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HIEs, CommonWell, Carequality Can Work Together: Here's How
Session 83, March 6, 2018
John P. Kansky, President & CEO, Indiana Health Information Exchange
Keith W. Kelley, Chief Operating Officer, Indiana Health Information Exchange
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John P. Kansky, MSE, MBA, CPHIMS, FHIMSS
Keith W. Kelley, MBA
Have no real or apparent conflicts of interest to report.
Conflict of Interest
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AgendaI. Current State of Interoperability
II. TEFCA and Interoperability Approaches
III. AND not OR
IV. What’s Next
Questions and Discussion
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Learning Objectives• Describe the existing national interoperability approaches.
• Identify the opportunities and challenges within each national interoperability approach.
• Assess the current competition/cooperation among interoperability approaches.
• Analyze how the interoperability approaches can and do work together today.
• Discuss how interoperability approaches can work together even more effectively in the future.
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Relevant Board and Committee Participation
• HIMSS North America
• The Sequoia Project
• eHealth Exchange Coordinating Committee
• Strategic Health Information Exchange Collaborative (SHIEC)
• Integrating the Healthcare Enterprise USA (IHE USA)
• ONC’s Health Information Technology Advisory Committee (HITAC)
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Current State of Interoperability
PART I
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We still have a lot of work to do.
There is an unsupported belief that one approach is the correct one.
There is no clear understanding of the various national approaches.
The HIT Industry is wasting time and resources in the process.
We’ve made little progress on interoperability from a patient outcome perspective.
AND
BECAUSE
AND
Interoperability 2017: First Look at Trending—Some Progress Toward a
Distant Horizon
Moving Past the EHR Interoperability
Blame Game
Tackling [interoperability] issues requires
multi-stakeholder coordinated action, and that
action will only occur if strong incentives promote it.
The point of the blame game is not to punish
the players. It is to understand the dynamics at play
and plot a path forward…Once the business case
for interoperability unambiguously outweighs the
case against it, both vendors and providers can
pursue it without undermining their best interests.
“
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KLAS, Perception Report October 2017
Julia Adler-Milstein, PhDNEJM Catalyst, July 2017
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The World is Flat
Industry professionals believe an oversimplified explanation based on a seemingly rational observation.
Art Credit: Kansas, Peter Lloyd, “Point of Know Return” [cover album]. 1977.
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The truth: It’s complicated and confusing.
• There are multiple interoperability approaches
• No one approach will work for all interoperability use cases
• Different types of organizations have different interoperability needs
• But using multiple interoperability approaches in our current environment is hard
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HIMSS
• Secure, appropriate, and ubiquitous data access and electronic exchange of health information
CMS
• The ability of two or more systems or components to exchange information and use the information that has been exchanged
21st Century Cures Act
• Technology that enables the secure exchange of electronic health information with, and use of electronic health information from, other HIT without special effort on the part of the user; allows for complete access, exchange, and use of all electronically accessible health information as authorized by State or Federal law
We don’t commonly define interoperability.
It’s not one thing.
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But 2018 looks promising!
21st Century Cures Act and TEFCA
CommonWell Carequality implementer
eHealth Exchange Carequality implementer
SHIEC PCDH live with national expansion
Interoperability
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TEFCA and Interoperability Approaches
PART II
Source: “A User’s Guide to Understanding the Trusted Exchange Framework,” ONC
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One On-Ramp VS “And” not “Or”• Interoperability beyond TEFCA use cases
• TEFCA timeline (realistically…years away)
• One on-ramp is a future state TEFCA believes will be helpful
– NOT a requirement on the provider
– Multiple on-ramps is YOUR prerogative
• No matter what, these concepts should inform your critical thinking about TEFCA
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National Interoperability Approach How it Aims to Connect the Whole Country
eHealth Exchange (eHEX)Framework to enable participating providers, federal agencies,
and HIEs to connect
Carequality Framework to enable EHR vendors and networks to connect
CommonWellNetwork to connect EHR vendors, which gain participation of their
customers
DirectTrustFramework to enable participating providers, EHR vendors, and
HIEs to connect
SHIEC Patient Centered Data Home™ Framework to enable HIEs to connect
eHealth
ExchangeCarequality CommonWell DirectTrust SHIEC PCDH
National Interoperability Approaches aim to connect the whole country.
HIEs and EHR Interoperability Platforms work with interoperability
approaches to connect the regions and/or customers they serve.
HIEsEHR Interop
Platforms
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Carequality/CommonWell Status“CommonWell will become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequalityparticipant.”*
* From 12/13/16 Carequality/CommonWell press release
SHIEC/HIE Status
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Carequality: Current State in Indiana*• ~50 physician practices – less than 1%
• ~18 hospitals – about 15% (16 are Epic facilities)
• 0 Long-Term Post-Acute Care (LTPAC) facilities
• 0 Behavioral Health facilities
• 0 Payers
• 0 Self-Insured Employers/Employer Clinics
• 0 Accountable Care Organizations (ACOs)
* Numbers are interpreted by organization names on Sequoia Project website for illustrative purposes (December 2018).
