Agrowing federally sanctioned healthcare community

Transcription

1 Advancements in Health IT (part 2) A Sense of Community Takes Hold, s1 A Closer Look at Fed Sector Healthcare IT Provision, s2 Spotlight on Governance, s4 Q&A with the ONC s Connect Initiative Lead, David Riley, s5 Best Practices Advice from Healthcare Technology Veterans, s6 A Sense of Community Takes Hold CONNECT Users Discuss Why Sharing Information Makes a Difference Custom Report Agrowing federally sanctioned healthcare community is starting to take hold, sharing information across agencies, healthcare providers and other external partners using CONNECT software to link to the Nationwide Health Information Network (NHIN). Federal, state agencies as well as healthcare solutions providers and Health Information Exchange (HIE) participants all agree. They joined the NHIN participant community primarily as a way to securely and safely share patient medical information that will help them further improve the quality of patient care. What they contribute to the community varies by the nature of their involvement, and each sees a range of benefits from the use of CONNECT to access the NHIN. Why Connect? Jim Garvie, senior analyst for the Indian Health Service, within the Department of Health and Human Services (HHS) We have collaborated with the Department of Defense (DoD) and the Department of Veterans Affairs (VA) on patient records programs for many years. We joined this community because we value both the ongoing collaboration and commitment to open standards in the public domain that this participation brings. As the largest rural healthcare organization in the U.S., we fully understand the value of bringing health information technology not only to urban populations, but to patients in remote areas as well. Sandy McCleaf, PMO Director, MedVirginia, Central Virginia Health Network, Richmond, Va. MedVirginia has been fortunate to be able to work with a variety of federal agencies, including the Social Security Administration (SSA) for Disability Determination, the Centers for Medicare & Medicaid Services (CMS) as an HIO participant in their CARE Health Information Exchange Pilot, and the VA and DoD as a private sector supplier of health information for the VLER program. All of these initiatives have been instrumental in advancing our participation in the NHIN as well as growing the NHIN participant community. With each new implementation, the standards become more enhanced and better positioned to be implemented by a larger community of participants. Brian Dixon, Health Information Project Manager, Regenstrief Institute, Inc. Indianapolis, Ind. As a regional HIE, our organization has a culture of embracing open source tools and using those platforms to advance the open source cause. We realize in order to gain true interoperability in the healthcare sector, transparent standards must be widely adopted. CONNECT fits well into our philosophy. We now exchange information with the Indiana State Department of Health, and other providers in the state, as well as the Centers for Disease Control (CDC), primarily to share information used to monitor influenza rates. We re also working with SSA to improve the disability approval process, and with CMS to improve data quality reporting. We hope to further expand our use of the NHIN to connect to the VA and other HIEs in our region to improve the quality of patient care. Chris Smith, Director of Business Development for MEDNET, a Minneapolis-based integrator working to help healthcare organizations link to the NHIN using CONNECT. It s no longer a question of if, but when HIEs and other healthcare providers will connect to the NHIN. This nationwide network infrastructure is really winning as a way to link all kinds of healthcare organizations to the federal agencies involved in healthcare provision. Jon Teichrow, president of Mirth Corp., a healthcare software developer in Irvine, Ca. This community s commitment to open source health IT is invaluable to us, as we couldn t afford to write our own gateway software to link to the NHIN. HIEs must move past doing the hard work of building links themselves, and use CONNECT so they can instead focus on critical clinical applications like those that will aid healthcare providers in achieving meaningful use requirements. We ve gained so much from what we ve learned about early case uses from federal agencies already participating on the NHIN. Will Ross, Project Manager, Redwood MedNet, an HIE solutions provider in Ukiah, Ca., Until smaller practices make the leap to electronic healthcare records, this ongoing effort to build a nationwide online community for exchanging information simply won t achieve success. Undoubtedly, CONNECT simplifies, or buries, the complexities involved in linking to the NHIN. What has been difficult for many doctors isn t just the cost or the complexity, but ultimately Continued on page s6 s1

2 A Closer Look at Fed Sector Healthcare IT Provision The provision of healthcare services to members of federally recognized tribes has grown from the ongoing relationship between the federal government and Indian tribes that dates back to Today, members of 564 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for healthcare services provided by the Indian Health Service (IHS), an agency within the Department of Health and Human Services (HHS). The IHS provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaskan Natives who live in 35 states. IHS uses technological solutions to improve health care quality, enhance access to specialty care, reduce medical errors and modernize administrative functions consistent with HHS enterprise initiatives, said Jim Garvie, senior analyst for IHS. Health services are provided directly by the IHS, through tribally contracted