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Emerging Interest in States, Regions and Communities Across the Nation for Health Information Exchan


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Title: Emerging Interest in States, Regions and Communities Across the Nation for Health Information Exchan

Emerging Interest in States, Regions and
Communities Across the Nation for Health
Information ExchangeEarly Learnings
  • Healthcare Information Technology Summit
  • Vermont Association of Hospitals and Health
  • Janet Marchibroda
  • Chief Executive Officer, eHealth Initiative and
  • Executive Director, Connecting for Health
  • November 18, 2004

Pioneers in Health Information Exchange
  • California
  • Delaware
  • Florida
  • Indiana
  • Los Angeles, CA
  • Maine
  • Maryland
  • Massachusetts
  • Michiana Health Information Network, IN
  • Michigan
  • Minnesota
  • New York
  • North Carolina
  • Northern California
  • Ohio
  • Pennsylvania
  • Rhode Island
  • Santa Barbara, CA
  • Tennessee
  • Utah
  • Vermont
  • Washington, D.C.
  • Washington State

What Problems Are They Trying to Solve?
  • Improving Healthcare Delivery at Point of Care
  • Reducing Costs Achieving Efficiencies
  • Biosurveillance/Public Health Initiatives
  • Quality Improvement Initiatives
  • Reaching out to Remote, Rural and Underserved

Common Issues and Challenges
  • Organization and governance engaging
  • Lack of upfront funding and sustainable model
  • Competing entities reluctant to share information
    that would undermine competitive advantage
  • Technical issues architecture, accurately
    linking patient data, applications, standards,

Connecting Communities for Better Health Program
  • Catalyzing activities at national, regional and
    local level to create electronic interoperable
    health information infrastructure
  • Providing seed funding to community-based
    multi-stakeholder collaborations that are engaged
    in health information exchange
  • Mobilizing pioneers and experts to develop and
    disseminate resources and tools to support health
    information exchange technical, financial,
    clinical, organizational, legal

Connecting Communities for Better Health Program
  • Widely disseminating resources and tools through
    a wide range of dissemination vehicles
  • National, state-level, and local meetings
  • Audio and web conferences
  • Connecting Communities resource center
  • Other organizations, such as medical societies
    and non-profit groups
  • Public sector initiatives such as the AHRQ
    National HIT Resource Center and CMS Program to
    Support Physician Offices through QIOs
  • Creating and widely publicizing a pool of
    electronic health information exchange-ready
    communities to facilitate interest and public and
    private sector investment

Connecting Communities for Better Health Program
  • Providing a cohesive and powerful voice for
    state, regional and community-based
    collaborations building health information
    exchange networks
  • Building national awareness regarding
    feasibility, value, barriers, and strategies for
    health information exchange networks

Response to Request for Capabilities
  • What We Asked For in our 2003 Request for
    Capabilities Statements
  • Multi-stakeholder initiatives involving at least
    three stakeholder groups
  • Matched funding
  • Use of standards and a clinical component
  • What We Received
  • 134 responses representing 42 states and the
    District of Columbia proposing collaborative
    health information exchange projects across the

What We Found
  • Diverse models
  • Varying stages of readiness
  • Wide range of technical models
  • Large use of laboratory and pharmacy data
  • Standards adoption is not widespread
  • Need for funding is clear
  • Full results will soon be published in journal
    J. Marc Overhage, MD, PhD Lori Evans, Janet

What We Found
  • Stage of Readiness
  • Beta 22
  • Pilot Mode 28
  • General Availability 28 (of the 64 only nine
    appeared to be fully operational)
  • Other 22
  • Diverse models
  • Organizational Structures
  • No organizational structure 5
  • Loose affiliation 28
  • Corporate 29

What We Found
  • Most Common Lead Respondent
  • Other 28
  • Hospital 23
  • Provider Organization 16
  • Academic Medical Center 10
  • Community Health Information Organization 9
  • Public Health 2
  • Lead Organization
  • Hospital Organizations 23
  • Provider Organization 16
  • Academic Centers 10
  • Community Health Information Organization 9
  • Other 29

What We Found
  • Technical Approaches
  • Personal Health Records 2
  • Peer to Peer 20
  • Federated 3
  • Centralized Databases 54
  • Not Yet Selected 18

What We Found
  • Initial Funding
  • Identified No Funding 32
  • Non-profits 37
  • Philanthropies 23
  • Federal Source 22
  • HIE Organization 18
  • States 17
  • Private 12
  • Other 11

What We Found
  • Operational Funding
  • Other 60
  • Subscriber Fees 45
  • Data Sources 20
  • Government 20
  • Pay for Performance 18

