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Southwestern Va Medical Technology Summit Oct. 2, 2009 Presentation Overview Background • Coordination of Care for Individuals • Regional Public Health Status Improvement Current Status • Regional Participation and Capabilities • State-level initiatives • National Future Plans • Support participants to achieve “Meaningful Use” • Expansion of cooperative efforts • Tracking and reporting of outcomes Background: Regional Health Improvement CareSpark’s Mission: to Improve the Health of People in northeast Tennessee and southwest Virginia through the Collaborative Use of Health Information 750,000 citizens (2/3 in Tennessee, 1/3 in Virginia) Disproportionately High Rates for •Premature mortality •Chronic Diseases •Prescription Drug Overdose Uneven Access to Services •18 hospitals •1400 physicians •18% uninsured CareSpark’s Core Strategies Provide patient 1. information and decision support at the point-of-care 2. Align financial incentives for 3. patients, providers, purchasers Compile and 4. analyze aggregate data for population health improvement Empower patients to make informed decisions and healthy choices Community-Wide Collaboration • Employers: Eastman Chemical Company, CGI, BAE Systems, City of Kingsport, Food City, ntara, the Creative Trust, Steadman Corporate Design, • Payors: Blue Cross Blue Shield of Tennessee, John Deere Health / United Healthcare, Cariten PHP, Highlands Wellmont Health Network, CIGNA • Hospitals: Mountain States Health Alliance, Wellmont Health System, Johnston Memorial Hospital, Quillen V.A. Medical Center, Laughlin Memorial • Physician Practices: Holston Medical Group, Highlands Physicians, Health Alliance PHO, Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Frontier Health, Southwest Virginia Community Health System, Mountain Region Family Medicine, Medical Care PLLC • Health Education: East TN State University School of Medicine / College of Nursing/ College of Public and Allied Health, University of Appalachia College of Pharmacy, University of Virginia • Public Health: Sullivan and Northeast Regional Health Departments in TN, Cumberland Plateau and Lenowisco Health Districts in VA, Tennessee Department of Health, Virginia Department of Health and Human Resources • Community Non-Profits: Kingsport Tomorrow, United Way of Kingsport, Rotary Club of Kingsport, Kingsport Chamber of Commerce, Bristol Chamber of Commerce, NETWORKS Sullivan County Partnership • Patient Advocacy Groups: American Cancer Society, Minority Health Coalition, Mountain Empire Older Citizens, Savvy Patient •Technology Companies: ActiveHealth, AllScripts, Anakam, BCTI, Cisco, CGI, Deliberare, Healthvision, Holston Technology, Initiate Systems, Intellithought, Intel, LucentGlow, OnePartner, Oracle, Wellogic Key Strategic Decisions 1. Enable voluntary participation by all patients and providers in region 2. Enroll patients through default Passive Enrollment (“opt-out”) with option for Active Enrollment (“opt-in”) 3. Hybrid Model, combining Federated Repositories and Centralized Repository for limited clinical data - Enabling coordination of care decision support, monitoring and aggregate data analysis 4. Data Access and Uses Patient: view content of records, view access log Provider: payment, treatment, operations Public health: required reporting and authorized queries Payers: de-identified aggregate data Research: IRB-approved studies 5. Fee-Based Revenue Model - Contracts with public agencies, insurers and employers - Transaction fees for data providers (labs, hospitals, large practices) - Contributions (cash and inkind) 6. Commitment to standards (ISO, IHE / HITSP / NHIN, other) CareSpark Data-Sharing Options Data Sharing Option Identified Data De-Identified Data Anonomized – patient data can never be re-identified Intended Data Use Patient Care and Treatment All data sent to CareSpark will be identified data in order to match patient records from multiple providers. Identified data will be available to authorized providers for access of additional healthcare information about the patient. Approved Population Health Improvement activities Identified data available to CareSpark will be de-identified according to the approved requirements and stored separately. Public Health Identified data available to CareSpark will be de-identified with the specified additional fields required for a limited dataset according to the approved requirements and stored separately. Pseudo-Anonomized – Patient data can be reidentified, if necessary, but only by the party who provided the pseudoanonoymized data Limited Data Sharing Result CareSpark’s infrastructure • We’ve Built a standards-compliant Clinical Document Exchange Network • Exchanges clinical documents between providers • Accepts patient demographic information from Providers • Controls clinical data in accordance with patient consent preferences • Supports direct integration and access through provider EMRs (standard and non-standard) • Allows access for providers without EMR • High levels of security Technical Architecture CareSpark ` Patient See Note 1. ` Https MPI Client Filters and Encryptions Provider 1 Secure & Redundant Network A Application Server Data Base Server EMPI Filters and Encriptions ` Provider 2 Internet MPI Client Filters and Encryptions Router Application Server Provider Load Balancer See Note 2. ` Provider using ASP App Firewall MPI Client Filters and Encryption Data Base Server See Note 3 CareSpark Secure & Redundant Network B Application Server EMPI Filters and Encriptions ` Small Doctors Office Active Health Note 1: Patient access will be via the internet thorough Https Protocol (SSL) Data Base Server Data Base Server Note 2: Although not pictured, the Internet connectivity, the Application Firewall and the Load Balancer will all be redundant, to avoid a single point of failure. NHIN Note 3: All non-patient connections to the Internet are secured connections, via SSL. Health Information Exchange Infrastructure CareSpark Service Providers DB Server Anakam Oracle OnePartner/ BCTI Consent Repository MPOP Consent ATNA Audit Repository ATNA WinSysLog CareSpark XDS Data Store For Patient Care XDS Patient Identity Source (MPI) Authentication Patient Identity Feed Patient Queries Send Clinical Documents XDS PDQ Service Initiate EMPI CareSpark Providers Patient Management System Query For Clinical Documents Retrieve Clinical Documents EMR XDS PIX Service ADT Service PostGreSql XDS Document Registry Portal XDS Rep Service Healthvision Wellogic Two-Factor Cloverleaf XDS Document Repository CGI Clinician Subscriber Identity Feed Clinical Documents XDS Registry XDS Reg Service NIST ActiveHealth Subscriber Management System CareEngine CT Time Client XDS Key Store CareSpark RHIO Timeline Strategic Planning Physician Portal, authenticatio n MPI build begins Jan 05 Clinical document Exchange document registry and repository Jan 06 Jan 07 Tn non-profit org chartered Claims-based decision support Jun 08 Datasharing agreements Immunization registry Build clinical data repository Jan 09 Jan 10 Jan 11 Decision Support delivered electronically Revenuegenerating services (med hx, results delivery) Funding Sources – Planning Phase BlueCross BlueShield of Tennessee Foundation for eHealth Initiatives (Office for Advancement of Telehealth, HRSA, DHHS) AllScripts HealthCare Solutions John Deere Health Eastman Chemical Company Mountain States Health Alliance Wellmont Health System Novartis Pharmaceuticals Corporation Frontier Health Health Alliance PHO Highlands Physicians Inc. Holston Medical Group United Way of Greater Kingsport Rotary Club of Kingsport East TN State University / Medical Education Assistance Corp. Laughlin Memorial Hospital Johnston Memorial Hospital Kingsport Tomorrow Cardiovascular Associates $162,125 $100,000 Total funds contributed: $562,875 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 25,000 41,500 50,000 50,000 50,000 15,000 10,000 10,000 10,000 10,000 10,000 10,000 5,000 2,500 2,500 1,500 250 Revenue Sources July 2005 – July 2009 Local Support Employer contributions: State grants / contracts Technology Partners CareEngine enrollment fees $ 678,000 $1,600,000 $2,250,000 $1,257,120 State contracts Tennessee Virginia $1,669,600 $1,369,600 $ 250,000 Federal contracts NHIN Prototype NHIN Trial Implementation NHIN Option year 1 $4,185,120 $4,917,098 $ 308,000 $3,609,125 $ 999,973 Total Funding: $10,771, 818 Participation and Capabilities July 2009 July 2010 July 2011 Patients 175,000 2,500,000 5,000,000 Data Sources 5 25 100 Clinician users 75 500 3000 Record types Labs Meds Allergies Radiology reports Diagnosis Immunizations Claims Patient access Discharge summaries Biosurveillance Authorizations e-Prescriptions Secure messaging Real-time decision support CareSpark’s Strategic Objectives Population Health Clinical Premature Mortality Adult Diabetics, Rx filled, vision / foot, HBA1C<7 New Diabetes Cases Lipid Panel Flu Vaccines for 65+ ER Visits for Health Attack Post- MI followup Deaths from Rx Overdose LDL < 100 Pneumo Vax for ages 65+, <2 Stroke Therapy Cancer Screenings (PAP, Mammogram, colorectal) Pain Medication Financial Savings -- ROI • • • • Patient Clinician Facilities Purchaser (health plan, employer, taxpayer, individual) Convergence of Interests Governance and Policy Clinical Administrative PatientCentered Care Billing & Claims Privacy & Confidentiality Consumer / Personal Health Record Research Best Practices Financial Incentives Technical Infrastructure Nationwide Health Information Network: “network of networks” NHIN Prototype Demonstration 2006-07 design for exchange between CareSpark, West Virginia, Kentucky