VITL Summit 14 - The HIE Experience

The HIE Experience Informing Health Care Decisions Across the U.S. Panelists: Dev Culver, ED & CEO, HealthInfoNet Mike Gagnon, CTO, VITL Charlie Hewitt, Director, Rhode Island Quality Institute Denise Hines, CEO, Georgia Health Information Network Joel Ryba, COO, Healthcare Information Xchange of New York Facilitator: Joel Benware, VP of IS and Compliance, Northwestern Medical Center VITL Summit 14 - The HIE Experience

HealthInfoNet Moving to the Next Generation of Value Added Statewide Information Services VITL Summit 14 Burlington, VT September 8, 2014 Devore S. Culver

Topics To Be Covered Update on HealthInfoNet Exchange Operations Value Added Service Portfolio Current Major Grant Related Activities Where HIN is Headed Evolving Challenges 3

About HealthInfoNet A private independent nonprofit HIT organization funded by both private and public sources. Operates the statewide HIE in Maine A query-based central data repository Health Information Exchange ONC Statewide Regional Extension Center. Primary technical contractor for ONC HIE Cooperative Grant and ONC Bangor Beacon Grant SIM Testing Grant Partner 4

HealthInfoNet History 2004 - Maine Health Access Foundation, Maine CDC, Maine Quality Forum and Maine Health Information Center study need and support for an exchange in Maine. 2005 - Stakeholders begin planning and development. 2006 - HealthInfoNet incorporated with Devore Culver, formally Chief Information Officer of Eastern Maine Healthcare, as Executive Director. 2008 - Demonstration phase begins. Participants included MaineHealth, Central Maine Healthcare, Eastern Maine Healthcare, Maine General Health, Martin s Point Health Care, Franklin Memorial Hospital and the Maine CDC. 2010 - Demonstration phase ends and statewide roll-out begins. Award of HIE, REC, and Beacon Grants 5

Data Categories Managed in the HealthInfoNet HIE Today Patient Identifier and Demographics, including insurer Encounter History Laboratory and Microbiology Results Radiology Reports Adverse Reactions/Allergies Prescription Medication History (claim/fill incomplete!) Diagnosis/Conditions/Problems (primary and secondary) Immunizations Vital Signs Dictated/Transcribed Documents Continuity of Care Documents (CCD) 6

HIE Connections 34 of 37 hospitals (all under contract to connect in 2014) 34 FQHC sites 400+ ambulatory sites including physician practices behavioral health and long term care facilities 7 www.hinfonet.org

Achieving Business Sustainability 8

HIE Population Statistics As of August 31, 2014 1,359,402 lives in the HealthInfoNet database (this includes 90% of Maine s resident population) 163,031 Non-Maine residents have clinical data in the exchange 16,111 individuals have opted out (1.2%) 2,349 Maine clinicians and support staff are active users of the exchange 50% of active users accessed the exchange in July, 2014

HIE Operating Statistics August 1, 2013 July 31, 2014 Incoming Data Over 15 Million inbound messages are received by HealthInfoNet each month Portal Use 185,454 patient records accessed by HIN portal users Between 810 and 1,173 authorized users per month Clinical Data Transfer - Over 2.6 Million patient clinical messages sent in support of ACO organizations 55,098 real-time email notifications 30,902 Continuity of Care Documents (CCD) sent for discrete data integration into EHR applications Public Health 496,719 data transmissions sent to Maine CDC in support of Electronic Lab Reporting and Syndromic Surveillance (Meaningful Use Measures) 3,446,990 Clinical Records Either Accessed or Transferred by HealthInfoNet over the Last 12 Months

HealthInfoNet Value Added Services Meaningful Use Stage 1 & 2 Connection to Public Health for Laboratory Reporting, Syndromic Surveillance, Immunization Reporting ACO/Value-Based Purchasing Data Source Real Time Notification Service Enterprise Master Patient Index Management Interoperable Secure Messaging Analytic and Reporting Tools 11

Analytic and Reporting Tools Leverage Transactional Data Flowing Into the Exchange to Support Quality and Population Health Analysis as well as State, Federal, and Health Plan Reporting Near Real Time Data Set to Support Market Share Analysis, Patient Origin Studies, etc. Foundation for Community-Wide Health Reform Reporting Near real-time clinical risk profiling Readmission Inpatient Utilization ER Admission High Cost 12

