Transcript Slide Title - Image Research LLC Website

Florida’s Initiative to Empower Regional
Health Information Organizations and
Enable the Development of Health
Information Exchange
Christopher B. Sullivan, Ph.D.
Florida Center for Health Information
and Policy Analysis
Agency for Health Care Administration
Florida’s Strategies for Empowering Regional
Health Information Organizations
This talk addresses three areas in the development of
health information exchange in Florida:
•
A summary background of need for health
information exchange in the coordination of change.
•
A summary of the Florida Health Information
Network (FHIN) initiatives.
•
The current status of Florida’s Regional Health
Information Organizations (RHIOs).
•
Florida’s ongoing strategies for developing health
information exchange with particular attention to eprescribing initiatives.
Major Challenges in Health Care
•
•
The increasing cost of health care.
•
Struggle to care for the the poor, uninsured and
patients with chronic diseases – i.e. Diabetes,
Asthma, Heart Disease and cancer.
•
Historic economic pressures, geographic diversities
and differing scope of care call for coordinated local
solutions.
•
Leverage health information technology efficiencies
while ensuring privacy protection of health care data.
Fragmented healthcare delivery and financing
environment and challenges with continuity of care.
MJJ - 2007
Government Budget Office Estimate of
Health Care Costs as % of GDP, 1960-2005
Retrieved from: http://www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf
Government Budget Office Projection of
Rising Health Care Costs as % of GDP
MJJ - 2007
Retrieved from: http://www.cbo.gov/publications/collections/health.cfm
Why Health Information Exchange?
•
The nature of modern health care requires
involvement of multiple medical providers to diagnose
and treat many medical conditions.
•
Effective coordination of care is dependent on
communication of information about a patient’s
medical condition.
•
The exchange of patient data currently depends on
telephone calls, mail, the transmission of fax copies
of records or photocopies carried by the patient.
•
A more timely, accurate, comprehensive and secure
method of exchanging patient records is electronically
through an electronic health record system that
includes the health information exchange.
Need for Better Information Exchange
Coordination of Specialty Referrals
•
“Better coordination between referring physicians and
specialists increases physician satisfaction with specialty
care and enhances referral completion.”1
Communication Breakdown in the Outpatient
Referral Process
•
“68% of specialists report that they received no
information from the primary care physician prior to
specific referral
•
“Four weeks after specific referral visits, 25% of PCPs
had still not received any information from specialists.”2
1. Christopher B. Forrest, MD, PhD, et al. (2000) Coordination of Specialty Referrals and Physician Satisfaction
With Referral Care. Archives of Pediatric Adolescent Medicine.
2. Tejal K. Gandhi, et.al. (2000). Communication Breakdown in the Outpatient Referral Process. Journal of
General Internal Medicine, Volume 15, Number 9, September.
Chronic Care Management Supported by
Health Information Exchange
•
Chronic Disease Management requires the coordination
of care with one or more specialists - an average
Medicare patient sees up to 6 physician specialists
annually.
•
Health information exchange can an enabler for
effective chronic disease management by supporting the
exchange of information across caregivers to coordinate
care among specialists, the primary care physician and
the patient.
•
Health information exchanges allow chronic disease
management to be implemented without providers
having to invest in duplicate information exchange
infrastructures.
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The Challenge to Define Health
Information Exchange
RHIO and HIE
Distinguishing & Common Characteristics
RHIO
Entity that governs the interoperable
exchange of health information
Entity that defines and has the authority &
responsibility for establishing and
enforcing information sharing policies and
procedures
Exchanges clinical information and can
exchange administrative information
Participants are geographically defined
Mission is to improve quality, safety,
efficiency of healthcare for communities in
which it operates
Exchanges information among organizations
that operate independently of each other
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January 16, 2008
HIE
Activity or process that moves healthrelated data
Agreed upon set of interoperable standards,
processes and activities needed to implement
information exchange
Exchanges clinical or administrative
information
Participants may be geographically defined or
be non-geographic communities of affiliation.
Purpose is to exchange information
Exchanges information among organizations
that operate independently of each other
17
What is a Regional Health Information
Organization?
What is a RHIO?
RHIO Infrastructure
Clinical Source Systems
Web-based Portal
Business Convener
Bring together health care stakeholders.
Manage Business Associate Agreements
Enable data-sharing among providers
Pharmacy
Inpatient
Security Management
Certify providers to access health care records
Authorize access to records
Log record access activity
Physician Portal
Identity Management
Identify patient records with MPI
Match patient records with an RLS
Laboratory
Physicians
Information Management
Gathers patient data into Minimal Clinical Dataset
Provide data access through a Web-based portal
Provide access to the FHIN
Patient Portal
Vision for the Florida Health Information
Network (FHIN)
The vision for the Florida Health
Information Network proposes
integrating Florida’s communitybased activity in clinical health
information exchange through a
statewide network, the FHIN.
