TRANSFORMING HEALTH CARE … Next Step … Health Information Exchange (HIE) Lisa Rawlins, Executive Director

SOUTH FLORIDA HIE STATUS Informing the Community …

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SF REC HIE Status … Today

• South Florida Regional Extension Center (SF REC) has received Federal Funds to Implement HIE in Support of Meaningful Use

• SF REC /HCN designated as an AHCA “early adopter”

• Phase One – Approximately 150 physicians from 25 FQHC Integration with FLHIE via existing Amalga utility

• Phase Two – 2800 SFREC members via interface with SF REC

Platform

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Harris Proposed Solution

Development Environment, Express

lite

3 months

Development Environment, Express

6 months Convert to Production Convert to Production

Load MPI with HCN Demographic data

HCN to Florida HIE gateway

12 months

50 50 100 100 100 100

150 GB 500 GB

Phase 2 Project Planning & Scope

Provider Portal

1000 GB 1.4 TB

9 months

Up to 10 EMR interfaces to Express

On-board REC providers with EMR

*REC providers have option to join through Amalga*

PHASE 1 PHASE 2

Community Referral Management

Population / Care Management

Quality Reporting

Patient Portal

Orders Management

Contract in Place Planning Starts Now

Harris Proposal

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EHR

Express

Integration Engine DOCUMENT GENERATION

Registry & Terminology

MPI/RLS

EHR

CONNECT Gateway

Local Labs Sage EHR

Clinical

Data Repository

AMALGA

Florida HIE

Physician Practices

Hospital

Express Lite Existing

Future

Group 2

One time initial load

MISSION AND VISION Mission • Provide Health

Information Exchange (HIE) services to support the SF REC mission. Specifically, to assist our members to achieve Stage 2 Meaningful Use

Vision • Use the tools and

mechanisms developed in support of MU Stage 2 to improve the delivery of healthcare throughout South Florida

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As a neutral, community based third party, the South Florida Regional Extension Center can build a Health Information Exchange focused on South Florida’s needs and responsive to South Florida’s realities. Services, outreach, collaboration, vision, trust, and transparency will guide us as we engage the people, processes, and technologies needed to serve the eight counties making up our region.

“

” Sandy Phillips, SF HIE

HIE Readiness Assessment How Ready is the South Florida Community for HIE?

Readiness Assessment Areas • Leadership • Activation • Vision • Governance & Management • Technical Interoperability • Organizational Capacity • Readiness for Megachange

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Leadership Activation Vision Governance &Management

TechnicalInteroperability

OrganizationalCapacity

Readiness forMegachange

3.267 3.317

4.972

3.050 3.028 2.875 3.396

Community HIE Readiness Self Evaluation

Assessment Conclusions

• Input received to date reflects a very small cross section of the REC service area/members (20% response rate of 34 visits)

• The only area with “positive” result is the Vision section

• Our efforts must not only convene the community but also create trust and confidence.

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Pricing Models, Governance, Implementation Planning

So what will the HIE look like?

Deg

ree

of D

iffic

ulty

Value

Results Delivery

Medication History

Eligibility Checking

Quality Reporting

Disease Management

Medication Compliance

e prescribing

Lifetime Medical Information

Electronic Health Record with Consumer

Access

Public Health Reporting

Public Health Surveillance

Research

Immunization & Disease Registries

Clinical Documentati

on

Alerts to Providers

Referral Processing

Patient Provider e

mail

Most operational HIEs are focused on results delivery, clinical documentation, and eligibility checking; As new more complex functions are added, value will increase …

Accountable Care

Improved Outcome

Data remains under the control of the owning institution and exchanges only when requested. Requires Record Locator Service to establish where the patient’s records exist and who to direct the request to.

Pros: Organizations retain control over their data. Reduced startup time. Lower cost of HIO infrastructure.

Cons: Data quality, data accuracy, and response time may differ across HIE data organizations

Federated Model Centralized Model

HIO collects and stores patient data in a centralized repository. The HIE has control over the data and the ability to authenticate, authorize, and provide concise audit trails. Data is often segregated by provider institution.

