breaking hie barriers - himss21 · in their ehr community record producing a comprehensive picture...

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Breaking HIE Barriers

Session #20, February 20, 2017

Robert M. Cothren, PhD, Executive DirectorCalifornia Association of Health Information Exchanges

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Speaker IntroductionRobert M. Cothren, PhDExecutive Director

California Association ofHealth Information Exchanges

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Conflict of InterestRobert M. Cothren, PhDHas no real or apparent conflicts of interest to report

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Agenda

• Barriers to HIE

• Transformation and maturation of HIE

• HIE in the face of national initiatives

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Learning Objectives• Discuss current and projected economic and technical barriers

to health information exchange

• Demonstrate practical, innovative and essential attributes of health information exchange and interoperability

• Identify how interoperability certification programs, such as ConCert by HIMSS, can support ubiquitous and secure access to patient data that enables widespread health information exchange

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Health Information ExchangeThe mobilization of health care information electronically across organizations within a region, community or hospital system

Allows health care professionals and patients to appropriately access and securely share a patient’s vital medical information electronically

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Barriers1. Providers expect HIE to be easy, ubiquitous

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Don’t I already have it?Didn’t Meaningful Use give me health information exchange?

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Easy: Transport Standards• HL7 v2

• Direct secure messaging

• IHE standards

• More IHE standards

• FHIR

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Easy: Content Standards• HL7 v2

• CCD

• C-CDA

• Care summaries

What’s the difference?

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UbiquitousMobilize information……among disparate systems

• Increasingly inclusive of providers and consumers, and other stakeholders such as payers, social services

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2. Providers and patients aren’t interested in just data movement

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Health Information ExchangeThe capability to electronically move clinical information among disparate healthcare information systems, and maintain the meaning of the information being exchanged

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InteroperabilityAbility of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged

The ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user

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Change

from Exchange… …to Interoperability

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TransformationShouldn’t even be talking about health information exchange

HIE

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2. Providers and patients are interested in the movement of data

3. HIE hasn’t demonstrated its value

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Sustainability• Must provide obvious value to users

• Users must be willing to pay for that value

• May not be just about health information

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Where is HIE going?• Exchange requires agreement on transport standards and

authorization standards

• Interoperability adds content standards and vocabulary standards

• Access shifts to detailed specification of and access to only what you want to know

Not just new standards, but a paradigm shift…

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Where are we today?

Exchange Interoperability Access

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Where are we today?


You receive email confirming your order

You download your account information

You access your account with context of purchase

You see what flights are available

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Where are we today?


Care summary via Direct messaging

Incorporated lab results

Singlesign-on

FHIR

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Where is HIE today?


We are here…

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Characteristics of HIEMobilize information……among disparate systems

• Increasingly inclusive of providers and consumers, and other stakeholders such as payers, social services

• Shifting from comprehensive information to critical / minimum necessary

• Shifting from exchanging copies to accessing data

NewHIE

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FunctionsResults Delivery providing the information a provider needs

in their EHR

Community Record producing a comprehensive picture of a patients data

Alerts ensuring a provider knows about health events

Population Health helping a provider understand the patient’s environment

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MaturityResults Delivery providing the information a provider

needs in their EHR




Information

Coordination

Awareness

Intelligence

ma

turi

ty

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ValueResults Delivery providing the information a provider

needs in their EHR




Information

Coordination

Awareness

Intelligence

va

lue

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Value• Providers focus on improving individual patient outcomes

• Providers are able to improve community outcomes

– within the region,

– their community,

– or the hospital system

with an EHR

with HIE

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Role of National Networks• Bringing basic interoperability at the national level

• Retrieving information from places where a patient is known to have been seen

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Role of HIE Organizations• Coordinating collaboration among stakeholders to solve

information problems of providers, consumers, employers, and payers in the region, community, or hospital system

• Bring interoperability at the community level

• Retrieving information from places where a patient is not known to have been seen

Not just implementing the technology

Not even just moving the data

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Role of National NetworkseHealth Exchange CommonWell Carequality Community HIE

Provider-centric network Patient-centric network Provider-centric network-to-

network trust framework

Patient-centric network

Peer-to-peer primarily query-

based exchange

Query-based exchange based on

centralized record location

Peer-to-peer query-based

exchange

Various use cases: alerts, results,

CPOE, query, PH reporting,

longitudinal records, analytics

Centralized provider-organization

directory

Centralized MPI and RLS Centralized provider-organization

directory

Various resources necessary to

meet participant needs

Members are provider

organizations

Members are primarily EHR

vendors

Members are primarily EHR

vendors with some HIEs

Participants are providers, labs

and ancillary services, Rx, PH,

payers, researchers

Primary participants are federal

agencies, hospital systems, large

and medium HIEs

Main vendors are athenahealth,

Allscripts, Cerner, eClinicalWorks,

Greenway, Meditech, and others

Main vendors are athenahealth,

eClinicalWorks, Epic, GE,

NextGen, Surescripts, and others

Systems may include nearly any

EHR, lab, pharmacy, or other HIT

system

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Role of Government• Coordination through funding and policy levers

• Driving industry in a coordinated direction

Fundamental support for HIE and interoperability

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Coordinating a VisionInteroperability is necessary for a “learning health system” in which health information flows seamlessly and is available to the right people, at the right place, at the right time

ONC’s vision: “to better inform decision making to improve individual health, community health, and population health.”

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Coordinating FeaturesCoordinating and prioritizing the functionality of EHRs and HIE

• Shared Decision-Making• Ubiquitous, Secure Network Infrastructure • Verifiable Identity, Authentication, Authorization• Industry-wide Testing and Certification• Consistent Data Semantics and Formats• Consistent, Secure Transport Techniques• Accurate Individual Data Matching• Directories and Resource Location

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Coordinating StandardsIdentifying priority standards investments for industry and SDOs

• Vocabulary, code sets, terminology standards• Content, data structure standards• Services, transport standards• Security frameworks

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Role of CertificationMaking interoperability easier…

• Constrained standards provide a common interpretation that implementers can use

• Certification ensures that every implementer uses the common interpretation the same way

Not plug-and-play, but toward plug-and-play…

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The Value of Health IT

S Better patient satisfaction with their healthcare experience

T Better patient outcomes through more complete information

E Better access to the right information at the right time

P Better-informed patients that participate in their wellness and health care

S Better outcomes, more efficient access, engaged patients leading to lower costs

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What did we cover?• Issues slowing the widespread adoption of HIE

• Characteristics of a transforming HIE environment, adding value

• Roles of the players

• How certification can help

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How do we move on?The vision of the LHS…

“ I can make a treatment recommendation informed not only by the latest clinical trials, but also by the real-world health experiences over time of every patient like you who has had this illness – and in turn I can tell you with a specified range of confidence which treatment has the greatest chance of success for a patient specifically like you. ”

http://www.learninghealth.org/

http://www.learninghealth.org/

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QuestionsRobert M. Cothren, PhD

Executive DirectorCalifornia Association of Health Information Exchanges

[email protected] or [email protected]

https://www.linkedin.com/in/rcothren/
mailto:[email protected]:[email protected]://www.linkedin.com/in/rcothren/

breaking hie barriers - himss21 · in their ehr community record producing a comprehensive picture...

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