e-Health Overview by ubs20614

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									  e-Health Overview:
Findings and Recommendations for the
   Kentucky e-Health Network Board

                    Presented by:
        Benjamin Beaton & Trudi Matthews
       Cabinet for Health and Family Services
                    April 18, 2006
                          Overview
1)       Kentucky in the National e-Health Framework
2)       Introduction to e-Health Efforts in Six States
3)       Summary of Lessons Learned from Other States
4)       Recommendations and Next Steps

Glossary of Terms
     –     AHIC = American Health Information Community
     –     EMR = Electronic Medical Record (clinical record system)
     –     HIE = Health Information Exchange
     –     HIT = Health Information Technology
     –     NHIN = National Health Information Network
     –     ONC = Office of the National Coordinator for HIT (Dr. Brailer)
     –     RHIO = Regional Health Information Organization
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Role of KY in National e-Health Framework
 •       National efforts:
     –     National architecture: National Health Information
           Network (NHIN)
     –     Standards development: HIT Standards Panel
     –     Technology certification: Certification Commission on
           Health Information Technology (CCHIT)
     –     Federal board: American Health Information Community
           (AHIC)
 •       State-level efforts:
     –     Regional and state information sharing projects
     –     Shared infrastructure
     –     HIE organization and governance
     –     Encouragement of increased EMR and HIT adoption
                                                             3
Role of KY in National e-Health Framework

 •       Federal-state partnership efforts:
     –     Security & Privacy collaboration (HISPC)
     –     4 AHIC workgroups, 5 breakthrough projects:
          1) Biosurveillance: ER data for public health
          2) Chronic Care: Secure messaging
          3a) Consumer Empowerment: Electronic registration summary
          3b) Consumer Empowerment: Electronic medication history
          4) Electronic Health Records: Lab data




                                                                4
                       Arizona
• August 2005: Governor signs Executive
  Order establishing “Arizona Health-e
  Connection”
• Nov. 2005: Statewide summit held, Steering
  Committee & Task Groups created
• April 5, 2006: Released Roadmap featuring
  priority projects
  –   State-wide Web portal
  –   Patient health history (Rx, Dx, tests)
  –   Regional clinical messaging
  –   Grant funds for small and rural providers for EMRs
                                                           5
                        Indiana
• Indiana Network for Patient Care: First e-Health initiative
  in IN lead by health informatics institute and univ. hospitals;
  allowed ED staff to request electronic patient clinical
  abstract (5 major Indianapolis hospitals)
• Clinical leaders saw that e-Health could work and offer real
  value
• Feb. 2004: Indiana Health Information Exchange (IHIE)
  incorporated
• Stakeholder-governed, little state involvement, not
  statewide but planning to build a statewide network
• IHIE uses Docs4Docs - clinical messaging service (labs,
  radiology, other tests)
• Self-supporting: IHIE cash-positive in 2006


                                                            6
                           Florida
• May 2004: Established Governor’s Health Information
  Infrastructure Advisory Board
   – Florida Health Information Network (FHIN): non-profit entity
     to facilitate statewide health information exchange
   – State record locator will assemble patient information from
     multiple servers based in RHIOs across state
   – Drawing on existing electronic information sources
   – Grants to support 8 of 12 developing RHIOs ($1.5M total)
• State-led efforts encouraging and utilizing additional
  private sector efforts
   – Availity: Multipayor Web portal for administrative & financial
     transactions between providers, payors; part of FHIN
   – Will soon offer Payor-Based Health Record (PBHR) to
     providers
                                                                 7
                       Minnesota
• Minnesota e-Health Initiative established by legislation
  in 2004
• Established Advisory Committee and subgroups to
  tackle work plan for statewide e-Health network
• Held statewide summit and released Roadmap to
  Legislature in 2005
• State created Minnesota Healthcare Connection –
  nonprofit entity to connect community e-Health efforts,
  including short term projects
   –   Medication history
   –   Enhanced disease reporting
   –   Immunization registry
   –   Electronic lab reporting
                                                        8
                         Utah
• 1993: Utah Health Information Network (UHIN)
  established as state-owned nonprofit entity
• One of the only states to see long-term success of its
  Community Health Information Network (CHIN) effort
• Common standards & shared technology used for
  electronic exchange (EDI) of administrative & financial
  information – claims submission & status,
  adjudication, eligibility
• State law requires Utah Insurance Department to
  adopt standards for health care claims if UHIN adopts
  them
• Working to expand into clinical areas (medical and Rx
  histories, labs, discharge summaries)
                                                      9
Categories of Common e-Health Projects
                              Regional/
                                State
                              Health Data
              Record          Exchange
             Locator &                        Electronic
               Master                         Prescribing
            Patient Index


                             Creation of
                             Statewide                  HIT
         Clinical
                                                       Grant
        Messaging             e-Health               Programs
                              Network

                                                 Hub for
            Medical and/or
                                             Administrative
             Drug History
                                              & Financial
                               Disease       Transactions
                              Reporting
                             or Registries