•
The FHIN will empower physicians to access
timely and accurate medical records in order to
deliver high quality medical care for their patients.
The Florida Health Information Network
Starts at the Local Level
The Florida Health Information Network is being built from
the local community up.
•
AHCA’s strategic plan for promoting health information
exchange is to empower local stakeholder
collaborations focused on creating local health
information networks.
•
The FHIN is a collaboration of Regional Health
Information Networks (RHIOs) funded by the FHIN
Grants Program and by local in-kind support.
•
Each RHIO is responsible for working with local
providers to initiate the exchange of medical records
through the RHIO portal.
12
FHIN Grants Project Categories
The driver of Florida’s plan for health information
exchange is the FHIN Grants Program for Regional
Health Information Organizations.
•
Planning Grants: Support appropriate health care
stakeholders to develop a strategic plan for health
information exchange in their communities.
•
Implementation Grants: Support projects that
demonstrate health information exchange among two
or more competing provider organizations.
•
Training Grants: Support practitioner training
designed to increase physician and dentist use of
electronic health record systems.
•
Over $5 million in grants since 2005.
The Florida Health Information Network
FHIN Grants
Program Funded
Grantees from FY
2005 – 2008
Northeast Florida Health Information
Consortium (NEFHIC)
15
NEFHIC Technical Capacity
•
ASP Model – Safety net data repository server hosted
in Cerner’s secure data center with redundant
hardware and power.
•
Records for 90,000 clients loaded with feeds from 7
participants, including hospitals and clinics.
•
System operational and accessible via the Internet
using 128-bit secured communications.
•
Pilot testing of user access and data retrieval is
complete.
Palm Beach County Community Health
Alliance (PBCCHA)
Private
Funders
Public
Funders
Free
Clinics
Health
Dept.
Hospitals
Social
Services
PBC Community Health Alliance
(An Alliance of Funders and Providers
Serving Health Care Consumers)
Care
Expansion
Language
Access
Project
Access
Shared
EHR
Common
Eligibility
17
PBCCHA All-Care Shared Health Record
•
Real-time electronic interface to existing data systems
used by hospitals, clinics, and other safety net providers.
•
Shared summary records created for all uninsured,
Medicaid, and other patients.
•
No duplicate data entry.
•
Free clinics, Federally Qualified Health Centers, PBCMS
Project Access and key competitor safety net hospitals
are participating.
•
Viewable via secure Internet connections - after patients
have signed authorizations.
18
Big Bend RHIO Regional Health Information
Network (RHIN) Architecture
Rx Claims
Disaster
Recovery Site
FHIN
Community Repository
&
Record Locator
pMAN
Connectivity –
Dedicated fiberbased Private
Medical Area
Network & VPN
gateway
Labs & Radiology
VPN
TMH
CRMC
CHP
Small organizations can
connect either directly to
the RHIN or through a
VPN gateway
Organizations can connect
bi-directly to feed their data
and receive data directly
into their EMR
In the early Phases CHP, CRMC & TMH will
provide a one way feed of their data. They have
the largest repositories and the priority is to
make their data available ASAP
Big Bend RHIO RHIN Services
•
Data Sharing – Patient demographic and clinical data feeds from
major providers.
•
RHIN Web Portal – Secure web interface for clinicians.
•
User Access & Audit Control – Detailed audit logs across the entire
system.
•
Disaster Recovery & Business Continuity.
•
Patient Portal – Web interface for electronic patient registration
form and Personal Health Record (PHR).
20
RHIN Portal Views from the Big Bend RHIO
Secure
Internet
Access
RHIN Web Portal
patient search
Data Exchange: Big Bend RHIO Applications
e-Prescribing and
Medication History
Clinical data display including: labs,
radiology reports, allergies, problems,
providers, and medication history
FCC Rural Broadband Pilot Program
In November 2007 the Federal Communication
Commission awarded $9.6 million to the Big Bend RHIO
and AHCA to build a gigabit fiber network to nine rural
hospitals and surrounding clinics in the Florida
Panhandle.
•
This contract will allow the Big Bend RHIO to connect
these hospitals with gigabit fiber and extend its RHIN
services to them.
•
The FCC pilot project will provide 1 Gigabit connectivity
to nine rural hospitals.
Once the nine rural hospitals are connected with gigabit
fiber, they will receive the data exchange services of the
Big Bend RHIO.
•
23
Connecting Rural Hospitals in the Florida
Panhandle
Broadband Rural Network Will Benefit
from Big Bend RHIO Services
•
Once the optical fiber is laid, a wireless broadband
network will be built to provide connectivity to
providers in the local community.