HIN Analytic and Reporting Dashboard Views 13

Volume and Market Share Dashboard Where their patients come from This chart shows that the selected hospital has 81% of market share for orthopedic surgery cases w/in County 14 And the highest volume procedures. 14

Volume and Market Share Trending This chart shows that volumes for orthopedic surgery for the sample hospital are declining for both outpatient and inpatients 15 and market share for inpatient orthopedic surgery within their service area is declining. 15

Readmission Risk Management Dashboards: Readmission Risk Profile The map shows where these patients originate. These charts show distribution of patients by chronic disease, service line, and diagnostic category 16 This visuals shows the number of inpatient encounters by 30 day readmission risk level.

Population Risk Management Dashboards: Population Profile This chart shows that for the selected health system there are 81 patients who have >70% chance of an ED visit, inpatient admission, and being high cost within the next 6 months The map shows where these patients originate. 17 The most common Diagnoses for these patients are Hypertension and Diabetes 17

Population Risk Management Dashboards: Individual Patient Summary The summary above shows that this 59 year old female had 5 inpatient admissions, 14 ED visits, and 36 outpatient visits in the last 12 month period. The chart shows the timing of each encounter along with the risk scores increasing over time. 18 18

Population Risk Management Dashboards: Individual Patient Summary Provides top 10 reasons driving each risk score. 19 Summarizes key clinical findings. 19

Population Risk Management Dashboards: Individual Patient Summary Provides top 10 reasons driving each risk score. 20 Summarizes encounter history. 20

HIN State Innovation Model (SIM) Grant Activities Provide automated notifications to MaineCare care management staff as well as participating provider care managers when MaineCare patients are admitted to Emergency Departments and Inpatient Settings Continuing HIN s Behavioral Health HIT efforts: Paying for HIE subscription fees for participating behavioral health providers Providing EHR adoption incentives to 20 BH Organizations to support their purchase and implementation of EHRs and connect to HealthInfoNet Developing and deploying the "blue button" approach to allowing patients who access their medical records through provider-base personal health portals, to access their HealthInfoNet data Providing Data Services and Analytics for MaineCare supporting patient care coordination and provider reporting 21

HRSA Flex Grant Make HIE available to all Maine VA clinics and Togus Hospital Web-based access to the HIE s Clinical Portal Connect HIE bi-directionally to VA EHR Focus on National VLER/VISTA onboard via Healtheway s ehealth Exchange network Primary function will be CCD exchange in year one Provide coordinated education and implementation support for VA providers Future activities: focused on expanding HIE services, discrete data management, and PHR/Veteran access to medical records 22

Where HIN Is Headed Finalization of 5 Year Strategic Plan (Nov 2014) Finalization of Business Development/Revenue Priorities -Connection to Social Security Administration -Enhanced Analytics with Inclusion of Claims Data to Compliment the Clinical Data Set -Inclusion of other data sources Statewide Adoption of HIN Analytic & Reporting Tools Expanded Adoption of HIE Service Adoption by Specialists and Non-Hospital Sectors Work Flow Optimization Within Care Coordination Process 23

Challenges Impacting HIN Changes in the Health Delivery System In Maine (and the region) -Corporate Consolidation -Evolving Models of Care -Uncertainties About Payment Reform Evolving Data Exchange Standards Meaningful Use Standards and Incentives 24

An Overview of the Vermont Health Information Exchange Mike Gagnon, CTO Vermont Information Technology Leaders VITL Summit 14 - The HIE Experience

VITL Statistics VITL was formed in 2005 from the Vermont Association of Hospitals and Health Systems VITL is a 501(c)(3) private not for profit Staff of 34 Offices in Burlington and Montpelier 12 member board State of VT Legislatively designated to operate the Health Information Exchange network Federal government designated Regional Extension Center for Vermont (REC) Selected as HIE infrastructure for VT s three ACOs VITL Summit 14 - The HIE Experience

VITL Statistics 16 hospitals and over 140 medical practices and other HCOs participating 1.5M identities in the Master Patient Index Approximately 4M messages per month VITL Summit 14 - The HIE Experience

