Transcript Slide 1

Health Information Exchange and the National Agenda
May 2008
Kelly Cronin
Director, Programs and Coordination
Office of the National Coordinator for
Health Information Technology (ONC)
HIE and the National HIT Agenda
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Where are we?
Challenges
Overcoming the barriers
Moving toward a connected network of networks – the
NHIN
– Trial implementations
– Accreditation and certification
– Develop the business case
• Where do we go from here?
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Key Health IT Components to Enable Transformation
A Robust, Interoperable, Health IT Environment that brings
together:
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Electronic Health Records (EHR)
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Personal Health Records (PHR)
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Population Health Information
(Public Health, Quality Improvement, Research)
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Standards (Data, Technical and Security)
Interoperable Health Information Exchange Network
(Nationwide Health Information Network - NHIN)
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Pieces of the Puzzle Necessary for Transformation
of Health and Care through HIT
Governance
Standards in HIT
Products
Privacy & Security Policies
Adoption of
Interoperable
Health IT
Nationwide Health
Information
Network
Status of HIE – Findings from eHI Survey
• 125 initiatives reported on stage of development in the 2007
survey
– 20 are just getting started (stage 1 or 2)
– 68 are in the process of implementation (stage 3 or 4)
– 32 are operational (stage 5, 6 or 7)
– 5 are no longer moving forward
• 15% fewer participating than in 2006
• 32 HIEs exchanging data (Stages 5-7)
• 25% dependent on grants (or don’t know)
• 75% rely on results delivery (but other sources important as
well)
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Funding Sources for RHIOs in 2007
Funding Source
May 2008
Overall
Advanced
Hospitals
24%
58%
Public Payors
21%
38%
Physician Practices
16%
46%
Laboratories
13%
33%
Private Payors
10%
46%
Philanthropic
9%
29%
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Services Offered in 2007
Service
Overall
Advanced
Results Delivery
30%
75%
Clinical Documentation
27%
63%
Enrollment or Eligibility Checking
26%
54%
Consultation/Referral
21%
54%
Alerts to Providers
19%
48%
Disease or Chronic Care Management
18%
32%
Disease Registries
14%
QI Reporting for Clinicians
12%
Reminders
12%
May 2008
33%
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32 Operational Initiatives: Sources of Revenues
May 2008
Funding Source
2007
2006
Hospitals
58%
54%
Payers – Private
46%
19%
Physician Practices
46%
33%
Payers – Public
38%
18%
Laboratories
33%
42%
Federal Government
29%
17%
Philanthropic Organizations
29%
21%
State or Local Government
21%
26%
Purchasers/Employers
17%
0%
Pharmacies
13%
11%
Pharmaceutical Companies
4%
6%
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State Level HIE - An Evolving Landscape
(CT)
(RI)
(DE)
State/Regional Contracts (6)
1. Early Planning
Medicaid Transformation
Grants – HIE/EHR focus (15)
2. Foundational
NHIN Trial Implementation (9)
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3. Early Implementation
4. Operating
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Major Challenges for All HIE Initiatives
Challenge
May 2008
2006
2007
Developing Sustainable Business Model
88%
91%
Securing Funding
88%
80%
Defining Value for Users of the HIE
89%
81%
Privacy
79%
85%
Engaging Clinicians
80%
82%
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Challenges: Sustainability of HIE
• No silver bullet to get to viable business model
• Need to be market savvy and develop HIE services that
meet a customer need and deliver value
• No obvious demand for HIE with current reimbursement
system
– But an increasing number of RHIOs are in the red
– Successful RHIOs are inducing demand by providing services
that demonstrate value
– Know your customer – don’t build it and expect they will come
– Need business acumen and good market research to develop
a viable, marketable services
• Social capital is essential for effective governance and
sustainability
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Challenges: Value Proposition
• Needs to be defined according to type of service and from each
stakeholders perspective
– i.e., results reporting for hospitals
• Are the costs and benefits of each function/service for each
stakeholder different at a regional and state level?
– Some providers, employers or plans might only have a
regional interest
• Data suggests that hospitals are deriving value more often than
other stakeholders
• Employers seem least likely to be engaged
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Value from a higher level perspective
Health information exchange can:
– Produce cost savings from decreased redundancy
• In duplicated care
• In the costs of data sharing
– Enable quality improvement and Medicare payment
reform by making clinical (not just claims) data available
for performance measurement and reporting
– Support public health and emergency preparedness
including situational awareness and response
management
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What is the problem we are trying to solve?
Market forces have not realized the potential of
electronic health information exchange
– Fee for service payment system provides no incentives
to share data
– Cost savings don’t accrue to those who need to invest
– Proprietary, one to one, relationships are easier to create
technically and legally
– Public health does not get the data it needs – it’s viewed
as a government, not a private sector responsibility
– The tipping point for participating in data exchange has
not been achieved
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Different models for exchanging health information
Network
Type
Examples
Example
Benefits
Biggest Challenge
Organizational
Integrated
delivery
systems,
hospital
chains
Effort of
exchanging data
internally is
aligned with
business
outcomes
Extra-organizational
exchange is needed
for care provided in
other organizations
Geographic
RHIOs,
jurisdictional
HIEs
Non-proprietary
exchange
Struggle to achieve
sustainable business
models
Personally
Controlled
Health data
banks:
Microsoft,
Google, Intel
Consumer
access to, and
control of, health
information
Based on point to
point connections,
have challenges in
supporting provider
data access
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Collaborative Governance Needed Across Jurisdictions
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With varying approaches to HIE, multi-stakeholder governance is
needed at the regional, state and national level
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There is currently no coordination of HIE governance across
jurisdictions to eventually reach interoperability on a technical and policy
level
– Some state level governance entities coordinate with RHIOs but not all
– No explicit coordination exists between national and state level governance
– National governance has been informal through AHIC and Secretary
Leavitt’s leadership
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No oversight mechanisms exist to ensure accountability of HIE
– State governments are increasingly interested in accountability and
mechanisms to protect consumers
– Accreditation and model data sharing agreements could support trust among
stakeholder involved with HIE and protect consumer interests
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Some Solutions to Challenges
• Improve business case at regional, state and
national level
– Stakeholder specific value propositions
– State and federal policy changes
• Advance governance of HIE
– Establish national level governance
– Promote effective governance models at state level
– Consider oversight mechanisms such as accreditation to
support interoperability of policies/data sharing agreements
• Identify and adopt common standards and
specifications for health information exchange
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Where are we going?