Communities Being Funded
  • Connecting Colorado (Denver, CO)
  • Indiana Health Information Exchange
    (Indianapolis, IN)
  • MA-SHARE MedsInfo e-Prescribing Initiative
    (Waltham, MA)
  • MD/DC Collaborative for Healthcare Information
    Technology (Baltimore/Washington Metro Area)
  • Santa Barbara County Care Data Exchange (Santa
    Barbara, CA)
  • Taconic Health Information Network and Community
    (Fishkill, NY)
  • Tri-Cities TN-VA Care Data Exchange (Kingsport,
  • Whatcom County e-Prescribing Project (Bellingham,
  • Wisconsin Health Information Exchange (National
    Institute for Medical Informatics Midwest)
    (Milwaukee, WI)

Recap Communities Focus
  • Strategically focused on critical areas that need
    to be addressed to implement health information
  • Replicable and sustainable technical architecture
  • Alignment of incentive models
  • Use of replicable data exchange standards
  • Addressing ways to accurately link patient data
  • Multi-jurisdictional models
  • Electronic prescribing issues

Technical Models
Fully Integrated Monolithic Database

Patient Carried
Federated Consistent Databases
Dictionary MPI
Federated Inconsistent Databases(includes
Information from This Weeks eHealth Initiative
Meeting Connecting Providers to Labs
Getting Data to the Correct ProviderPoint-to-Poin
t Push
Getting Data to the Correct ProviderPoint-to-Poin
t Pull (Query)
Getting Data to the Correct ProviderHIE Push
Getting Data to the Correct ProviderHIE Pull
Getting All Data About The Patient
An Example Indiana Health Information Exchange
  • Our strategy for achieving this vision is to
    wire health care first in Central Indiana and
    eventually across the entire state by creating
    a common, secure, electronic infrastructure that
    expands communication and information-sharing
    among participating providers, hospitals, public
    health organizations, and other health care
    entities. Ultimately, the system will give
    providers better information for treatment
    purposes at the point-of-care, and it will give
    researchers a richer pool of data to guide more
    far-reaching treatment improvements over the
    longer run.

INPC Participants
  • Includes 17 hospitals from the 5 major
    Indianapolis hospital systems (99 of non-office
  • ED providers
  • Hospitalists
  • Hospital based specialists
  • Approximately 30 of physician practices and
  • Includes all four homeless care systems
  • Public school based clinics
  • Public health departments (county and state)

INPC Contents
  • In the system
  • 1.3 million patients, 5 million registration
  • 24 million orders
  • 489 million coded results
  • 12 million dictated reports
  • 8.8 million radiology reports
  • 25 million prescriptions
  • 480,000 EKG tracings
  • 45 million radiology images
  • Added Per Year
  • 600,000 ambulatory encounters
  • 50,000 inpatient encounters

Other Data Sources
Data Reuse
Connecting for Health
  • Catalyzing changes on national basis to create an
    interconnected, electronic health information
    infrastructure to support better health and
  • Founded and supported by the Markle Foundation,
    with additional support from the Robert Wood
    Johnson Foundation
  • More than 100 collaborators from all sectors of

The Assumptions
  • A future of better, more efficient care can be
    accomplished through dynamic connectivity that
    allows information to move
  • Where its needed
  • When its needed
  • In a private and secure manner
  • Achieving this goal will require public and
    private sector collaboration
  • A Roadmap is needed to chart the course


What is the Roadmap?
  • Shared vision of what to do nextdeveloped and
    agreed to by all major stakeholders
  • A set of practical actions and achievable goals
    in a 1-3 year time frame
  • Provides necessary cohesion for multiple
    stakeholder efforts
  • Building on where we are, not overhauling
    everything at once

Eight key areas of Roadmap recommendations
  • Funding and Incentives
  • Clinical Applications
  • Legal Safe Harbors
  • Engaging the American Public
  • The Infrastructuretechnical architecture and
  • Designing for Privacy and Security
  • Accurate Linking of Patient Information
  • Data Standards

Key Recommendations July 2004
  • Creating a Technical Framework for Connectivity
  • Non-proprietary network of networks
  • Common framework of standards, policies
  • Decentralized, federated, based on standards,
    safeguards patient privacy, and built
    incrementally without use of a National ID
  • Test standards working together through reference
    implementation and make widely available

Key Recommendations July 2004
  • Addressing Financial Barriers
  • Financial incentives are needed - 3 to 6 per
    patient visit or .50 to 1.00 per member per
    month to cause tilt
  • Safe harbors needed
  • Align incentives with standards-based
    applications and connectivity
  • Engaging the American Public
  • Key messages and standards for PHRs

Technical Recommendations The Roadmap does NOT
  • A national patient identifier number
  • A single proprietary solution
  • A single centralized database
  • A massive new government program
  • A one-size-fits-all mandate
  • A rip-and-replace overhaul