                                                                10
    Summary of Lessons Learned
•       Funding
    –    Major external funding has waned
    –    Smaller funding opportunities mean narrowly-
         tailored projects with near-term ROI
    –    Build toward overarching goal through
         smaller, incremental projects
•       Organizational/Leadership Structures
    –    State-led (Governor’s Exec Order – AZ, FL;
         Legislation – MN, OR, VT)
    –    Public/Private (MN, RI)
    –    Private Sector-led (CO, IN, MA)           11
    Summary of Lessons Learned
•       Research Needs
    –    Policy-oriented research; not technical, theoretical
    –    Great strides coming from private sector innovation
    –    Collaborative hurdles are greater than technological
         challenges
•       Progress most likely when parties…
    –    Identify space where it makes sense to collaborate,
         not compete
    –    Frankly acknowledge proprietary interests &
         competition in the room
    –    Identify common goals and objectives of improved
         quality, increased efficiency
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           Recommendations
1. Be ambitious but practical
2. Focus on facilitating health information
   exchange, not financing HIT adoption
3. Leverage health data already available
   electronically& projects already underway
4. Respect provider needs & practice patterns
5. Identify barriers to HIT adoption and HIE;
   propose common solutions
6. Combine long-term vision with short-term
   quality improvement and ROI

                                              13
Recommendations and Next Steps
1) Be ambitious but practical
   – Pursue projects that offer ROI and tangible quality
       improvement
   – Incremental, rather than whole-scale, change
   – Build experience, trust, & knowledge base by
       working together over time
   – Pursue collaborative and voluntary projects; don’t
       force e-Health on KY providers
   – Identify common issues and agree not to compete in
       that space: Move them from a competitive
       environment to a collaborative environment
   *Next Step: Pursue common administrative project(s) that
       facilitate and fund sustainable clinical information
       sharing
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Recommendations and Next Steps
2) Focus on facilitating health information exchange, not
     financing HIT adoption
    –    Health information cannot be exchanged electronically unless it is
         first recorded electronically
    –    Policies and projects should always encourage smart HIT
         investment by KY providers
    –    The e-Health Board cannot subsidize statewide HIT adoption;
         neither should it prescribe the vendors and software providers
         should utilize
    –    Provider investment in EMRs and other HIT encouraged:
            –   In a collaborative fashion whenever possible, and
            –   Mindful of national certification and standards efforts

    –     HIE = Moving data from silos to the point of care; working toward
          accurate, interoperable records
*Next Steps: ePrescribing grant program; Partnerships with
provider associations on HIT adoption
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Recommendations and Next Steps
3) Leverage available electronic health
    information & ongoing projects
  –  Projects should target data already available
     electronically (claims data, Rx, some labs)
  – KY can’t afford to wait until all clinical data is
     digital – we must begin exchanging the most
     useful data available
  – When possible, coordinate among & learn
     from various local & regional e-health efforts,
     e.g., Accenture NHIN prototype
  *Next Step: Target health data available through
     claims histories
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Recommendations and Next Steps
4) Respect provider practice patterns,
    patient needs
  –   Providers will not utilize tools or information
      that does not integrate into their workflow
  –   All e-health projects should meet thresholds
      of usefulness and pervasiveness
  –   What information will help engage patients
      and providers in better health?
  *Next Step: Work with provider & patient communities to
      identify current HIT utilization and biggest needs,
      challenges



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Recommendations and Next Steps
5) Identify barriers to HIT adoption and
  information exchange; propose common
  solutions to those barriers
  – Could include laws, regulations, incentives,
    business practices, and reimbursement patterns
  – Continuous effort to improve the regulatory and
    business climate in KY for HIE and HIT
  *Next Steps: HISPC Security & Privacy
    Collaboration; Board should identify and vet
    marketplace barriers, then propose and pursue
    solutions

                                                18
Recommendations and Next Steps
6) Focus on projects with early ROI & quality gains that
    build toward long-term goals
   –   Develop and refine goals for statewide HIE and integration with
       NHIN
   –   Flexibility and feedback are necessary in fast-changing national
       and industry landscape
   –   Projects should be sustainable: KY cannot rely on large
       amounts of external funding
   –   Projects must be scalable to long-term goals: Initial
       collaborations may form foundation for larger network, with
       shared experience generating trust & benefits
   *Next Step: Appoint multi-stakeholder Advisory Group
       tasked with exploring best models for statewide HIE
       in KY and how KY will interface with the NHIN

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Recommendations and Next Steps
7) Role of the state government in development of KY
     e-Health Network
    –    Major force in health care market through purchase, use, and
         reimbursement of HIT by state agencies
   –     Facilitator and convener of community and statewide
         initiatives
   –     Partner with associations in encouragement of HIT
         investment
   –     Policy development and support of e-Health Network Board
   –     Interface with federal government (ONC) and other states’ e-
         Health efforts
   –     NOT the builder/purchaser/owner/operator of large HIE
         infrastructure, or record keeper for patient health information
*Next Steps: Partner with provider associations; Link Board liaisons to
      4 AHIC workgroups; Examine regulatory issues that help or hurt
      HIE or HIT investment
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             CHFS Action Items
May Meeting:
•   Develop proposed 2006 Work Plan based on
    feedback of e-Health Network Board
•   Work with co-chairs to configure Advisory Group for
    Board approval
•   Identify and research potential projects based on
    Board feedback
•   HISPC Security & Privacy Collaboration
•   ePrescribing grant opportunity
•   Link board member liaisons to AHIC workgroups
      1)   Biosurveillance
      2)   Chronic Care
      3)   Consumer Empowerment
      4)   Electronic Health Records

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