Pros: Efficiency in retrieval, audit and reliability checks, ability to mine data for other purposes

Cons: Security and privacy concerns, post-storage synchronization of data

The federated model retrieves records from any HIE-connected organization, but the HIE also maintains that central repository. The size and intent of the CDR can differ, ranging from a focused database (e.g. all immunization data) to the ultimate creation of a Centralized model

Hybrid

Physician Practice

Hospital

Patient Data

Repository

Ancillary Provider

IDN

Notional Design

Notional Design

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Interfacing

Hosting or SaaS/IaaS

Technology “Footprint” for HIE

Dat

a Is

land

s

Sustainability Of Health Information Exchanges

• Business planning to define HIE scope, services, value proposition and deployment schedule

• Policies for data ownership, security and privacy along with corresponding governance structure

• Technology architecture that supports the business model

• Stakeholder buy-in as data providers, data users, or funders

• Stakeholder automation and critical mass necessary to achieve the value proposition at each stage

• Start up capital • Experienced business and technology

partner

The community has identified several critical success factors that support HIE sustainability in the design, build, and operations phases …

Design/Build Operations

• Business model that funds on going operations

• Stakeholder subscription • Transaction fees • Legislated mandate for ongoing

public or private funding • Achieving and reporting on the intended

value proposition • Business office service to support

membership management • Continual engagement of stakeholders

to drive clinical adoption

Health Information Organizations

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Healthcare Payors

Physicians

Medication Intermediaries Laboratories

Hospitals

Diagnostic Imaging

Public Health Agencies

Consumer

NwHIN

Health Information Exchange

HIE Member Management

HIE Business Office

HIE Governance & Planning HIE Systems

Implementation

HIE Platform Creation

HIE Operations Management

In order to facilitate the continual exchange of health information, Business Processes are a critical factor. Within every HIE there must be an effective governance, technology and membership management program to ensure sustainability.

SFREC Governance Structure

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Standing Advisory Groups

Management Team

REC Board & Committees

The recommended governance structure seeks to balance the organization’s need for consensus with the need to efficiently reach and implement decisions. The result is a fairly centralized decision-making structure that seeks broader input and participation through subcommittee and advisory group structures.

• Physician Advisory- Outreach and Education • Standards/Technology – TPS • Clinical Transformation - MU • Compliance and Outreach – Workforce

Notional Cost Experience for HIE

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Notes & Cost Model *The CareSpark project cost approximately $15M over 3 years ** Indiana HIE received $11 M of funding

Estimated Cost of HIE by Stage:

1.Planning: $330 k-$1 M 2.Development and Implementation: $3 M to $10 M 3.Operations: $2 M to $5 M

HIE Size Planning Development & Integration Operations

Small $330,000.00 $3,000,000.00 $2,000,000.00

Medium $600,000.00 $6,000,000.00 $3,500,000.00

Large $1,000,000.00 $10,000,000.00 $5,000,000.00

$0.0

$500.0

$1,000.0

$1,500.0

$2,000.0

$2,500.0

$3,000.0

$3,500.0

$4,000.0

2007 2008 2009 2010 2011 2012

X 1,

000

Large

Medium

Small

Source: AMA: Health Information Exchange Projects

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Delaware DHIN

Maine HealthInfoNet

Rhode Island RIQI Currentcare

Total hospitals Total physicians Total Population

6 2,325

864,746

37 4,052

1.3 million

11 4,141

1.0 million

Technical Architecture

Federated/Hybrid Utilizes a federated

approach whereby clinical results are delivered or “pushed” to providers; a

query function has enabled “pull” capabilities.

Centralized, “Pull” Using a centralized approach

to share clinical data at the point of care. Clinical

database where participants send data to one repository and participants query the

repository.

Hybrid Model Using decentralized

servers/vaults for each provider location with a

central repository of exchange.

Services -Clinical messaging -Med History -Public health reporting

-Clinical data at point of care -Med History

- Med History via portal

Capital investment for state-level HIE

$11.8 million over 5 years

$4.0 million over 2 years

$10.3 million over 5 years

HIE Examples

Delaware Health Information Network (DHIN) Funding • 34% Federal funds allocated through contracts

will total $11.7 million through fiscal year 2012 • 35% State funds totaling $12.1 million in

appropriations through fiscal year 2012. • Average annual per capita State funding - $2.25 • Average annual per capita leveraged funding -

$4.18 • 31 % Private funding (from hospitals, labs, and

payers) through fiscal year 20

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HIE Savings/Cost Avoidance • 65% of value from avoiding unnecessary care. • 27% of value from eliminated redundancies. • The remainder, 8% of value, was due to reduced work,

decreased operating expenses, and freed work space.

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Source: DHIN Business Plan, September 2011

Supporting 2,500 Priority Primary Care Providers* Meaningfully Using EHR

Action/Implementation Planning

• Establish Working Group • Create Plans, Policies, and Budgets • Gather Input and Support from the

Community • Execute!

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What the Future Holds for US