and operated health programs and through services purchased from private providers. The federal system consists of 29 hospitals, 63 health centers and 28 health stations. Through self-determination compacts and contracts, American Indian tribes and Alaska Native corporations administer 16 hospitals, 250 health centers, 93 health stations and 166 Alaska village clinics. In addition, 34 urban Indian health projects provide a variety of health and referral services. The Resource and Patient Management System (RPMS) is the IHS enterprise health information system. The RPMS consists of more than 60 software applications and is used at approximately 400 IHS, tribal and urban locations. The RPMS has been provisionally certified by the Commission for Healthcare Information Technology, a recognized certification body for electronic health records (EHR). Local RPMS data is used to evaluate clinical quality as well as population and public health status. Aggregate data is used to report on clinical performance measures to Congress. The IHS also maintains a centralized database of patient encounter and administrative data for statistical purposes, performance measurement for accreditation, and public health and epidemiological studies. The IHS telecommunications infrastructure connects IHS, tribal and urban facilities and links to the HHS telecommunications network. The IHS also works with the Department of Veterans Affairs and other federal partners to develop software and share technology resources. One example is IHS s ongoing testing of CONNECT for use on the Nationwide Health Information Network (NHIN). IHS is testing CONNECT to accommodate health information exchanges at facilities in New Mexico and Arizona to provide more complete healthcare summaries for each patient. Once we are complete with internal testing, IHS intends to go through the onboarding process to exchange information on the national network. Limited production exchange is expected to commence this fall, said Mike Danielson, Chief Tech Officer, IHS. Understanding IHS The Indian Health Service (IHS) health care services are administered through a system of 12 area offices and 161 IHS and tribally managed service units. Population Served 1.9 million American Indians and Alaskan Natives residing on or near reservations. FY 2010 IHS budget appropriation $4.05 billion IHS Third-Party Collections, FY 2010 (estimated) $829 million Per Capita Personal Health Care Expenditures Comparison: IHS user population, $2,690 Total U.S. population, $6,826 Total IHS employees: 15,676 (71% are Indian) IHS is also working on the implementation of a master patient index (MPI) that will link patient records in a central registry. The MPI will help bridge an information gap, IHS officials said. Currently, there is incomplete information about patients at the point of care. The MPI is considered vitally important to enabling healthcare providers to gather as much information as possible about each patient, to help treat certain conditions, Danielson explained. The Indian health model along with the participation of Indian people in decisions affecting their health has produced significant health improvements. Indian life expectancy has increased by more than nine years since Mortality rates have decreased for maternal deaths, tuberculosis, gastrointestinal disease, infant deaths, unintentional injuries and accidents, pneumonia and influenza, homicide, alcoholism and suicide. Disparities continue, however. Indian life expectancy (72.3 years) is still about 4.6 years less than the U.S. general population (76.9 years). Death rates are significantly higher among Indians for diseases such as tuberculosis (500% higher), alcoholism (519% higher), diabetes (195% higher), unintentional injuries (149% higher), Continued on page s4 s2

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4 Spotlight on Governance Continuing Evolution of NHIN Governance Strives to Balance Info-sharing Goals with Privacy and Security Requirements The Office of the National Coordinator (ONC) is currently addressing a complete set of rulemaking requirements for participation in the Nationwide Health Information Network (NHIN), to establish governance processes to manage, monitor and enforce the rules. The Nationwide Health Information Network (NHIN) is a developing infrastructure that provides a secure, nationwide, interoperable health information infrastructure that will connect providers, consumers and others involved in supporting healthcare. New governance for NHIN was deemed necessary earlier this year, to ensure users have trust in how information is shared, along with an understanding that the exchange of information on NHIN is working effectively and that consumers expectations are met. While current participation in the NHIN is limited to federal agencies and contractors or grant recipients, the long-term vision includes a wide range of state, regional and federal government entities, commercial health care enterprises and potentially researchers and other relevant organizations. ONC is working hard to create a vetted process, the rules of road for allowing us to broaden participation in NHIN, said Doug Fridsma, Acting Director of the Office of Interoperability and Standards within the ONC. The intention is to be open practical process. The Social Security Administration, for example, is currently bringing 15 contractors on board the NHIN, along with an unknown number of Health Information Exchange (HIE) grantees. Meanwhile, the Centers for Medicare and Medicaid Services (CMS), along with the Centers for Disease Control (CDC) are also bringing partners on board the NHIN. Even within the limitations of the current NHIN framework, we can still do a lot of preliminatry testing of information exchange, said Mary Jo