providers NHIN Trial Implementation 2008 * Core Services: Consumer permissions Security exchange Standardized interfaces Summary medical record * Medication Management eRx, med history, decision support * Consumer Empowerment personal health record, registration and medication history Health Information Exchange in Tennessee Common Portal Tennessee Roadmap for Health IT Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework • Standards H.I.E. • Interoperability • Transparency EMR / EHR/PHR implementation • Value Structured notes & paper records • Quality/Cost Administrative transactions (claims…) Secure clinical messaging (labs, imaging, email….) E-prescribing roll out Broadband % of Access, Stakeholders, Automation Framework for trust and collaboration Tennessee eHealth Council: seed funds for RHIO’s, grants for eRx, broadband Virginia RHIO initiatives Virginia Health IT Council Health Information Exchange Stages of Evolution Pre-operational 1: Recognize need 2. Organizing and planning 3. Securing resources 4. Developing and implementing Operational 5. Transmitting data 6. Sustainable business model 7. Expanding participation In August 2008, 57 report being operational, 88 pre-operational HIT-Enabled Health Reform Achieving Meaningful Use 2009 2011 2013 2015 Meaningful Use Criteria HIT-Enabled Health Reform HITECH Policies Protect privacy and security, 2011 Meaningful Use Criteria (Capture/share data electronically) 2013 Meaningful Use Criteria (Advanced care processes with decision support, patient access) 2015 Meaningful Use Criteria (Improved Outcomes) 23 State & Regional Demonstrations AHRQ Medicaid HIE Administrative Funding - CMS MU Incentive Payments - CMS Health Center/Health Center Controlled Networks Funds - HRSA Standards/Certification - ONC Extension Centers - ONC Promoting HIE State Grants - ONC NHIN - ONC Medicaid Technical Assistance AHRQ States Promoting MU of EHR Technology Federal Government Coordination Overview of Federal HIT Programs Providers 24 Federal Stimulus Funds HITECH legislation in February 2009 • Increased privacy and security requirements • Funding for health information exchange (State HIE Cooperatives) • Funding for National Research Center (“comparative effectiveness”) and Regional Health IT Extension Centers • Funding for Healthcare Workforce Development • Incentives for adoption and “meaningful use” of health information technology EMR eRx + HIE + Quality Reporting + Patient Access $$$$$$$$ = 2011-2015 State HIE Cooperatives Health Improvement Partnership of Tennessee (HIP-TN) not-for-profit entity formed to facilitate and oversee application and distribution of ARRA funds workgroups: Technical, Privacy & Security, Clinical, Governance / Policy, Financial Sustainability Board members from this region: Doug Varney, David Sensibaugh Virginia Health IT Interoperability Commission established under Virginia Department of Health by executive order priorities to be addressed: childhood immunizations, infant mortality Local appointee: Liesa Jenkins Regional Health IT Extension Centers Virginia: statewide collaboration with regional variation, led by Va Health Quality Center Tennessee: statewide proposal submitted by QSource, contracting with regional partners for delivery of services Letters of intent submitted Sept. 8 Full proposals due Oct. 16, if requested Future Plans for CareSpark Local Increased participation: Enhanced capabilities Sustainability Providers Secure messaging for users Fees for services Patients Clinical data repository Regional Extension Centers Knoxville / Danville Population Health Improvement Virginia Tennessee Public health Other Public health Other Immunization telemedicine Immunization HIP-TN Rx Monitoring HIT Commission Rx Monitoring VHEN National NHIN Gateway Other Federal agencies (VA, SSA) Benchmarking Other HIE’s (NC, KY, WV) Sharing best practices Next Steps for YOU 1. Begin planning for EMR 2. Participate in Health Information Exchange 3. Enter into Data-sharing agreements Access broadband services and network(s) Train users Inform patients Shared costs for infrastructure and services Monitor your results 4. Assess your organization’s business requirements, including functionality, cost, privacy and security protection Evaluate, select certified, standards-based solution, contract, train users and implement (assistance from Regional Health IT Extension Center or other) Consider modularity for future needs: eRx, decision support, analytics and reporting, patient access Measure your own results (efficiency, cost, patient outcomes) Report outcomes to access incentives payments Benchmark with peers, share best practices Participate in research to improve effectiveness Take pride in your success! Better Health for Central Appalachia www.carespark.com Liesa Jenkins, Executive Director 423-963-4970 [email protected]