New Jersey Health Information Network (NJHIN) RFI Response Evaluation - PowerPoint by U6be1K


									Connecting Patients to a Greater State of Health

Colleen Woods
Health IT Coordinator
State of New Jersey

June 8, 2012

The Population is Aging (Baby Boomers)
Nursing, Physician and Other Clinical
More than 51% of the US Population’s
healthcare is financed in some way by tax dollars
(Medicare, Medicaid, Charity Care, Government
Employees, Armed Services, Firefighters, Police, Teachers,
Healthcare IT adoption is 12 years behind other industries
Today’s healthcare information network for sharing clinical
information is connect via phones and fax
In New Jersey 60 – 70% of providers are still using paper-
based medical records (NJHA Estimate)

            David Brooks
            New York Times Columnist

“The average 56-year-old couple pays about $140,000 into the
 Medicare system over a lifetime and receives about $430,000 in
 benefits back. The program is also completely unaffordable.
 Medicare has unfinanced liabilities of more than $30 trillion. The
 Medicare trustees say the program is about a decade from
 insolvency. “
                          – New York Times, Monday June 6, 2011

Transformation   Delivery of Care


                  1. Electronic Health Records (EHRs)
                  2. Health Information Organizations (HIOs)
                  3. Health Information Network (HIN)
Primary Care Practices of Better Health
Greater Cleveland
Practices that use electronic health records
saw significantly higher achievement
and improvement in meeting standards
of care and outcomes in diabetes
than practices using paper records.
                --NEJM, September 1, 2011
   Nearly 51% of patients in EHR
   practices received care that met
   all of the endorsed standards.
   Only 7% of patients at paper-based practices received this same level
   of care– a difference of 44%.
   After accounting for differences in patient characteristics between
   EHR and paper-based practices, EHR patients still received 35% more
   of the care standards.
  Adoption of health information technology (IT) among primary care practices is highly
  variable across countries, with the United States lagging well behind other nations
                        Percent reporting at least 9 of 14 clinical IT functions*

* Count of 14 functions includes: electronic medical record; electronic prescribing and ordering of tests; electronic access test results, Rx alerts,
  clinical notes; computerized system for tracking lab tests, guidelines, alerts to provide patients with test results, preventive/follow-up care
  reminders; and computerized list of patients by diagnosis, medications, due for tests or preventive care.

1. 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians                                                            6
  New Jersey (31%) has a lower percentage of physicians potentially able to meet
  meaningful use core criteria when compared with national average
                                                                                                     New Jersey (16%) has the lowest percent
                                                                                                     of physicians in the country using any
                                                                                                     EMR/EHR system