Deering, senior policy advisor in the Office of Policy and Planning within ONC. ONC officials plan to publish an initial request for public comment, and to keep the arduous rulemaking process on a brisk pace. The process can take 18 months or longer, because due diligence is required at every step, so public and stakeholder input can be incorporated throughout the process. Meanwhile, public hearings and policy committee input will also be important, Deering explained. The rules to be incorporated in the new NHIN governance will likely incorporate agreed upon business practices, policy and legal requirements, transparent oversight, enforcement and accountability, identity assurance and technical requirements. Questions to be addressed include, Where are the urgent priorities? What can we deliver that is flexible enough to evolve over time? Deering said. Because of the issue s complexity, the Office of Policy and Planning will be requesting public comment on NHIN s governance. Formal governance procedures, not to mention a governing body, are still to be determined. At this point it s also unclear whether there s a need for a governance czar, Deering said. There will also be an evolution of uses and users on the NHIN and there must be a mechanism flexible enough to accommodate changes and make the governance at least future friendly. Ultimately, crucial elements that governance rules must address include security and privacy provisions, including the obvious requirements to secure communication, provide entity authentication and authorization, and conduct audits, along with other practices such as consent management. We want to support meaningful use and the concept of data liquidity, where data freely flows because all of the necessary security and privacy pieces are in place. Governance really only provides one piece of puzzle, albeit an important one, trust in the information to be exchanged. ONC is working to develop a transparent process to help with interoperability, security and provide the glue that ensures all pieces are working properly, said Fridsma. More information on the NHIN Work Group and the HIT Policy Committee can be found at policycommittee. Continued from page s2, A Closer Look at a Fed Sector Healthcare IT Provision homicide (92% higher) and suicide (72% higher). Federal initiatives, such as the NHIN are expected to dramatically improve the exchange of health care information. The HHS priority to accelerate the adoption of IT in health care will reduce medical errors and improve health care quality. The IHS EHR initiative, meanwhile, provides computer-based physician order entry, encounter documentation, access to medical literature and other capabilities. These initiatives, as well as more affordable and available telehealth alternatives, are part of the ongoing continuous improvement programs at IHS, officials said. s4

5 Q&A with the ONC s Connect Initiative Lead, David Riley David Riley functions as the CONNECT Initiative Lead for the Office of the National Coordinator s (ONC) Federal Health Architecture (FHA) program. In this role, he promotes the advancement of federal health IT and especially, CONNECT, the software gateway used for access to the Nationwide Health Information Network (NHIN). In an interview, he discussed features of the latest CONNECT release, along with future upgrades and security/privacy improvements. Question: What s the status of CONNECT Release 3.0? Riley: The new release, launched in June, gives CONNECT platform independence in terms of operating system (Windows, Linux, Solaris); application server (Glassfish, JBoss, WebSphere) or integrated development environment (Netbeans, Eclipse) giving adopters of the solution more flexibility in running it in their operational environment of choice. There also continues to be a refactoring of the core to improve performance, scalability and support both new protocols and interfaces. Currently CONNECT uses SOAP over HTTP, and the refactoring over the next two releases will enable support for REST, XMPP and SMTP, which provide support for multiple protocols in the CONNECT backbone. Question: How will the new release support meaningful use? Riley: CONNECT fulfills the meaningful use requirements for health information exchange. Now with the finalization of meaningful use requirements, we believe the CONNECT federal agency partners will begin to articulate their requirements for supporting additional meaningful use capabilities in the CONNECT solution. In general these capabilities will be implemented in the CONNECT adapter and Universal Client Frameworks. Some of these capabilities include identity management, semantic interoperability, the NHIN Direct scenarios, etc. Because health information exchange is part of the meaningful use requirements, ONC will also be working to exchange information between doctors in differing settings, such as a primary care hospital and a rehabilitation center or other care facility. systems such as EHRs, Lab systems and pharmacy systems they can now communicate using NHIN services through the CONNECT gateway, for example. The addition of open source interface engines such as Mirth only adds to CONNECT s interoperability. If an EHR system sends out HL7 messages, the integration engine in CONNECT can capture and convert the messages to a standard format for use on the NHIN. Question: What about privacy and security improvements? Riley: Among the strongest features of CONNECT features that express policies for the release of information. If for example, as a consumer I don t want to share information about my mental health in transferring medical documents, I can restrict which documents are sent, so labs and other healthcare providers querying my medical information only receive the information I agree to release. In