,000 providers– On average it takes 7 minutes to research one provider, if all
the information is accurate. Verify address, phone, fax, providers, other staff, POC, delivery needs, office flow
• What we find that is NOT accurate– Providers who are deceased / no longer in practice– Moved and are not listed with the correct practice– No longer practicing in the state– Expired license– They practice at multiple locations– Contact numbers and addresses are invalid
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 50
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Discussion
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 51
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Three Types of Business Risk an HIE Needs to Manage
Operating Risk
Execution Risk
Market Risk
How the company is structured, and the details of its basic logistics in order for it to carry out its plan successfully
To what extent the market for the HIE’s services is ready for its adoption, what barriers or obstacles if any exist, and how well the marketing plan meets market needs and obstacles
Ability of the HIE’s team to actually execute, given the complexity of the endeavor and their track record at rolling out such products and services
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 52
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Lessons Learned…
• Technology is just one piece– How is it implemented matters!
• Provide incremental value to the stakeholders– Small steps (don’t try to boil the ocean)
• Customer support is crucial– Communicate with customers often (data providers and users)
• Expect the unexpected– Interfaces change often and without notice
• Hospitals must shut-off delivery processes– Change in culture for internal departments
• Concentrate on value and satisfaction
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 53
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
If I Had a Crystal Ball…IHIE 2010
• Acquired new data sources– Medicaid / Medicare data
– Additional hospitals, labs, other data sources
• Connected to other HIEs– Inside and outside of IHIE
– National participation (NHIN)
• Continued participation in the Indiana Health Information Commission (IN state-wide group)
• Further work with quality and population-based initiatives
• Extended IHIE into a new entity to market and implement our HIE solutions to other HIE communities outside of Indiana.
Copyright © 2008 Indiana Health Information Exchange, Inc. Page 54
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Ind
ian
a H
ealt
h I
nfo
rmat
ion
Exc
han
ge
Questions
Emily Welebob, RN, MS
Indiana Health Information Exchange
VP, Strategic Development
Phone: 317-644-1725