*Also includes office-based physicians who have EHR system capabilities to support eight Stage 1 Core Set meaningful use objectives
   1. CDC/NCHS, National Ambulatory Medical Care Survey
      Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2010, and Preliminary 2011 State Estimates
Jersey Health Connect (McKesson                                                                         Health-e-cITi-NJ (IGI Health / ORBIT)
RelayHealth)                                                                                            Hospitals:
Hospitals:                                                                                               • Christ Hospital
 • CentraState Medical Center                                                                            • East Orange General Hospital
 • Children's Specialized Hospital                                                                       • Jersey City Medical Center
 • Clara Maass Medical Center                                         Sussex                             • Meadowlands Hospital Medical Center
 • Hackensack University Medical Center                                                      Bergen      • Newark Beth Israel Medical Center
 • Holy Name Medical Center                                                                              • Saint Michael's Medical Center
 • Hunterdon Medical Center                                                                              • St. Joseph's Hospital (Paterson, Wayne)
 • JFK Medical Center                                          Warren
                                                                                        Essex            • UMDNJ-University Hospital
 • Morristown Memorial Hospital                                                                         Federally Qualified Health Centers:
 • Newton Memorial Hospital                                                            Union             • Newark Community Health Centers, Inc.
 • Overlook Hospital                                                        Somerset                     • Newark Homeless Health Care
 • Robert Wood Johnson University Hospital (New                                                          • Horizon Health Center
   Brunswick, Hamilton, Rahway)                                                                          • North Hudson Community Action Corporation
 • Saint Barnabas Medical Center                                                                           Health Center
 • Saint Clare's Hospital (Denville Campus, Dover                                            Monmouth    • Metropolitan Family Health Network
   General, Sussex)                                                          Mercer                      Home Health
 • Saint Peter's University Hospital                                                                     • Visiting Nurse Association of Central Jersey
 • Somerset Medical Center
 • Trinitas Regional Medical Center
                              Trenton Health Team (Covisint)                                   Ocean
                                                                                                        MOHIE (ICA)
 • Summit Medical Group Public Health Department
                              • City                                              Burlington            Hospitals:
 • Central Jersey HIE Project (CHIEP) of Trenton
                              Hospitals:                                                                 • Bayshore Community Hospital
 Long Term Care
                                • Capital Health Regional Medical Center Camden                          • Community Medical Center
                                • Capital Health Medical Center – Hopewell                               • Jersey Shore University Medical Center
                                • St. Francis Medical Center
                                                                    Gloucester                           • Kimball Medical Center
Camden (Noteworthy)           Federally Qualified Health Center:Salem                                    • Monmouth Medical Center
                                                                                        Atlantic         • Ocean Medical Center
Hospitals:                      • Henry J. Austin Health Center, Inc.
                                                                  Salem                                  • Riverview Medical Center
 • Cooper University Hospital
                                                                                                         • Southern Ocean Medical Center
 • Kennedy University Hospital (Turnersville, Cherry                     Cumberland
                                                                                                        Federally Qualified Health Center:
   Hill, Stratford)                                                                     Cape
                                                                                                         • Monmouth Family Health Center
 • Lourdes Medical Center of Burlington County                                          May
 • Our Lady of Lourdes Medical Center
 • Underwood Memorial Hospital                                                                          Integrated Delivery Networks
 • Virtua Hospital (Berlin, Marlton, Memorial,                                                          Hospitals:
   Voorhees)                                                                                             • AtlantiCare Regional Medical Center (Atlantic City,
Federally Qualified Health Centers:                                                                        Mainland Campus)
 • CAMcare Health Corporation                                                  • South Jersey Healthcare (Regional Medical Center,8
 • Project Hope, Inc.                                                                                      Elmer Hospital)
      State Data Sources:
       •   Immunizations                                                           •Security Compliance
       •   Medicaid
       •   Blood Screening
       •   Bio surveillance
       •   DMV Demographics
       •   Other registries

                                                   Health Entity Directory    State Gateway Services
   NJHIN Core                        Certificate   • Web Services Registry    • Relay Service (External Queries)
                                                   • Provider Directory       • Patient Discovery & Document
   Services                          Authority       (supporting DIRECT)        Exchange
                                                   • Provider Credentialing   • Statewide Data Aggregation

     & Labs

• Pt Discovery & Document Exchange
• HIO-level MPI
• HIO-level Record Locator
• Consent Mgmt (interim)
• DIRECT Services                                                                                                  9
• Security Compliance

   * Physicians in these hospitals access data within their own hospitals only                                                                     10
    Use Case Name                                      Description
1. Medication History    Patient medication histories are made available for Emergency Room
                         admissions only. This Use Case will include the Cross Community Patient
                         Discovery (XCPD) Profile to support accurate patient identification.

2. Public Health Data    To provide patient immunization history directly to the physician EHR.
  (Immunization Data)    The State registry connection will be direct to the physician EHR.

3. Diagnostic Results    To provide patient laboratory test and radiology images results (later Use
  Available to All HIE   Case will address the Order side as well as open order/pending result).
  Customers              This Use Case will include the radiology report and not the image.

4. ED/Acute Discharge    The transfer of patient information in the form of discharge notes to the
  Summary                PCP or specialists at the time of discharge.
                         Near term – ED/Acute Hospital discharge information only.

