Florida Health Care Coalition Central Florida RHIO The Value of Interoperable Health Information Technology March 23, 2006 Washington, DC
Florida Health Care Coalition
Service Area Orange Seminole Osceola Polk Brevard Lake Volusia Central Florida RHIO
Key principles Central Florida RHIO It s about improving patient care Emphasize the value One calculated step then the next Infrastructure - not Reform Collaboration - not Competition Open, non-proprietary technology & data exchange standards Scaleable & replicable
Key principles (cont.) Central Florida RHIO Highly secure, Internet-based Federated, Peer-to to-peer approach (e.g. MA- SHARE) Start with fetch and view Multi-phase, planned delivery and growth Project II Extend as FHCC convener in South Florida
The Cost Landmark Clinical Trials and Current Rate of Use for Selected Procedures linical Procedure Landmark Trial Current Rate of Use lu Vaccination 1986 (7) 55% (8) hrombolytic Therapy 1971 (9) 20% (10) neumococcal Vaccination 1977 (11) 35.6% (8) iabetic eye exam 1981 (4) 38.4% (6) eta blockers after MI 1982 (12) 61.9% (6) ammography 1982 (13) 70.4% (6) holesterol screening 1984 (14) 65% (15) ecal occult blood test 1986 (16) 17% (17) iabetic foot care 1993 (18) 20% (19) ource: Yearbook of Medical Informatics 2000, Diabetic Retinopathy Research Gp., Altman & Goodman
Governance Central Florida RHIO 501(c)(3) most likely Studies recommend neutral third party convener (FHCC) Chair: Becky Cherney, Florida Health Care Coalition Co-Chair: Chair: Rick Schooler, Orlando Regional Healthcare
Central Florida RHIO Governance (cont.) RHIO Committees Clinical Technology Legal Financial & Governance Education & Communication
Committees Clinical Central Florida RHIO Chair: Phil Chen, MD, PhD (Cognoscenti Health Institute) Vice Chair: Robert Westergan,, MD, (Jewett Orthopaedic Clinic) Core data set Clinical protocols Clinical process improvement
Committees Technology Central Florida RHIO Chair: Rick Schooler, FACHE, MBA (Orlando Regional Healthcare) Vice Chair: Eddie Soler (Florida Hospital) Operating standards Privacy and Security Training NHIN compliance
Committees Legal Central Florida RHIO Chair: Greg Chaires,, Esq. (Webster, Chaires & Partners) Vice Chair: Michael Lowe, Esq. (Michael Lowe, PA) Legal structure 501(c)3 Articles of Incorporation & By-laws Terms and conditions of participant agreements Consent forms
Committees Central Florida RHIO Finance & Governance Chair: Becky Cherney (FHCC) Vice Chair: Andrew Crooks (CIGNA HealthCare) Planning Development Operational Board of 5 Chairs for 2006 Add 2 to 4 members 2007
Committees Central Florida RHIO Communication & Education Chair: Karen Van Caulil, PhD (District VII Health Planning Council) Vice Chair: George Ellis, MD (PCAN & OCMS) Marketing strategy Communication plan Website management Media management Patient involvement strategies
Communications Central Florida RHIO Engage consumers and industry stakeholders Focus groups, surveys, public announcements Education, education, education! Sell the value why do we need this? High school seniors and older Use industry-recognized recognized subject matter experts Distribute brochures (e.g. CareScience use of physician offices to obtain patient consent to share information)
Local Support Orlando Sentinel Editorial urged support for sharing clinical information myregion.org Central Florida RHIO An organization of citizens and leaders from public, private and institutional sectors RHIOs are a key health initiative
Phase I 2 Health Systems (14 Hospitals) 2-33 Community Medical Groups Reference Lab Health Care Center for the Homeless Primary Care Access Network (Orange County) Future Phases Central Florida RHIO Extend to South Florida Seek links with other RHIOs
Central Florida RHIO Funding Initial Central Florida RHIO Employers and Foundations $1,500,000 Grants (government) $500,000 Health Plans $1,500,000 Pharmaceuticals and others $500,000 $4,000,000
Central Florida RHIO Health Plans Participation Funding Data
Central Florida RHIO evalue8 Disease management IT adoption Administrative efficiency
Central Florida RHIO Community Health The Shape Of Things To Come The Economist December 13, 2003 5.4 M years 50
Central Florida RHIO Incremental Growth Don t try to pop all the corn in the field. Jerry Rankin CareScience,, Inc.
