Patient Centered Data Home. David Kendrick, MD, MPH CEO, MyHealth Access Network SHIEC Board of Directors
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1 Patient Centered Data Home David Kendrick, MD, MPH CEO, MyHealth Access Network SHIEC Board of Directors
2 Interoperability happens at the speed of trust.
3 Public Health Department SureScripts 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution. Independent Pharmacies Federal Source (VA/DoD/IHS) Claims Data Claimed diagnoses, procedures, medications Patient A Patient D Patient Out of Pocket Patient C Patient B
4 Fragmentation quantified 42% of all patients have records in 2 or more systems Average PCP must coordinate care with 225 other providers in 117 other organizations Mai Pham, NEJM
5 Fragmentation: Pt s with Diabetes 66.6% of patients with DM have records in 2 or more places
6 Public Health Department SureScripts 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution. Independent Pharmacies Federal Source (VA/DoD/IHS) Claims: Medicaid Claims: Claims: Data Claims: Claims: Patient Medicare Out Commercial Claimed diagnoses, 1 Commercial procedures, 2 Commercial medications 3 Commercial 4 Commercial of Pocket Patient A Patient D Patient C Patient B
7 The details member HIE s across 34 states Provide person-centric health records Unbiased data trustees focused on better health Altogether currently serve >195M patients Rapid growth from foundation 2 years ago 29 strategic business and technology partners
8 Critical Infrastructure SHIEC s HIE s provide critical infrastructure for interoperability Identity matching and resolution Impartial wiring for information routing Tools for data quality improvement Multi-organizational trust agreements Governance inclusive of Those who receive care Those who deliver care Those who pay for care More than healthcare: behavioral health social determinants of health
9 Percent of US Population Served >220M patients in the US covered
10 Number of HIE s serving patients in each US zip code Count of HIE s serving patients in each zip code
11 Number of HIE s serving patients in each US zip code 1.4M patients 35M patients Count of HIE s serving patients in each zip code (sized by population)
12 3 key questions Where did my patients get care? (where do I need to query to get the information?) When did my patients get care? (who is getting it right now that I don t know about)? Who is the patient that got care? (do my identifiers for the patient match all of the other organizations?)
13 Patient Centered Data Home : The Vision Standards based, cost effective, scalable data exchange model Links existing HIE systems together Maintain patient-centric data view Provides comprehensive real time patient information Requires ability to PUSH Answers the three key questions Who, When, Where Resolve identity across HIE s Singe universal identifier not required Preserves local governance and protects local stakeholders honors local data use policies Enhances data aggregations required for quality reporting and shift to Value Based Payment Models
14 PCDH Core Principles Every person deserves to have their complete, longitudinal health record available whenever and wherever it is needed for decisions that affect their health or well-being Local Governance (and trust relationships) preserved Identity management processes sustained and coordinated Existing data use agreements honored Privacy and consent models maintained Business models preserved and expanded Technical architecture preserved Use cases outside of PCDH encouraged
15 PCDH: How it works DT 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution.
16 PCDH: How it works DT 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution.
17 PCDH: How it works Result: All health record data on CO residents returns to PCDH Subsequent transactions If patient possible recognized via ehx, and ADT Direct,consented, etc. Resident of Follow-up queries to OK can be made for completed records and results notification passed CO appears to provider in an OK ER Zip = QHN MyHealth receives the ADT and checks the zip code 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution.