•
Creating these broadband optical fiber connections
brings the nine rural hospitals into the Florida Health
Information Network.
•
Each hospital will be able to send digital image files
(X-rays, Cat Scans, MRIs) downstream for diagnosis
by specialists.
•
County health departments, Federally Qualified Health
Centers, free clinics and primary care physicians will
be encouraged to connect to the broadband network.
Florida Health Information Privacy and
Security Project
•
National Project was intended to provide the Office of
the National Coordinator of HIT with information about
privacy and security practices and laws in 33 states
that were part of the project.
•
Each state identified business practices related to
electronic health information exchange and analyzed
practices and laws that are barriers to interoperability.
•
The goal of the project was to develop state specific
solutions and develop a plan for eliminating barriers to
health information exchange.
•
The long term outcome is to facilitate development of
an interoperable nationwide health information
network.
Major Barriers to Health Information
Exchange
•
Inconsistent and fragmented laws at state and federal
level – conflicts between Florida statutes and HIPAA.
•
Lack of standard requirements for when to use
patient consent – proposed uniform consent form.
•
Mistrust among health care entities, liability concerns
and fear of violating rules or litigation.
•
Solution is to develop priority legislative
recommendations for legislative action that would
have the most immediate impact.
• Reporting of lab records (s. 483.181 FS).
• Exchange of hospital records (s. 395.3025 FS).
Medicaid Claims-Based Electronic Health Record
System Ported Through RHIOs
•
•
•
Working with the new Medicaid fiscal agent, EDS, on
a pilot project to roll out a claims-based EHR for
Medicaid physicians.
Medicaid pilot to work with Big Bend RHIO to
integrate the claims data feed for display through the
Big Bend portal.
Plan to roll out the Medicaid EHR through RHIO
portals in Summer 2008.
Lab Claim
Pharm
Claim
Hospital
Claim
Specialt
y Office
Claim
Medicaid
Claims
Primary
Care
Office
Claim
ER Claim
Radiol
Claim
Medicaid-EDS
Web
Application
Local
RHIO or
Direct
Medicai
d
Portal
Access
Home
Office
Hospital
28
Accessing Medicaid Prescription Data
Through Gold Standard
o Florida Medicaid eMPOWERx e-prescribing software is
available to all Medicaid physicians.
o eMPOWERx makes 100 days of a patient’s prescription
drug history available to physicians.
o eMPOWERx uses clinical pharmacology and report tools
that alert the provider to potential drug-drug and drugallergy interactions.
o Providers can write prescriptions from a desktop computer
to any pharmacy for dispensing and adjudication.
o The Florida Center is working with Gold Standard and
Medicaid to make eMPOWERx medication history
available to Medicaid physicians through RHIO portals.
Florida Medicaid Wireless Handheld PDA
Project Approach
Outcomes of the Medicaid e-Prescribing
Pilot Project Using PDAs
•
Prescribers who used eMPOWERx write 25% fewer
prescriptions than physicians not using the system.
•
Prescribers who use eMPOWERx save Medicaid an
average of $48 more per month per patient on
prescription claims.
•
Florida Medicaid reports $1.8 - $2 million in monthly
savings from electronic prescribing.
•
During 2006, eMPOWERx users received more than
5,000 drug interaction alerts each week, more than
1,000 of which were of high or very high severity.
•
Physicians wrote an average of 4,115 electronic
prescriptions per month.
eMPOWERx Usage Statistics, July 2006 to
Number of ePrescriptions, Patients
with ePrescriptions and
Prescribers Using eMPOWERx
September
2007
3,000
5,000
4,707
4,000
3,762
1,500
3,500
3,000
2,500
2,000
1,000
1,500
1,000
274
270
500
276
287
291
301
317
299
331
310
326
362
391
381
500
0
0
Jul
2006
Aug
2006
Sep
2006
Oct
2006
Nov
2006
Providers Using eMPOWERx
Dec
2006
Jan
2007
Feb
2007
Mar
2007
Apr
2007
May
2007
Patients Receiving Prescriptions
Jun
2007
Jul
2007
Aug
2007
Sep
2007
ePrescriptions
Number of ePrescriptions
3,587
1,980
1,934
3,515
1,841
2,174
2,039
2,118
2,053
2,331
2,323
3,990
3,956
2,174
2,428
2,478
2,519
4,199
3,949
4,050
2,005
2,000
4,500
4,246
3,770
376
Number of Patients and Providers
2,500
4,481
4,463
4,562
1,838
4,494
Average Monthly Cost Savings per Patient
in Medicaid Wireless PDA Program
Comparison of the Average Cost of Prescriptions per Patient for PDA and Non-PDA Groups
and the Average Prescription Cost Savings for PDA Users
$350
$330
$294
$290
$284
$281
$275
$272
$270
$290
$286
$280
$275
$274
$274
$274
$263
$258
Average Non-PDA = $276
$254
$250
Average PDA = $228
$242
$230
$230
$210
$240
$239
$228
$243
$233
$228
$229
$226
$225
$222
$218
$216
$203
$190
$170
Average Prescription Cost per Patient, PDA Group
ge
ra
Av
e
20
07
Se
p
7
20
07
Au
g
00
l2
Ju
n
Ju
ay
M
20
07
20
07
07
20
Ap
r
00
7
M
ar
2
07
Fe
b
20
20
07
Ja
n
20
06
c
De
6
20
06
v
No
ct
20
0
O
20
06
Se
p
20
06
Au
g
l2
00
6
$150
Ju
Average Prescription Cost per Patient
$310
Average Prescription Cost per Patient, Non-PDA Group
AHCA’s Electronic Prescribing
Clearinghouse Home Page
•
http://www.fhin.net/eprescribe
ePrescribing Today
29%
70%
2.