Technology Central Florida RHIO The RHIO network will be highly secure, Internet- based RHIO participants retain ownership of their data, but share it given an authorized request This approach is known as Federated, Peer-to to- Peer Features Fetch and View capabilities Multi-phase, planned delivery and growth starting with seven pilot provider organizations
entral Florida RHIO Architecture Phase I Fetch & View Physician Associates Of Florida Healthcare Center for the Homeless Orlando Regional Healthcare Jewett Orthopaedic Clinic Central Florida RHIO RHIO Registry Link to other RHIOs All network participants forward patient identification and encounter information to the RHIO index Florida Hospital May be within or external to RHIO Research Databases (deidentified data) Cognoscenti Health Institute Orange County PCAN
entral Florida RHIO Architecture Phase I Fetch & View Physician Associates Of Florida Healthcare Center for the Homeless Orlando Regional Healthcare Jewett Orthopaedic Clinic ED Patient Information Request Central Florida RHIO RHIO Registry Link to other RHIOs All network participants forward patient identification and encounter information to the RHIO index Florida Hospital May be within or external to RHIO Research Databases (deidentified data) Cognoscenti Health Institute Orange County PCAN
entral Florida RHIO Architecture Phase I Fetch & View Physician Associates Of Florida Healthcare Center for the Homeless Orlando Regional Healthcare Jewett Orthopaedic Clinic Link to other RHIOs Central Florida RHIO Available Patient Information ED Patient Information Request RHIO Registry All network participants forward patient identification and encounter information to the RHIO index Florida Hospital May be within or external to RHIO Research Databases (deidentified data) Cognoscenti Health Institute Orange County PCAN
entral Florida RHIO Architecture Phase I Fetch & View Physician Associates Of Florida Healthcare Center for the Homeless Orlando Regional Healthcare Jewett Orthopaedic Clinic Link to other RHIOs Central Florida RHIO Available Patient Information ED Patient Information Request RHIO Registry All network participants forward patient identification and encounter information to the RHIO index Florida Hospital Request Patient Information May be within or external to RHIO Research Databases (deidentified data) Cognoscenti Health Institute Orange County PCAN
entral Florida RHIO Architecture Phase I Fetch & View Physician Associates Of Florida Healthcare Center for the Homeless Returned Patient Information Orlando Regional Healthcare Jewett Orthopaedic Clinic Link to other RHIOs Central Florida RHIO Available Patient Information ED Patient Information Request RHIO Registry All network participants forward patient identification and encounter information to the RHIO index Florida Hospital Request Patient Information May be within or external to RHIO Research Databases (deidentified data) Cognoscenti Health Institute Orange County PCAN
Benefits Provider-Lab HIEI Improve clinician access to longitudinal test results Eliminate errors from reporting results verbally Make cost information available, optimize ordering Improve convenience for patients Reduce redundant tests Save time ordering tests, sending and receiving results Evidence re current rate of redundancy, time cost Experts estimated HIEI impact
Provider-Lab Annual Benefit in billions $35 $30 $25 $20 $15 $10 Payers Labs Providers 13.6% from avoided tests 86.4% from time savings $31.8B national benefit at Level 4 $118,000 per MD in free- standing offic at Level 4 $5 $0 Level 2 Level 3 Level 4 Eric Pan, MD, MSc, CITL, 2005
Benefits Provider-Radiology HIEI Improve patient safety and optimize ordering by giving radiologist access to relevant clinical information Reduce errors of omission with automated reminders for follow-up studies Reduce environmental impact Reduce redundant tests Save time ordering tests, sending and receiving results/images Evidence re current rate of redundancy, time cost Experts estimated HIEI impact
Provider-Radiology Annual Benefit $30 $25 Payers Labs Providers 35% from avoide tests 65% from saved time in billions $20 $15 $10 $26B national benefit at Level 4 $60,000 per MD i free-standing office at Leve 4 $5 $0 Level 2 Level 3 Level 4 Eric Pan, MD, MSc, CITL, 2005
Benefits Provider-Pharmacy Pharmacy HIEI Improve patient safety: access to complete medication lists will reduce drug interactions and adverse drug events More convenient for clinicians: automatic refill alerts, access to adherence information, automated insurance forms, identify patients for drug recalls Efficient formulary management between pharmacies and payers probably biggest financial impact Save time ordering, dispensing prescriptions Evidence re time and phone calls: 55% of prescriptions involve a phone call Each call + 2 provider minutes + 3 pharmacist minutes Experts estimated HIEI impact on % calls
Provider-Pharmacy Pharmacy Annual Benefit in billions $3.0 $2.5 $2.0 $1.5 $1.0 Pharmacies Providers $2.7B national benefit at Level 4 $4,700 per MD in free-standing office at Leve 4 Probably most benefit from pharmacy- payer HIEI $0.5 $0.0 Level 2 Level 3 Level 4 Eric Pan, MD, MSc, CITL, 2005
Benefits Provider-Provider HIEI Reduce fragmentation Reduce educated guesses in clinical care Improve referral quality by making relevant information available to the consultant Save time responding to referrals Save time responding to chart requests Evidence re referral rates, % visits missing information, administrative costs of referrals and chart requests Experts estimated HIEI impact on administrative costs
Provider-Provider Annual Benefit $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 Level 2 Level 3 Level 4 $43,000 per offic MD National Benefit: Level 2: $2.8 billion Level 3: $8.1 billion Level 4: $13.2 billion $500,000 $0 Small Group Medium Group Large Group Small Hospital Medium Hospital Large Hospital Jumbo Hospital Eric Pan, MD, MSc, CITL, 2005
Provider-Public Public Health HIEI Benefits Earlier recognition of disease outbreaks Biosurveillance: : identify warning signs by aggregating data from many sources Increase % of disease reported Save time reporting vital statistics and disease Evidence re number of vital statistics and disease reports, and time required Experts estimated HIEI impact
Provider-Public Public Health Annual Benefit $250 $200 Public Health Providers $195 million nation benefit in millions $150 $100 $50 $0 Level 2 Level 3 Level 4 Eric Pan, MD, MSc, CITL, 2005
Provider-Payer Payer HIEI Benefits Save time Reduce rejected claims Evidence re % of transactions already automated due to HIPAA Calculated impact of full automation at Level 4 Levels 2-32 3 not allowed by HIPAA
Provider-Payer Payer Annual Benefit $25 $20.1B national net benefit $10.3B to providers $20 $9.8B to payers in billions $15 $10 $5 $0 Level 4 Medicaid Medicare Commercial Providers Eric Pan, MD, MSc, CITL, 2005
Questions? Becky J. Cherney President/CEO Florida Health Care Coalition 4401 Vineland Road, Suite A10 Orlando, FL 32811 407-425 425-9500 becky@flhcc.com