Health Information Exchange in South Carolina: SCHIEx in Context W. David Patterson, Ph.D. Chief, Health and Demographics SC B&CB - SC HIT Coordinator Columbia, SC March 9, 2012 1
SCHIEx South Carolina Health Information Exchange A Network of Networks Why Health Information Exchange: Systemic Needs and ONC Requirements SC s Response: SCHIEx An extensive tool box for shared problems with diverse manifestations and contexts 2
WHY EXCHANGE? 3
Medical Errors from Lack of Information: an Unsolved Problem? In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to obtain hospital records fit for any purpose of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was being spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good. The lack of immediate access to patient healthcare information is the source of one-fifth of these errors 1. 80 percent of errors were initiated by miscommunication, including missed communication between physicians, misinformation in medical records, mishandling of patient requests and messages, inaccessible records, mislabeled specimens, misfiled or missing charts, and inadequate reminder systems 2. Florence Nightingale, 1873 Courtesy: Jodi McDaniel, ONCHIT 1 Health Research Institute &GlobalTechnology Center. Reactive to Adaptive:Transforming Hospitals with DigitalTechnology, PriceWaterhouseCoopers. 2005. 2 Smith, Peter, et. al. Missing Clinical Information During Primary Care Visits, The Journal of the American Medical Association. February 2005. 4
Vision: The Triple Aim Institute for Healthcare Improvement (2012). http://www.ihi.org/offerings/initiatives/tripleaim/pages/default.aspx. The Institute for Healthcare Improvement (IHI) believes that new designs can and must be developed to simultaneously accomplish three critical objectives, or what we call the Triple Aim : Improve the health of the population; Enhance the patient experience of care (including quality, access, and reliability); and, Reduce, or at least control, the per capita cost of care. 5
Areas of Emphasis by US Health an Human Services and the Office of the National Coordinator for Health IT Coordination and synergy among multiple programs (HIE, REC, MU Incentives, as well as Public Health and others) HIE must be standards based, and leverage multiple tools and approaches including robust query-retrieve and direct messaging HIE Program must advance the exchange of clinical histories, structured lab results, and e-prescribe and support public health reporting As HIE advances it must address care coordination, transitions of care, and enhance patient engagement State programs have flexibility in how the above might be achieved, but there must be a coherent strategy for each as well as coverage for all areas and providers within the state white space strategy 6
Physical Primary Therapy Care Self Regional Hospital Pain Management Orthopedist Rheumatologist University Hospital Car Accident 7
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SCHIEX 9
Guiding Principles Competing Forces o Meet federal expectations while keeping it simple for SC providers o Provide a variety of technical tools and options that can matched to the needs and contexts of a diverse provider community (i.e. no one size fits all, but selection a la carte) o Focus on Stage 1 MU (CMS Meaningful Use) needs and upcoming stage 2 to prioritize activities o Leverage (EHR MU, REC (SC CITIA), HITSP standards) work with those incentivizing and assisting healthcare providers with technology. o Low barrier to entry while providing glide-path to increasing functionality o Accommodate diverse views on data sharing preferences, but focus first on TPO (treatment, payment, and operations) o Any approach must be sustainable and worth the value the enemy of good is better 10
Standards Based Network of networks CDC VA Federal Health Architecture CONNECT 2.4 Compliant Gateway SSA CMS DoD C O R E Optional Other State Hosted Applications HIEs Core Connectivity Services. Clinical Viewer eprescribe ThinEMR CareCoordinate. MPI RLS Audit/Log Authentication Time Server ORS Hosted Data Assets. Medicaid UB92/04 XDS Repo Provider Pharmacies Labs HITSP/IHE Compliant Standards PIX, XDS/CCD (HL7 2.x), DIRECT IZ Registry Integrated Delivery System MPI Community #1 CHCs Clinics Community #2 11
SCHIEx Direct: Simple 2-layer network view Endpoint system Gateway system Endpoint system Gateway system Discharge@gothamgeneral Dr.Juan@sunnysidepractice Top layer: User Perception User 1 EHR Send message Authenticate User perception of transaction Authenticate Receive message EHR User 2 Second layer: Routing Authenticate Message routed Gateway Gateway
Additional information is available at www.schiex.org.