Health Information Exchange - A Critical Assessment: How ... · Health Information Exchange ......

Health Information Exchange - A Critical Assessment: How Does it Work in the US and What Has Been Achieved?

Use cases, best practice and examples for successful implementations

1 ©2017 Copyright The Sequoia Project. All rights reserved.

Agenda

• Overview of The Sequoia Project

• History of Exchange in the United States

• Lessons Learned

• Discussion


Overview of The Sequoia Project


The Sequoia Project’s Role

The Sequoia Project brings together industry and government to systematically address the practical challenges of secure, interoperable nationwide health data sharing

NATIONWIDESECURE INTEROPERABLE


The Sequoia Project Initiatives

The Sequoia Project’s independent initiatives each have their own:

• Mission

• Governance

• Membership

• Structure

The Sequoia Project is an ideal home for projects that

require a collaborative environment where multiple

parties with differing perspectives can work together.

5©2017 Copyright The Sequoia Project. All rights reserved.

Current Sequoia Project Initiatives

6 6

The eHealth Exchange is the largest health data sharing network in the US

Carequality facilitates consensus on a standardized, national-level interoperability framework to link all data sharing networks

RSNA Image Share Validation Program is an interoperability testing program to enable seamless sharing of medical images

©2017 Copyright The Sequoia Project. All rights reserved.

Health Information Exchange in the United States


The Largest Health Information Exchange Network in the U.S.

8

An initiative of


Introduction to the eHealth Exchange

9

Shared Governance and Trust Agreement Common Standards, Specifications & Policies

Tech Vendors

Federal Govt

States

PharmaciesPayers

Regional Networks

Care Facilities


10 Years of Experience

10

• A solid proven governance model

• Common legal agreement minimizes barriers to nationwide exchange

• Mature capabilities, processes, operations, testing, and strong cultural knowledge base

• Testing and onboarding have simplified efforts for partners to exchange nationwide

• Growth is in the number of medical groups

• Federal partner programs leverage eHealth Exchange as integral part of their interoperability strategy

• Relatively negligible maintenance costs

• Recognized by SDOs as significant nationwide community of implementers

2006

ONC Conceives the Nationwide Health Information Network

(NHIN / NwHIN)

2008

NHIN moves from prototype to production

pilot

2009

First production exchange between Social Security Administration &

MedVirginia

NHIN transitions from government to private sector & renamed

eHealth Exchange

2012

2015

Participation quadruples & expands to all 50 states

2016

New initiatives increase quality & types of

content shared


Critical Architecture Decision

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Centralized Federated Federated with

Shared Services

(Hybrid)

The Internet“Hub” networks


In 2017, the eHealth Exchange connects:

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50,000 medical groupsAll 50 states

Four federal agencies(DoD, VA, CMS, SSA)

65% of U.S. hospitals

47 regional and state HIEs in production


8,300 pharmacies

Supporting more than109 million patients

3,400+ dialysis centers

National Use Cases and Standards Supported

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•Treatment / Care Coordination

•Military / Veteran Health

•Disability Benefits Determination

•Quality Measures Reporting

• Immunizations

•Consumer Access

•Life Insurance

•Syndromic Surveillance

• Image Share

•Query: SOAP / SAML + IHE Suite

•Push: Direct, Document Submission / Admin Distribution

•Content: C32, CCDA, quality measures

•FHIR

•Others under consideration

Use CasesSpecifications & Standards


Interoperability Framework to Connect Networks to Networks

14

An initiative of


A Changing Landscape

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A Shifting Marketplace

from 2008 to 2015

• Greater EHR adoption

• MU, MACRA and Consumer Directed Exchange driving need for widespread exchange

• HIEs have evolved and many new types of data sharing networks have developed

• Evolving role of EHR vendors

• New types of services for data sharing (e.g. RLS)

• Growing pressure from policy makers to connect “health data silos” that are still prevalent

State EHR Adoption Rates have Increased from 2008 to 20141

2008 2014


The Situation

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Some are geographically based, but many other types of data sharing communities also exist.

Communities of data sharing partners have formed,

brought together by specific needs.


One Framework to Unite Many Networks

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Carequality Interoperability FrameworkPublic and private stakeholders developed

a trusted exchange framework and common legal agreement to enable data sharing across

different networks

Carequality is creating a web of interconnected networks


The Network Effect

How do you get nationwide connectivity? Clinic by clinic, hospital by hospital?

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• 15,000+ Clinics• 600+ Hospitals • 210,000+ Clinicians

Case Study Example: Exchange began in 2016, connecting in just the first 6 months:

Data sharing networks have already connected many participants within communities. The connections grow exponentially by connecting these networks.

If you connect six clinics, you might reach a few dozen physicians.

If you connect six communities, you can reach thousands of physicians.


Lessons Learned


Common Legal Agreement

• Eliminates one-to-one legal agreements

• Saves money with uniform contracts, policies and governance

• Contractual enforcement of compliance

• Provides transparency

• Creates clear expectations for participants

• Provides for oversight and accountability


Interoperability Testing

• Testing should meet business and technical objectives (e.g. test once, exchange with many)

• Need for more rigorous testing of clinical content • Network-level testing should focus on increasing assurances of interoperability

in production• Goal should be to reduce network-level testing over time as interoperability

“is built into” products• Testing should evolve as health IT capabilities mature• Optional vendor/product testing reduced level of effort • Automation is the absolute key (quality, fast turnaround loop, continuous

testing, cost-efficient)• Incremental improvements over time essential• Feedback loop to standards development organizations• Testing is not a profit center


Recipe for Success

• Industry led, with strong governmental support and public-

private collaboration

– Progress can be accelerated when industry and government

are working together toward a more unified direction

• Capability to exchange doesn’t guarantee use

– Quality and value of the data exchange will encourage use

– Must align business incentives to drive utilization and fit

within clinical work flow

• Trust is the foundation, but a viable business case is the driver

– A trust framework is a critical foundation for nationwide data

sharing, but is not sufficient without a business case to share

data (e.g. value-based payment models)


Discussion Topics


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