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CommonWell: Current State in Indiana*• 62 physician practices
• 30 hospitals
• 2 Long-Term Post-Acute Care (LTPAC) facilities
• 0 Behavioral Health facilities
• 0 Payers
• 0 Self-Insured Employers/Employer Clinics
• 0 Accountable Care Organizations (ACOs)
* Numbers are interpreted by organization names on CommonWell Alliance website for illustrative purposes (December 2018).
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HIEs: Current State in Indiana*• 3 HIEs connected to 12 HIEs across western and central US
• ~120 hospitals – more than 90%
• ~7,000 physician practices receive data – more than 90%
• ~50 LTPAC facilities
• Some Behavioral Health
• All Medicaid payers; 0 Commercial payers
• Some ACOs – many of the largest
• Some self-insured employers/employer clinics
* Numbers are estimates for illustrative purposes (December 2018).
Regional Information Exchange in California
• No large-scale, robust HIE presence
• Comprised of multiple institutions in the Bay Area that primarily use single EHR vendor for exchange
• Bi-directional sharing occurs
• Carequality enables more than one EHR vendor platform to successfully exchange data
University-affiliated
academic systems
EHR Vendor Platform
+ Carequality
Safety net health
systems
Network of
community
clinics
Healthcare
systems
Large
integrated
delivery
networks
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AND not OR
PART III
HIEProvider Provider
Other
Providers
Regional HIE Networks
HIE Approach CIRCA 2012
HIEProvider Provider
Other
Providers
Provider Provider
(same EHR)
Other
ProvidersHIE
Regional HIE Networks EHR Vendor Framework
HIE Approach EHR ApproachCIRCA 2012
OR
HIEProvider Provider
Other
Providers
Provider Provider
(same EHR)
Other
ProvidersHIE
Regional HIE Networks EHR Vendor Framework
eHealth Exchange Framework
HIE Approach EHR Approach
eHEX Approach
CIRCA 2012
OR
HIE
Fed
Govt
Some Epic
Providers
Other
Providers
HIEProvider Provider
Other
Providers
Regional HIE Networks
TODAY
HIE Provider
SHIEC Framework
HIE Approach
.Vendor Vendor
Other
VendorsHIE
Carequality
Framework
TODAY
CommonWell
EHR Approach
AND/
OR
HIE Approach
HIEProvider Provider
Other
Providers
Regional HIE Networks
HIE Provider
SHIEC Framework
eHealth Exchange
Framework
More
HIE
Fed
Govt
Many Epic
Providers
Other
Providers eHEX Approach
.Vendor Vendor
Other
VendorsHIE
Carequality
Framework
TODAY
CommonWell
EHR Approach
AND/
OR
HIE Approach
HIEProvider Provider
Other
Providers
Regional HIE Networks
HIE Provider
SHIEC Framework
Use Case ExerciseUSE CASE:
Exchanging data between
VA and non-VA providers
INTEROP APPROACH(ES):1. HIE + eHEX
2. EHR vendor + eHEX
MY CONSTRAINTS:1. Does my EHR vendor
enable exchange with
the VA?
2. Does my HIE enable
exchange with the VA?
SOLUTION FOR MY ORG:
Which is right for your
organization?
SOLUTION FOR MY ORG:
Which is right for your
organization?
INTEROP APPROACH(ES):1. HIE
2. Carequality + EHRIP*
3. EHRIP to EHRIP (Same vendor)
4. eHEX to EHRIP or HIE
*EHRIP = EHR Interoperability Platform
Use Case ExerciseUSE CASE:
Patient information at point of care
MY CONSTRAINTS:1. Onboarded to eHEX?
2. Participate in HIE?
3. Is HIE robust?
4. Is my EHR vendor highly penetrated in my region?
SOLUTION FOR MY ORG:
Which is right for your
organization?
INTEROP APPROACH(ES):1. HIE
2. SHIEC Patient Centered Data Home™
3. eHEX
Use Case ExerciseUSE CASE:
Clinical event notifications
MY CONSTRAINTS:1. Participate in HIE?
2. Does your HIE offer notifications?
3. Does your HIE participate in Patient Centered Data Home™?
4. Onboarded to eHEX?
.
Carequality
Framework
eHealth Exchange
FrameworkFuture
Frameworks?
SHIEC
Framework
Santa Cruz
HIE
Patient Centered
Data Home™
SSA
HIE as
Content
Manager?
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What’s Next
PART IV
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Education
Acknowledge the Barriers
Providers
don’t want it
Fee for
service Lure of “silver
bullet” solution
Changes
in market
Competin
g priorities
TEFCA
uncertaint
y
Paying
for
duplicate
services
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What’s next in 2018…
21st Century Cures Act and TEFCA
CommonWell Carequality implementer
eHealth Exchange Carequality implementer
SHIEC PCDH live with national expansion
Interoperability
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What’s next in 2018…
21st Century Cures Act and TEFCA
CommonWell Carequality implementer
eHealth Exchange Carequality implementer
SHIEC PCDH live with national expansion
Interoperability
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John Kansky
President and CEO
@jkansky
QuestionsKeith Kelley
Chief Operating Officer