the future, information will be able to be restricted by type, or by section within documents. Users of CONNECT can expect to see more granularity of control in terms of the release of information. Question: So what s coming next for CONNECT? Riley: There will be refactoring in Release 3.1 to further improve performance, scalability, efficiency and the addition of more interfaces. There will also be an ability to send larger file sizes so multi-gigabyte files can be transferred among healthcare facilities. New logging capabilities will also be incorporated to trace messages. And there s also a planned addition of an Administrative Distribution Service based on the HITSP/T63, which uses the OASIS EDXL-DE standard for data sharing among emergency information systems. Finally, there will also be added support for secured and unsecured communication between the adapter and the gateway which will be configurable by the organization using it. Question: Can you address the need for greater communication among electronic health records (EHRs)? Riley: The more platform neutral CONNECT becomes, the more these systems will be able to talk to each other. By building integration services into the adapter layer edge s5

6 Best Practices Advice from Healthcare Technology Veterans Healthcare providers who participated in the creation of this report offered advice aimed primarily at how to continue the migration to electronic health records and the sharing of information via the Nationwide Health Information Network (NHIN). Brian Dixon, Health Information Project Manager, Regenstrief Institute, in Indianapolis, Ind., said it s important NOT to boil the ocean. This means trying to do too much too quickly, which can lead to disaster. Pressure to meet the ARRA funding requirements will likely make it tempting to go through the process of achieving meaningful use all at once, but it s much better to break the process down, and incorporate data elements incrementally. Making incremental changes has brought us the greatest success. It s best to define a use case and identify the data elements to improve the capture of records electronically. Once you make progress on those initial data elements, you can move on to incorporate additional elements. Trying to get everything up and running at once is a recipe for disaster. Starting small and building incrementally is the best route to successful EHR implementation. Nearly every healthcare practice is different in the way it codes and collects information. Suppose a federal agency was planning to use data on patient weight. That information may not be readily available, or measured in the same way, from all sources. Will Ross, Project Manager, Redwood MedNet, recommended that healthcare providers attend software development forums such as the CONNECT Code-A-Thons, which are periodically held in various U.S. locations, attended by representatives of federal and state agencies, healthcare providers, insurance companies, health information exchanges, cities, universities and health IT vendors, among others. Code-A-Thons typically last two days and include short plenary sessions where experts provide detail about their experiences in the open source community, and program personnel provide insight into the current and future architecture of the solutions. This is followed by hand-on programming where attendees break up into groups and work on projects they are interested in. Learn more about CONNECT code-a-thons at: Chris Smith, Director of Business Development, MEDNET, Minneapolis said healthcare providers must understand they don t need to do this alone. There are really good suppliers with experience who are ready to help. There are workgroups, resources and professional services organizations who can help any provider get started. One place to start is Leverage the expertise available to reduce your costs in the long run. According to Sandy McCleaf, PMO Director, MedVirginia Central Virginia Health Network, Richmond, Va., for those seeking to participate in the NHIN it s important to understand that its not just a technical endeavor, but a combination of technology, standards, governance, policies and procedures. All of these elements must be brought together to achieve success. CMS Offers Advice The American Recovery and Reinvestment Act authorized the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who are successful in becoming meaningful users of an electronic health record (EHR). These incentive payments begin in 2011 and gradually phase down. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the meaningful use definition or they will be subject to financial penalties under Medicare. The focus on meaningful use is a recognition that better healthcare does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care. Providers of all kinds can now get up-to-date and accurate information about the Medicare and Medicaid EHR incentive programs from CMS at Visit the website to get specifics about the program and download new tip sheets. Continued from page s1, A Sense of Community Takes Hold understanding the benefits they will derive from linking to this community. Our surveys regularly indicate that about half of all doctors in our region are willing to link to NHIN. But that leaves 50 percent who have either no interest, or only long range plans to consider linking to the NHIN someday in the future. That s because the typical onboarding process can take as long as 18 months, and most smaller doctors practices are simply still waiting to see more direct benefits. If, by mid 2011, 40 percent or more of physicians start the process of linking to NHIN, this effort will have finally reached a crucial tipping point, using CONNECT as the fulcrum to lift information sharing to critical mass in acceptance. s6