Mike Gagnon CTO, VITL mgagnon@vitl.net VITL Summit 14 - The HIE Experience

VITL Summit 14 - The HIE Experience

Lots of interfaces Current Services ADT, Labs, Transcribed Reports, CCDs, Immunizations Core capabilities: MPI, RLS and CDRs VITLAccess Provider Portal VITLDirect ACO Gateways VITL Summit 14 - The HIE Experience

Consent Current model is Global Opt-In Previously were Opt-In by Organization How will we do cross community (HIE or State) consent? VITL Summit 14 - The HIE Experience

VITL Summit 14 - The HIE Experience

Planned Services Imaging Event notification Analytics HIXNY Interface Healtheway certification Patient portal VITL Summit 14 - The HIE Experience

What is special or unique? HIT Fund State matching funds come from a tax on claims Many CCD interfaces Blueprint for Health Have been sending data to the Blueprint for Health PCMH registry for many years ACO Gateways Now sending data to ACOs with a filter for their beneficiaries Data Warehouse (SAS) VITL Summit 14 - The HIE Experience

Coolest Project Combined Claims and Clinical Data Co-bid for the All Payer Claims Database with Onpoint VITL will provide MPI to match across beneficiary and patient identities Proposed two pilot projects to match clinical and claims data VITL Summit 14 - The HIE Experience

Core Challenges Moving from State funding to other sources of income EHR vendor systems interoperability New Document types beyond C-CDA Sustainability Utility model with private subscriptions? Data quality VITL Summit 14 - The HIE Experience

A New Standard of Care for Rhode Island Charles Hewitt Director, HIE Product Delivery Rhode Island Quality Institute September 2014

Overview CurrentCare is a path forward for the delivery of outcome-based healthcare for Rhode Island s providers. 38

Benefits Overview Take advantage of a broad frame of reference on every enrolled patient. Quickly look up: Medications Lab results Imaging reports Medical history 39

415,000 enrolled CurrentCare Hospital Alerts Providers receive real-time notifications of Patient Hospital Encounters Secure repository containing healthcare information for enrolled patients CurrentCare Viewer Providers view patient information via secure website

Hospital Alerts Sends real-time Hospital Alerts when an enrolled patient is admitted to or discharged from a hospital or emergency department. Timely follow-up Reduce costly re-admissions Strengthen patient-provider relationship 41

Telehealth Alerts Telehealth Alerts track a patient s health at home in coordination with a visiting nurse service. And notifies providers when a patient s symptoms need attention. 42

What does a Hospital Alert look like? The following patient has been discharged from LMC: Name: STONEWORTH, MELISSA CurrentCare ID: 578126 Date of Birth: 04/04/1944 Primary Care Provider: Albert Puerini Visit Start Date: 2014-03-11 09:30:00 Visit End Date: 2013-03-12 19:27:00 Patient Class: 1 Reason for visit: chest pain For more information on this encounter, log into CurrentCare to view the patient s record. https://login.currentcareri.com

Viewer Provider Log-in 44

Viewer The CurrentCare Viewer puts medications, real-time lab test results, radiology reports, hospital and emergency room visits and clinical summaries at your fingertips. 45

Viewer--Medications 46

Viewer--Labs 47

By the Numbers An emerging standard of care in Rhode Island 2 in 5 Rhode Islanders enrolled (8K new enrollees per month) More than 25 million transactions posted 70+ data-sharing partners 90% of RI prescription data from retail pharmacies 85% of RI laboratory data 400+ enrollment partners All Rhode Island acute care hospitals 48

Provider Use of CurrentCare Viewer 83% use Viewer 2x/wk most find it easy to use 51% use it daily Hospital Alerts 47% use Hospital Alerts 91% found them helpful 49

Provider Satisfaction Care teams that leverage CurrentCare services are seeing the value. 90% - agree CurrentCare provides benefit to their practices 62% strongly agree 79% - agree that CurrentCare helps them treat patients more effectively 57 % strongly agree 50

Testimonials Hospital follow-up is already a lot easier. We now get rapid notification from the hospitals when a patient is discharged. No longer do we rely on inconsistent faxes. My staff is able to quickly contact patients regarding hospital follow-up, and lab results are readily available through the CurrentCare system. Gregory Steinmetz, MD Family Physician Associates in Primary Care Medicine Warwick, RI 51