1.
or
1%
&
Cursive
or
Fax
eRx
Phone(Cursive/Typed)
vs.
Physician Evaluates Patient
& Prescribes Drug
Typed
3.
Manual Entry
By Pharmacist
Pharmacist review
prescription
and routes it to the
patient’s insurer.
5.
Payment is collected and
Medication is dispensed
to the patient
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4.
Script to Patient Benefit Manager
for Adjudication
Rx Approval
Patient Benefit Manager
Approves Script
Florida 2007 Electronic Prescribing Report
•
E-prescribing was on the increase in Florida in 2007, but
fewer than 1% of prescriptions were electronic.
•
During 2007 the number of physicians e-prescribing
increased by 80%.
•
There was a 199% increase in the number of electronic
prescriptions in 2007.
•
Across the state, 63% of all pharmacies in the state are
actively receiving e-prescriptions.
•
New prescriptions make up the greatest number of
prescriptions in 2007, at about 47.2%.
•
The Tampa-St. Petersburg MSA accounts for the largest
number of electronic transactions of all types related to
electronic prescribing, with 850,619 in 2007.
Number of Physicians Actively E-prescribing
ePrescribing in Florida: Active aPrescribers and Total ePrescriptions Submitted, 2007
and Number of New Prescriptions and Refills
2,400
220,000
198,538
202,225
1,200
1,362
1,380
1,400
20,000
1,721
1,000
-30,000
Jan 2007 Feb 2007
March
2007
April 2007 May 2007 June 2007 July 2007 Aug 2007 Sept 2007 Oct 2007 Nov 2007 Dec 2007
Active ePrescribers in Florida, 2007
Total ePrescriptions in Florida, 2007
Number of ePrescriptions
70,000
1,507
64,794
1,421
64,192
77,361
1,644
74,833
120,000
1,803
1,800
92,954
170,000
2,026
1,918
118,623
1,600
150,153
141,018
1,295
Number of Prescribers
2,000
2,194
158,847
2,331
191,945
2,200
E-prescribing Transactions in Florida
2007 MONTHLY EPRESCRIBING TRANSACTIONS VOLUMES BY MESSAGE TYPE
Broken Down by Transaction Type
160,000
134,979
140,000
Number of ePrescribing Transactions
129,724
132,156
120,000
103,324
100,000
99,658
89,644
76,420
80,000
77,726
81,990
70,764
60,698
60,000
49,613
41,616
58,829
43,560
51,374
36,625
27,758
23,890
20,000
22,576
21,234
Jan 2007
Feb 2007
68,814
70,069
55,523
56,966
50,495
42,203
30,840
22,961
61,557
52,759
49,833
40,000
62,514
32,256
25,220
27,528
0
March
2007
April 2007 May 2007 June 2007 July 2007
New Prescriptions from Physicians
Aug 2007 Sept 2007
Refill Requests from Pharmacies
October
2007
Nov 2007
Dec 2007
Refill Responses from Physicians
Ongoing Strategies for Fostering Statewide
Health Information Exchange in Florida
•
Continue the FHIN Grants Program and foster the
development of Regional Health Information
Organizations (RHIOs) across Florida.
•
Seek alternate, additional funding sources to ensure
the viability of RHIOs currently in operation and to
develop sustainability models for their continued
success.
•
Work with the RHIOs to establish a statewide,
interoperable health information network.
•
Work with the Health Information Exchange
Coordinating Committee for state level leadership.
•
Work with the Health Information Security and Privacy
Collaboration to reduce barriers to HIE.
39
Christopher B. Sullivan, Ph.D.
Agency for Health Care Administration
Florida Center for Health Information and Policy Analysis
Office of Health Information Technology
2727 Mahan Drive
Tallahassee, FL 32308
[email protected]
850-414-5421