Maryland s Health Information Exchange 6 th National Medicaid Congress

Transcription

1 Maryland s Health Information Exchange 6 th National Medicaid Congress Health Information Exchange in the Context of Evolving Payment Reform Initiatives Scott Afzal June 14 th,

2 What is CRISP? CRISP (Chesapeake Regional Information System for our Patients) is Maryland s statewide health information exchange (HIE) and Regional Extension Center (REC) Health Information Exchange, or HIE, allows clinical information to move electronically among disparate health information systems. The goal of HIE is to deliver the right health information to the right place at the right time providing safer, more timely, efficient, effective, equitable, patient-centered care. Regional Extension Center (REC) is a program created by the ONC that is funded through the stimulus bill. RECs will offer technical, implementation, and educational assistance to facilitate providers adoption and meaningful use of electronic medical records (EMRs). 2

3 Mission Statement Our mission is to advance the health and wellness of Marylanders by deploying health information technology solutions adopted through cooperation and collaboration. We will enable the Maryland healthcare community to appropriately and securely share data, facilitate and integrate care, create efficiencies, and improve outcomes. Key Points Above 1) We are about health IT 2) We exist to facilitate cooperation around a narrow set of activities 3) We are an enabler, but technology is necessary but insufficient 3

4 HIE Principles Guiding Principles Begin with a manageable scope and remain incremental Create opportunities to cooperate even while participants still compete in other ways Affirm that competition and market-mechanisms spur innovation and improvement Promote and enable consumers control over their own health information Be flexible to support both distributed and data bank models Use best practices and standards Serve the entire Maryland healthcare community 4

5 Governance 5

6 State and Federal Funding Health Information Exchange $10 million in state funding trough HSCRC $9.3 million in HITECH HIE funding -MHCC prime recipient with CRISP as execution partner $1.7 million in HITECH Challenge Grant funding -MHCC prime recipient with CRISP as execution partner Regional Extension Center $5.5 million in HITECH funding -CRISP prime recipient with MSOs as sub-recipients 6

7 Infrastructure Design 7

8 Master Patient Indexing The Challenge: accurately and consistently linking identities across multiple facilities to create a single view of a patient. A zero or near-zero tolerance of a false positive match with a low tolerance of a false negative match. Accurate cross-entity patient identity management is a critical function for an HIE to serve multi-organizational reform initiatives 8

9 Initial Data Types Submitted / Available Patient demographics Lab results Radiology reports Electronic documents (discharge summaries, history & physicals, operative notes, and consult notes) Transport approaches include pushing results, querying or searching for data, and subscribing to specific patients The subscription service has important continuity of care potential (which relates to both PCMH / ACO initiatives) but comes with difficult policy challenges 9

10 Connectivity Efforts CRISP has established relationships with nearly every hospital in the state at some level (we are currently live with 9 hospital as data providers ) We are actively working on technical connectivity with 30 hospitals (out of 46) We expect additional hospitals to go live over the next 6 months 10

11 HIEs as Infrastructure Solution for Payment Reform Initiatives Payment reform initiatives at both Federal and State levels as well as private sector (ACO, PCMH, other quality initiatives, etc) have either primary or secondary reliance on patient engagement, improvements in coordinated transitions of care, and quality reporting to realize the opportunity of the programs. These improvements envision placing health IT, and specifically HIE, at the heart of the infrastructure requirements for the programs / organizations. A key question of whether HIE as the noun or HIE as the verb (or both) will be the solution for reform initiatives. 11

12 Exchange Infrastructure as Competitive Advantage or Commodity? HIE can be considered as an infrastructure solution that can be offered / deployed by multiple entities: State-Designated Entities (as defined by ONC) Regional HIE initiatives that receive funding from SDEs Community Hospital-based HIE solutions IDN-based HIE solutions Will the infrastructure component of wellness / care coordination-based reform initiatives evolve as a common utility or will ACOs and PCMH programs compete on the functionality of their independently deployed exchange infrastructure? As with many HIE efforts, the mantra of not competing on the availability of data but how well that data is used could be extended to these initiatives Platform-style HIE models that allow for 3 rd party development and customization may present the best opportunity for HIE organizations to serve multiple competing entities while still preserving their ability to compete on top of the exchange technology 12