Website www.currentcareri.org 54

For More Information Charlie Hewitt Director, HIE Product Delivery Rhode Island Quality Institute 401-276-9141 x225 chewitt@riqi.org 55

CARE IS BETTER WHEN WE RE CONNECTED

Denise Hines, DHA, PMP, FHIMSS Executive Director, GaHIN dhines@gahin.org www.gahin.org info@gahin.org 866-233-8203 Sign up for our enewsletter! 57

G E O R G I A H E A LT H I N F O R M AT I O N N E T W O R K The statewide Georgia Health Information Network,Inc. (GaHIN), a non-profit organization, is dedicated to the use and exchange of electronic health information to foster a healthier Georgia improve patient-centered healthcare, increase efficiency and promote the health status of the entire state population. 58

T H E P U R P O S E O F G A H I N Close the patient information gap across care settings by electronically connecting disparate systems and data sources to support improved quality of care, better health outcomes, and reductions in cost. 59

G A H I N N E T W O R K M O D E L GaHIN is a Network of Networks Model Facilitates a Georgia statewide electronic Network connecting everyone payers, providers, and patients in the entire healthcare system, thus enabling better communication and collaboration among clinicians. Keeps operations manageable & costs low reducing barriers Allows GaHIN to leverage federal funding and provide guidance on complex issues to strengthen and advance the network. 60

T H R E E WAY S T O G E T G E O R G I A C O N N E C T E D 1.Provider organization directly connects to GaHIN 2.Provider connects through a networked HIE 3.Provider connects through their EHR vendor to a networked HIE or GaHIN 61

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M E A N I N G F U L U S E Exchange Types Secure, Directed Exchange Query-Based Exchange Consumer-Mediated Exchange 63

64 P R O D U C T S & S E R V I C E S

M E M B E R C O N N E C T I V I T Y Direct 2,800 Registered Providers Specialized Projects Dialysis Asthma Direct w/xdr Integration 20+ Organizations Small, Rural Hospitals Large, Urban Hospitals Long-Term Care Facilities Employee-Health Clinics 65

M E M B E R C O N N E C T I V I T Y Medicaid Health, Pharmacy & Dental Data Bi-Directional Immunization (GRITS) Web-based Clinical Portal for Medicaid Providers without EHR s Public Health Gateway-eLab & Syndromic Surveillance Reporting National Network (Healtheway) South Carolina Health Information Exchange (Live) Event Notification Services (Payer/Provider) Q4 2014 Registries Q4 2014 66

M E M B E R C O N N E C T I V I T Y Anticipated Features Advanced care alerts and notifications Personal health records and integrated consumer health and wellness tools Health analytics and advanced population health management Vendor-neutral medical imaging exchange platform Lab, pathology, and radiology ordering, results & reports Support for long-term care, behavioral health, and specialty pharmacy 67

M E M B E R C O N N E C T I V I T Y Connected State Agencies: Medicaid Public Health DFCS DJJ Amerigroup (CMO) Emory Healthcare (Cerner) Grady Health System (Epic) Children s Healthcare of Atlanta (Epic) Q32014 Georgia Health Connect (Liaison) Q42014 68

M E M B E R C O N N E C T I V I T Y Queued GaHIN Members State Agency: DBHDD (MA In Progress; Planning for Sept Kick-Off) GRAChIE/Chatham HealthLink (Planning for Sept/Oct Kick-Off) West Georgia HIE (Q1 2015) Georgia Partnership for TeleHealth (Q1 2015) GAPHC (Q1 2015) ArchHIE (TBD) HealtheConnection (TBD) Alabama One Health Record (TBD) 69

M E M B E R C O N N E C T I V I T Y Engaged Blue Cross/Blue Shield of GA Florida HIE (National Exchange) Tennessee (National Exchange & GeorgiaDirect) North Carolina HIE (National Exchange) VA & SSA (National Exchange) Kaiser Permanente Gwinnett Medical Center WellStar Health System RiteAid LifePoint Hospital (includes Rockdale) Piedmont Healthcare Dekalb Medical Center University Hospital (Augusta) Phoebe Putney Memorial Hospital Columbus Regional Health System Tenet Health (Atlanta Medical) Athens Regional Medical Center 70

