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Technology Models for Building Health Information Infrastructure I

John LightfootVP Technology

Healthvision, [email protected]


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e it Agenda

> Value of Health Information Interoperability

> How does a community get there?

> Real-life RHIO example

> Technology Models

> Standards

> Challenges for a National Model


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e it Value of Healthcare Information Exchange and

Interoperability (HIEI): CITL Key Findings

> Standardized, encoded, electronic healthcare information exchange would: ● Save the US healthcare system $337B over a 10-year

implementation period● Save $78B in each year thereafter● Total provider net benefit from all connections is $34B

● Net benefits to other stakeholders: - Payers $22B - Pharmacies $1B - Laboratories $13B - Public Health $0.1B - Radiology centers $8B

> Dramatically reduce the administrative burden associated with manual data exchange

> Decrease unnecessary utilization of duplicative laboratory and radiology tests


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e it CITL HIEI Taxonomy

Level Description Examples

1 Non-electronic data Phone, US Mail

2Machine-transportable data

Fax/Email without categorization

3Machine-organizable data

Text reports, HL7 messages

4Machine-interpretable data

LOINC-based lab results from lab system; codified medication hx


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e it HIEI National Net Cost-Benefit

Level 2

Level 3

Level 4

$22B

$24B

$78B

Annual Net Return after

Implementation

$141B

-$34B

$337B

Net Return over 10-year

Implementation

Value of HIE standards is the difference between Level 3 & 4


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$(200)

$(100)

$-

$100

$200

$300

$400

0 1 2 3 4 5 6 7 8 9 10

Years

10-Year Cumulative Net Return by HIEI Level

Level 1

Level 2

Level 3

Level 4

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e it The Connected Healthcare Community

> Patient-centric design

> Disparate IT systems are unified through a shared information architecture

> Collaborative Care Model

> All providers have access to complete, up-to-date patient information

Physicians Physicians

& Staff& Staff

HospitalsHospitals

PharmaciesPharmaciesDiagnostic Diagnostic

LabsLabs

PatientsPatients

Managed Managed CareCare


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e it How does a community get there?

Four Step Process


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Implementation / Integration Services

Application / ASP / Service Delivery Connecting Hospitals, Labs, Pharmacies Connecting Physicians Connecting Patients

Ongoing Training & Support Office Workflow Optimization Benefits Analysis Trading Partner Management

Strategic Planning Governance Funding Models Information Systems Strategy

Information Systems Strategy e-health Interoperability Platform Implementation / Integration Services

Application / ASP / Service Delivery

Phases


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e it Imagine . . . .

> Connecting 8 competing hospitals, 2 competing reference labs, and thousands of physicians and pharmacies to build an entire community’s shared patient record

> Providing an entire care team (primary care physicians, specialists, nursing staff and hospital staff) access to an integrated patient record view

> Viewing historical and codified lab data from multiple labs (reference, in-patient and ambulatory)

> Delivering comprehensive current problem lists and allergies to the point of care

> Having access to a patient’s medication history and knowledge tools that check allergy and drug to drug to reactions

> Driving formulary compliance on prescriptions and lower cost substitutions for high prescribing physicians that save the community as much as $15,000 per physician per year

> Providing a community infrastructure that supports EMR interoperability so that physicians with different IT systems can share relevant patient information among them

> Implementing all of this within a 3–6 month timeframe


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e it Reality

> Taconic IPA (Mid-Hudson Valley, NY) has established an operating RHIO

> 1000+ current users (400 physicians) using a shared data exchange

> 4 Hospitals, 2 Reference Labs (LabCorp and Quest) connected

> EMPI established to handle person identity resolution

> System live and users trained within 90 days of project kickoff

● Data Exchange (Connectivity)● CDR – Shared Patient Record● Community Portal (Physician View)● EMPI – Person Resolution● eResults Software Applications ● 18 Hospital and Lab interfaces

> 3 EMR vendors (Allscripts, NextGen, GE) agree to interoperability w/ CCR and HL7 Data Exchange

> Contract Signed on October 1, 2004 – system live and users trained December 31, 2004.


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e it “Stunning” Interoperability


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e it Technology

> Delivered via an ASP model

> IBM servers on Intel architecture

> Portal built on a Microsoft platform● Windows Server 2000/2003● Internet Information Server● SQL Server 2000

> Data exchange and routing via Cloverleaf interface engine

> EMPI services provided by Eclipsys

> Clinical vocabularies and libraries from IMO, Multum, Healthwise and others


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e it Healthvision - Scale

> 1000+ hospitals utilize servers daily

> Manage a Microsoft environment of approx 250 servers

> Platform database grows 12-15% per month and currently is approx 2 TB in size

> Over 8 million unique patients in database

> Interface Engine processes approximately 310,000 clinical transactions per day

> Support 2.0 Million+ unique users/month

> Over 11.7 TB per year in network traffic


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e it Technology Model

> Regional Clinical Data Repository

> Longitudinal patient record across all systems

> Reference pointers back to images and documents

> Single sign-on to third party systems

> CCOW support

> Intelligent routing of HL7 and CCR data to EMRs

> Record Locator Service to find national records

> National exchange of clinical data among RHIOs


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e it Clinical Advantages of a Regional CDR

> Effective re-use of clinical data● Codified data for reporting, graphing, and clinical

decision support● Ongoing surveillance

• Hazardous conditions• Missed disease management opportunities• Potential errors• Adverse effects

> Automatic alerts to providers● Data from multiple sources combined● Clinical alerting rules run across combined data


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e it Clinical Advantages of a Regional CDR

> Longitudinal, patient-centric view● Multiple providers in multiple locations easily share data

from multiple systems

> Proven physician and staff acceptance


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e it Technical Advantages of a Regional CDR

> Centralized security access model for easier management of access to protected health information

> Time to market● Common data framework● Common configuration tools● Common implementation process● Reusable interface libraries

> System performance and reliability● End user not waiting while multiple systems are queried● Easily scalable with increased number of source systems

and users


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> Easy to integrate new modules● Applications leverage a common set of clinical data and

system services

> Not dependent on source system availability● Easy to provide redundancy and eliminate single points

of failure

> Person resolution complexity● Fully decentralized system requires matching patients

across multiple systems in real time● Allows timely human resolution of ambiguous matches


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> Standard legacy system interfaces● HL7 and now CCR● Takes advantage of built-in interface capabilities already

built in to most clinical information systems

> Centralized security model● No need to provision multiple individual systems


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e it Standards

> In order to deliver interoperability, adherence to standards is key● HL7 for registration and results exchange● CCR for visit snapshot● ICD9 for problems● CPT for procedures● NCPDP for pharmacy● X.12 for eligibility and billing

> Problem with standards is definition● HL7 too loose● CCR doesn’t define vocabularies


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e it Healthvision Interoperability platform


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e it Challenges to a national model

> Scalability● Can systems scale from a few million patients to a few

hundred million?

> Identity resolution● How do you quickly resolve patient identity across

systems nationally?● Privacy concerns over a national patient identifier

> Security model● How do you know who should get access to what data on

a national level?


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Questions or Comments

John LightfootHealthvision, Inc.

[email protected](972) 819-4353

Thank You!

Date post:	23-Dec-2015
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