13 Maturity / Capability of HIE versus ACO / PCMH Development Timelines Timing Proposed regulations show ACO program scheduled to be launched January 1, 2012 (pilots currently under way) Many payers and states have already started PCMH programs Many insurers are developing and deploying quality-based payment methodologies (e.g. readmission reduction initiatives) 13

14 Maturity / Capability of HIE versus ACO / PCMH Development Timelines Considerations Current level of connectivity (i.e. how relevant has the HIE become)? The willingness of an ACO to trust an SDE (or otherwise geographic-oriented / nonhospital driven HIE) as critical infrastructure will vary depending on the current progress and trust level to date and the perceived stability of the organization. The governance of the HIE organization, both from a composition as well as from an ability to act quickly perspective, will also factor into whether the HIE can serve as a viable infrastructure solution. Many HIEs are currently determining where to focus energy. Focusing on certain types of functionality, such as Direct messaging over the ability to query for data, or vice-versa, may appeal differently to different ACOs. The ability for an ACO to leverage and configure current in-house infrastructure to meet their care coordination and patient engagement goals will be an important factor. Some HIEs may offer sophisticated tools that are rightly relevant to cross-organization patient and provider data management (Master Patient Index, Provider and Entity Level Directories, etc.) 14

15 HIE as ACO Exchange Infrastructure Solution ACO regulation criteria include several key areas that present specific opportunities for HIEs Topic ACO Regulation(s) HIE Opportunity How can HIEs facilitate ACO functions? Patient Engagement Criteria Promotion of patient engagement through Connect PHRs (potentially multiple) and decision support tools and improved the ACO s electronic health record health literacy, such as managing existing system(s) via HIE conditions Quality and Cost Reporting Coordination of Care/ Patient Centeredness Criteria Improve quality and cost outcomes by aggregating and analyzing data, providing patient specific feedback and sending alerts and reminders to providers at pointof service Manage care throughout an episode of care and during transitions Exchange a summary of care during transitions of care within and outside an ACO Identify high risk patients and develop individualized care plans Facilitate point of service alerts and reminders for physicians through discrete data filing in EHRs. Provide patient information to providers within and outside an ACO Provide notification of cross ACO transitions of care. Facilitate availability of individualized care plan to ACO/non ACO participants involved in patient care. 15

16 HIEs as PCMH Oriented Infrastructure Two specific PCMH use cases that could be facilitated by HIEs include: PCPs and / or Nurse Navigators as Subscribers to the patients enrolled in the PCMH program Allow PCP to be proactively notified when their patient has an encounter within our outside their circle of care A step further would directly send clinical data from the encounter (such as a discharge summary) to the physician so he/she can determine the best course of action for follow-up care Sharing of care plan among the care team Ensure that more than the PCP has awareness about the care plan that has been developed for a given patient Care plans could be made available for query in the event of emergent care situations 16

17 Looking Forward Near- to Mid-Term Continue to drive hospital connectivity while working on XDS.b and XCA-based (NHIN-based standards) exchange with sub-networks and other ambulatory hubs Establish public health connectivity (we are starting with electronic lab reporting) Become critical infrastructure for key constituents (we are starting with a preventable readmissions reporting program) Expand access to providers for the ability to query Mid- to Long-Term Ensure we stay true to our consumer-centric goals and create PHR / HRB connectivity Work towards platform-style 3 rd party development Maintain flexibility to provide payment reform-supporting infrastructure (i.e. PCMH and ACO offering) 17

18 Questions? Scott Afzal Program Director, CRISP Principal, Audacious Inquiry