G A H I N N E T W O R K M O D E L GaHIN is a federated-hybrid model, NOT a central repository of clinical data Information remains with the treating provider and only flows when there is authorization. GaHIN makes an individual data repository available to Members directly connected to the Network. 71

S U S TA I N A B I L I T Y Sources of Revenue Payers Grants/Private Donations Providers (pay for Advance Product/Service) State/Federal Funding 72

73 GEORGIA HEALTH INFORMATION NETWORK

Q U E S T I O N S? Denise Hines, DHA, PMP, FHIMSS Executive Director, GaHIN dhines@gahin.org www.gahin.org info@gahin.org 866-233-8203 Sign up for our enewsletter! 74

Healthcare Information Xchange of New York, Inc. Joel T. Ryba, COO Architecture of Collaboration Views of a Viral, Business Grade Information Sharing Social Network

Overview Business View of Collaboration How it differs from transactional systems Process View of Information Sharing Policies and Events and make data flow IT Views of the Social Network How Abstraction and Standards open communications Success Key success factors for similar products

The view of why we do it Business View

Drivers of the Social Network Goal is to achieve the Triple Aim of Improving the patient experience, Improving the health of populations, and Reducing the per capita cost of health care To do this, we create a single point of truth for all patient data by having all members of the community feed and access this social network Patient experience with this connected community should feel like a single integrated organization The patient now engages a community rather than moving silo to silo Care is continuous rather than broken

Collaboration is Key Being able to have mutual benefit This means constantly answering the question: What s in it for me? (WIIFM) If you don t produce content that I am interested in, then I am not giving you my content that you are interested in You can t force social networking This is a huge difference versus other types of systems that are driven internally by mandate

Rewarding is Key Like all business decisions, it needs to have a financial payback for those doing it, not just for patient care or select stakeholders. You may need to change business models to change behavior. Cost of Quality = Cost of Compliance + Cost of Noncompliance Started with some cost to comply and no cost to not. Lower the cost of compliance by making it easy to do (workflow), cheap to do (standards). Raise the cost of noncompliance primarily though missed revenue (payment reform)

Viral is Key Social Networks depend on actions within the system that introduce other users to the system. Viral Branding Has built HIXNY as users make offline recommendations to peers to join. Viral Action Is our next level of expansion as Hixny Delivered information makes its way from system to system, including to non-participants. Easing signup process for providers and patients will lower the cost of joining.

The view of what we do Process View

What we do Performs two clerical functions File Room Mail Room Combination of the two Surveillance

Consent Model is Key The Consent to Access model (not opt in, not opt out) All data flows into the file room, regardless of consent. Consent is used to pull records from the file room One-to-One messaging no consent is required Subscription set by data supplier Surveillance (aka alerts or notifications) Consent is required Subscription is set be the data recipient

The view of how we do it IT Views

Abstraction is our Technical Value SOA Platform HIE is the middleman Syntactical Interoperability (hear me) Transforms and standardizes messages Adapts to multiple transports Like the Telephone Network Semantic Interoperability (understand me) Common Data Model Terminology service translations

ESB is the platform for SOA Plumbing for SOA Connection interfaces Transformation Security Message routing Business process orchestration Auditing, Monitoring, Logging, Software Factory A central bus connecting everyone though a common data model. Orchestrates business processes based on complex events Conceptual IT Views are implemented as services and orchestrations

Success We made collaboration Viral by answering the question What s in it for me? By changing the cost of quality equation so that sharing information is more valuable than monopolizing it. By standardizing content and events and thus enabling mass customization of business processes above it. SOA/ESB flexibility and extensibility allows us to easily implement our conceptual architecture. Hixny is a success with 70% of our Provider market actively using our healthcare social network.

Panel Discussion Facilitator: Joel Benware VITL Summit 14 - The HIE Experience

Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure We view the nationwide health information network as a continually expanding ecosystem of electronic exchange activities and network service providers across the nation that rely on a set of standards, policies, and services to meet electronic exchange needs including the privacy, security, and appropriate use of the information exchanged. http://healthit.gov/sites/default/files/onc10yearinteroperabilityconceptpaper.pdf 90 VITL Summit 14 - The HIE Experience