• What projects and efforts are advancing HIE?
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State-level Health Information Exchange Consensus Project
• State-level HIE governance role is primary
• Ensure that HIE develops as a public good
• Serves all statewide stakeholders and data needs
• Reduces technology investments and other costs
• State-level HIE governance entity is a public-private partnership
entity
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Sits between state government and the health sector and industry
Involves state government, but independent of state government
Addresses public and private sector interests, blends investments
Mechanism for coordination of HIE policies and practices
• State governments play important roles
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May 2008
• Designating authority to a state-level HIE governance entity
• Providing resources: start up and ongoing
• Leveraging public programs, policy levers to create incentives for
HIE
Statewide technical approaches can vary and will likely evolve
• Size, market characteristics, resources, stages
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State-level HIE Leadership Forum
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In 2008, a forum will be established for all states to share
information among peers who are responsible for leading state
level efforts to advance HIE
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Enable peers to learn from each other and share progress,
challenges, and creative ways to advance statewide agendas
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The forum will foster better understanding and coordination of
many related but separate projects to advance HIE including
HISPC, HITSP, NHIN, CCHIT, and AHIC 2.0
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State Alliance for e-Health
• Examination of Financing, Accountability and Oversight
Models to Sustain Health Information Exchange
– To inform Governors and State Legislators about the various
models for financing and ensuring accountability
– A key financial consideration: appropriate role for states in
providing oversight and support
– Final report to the Alliance in August 2008
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The AHIC Successor – Why Change?
• Continuity of leadership is needed to sustain the momentum
gained over the past 24 months
– Government transition occurs every four years
– Uncertainty under new leadership places momentum at risk
• Sustainable business model is needed to support perpetual
operation
– Congressional appropriations are a cyclical model
• Decisive action is needed keep pace with large scale innovation
and transformation
– Government is necessarily a deliberate process
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AHIC 2.0 – What It Will Do…
• Provide continuity -- accelerate and coordinate
current AHIC interoperability initiatives
• Provide strong leadership in
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determining priorities
harmonizing interoperability standards
certifying products and systems to those standards
overseeing and facilitating the NHIN
establishing criteria for assuring interoperability, privacy and
security
• Construct and champion a balanced view
– that takes into account the needs of all stakeholder groups
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NHIN Trial Implementations
• Awards to 9 state & regional Health Information
Exchanges (HIEs) and another 6 grants to other entities
• Forming the NHIN Cooperative to implement, test, and
demonstrate core services by September 2008
– Support of consumer access controls
– Lookup and retrieval of clinical information
– Exchange of patient summary records
• Test implementations of the first 7 priority scenarios
– Lab result reporting ; medication history exchange; quality and
public health, etc.
• Expanding to include other types of HIEs, such as
– Multi-community Integrated Delivery Systems
– Health plans
– Health data banks
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NHIN Business Model
• Contract awarded to nine HIEs for trial implementations
of inter-HIE connectivity
• Contract requirement to develop business model
• Emphasis on HIE-to-HIE sustainability. Considerations
may include:
– What are the business drivers for inter-HIE connectivity?
– Sourcing of core services (in-house, outsource, some services
being provided by a state-level HIE, etc.)
– Costs to obtain core services
– Source of funds for start-up costs and ongoing funding options
– What is the value proposition for each participant in the
transaction?
– How does cost and benefit distribution work for a transaction that
has participants residing in more than one HIE?
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Other Federal Activities Addressing Sustainability
• Six state HIE initiatives with State and Regional Demonstration
Project contracts from AHRQ are informing business model
development using the eHI Value and Sustainability Model
• AHRQ sponsored case studies of stakeholder engagement in
HIEs and the impact on sustainability
• Thirteen state Medicaid agencies are using their Centers for
Medicare and Medicaid Services Medicaid Transformation Grant
awards to advance HIE efforts within their states.
• State-level HIE Consensus project will address the Value
Proposition for each Stakeholder participating in a state-level HIE
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Important Next Steps to Advance Sustainable HIE
• Coordinated research agenda
– NGA, eHI, AHIMA, HHS, and other partners work together to
answer key questions
• State and federal policy development to support sustainability
– Commonwealth report called for mandates for providers to
participate in interoperable networks
• AHIC 2.0 established - national governance
• State Forum established to facilitate state level approached to
HIE governance
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The Ultimate Reason for Health IT
Health IT is a
key enabler for us
ALL to get:
The quality of health we want and deserve
The quality and value of health care services
we demand
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For More Information:
www.hhs.gov/healthit
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