Breaking HIE Barriers

Transcription

1 Breaking HIE Barriers Session #20, February 20, 2017 Robert M. Cothren, PhD, Executive Director California Association of Health Information Exchanges 1

2 Speaker Introduction Robert M. Cothren, PhD Executive Director California Association of Health Information Exchanges 2

3 Conflict of Interest Robert M. Cothren, PhD Has no real or apparent conflicts of interest to report 3

4 Agenda Barriers to HIE Transformation and maturation of HIE HIE in the face of national initiatives 4

5 Learning Objectives Discuss current and projected economic and technical barriers to health information exchange Demonstrate practical, innovative and essential attributes of health information exchange and interoperability Identify how interoperability certification programs, such as ConCert by HIMSS, can support ubiquitous and secure access to patient data that enables widespread health information exchange 5

6 Health Information Exchange The mobilization of health care information electronically across organizations within a region, community or hospital system Allows health care professionals and patients to appropriately access and securely share a patient s vital medical information electronically 6

7 Barriers 1. Providers expect HIE to be easy, ubiquitous 7

8 Don t I already have it? Didn t Meaningful Use give me health information exchange? 8

9 Easy: Transport Standards HL7 v2 Direct secure messaging IHE standards More IHE standards FHIR 9

10 Easy: Content Standards HL7 v2 CCD C-CDA Care summaries What s the difference? 10

11 Ubiquitous Mobilize information among disparate systems Increasingly inclusive of providers and consumers, and other stakeholders such as payers, social services 11

12 Barriers 1. Providers expect HIE to be easy, ubiquitous 2. Providers and patients aren t interested in just data movement 12

13 Health Information Exchange The capability to electronically move clinical information among disparate healthcare information systems, and maintain the meaning of the information being exchanged 13

14 Interoperability Ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged The ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user 14

15 Change from Exchange to Interoperability 15

16 Transformation Shouldn t even be talking about health information exchange HIE 16

17 Barriers 1. Providers expect HIE to be easy, ubiquitous 2. Providers and patients are interested in the movement of data 3. HIE hasn t demonstrated its value 17

18 Sustainability Must provide obvious value to users Users must be willing to pay for that value May not be just about health information 18

19 Where is HIE going? Exchange requires agreement on transport standards and authorization standards Interoperability adds content standards and vocabulary standards Access shifts to detailed specification of and access to only what you want to know Not just new standards, but a paradigm shift 19

20 Where are we today? Exchange Interoperability Access 20

21 Where are we today? Exchange Interoperability Access You receive confirming your order You download your account information You access your account with context of purchase You see what flights are available 21

22 Where are we today? Exchange Interoperability Access Care summary via Direct messaging Incorporated lab results Single sign-on FHIR 22

23 Where is HIE today? Exchange Interoperability Access We are here 23

24 Characteristics of HIE New HIE Mobilize information among disparate systems Increasingly inclusive of providers and consumers, and other stakeholders such as payers, social services Shifting from comprehensive information to critical / minimum necessary Shifting from exchanging copies to accessing data 24

25 Functions Results Delivery Community Record Alerts Population Health providing the information a provider needs in their EHR producing a comprehensive picture of a patients data ensuring a provider knows about health events helping a provider understand the patient s environment 25

26 maturity Information Coordination Awareness Intelligence Maturity Results Delivery providing the information a provider needs in their EHR Community Record producing a comprehensive picture of a patients data Alerts Population Health ensuring a provider knows about health events helping a provider understand the patient s environment 26

27 value Information Coordination Awareness Intelligence Value Results Delivery providing the information a provider needs in their EHR Community Record producing a comprehensive picture of a patients data Alerts Population Health ensuring a provider knows about health events helping a provider understand the patient s environment 27

28 Value with an EHR with HIE Providers focus on improving individual patient outcomes Providers are able to improve community outcomes within the region, their community, or the hospital system 28

29 Role of National Networks Bringing basic interoperability at the national level Retrieving information from places where a patient is known to have been seen 29

30 Role of HIE Organizations Coordinating collaboration among stakeholders to solve information problems of providers, consumers, employers, and payers in the region, community, or hospital system Bring interoperability at the community level Retrieving information from places where a patient is not known to have been seen Not just implementing the technology Not even just moving the data 30

31 Role of National Networks ehealth Exchange CommonWell Carequality Community HIE Provider-centric network Patient-centric network Provider-centric network-tonetwork trust framework Patient-centric network Peer-to-peer primarily querybased exchange Query-based exchange based on centralized record location Peer-to-peer query-based exchange Various use cases: alerts, results, CPOE, query, PH reporting, longitudinal records, analytics Centralized provider-organization directory Centralized MPI and RLS Centralized provider-organization directory Various resources necessary to meet participant needs Members are provider organizations Members are primarily EHR vendors Members are primarily EHR vendors with some HIEs Participants are providers, labs and ancillary services, Rx, PH, payers, researchers Primary participants are federal agencies, hospital systems, large and medium HIEs Main vendors are athenahealth, Allscripts, Cerner, eclinicalworks, Greenway, Meditech, and others Main vendors are athenahealth, eclinicalworks, Epic, GE, NextGen, Surescripts, and others Systems may include nearly any EHR, lab, pharmacy, or other HIT system 31

32 Role of Government Coordination through funding and policy levers Driving industry in a coordinated direction Fundamental support for HIE and interoperability 32

33 Coordinating a Vision Interoperability is necessary for a learning health system in which health information flows seamlessly and is available to the right people, at the right place, at the right time ONC s vision: to better inform decision making to improve individual health, community health, and population health. 33

34 Coordinating Features Coordinating and prioritizing the functionality of EHRs and HIE Shared Decision-Making Ubiquitous, Secure Network Infrastructure Verifiable Identity, Authentication, Authorization Industry-wide Testing and Certification Consistent Data Semantics and Formats Consistent, Secure Transport Techniques Accurate Individual Data Matching Directories and Resource Location 34

35 Coordinating Standards Identifying priority standards investments for industry and SDOs Vocabulary, code sets, terminology standards Content, data structure standards Services, transport standards Security frameworks 35

36 Role of Certification Making interoperability easier Constrained standards provide a common interpretation that implementers can use Certification ensures that every implementer uses the common interpretation the same way Not plug-and-play, but toward plug-and-play 36

37 The Value of Health IT S T E P S Better patient satisfaction with their healthcare experience Better patient outcomes through more complete information Better access to the right information at the right time Better-informed patients that participate in their wellness and health care Better outcomes, more efficient access, engaged patients leading to lower costs 37

38 What did we cover? Issues slowing the widespread adoption of HIE Characteristics of a transforming HIE environment, adding value Roles of the players How certification can help 38 38

39 How do we move on? The vision of the LHS I can make a treatment recommendation informed not only by the latest clinical trials, but also by the real-world health experiences over time of every patient like you who has had this illness and in turn I can tell you with a specified range of confidence which treatment has the greatest chance of success for a patient specifically like you. 39

40 Questions Robert M. Cothren, PhD Executive Director California Association of Health Information Exchanges or 40