e-Health Overview by ubs20614


									  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
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
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
 •       State-level efforts:
     –     Regional and state information sharing projects
     –     Shared infrastructure
     –     HIE organization and governance
     –     Encouragement of increased EMR and HIT adoption
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

• August 2005: Governor signs Executive
  Order establishing “Arizona Health-e
• 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
• 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
• Feb. 2004: Indiana Health Information Exchange (IHIE)
• 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

• 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
• 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
• 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
• Working to expand into clinical areas (medical and Rx
  histories, labs, discharge summaries)
Categories of Common e-Health Projects
                              Health Data
              Record          Exchange
             Locator &                        Electronic
               Master                         Prescribing
            Patient Index

                             Creation of
                             Statewide                  HIT
        Messaging             e-Health               Programs

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

    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
•       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
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

Recommendations and Next Steps
1) Be ambitious but practical
   – Pursue projects that offer ROI and tangible quality
   – 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
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
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
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,

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

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
   –   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

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
   –     Partner with associations in encouragement of HIT
   –     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
             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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