18 Care outside the PCDH s: ~20M patients 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution.
19 Implications of PCDH Centralization of all data on each patient in their PCDH enables: Nationwide ADT alerting (with complete histories) More accurate care gap analysis (support quality) More accurate quality measures (support VBPM s) National patient identity assurance Possibility of centralized patient consent management Patient access to their entire record in one place for the first time (patient empowerment & engagement) Costs: Relatively little must maintain governance, geographic relationships, and minimal technology
20 PCDH: Current State Western Heartland Regional Gateway Connections Central Since April, 2016: 3 regions in Production 18 HIE s connected Serving 33.9M patients >2M notifications PUSHED in response to events 1,000 s of CCDA s pushed
21 Growth: National Model with Multiple Regions Northwest Region Western Heartland Northeast Region Southeast Region Regional Gateway Connections Central
22 Embracing and Accounting for CHANGE PCDH Governance designed to accommodate marketplace changes New HIE s or regions Consolidation or fragmentation among HIE s Consolidations or fragmentation of regions New kinds of entities to connect Trust relationships guide changes
23 PCDH Strengths PCDH Adds Value SHIEC s PCDH leverages current national frameworks (ehx, Carequality, DIRECT) PCDH (national) Infrastructure supports and enhancing ONC standards Reduces need for single nationwide patient identifier Patient Centered Longitudinal Record - Not a provider, payer, or agency centric record Supports multiple local and regional use cases
24 Other initiatives supported PCDH with real time nationwide alerting enables: PDMP Services and medication data to facilitate management of Opioid abuse Business continuity support during outages or cyberattacks Qualified Clinical Data Registry (QCDR) services to support analytics and MIPS Reporting, Value Based Payment models Connect and support behavioral health improvement Disaster response support
25
26 Other initiatives supported PCDH with real time nationwide alerting enables: PDMP Services and medication data to facilitate management of Opioid abuse Business continuity support during outages or cyberattacks Qualified Clinical Data Registry (QCDR) services to support analytics and MIPS Reporting, Value Based Payment models Connect and support behavioral health improvement Disaster response support Track and address health related social needs (AHC)
27 Food Pantry Homeless services Public Health Department Public Utilities Assistance Transportation Agency Department of Corrections Emergency Infant Services Disability Services 2017, SHIEC. All rights reserved, Proprietary & Confidential. Not for further redistribution. Department of Human Services Interpersonal Violence Federal Partenrs (VA/DoD/IHS/SAMHSA) Early Childhood Education Jobs Training Programs Legal Aid Funders: Governmental, Philanthropy Client A Client D Client Out of Pocket Client C Client B
28 Navigators Clinical Sites Clinics Hospitals FQHCs Community Behavioral Health Centers Social Determinants Vital Signs Closed Loops In Centralized De Centralized Positive SDVS Social Services Referral Orders (ORM) Bridging Organization Reporting on Service Usage (Customer) Claims Data (837) & Rosters (834) Payers Referrals inbound Response with Loop Closures Housing Transportation Food Interpersonal Violence Community Services Utilities
29 Other initiatives supported PCDH with real time nationwide alerting enables: PDMP Services and medication data to facilitate management of Opioid abuse Business continuity support during outages or cyberattacks Qualified Clinical Data Registry (QCDR) services to support analytics and MIPS Reporting, Value Based Payment models Connect and support behavioral health improvement Disaster response support Track and address health related social needs (AHC) Enable the generation of new knowledge per 21 st Century Cures ACT
30 Starting to get fun... Western PCDH Project: Enlarged interoperability 10 Million Lives Arizona: population 6.6M - HIE: AzHeC MPI: 5.9M 21 hospitals and health systems 2 reference labs and imaging centers Utah: population 3M - HIE: UHIN MPI: 1.8M All 4 of the major health systems and most clinics/labs 80% of all providers Western CO: Population.5M - HIE: QHN MPI:.6M with Clinical Data 12 Hospitals, all reference labs and imaging centers 94% of all providers
31 What do Providers See?
32 Sample Detail Location of care event Contact info Providers noted
33 Sample CCD with live link to images.
34 PCDH Value It works! It s low cost. It s effective. Users love it. Leverages Existing Connectivity & Trust Agreements Local Consent honored Standards based architecture Easily expandable use cases Provides Data Aggregation across multiple domains Medical, Behavioral, Social Services Supporting opioid crisis assessment and intervention Supports Qualified Clinical Data Registry services for VBPM s Meets HIE s where they are and elevates from there Governance Model for nimble national interoperability
35 Find more information:
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