“from interaction to integration to transformation: healthcare’s journey & information’s...

HealthBridge is one of the nation’s largest and most successful health

information exchange organizations.

“From Interactionto Integration

to Transformation: Healthcare’s Journey &

Information’s Role”

Mike MoteVice President

Product & Service Strategy 1

2

HealthBridge

Background

3

HealthBridge

One of the nation’s oldest, largest, most advanced and successful health information exchanges

In operation since 1997

501c3 Not for Profit

One of only a handful of HIE/RHIOs nationwide with a sustainable business model

• (Pre ARRA) 97% of revenue from fees; <3% grants

• 5-12% annual return for last eight years

4

HealthBridge

Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010

Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors,

60+ versions Provide technology infrastructure for four other HIEs – Dayton

HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network

• 26 local hospitals in Kentucky, Ohio and Indiana• 5500+ physicians• 17 local health departments• Large commercial, hospital, & physician office labs• Diagnostic centers

5

HealthBridge

6

HealthBridge HIE Value ProgressionMeaningful Use, Medical Home and Payment Reform

Basic

HIE

• Stage 1 MU • EHR Adoption (REC Services)• Basic Electronic Messaging (NHIN DIRECT)• Community Portal • Web-Based Results Delivery • Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency

Intermediate HIE

• Stage 2&3 MU• Structured Data Delivery to EHRs• Results Delivery (Lab, Rad, ADT, etc.)• ED, Admission, & Discharge Alerts & Notices• Summary Record Exchange (CCD)• Value: Necessary to achieve truly electronic workflows; Dramatic increase in

efficiency

Advanced HIE

• PCMH, ACO & Payment Reform Readiness•Data Warehouse & Analytics • Disease Registry•Quality Reporting Support•Full Integration Services & Bidirectional Exchange•Value: Dramatic improvements in quality and performance

7

HealthBridge – HIE Services

EHR Integration/Interfaces Electronic Results Delivery –

• Labs, Radiology, ADT, etc. Electronic Order Entry E-Prescribing HIE Portal & User Management HIE Technology Support – Master Patient Index, Provider

Directory and Record Locator Service Summary Record Exchange Nationwide Health Information Network Direct and CONNECT

Gateway & Connectivity Public Health Reporting & Syndromic Surveillance Billing and Eligibility Verification HIE Consulting, Outsourced Technology & Implementation

8

HealthBridge – Future Plans

REC - Expanded Meaningful Use Assistance for Stages 2-3 Beacon - Enhanced Suite of Quality Improvement, Care

Transformation and Accountable Care Services and Tools (Data Warehouse, Data Analytics, Summary Patient Records, etc.)

Patient Engagement - Connectivity to Personal Health Records, Mobile Technologies and Consumer Technologies (Beacon, IN Challenge Grant)

HIE Expansion – • Connect to new providers and stakeholders for improving

continuity of care (home health, long-term care, payers, etc.) • Connect with State HIEs and Provider Networks (IN, KY, OH) • Use Nationwide Health Information Network (NwHIN) Direct and

CONNECT platforms• Spread of Advanced Technologies to Other Communities • Community Credentialing

9

“From Interactionto Integration

to Transformation: Healthcare’s Journey &

Information’s Role”

Creating a CommunityData Repository

10

Healthcare’s Journey Whether or not you believe that REFORM is coming here are some

thoughts to ponder:

• The US healthcare system is broke; the current rate of growth can not be sustained; 1/6th of the US economy is based upon healthcare

• New York Times article claims “By 2020 the American health insurance industry will be extinct.”

• Accountable care is coming; Value based payments are coming; Volume based payments will continue to decline

• Missing data today results in missed opportunities to:

• Prevent complications• Ensure better outcomes• Reduce unnecessary costs• Reduce patient’s safety risks• Improve transitions in care

2012

2015

2020

11

Incentives

Penalties

Business Realities

The “Journey”

12

Care Transactions

Individual ProviderCare Plans with some

coordination via referrals

Care Integration

Coordinated Care Plans &

Early stage PCMH

Care Transformation

Single Care Plan &Advanced stage PCMH;

theMedical Community

Care Delivery’s Journey

13

Care Transactions

Patient Outcomes Measures

Care Integration

Population based metrics & health status

measurements

Care Transformation

Demonstrable Improvement in

Population Health with ongoing refinement

of the metrics

Quality Metrics’ Journey

14

Care Transactions

Fee for Service

Care Integration

Pay for Performance & Shared Savings

Care Transformation

Providers at Partial to Full Risk

Payment Reform’s Journey

15

Care Transactions

Provider-centric reporting based upon productivity & patient

care protocols

Care Integration

Population based quality & performance analysis, health status

analysis, & risk analysis

Care Transformation

Predictive modeling & performance

forecasting, outcomes analysis, & incentive

modeling

Data Analytics’ Journey

16

Care Transactions

Individual EHR or paper medical records;

individual vendor or provider application of

standards & codes

Care Integration

Clinical information sharing with standards based interoperability

moving to data integration with

semantic normalization

Care Transformation

Community based clinical & claims data

repository with community data and

coding standards

Information’s Journey

Information’s Role

17

Care Transactions

Support Provider delivered care; support

patient level quality reporting

Care Integration

Longitudinal patient record, ED & Public

Health alerts; Point-of-care decision support, PHR, & remote patient

monitoring

Care Transformation

Enable predictive modeling, risk

adjusted analytics, accountable care

business & operational modeling

Information’s Role – Domain Requirements

18

People & Organizations

Lab Orders & Results

Medications & Prescription Information

Patient

Provider

Payer

Staff

Facility

Immunizations

Radiology & Transcribed Reports

Referrals & Authorizations

Medical Conditions (Allergies, Family-social-medical history)

Encounters

Appointments

Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography

Revenues (Charges, Grants ..)

Products

Member Enrollment

Medical & Rx Claims

Revenue, Billing, & Payment Data

Utilization

Provider PayerLegend:

Clinical Observations & Vital Signs

Expenses (Payroll, Supplies, Infrastructure, …)

19

Creating a CommunityData Repository

&Establishing a

Community Data Trustee

20

HealthBridge’s Data Infrastructure

New Suite of Health Care Innovation & Quality Improvement Tools and Services funded through Beacon Program: • Disease Registry • Clinical & Claims Data Warehouse• Data Analytics and Business Intelligence• Alerts & Notifications • Transitions in Care Assistance• Quality Reporting Support • Process Improvement and Workflow Redesign Support

21

HealthBridge’s Solution Components

Enterprise Master Patient Index (eMPI)

• IBM’s Initiate™

Clinical & Claims Data Repository & Clinical Analytics

• PluralSoft’s CareQuotient™

Semantic Data Normalization

• Clinical Architecture’s Symedical™

Claims Data Grouping Engines

• OPTUMInsight’s Symmetry™

Patient Registry

• WellCentive’s Registry™

22

Why?

Today this enables

• Identification of gaps in care

• Point-of-Care Decision Support

• Patient engagement

• Longitudinal Patient Record

• ED, Admission, & Discharge Alerts & Notices

• Information exchange at the point of Transitions in Care

• Intra-practice comparative performance analytics

• Interoperability between organizations (“Rosetta Stone”)

23

Why?

Tomorrow this will enable:

• Population-based performance measurement

• Risk adjusted comparative performance analytics

• Risk adjusted comparative cost analytics

• Predictive modeling & performance forecasting

• Service demand forecasting

• Payment incentive modeling

• Revenue versus cost modeling

• ACO business and operational modeling

• Best practice identification & modeling

24

Q & A