Finding HIE in Value David C. Willis, MD

CMIO, CommunityHealth IT

Objectives • Gain a better understanding of the HIE options being

implemented and how to find likely projects that should

be connected.

• Gain a better understanding of how discovering and

promoting local values can spur adoption by institutions

and providers.

• Be encouraged to take an ‘HIE’ approach to project

planning and development that incorporates project

‘interoperability’

Basics: What is HIE?

• Verb: the act of exchanging data

• Data can be Pushed: Direct email, secure portal,

results distribution systems

• Data can be Pulled: extraction from CCD, data

repository

Basics: What is HIE?

• Noun: the exchanging organization (HIE, RHIO, RHIN,

etc.)

• Vendor based

• Hospital or Institution based

• Community Based

Basics: HIE types? • Technical Infrastructure

• Centralized data model - aggregated data, easier

reporting, simpler connections; more difficult politics

• Federated model - segregated data, push/pull when

queried, complicated-multiple connections; simpler

politics

• Hybrid model - the ‘unsaid’ reality of most HIE

systems; best and worst of both systems

Why Exchange Data?

• Common Reasons

• Meaningful Use requires it

• Need for data for emergency care

• Enhance specific chronic disease management

• Quality reporting

• Referral management

Defining the Value of HIE

How?

Who?

What?

When?

Where?

Why?

Defining the Value of HIE Who?

Stakeholders Providers

All Patients

Certain patient populations

Businesses Insurers

Government agencies

Defining the Value of HIE What?

What data to be exchanged?

What specific populations involved?

What HIT systems currently exist? What will be

needed?

What investments: money, time, expertise?

Defining the Value of HIE When?

Regular business hours

After hours

Real-time data needs

Delayed data needs, next

day or week?

Defining the Value of HIE Where?

Hospital

Provider practices

Emergency Room

Mobile devices

EMS Vehicles

Patient homes

Web-based

Public kiosks

Why should my organization be involved? or

support? or sponsor? an HIE project

Defining the Value of HIE Why?

Why exchange any

data all?

Why will exchange benefit me/my

organization?

Defining the Value of HIE

How?

Defined values of HIE

can be evaluated to construct

useful implementation.

Organizing the

Who, What, When, Where,

Why

into the How

How to Accomplish the HIE

Values

• Technical Component

• Workflow Component

• Involvement of the

Stakeholders that

perceive the values

How to Accomplish the HIE

Values

• Technical Component

• Workflow Component

• Involvement of the

Stakeholders that

perceive the values

• Software - Hardware

issues

• Vendor options

(current and needed)

• Network configuration

• Security issues

How to Accomplish the HIE

Values

• Technical Component

• Workflow Component

• Involvement of the

Stakeholders that

perceive the values

• Impact on Providers,

Patients, Staff, other

users

• Disruption to care

delivery

• Disruption to cash-flow

• Different, enhanced

workflows

From the Telegraph's Pictures of the Day for 11 July 2012: A baby chimpanzee looks a little unsteady on his feet as he takes his first steps away from his

mum. Photographer Konrad Wothe captured the youngster at play in the Mahale Mountains National Park in Tanzania, Africa. [Konrad Wothe/Minden

Pictures/Solent News]

Change . . . like

walking,

is inherently unsteady during each step.

How to Accomplish the HIE

Values

• Technical Component

• Workflow Component

• Involvement of the

Stakeholders that

perceive the value

• Create value for each

stakeholder

• Leverage existing

resources - any

resources

• Maintain communication

of processes,

achievements, problems

Hayden Cohen and his team of New Zealand junior men's quad sculls during day one of the FISA World Rowing

Junior Championships at the Lac du Causse Correzian on August 5, 2009 in Brive-la-Gaillarde, France.

(August 4, 20092009-08-04 16:00:00 - Source: Michael Steele/Getty Images Europe)

Sculling

balance teamwork synchronicity common direction

trust

Think Outside the Project Box

HIE Project Various concurrent projects

Think Outside the Project Box

Meaningful Use requirements

PHR development/implementation

Secure messaging

Referral management

Lab exchange

Online bill payment Various concurrent projects

Interoperability Approach to HIE

Disassemble the

defined HIE values

Identify various concurrent projects

Reassemble the HIE

with stakeholder

involvement

Interoperability Approach to HIE

Overlapping projects,

stakeholders, resources,

and goals can produce

enhanced:

Planning

Marketing

Referral Management

Clinical opportunities

Patients

Outside the Medical Box

Community groups

Disease-oriented organizations

Support groups

Volunteer organizations

Consider Non-Medical stakeholders, needs, resources,

values

Outside the Medical Box Consider Non-Medical stakeholders, needs, resources,

values

Business Community

IT organizations

Financial institutions

Small business development

Economic development

Healthier employees

Wellness programs

Patient/Disease sponsorship

Health insurance alternatives

Outside the Medical Box

Educational and

Learning

Institutions

Local schools

Research opportunities

Grant opportunities

University and Technical

Schools

Consider Non-Medical stakeholders, needs, resources,

values

Summary

Gather and define HIE value

among stakeholders

Think outside the box:

Flatten the project landscape

Achieve HIE Value

through ‘Project

Interoperability’

Technology is nothing.

What's important is that

you have a faith in people,

that they're basically good

and smart, and if you give

them tools, they'll do

wonderful things with

them.

Steve Jobs