5. Transition of Care-   This Use Case is to enhance communications between PCP and specialist
  Referral Information   with an opportunity to use “Direct” as a near-term way to conduct
                         secure exchange of health information.

                               Hospital EHR Adoption
               Hospitals            Count            EHR Adoption            EHR Adoption %

  Total Hospitals                    111                    63                      57%

     General Acute Care              71                     61                      86%

     Comprehensive Rehabilitation    14                     1                        7%

     Special                         15                     1                        7%

     Psychiatric                     11                     --                        --                      Source: EHR Incentive Program Registrations and NJHA survey   12
    County        Population
                                  in Patient Care
     Atlantic           270,609                  244   County Health Rankings 2011
     Bergen             889,915                1,527    Primary care physicians include
     Burlington         445,492                  434    practicing physicians specializing in
     Camden             517,739                  626    general practice medicine, family
     Cape May            96,470                   42    medicine, internal medicine, pediatrics,
                                                        and obstetrics/gynecology. The
     Cumberland         156,784                   94    measure represents the population per
     Essex              767,075                1,191    one provider.
     Gloucester         288,168                  189
     Hudson             592,111                  506    The data on primary care physicians
     Hunterdon          129,806                  279    were obtained from the Health
                                                        Resources and Services
     Mercer             364,571                  490
                                                        Administration’s Area Resource File
     Middlesex          785,324                1,242    (ARF) for 2009. The ARF data on
     Monmouth           641,864                  984    practicing physicians come from the
     Morris             486,946                  717    AMA Master File (2008), and the
     Ocean              569,662                  336    population estimates are from the U.S.
     Passaic            488,364                  457    Census Bureau’s 2008 population
     Salem               66,194                   36
     Somerset           323,160                  587    County Health Rankings (CHR) Web
     Sussex             151,431                   77    site. CHR is a program of the Robert
     Union              521,816                  551    Wood Johnson Foundation (RWJF) and
     Warren             109,897                  117    the University of Wisconsin Population
NJ TOTAL              8,663,398               10,726    Health Institute.

                                Physician EHR Adoption
                                                         EHR                     EHR
                   Physicians             Total
                                                       Adoption #             Adoption %

      Total Licensed Physicians          33,840            8,330                   25%

       Active Physicians                 25,629

       Active Patient Care Physicians    21,958

         Hospital-Based                  3,428

         Target Priority: Office-Based   18,530            6,411                   35%

           Primary Care Physicians       10,726            3,305                   31%

           Specialists                   7,804             3,106                   40%

                                              BME: New Jersey Board of Medical Examiners                              AAMC: Association of American Medical Colleges, Estimate   14
                                              SK&A: Research Vendor County Health Rankings, NJ-HITEC
  Medicare EHR                                        NJ Medicaid EHR
  Incentive Payments                                  Incentive Payments
                      Provider   Medicare Incentive                        Provider Medicaid Incentive
   Provider Type                                       Provider Type
                       Count     Payment Amount                             Count   Payment Amount
 Eligible                                             Eligible
                         1,878          32,930,174                             699            14,621,421
 Professionals                                        Professionals
 Eligible Hospitals         14          37,070,065    Eligible Hospitals        37            45,800,838

                        Total:      $70,000,239                              Total:      $60,422,259

  Total EHR Incentive Program Registrants:
       • Eligible Professionals = 5,884
       • Eligible Hospitals = 57

                                                                                CMS, June 5, 2012      15
     Highest utilizers of HIOs – office staff,
     medical records staff, nurse practitioners
     Real cost savings seen in the administrative
     processes – referrals, prior authorization
     Communication with the patient
     Point of care reminders
     PCP’s who have EHR’s now want HIE                                    16
      HIE to HIE and the NJHIN – slow
      Trust agreements – difficult
      Implementation – climb the wall, reenergize
      Moving closer to the “tipping point”
      New focus on accuracy
      Consent – a bear
      Integration/Interoperability – hard
      Collaboration is vital!                                    17


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