Roadmap Infrastructure Recommendations
  • Principles of infrastructure design
  • Safeguards privacy
  • Leverages both bottom-up and top-down
  • Builds on existing systems (incremental)
  • Consists of an interoperable, standards-based
    network of networks built on the Internet
  • Patient information remains where it is now and
    is not kept in a central database
  • Data-sharing initiatives have local autonomy but
    follow certain standards and policies to enable
    interoperability (federated)

Infrastructure A Common Framework
  • Comprised of public domain standards, policies
    and methodologies that can be quickly replicated
    to provide
  • Secure connectivity
  • Reliable authentication
  • A minimum suite of standards for information
  • Adhering to the Common Framework ensures that
    data exchange pilots, personal health records and
    regional systems can interoperate
  • Grounded in the Roadmap, the RI will provide a
    concrete, functional demonstration of the
    critical common standards-based components of an
    interoperable, community-based infrastructure

RI strategic objectives
  • Create a body of work the Common Framework
    from a live laboratory
  • Show that the Common Framework can be achieved
    across diverse settings and technologies
  • Bring together multiple, competing institutions
  • Disseminate findings
  • Demonstrate ease of management and implementation

What will the RI do?
  • The RI will establish, demonstrate and
    disseminate a national Common Framework for
  • Data standards
  • Methodology for validating interoperable
    interfaces and applications
  • Standard patient and provider identification
  • Exchange of clinical information across networks
  • Policies for information sharing
  • It is comprised of network standards, common
    policies, documents and methodologies that will
    be shared in the public domain

Whats Needed Key Imperatives
  • Alignment of incentives around quality healthcare
    and the standards-based tools that will help us
    get therehealth information technology
  • Use of standards for applications, architecture,
    identification and transport must be taken to the
    next level to get to full interoperability
    Connecting for Health in collaboration with
    eHealth Initiative Foundation Connecting
    Communities looking for communities to help build
    these in the field!
  • Innovation and collaboration to support small to
    medium physician practices as they migrate to an
    electronic system

Whats Needed Key Imperatives
  • Leverage HIT investments and incentives to
    address multiple challenges
  • Driving cost out of system through electronic
  • Providing clinical knowledge and information at
    the point of care
  • Promoting quality and performance improvement
    efforts including those related to measurement
    and chronic care management
  • Supporting public health related activities

Whats Needed Key Imperatives
  • Demonstration programs and projects should not be
  • Align with replicable, sustainable models for
  • Align with efforts to create interoperable
    applications and standards-based electronic
  • Assure lessons are shared with others through
    dissemination and communication vehicles

What Were Doing to Help
  • Developing a repository of best practices and
  • Developing assessment tools to understand where
    you are and what you need to do
  • Developing an inventory of all state, regional
    and community-based health information exchange
  • Launching HIT State Summit Initiative first in
    New York
  • Disseminating resources through Connecting
    Communities Resource Center and Learning Network

What Were Doing to Help
  • Creating a place for learning and dialogue and
    development of work products Working Group for
    Connecting Communities
  • Disseminating information through Connecting
    Communities Annual Learning Forum and a Set of
    Regional Meetings
  • Participating in the AHRQ National HIT Resource
    Center partnership led by NORC and including
    Regenstrief, CITL, Vanderbilt, CSC and eHealth
  • Hold the Date for Dec 6-7 Meeting Focused on
    RHIOs Connecting Communities for Better Health

Working Group for Connecting Communities
  • Chairs
  • Mark Frisse, MD, MBA, Director, Regional Health
    Initiatives, Vanderbilt Center for Better Health
  • J. Marc Overhage, MD, PhD, Chief Executive
    Officer, Indiana Health Information Exchange
  • Primary Lead Emily Welebob, eHI Program Director

HIE Readiness Assessment Proposed Approach
  • The HIE assessment is completed to
  • Gain an understanding of the current state
  • Identify success factors and areas of opportunity
  • Provide recommendations to move forward
    successfully with HIE
  • The HIE model and survey instrument are being
    based on industry research, literature review,
    and lessons learned from sites who have been
    successful and who have not been successful
  • The assessment should be completed using
  • Document review
  • Interviews
  • Site visits
  • Survey instrument
  • Assessment tool is currently under developmentwe
    need your help!

HIE Readiness Assessment Assessment Factors
  • Environmental Factors
  • Organizational process and structure
  • Culture
  • Leadership / Commitment
  • Champions
  • Physician involvement
  • Key Stakeholders
  • Business community
  • Consumer community, etc
  • Technology (Process and Infrastructure)
  • Communication
  • Shared vision
  • Change Management
  • Legal Issues
  • Funding/Sustainability Model
  • Politics
  • Business drivers
  • Neutral parties

Hold the Date!
  • December 6-7, 2004 Community or RHIO-Centric
    Meeting Connecting Communities for Better Health
    Co-Sponsored by eHealth Initiative Foundation and
  • Vetting a set of alternatives for the following
    RHIOs or state, regional and community based
    health information networks
  • Financial and Sustainability Models
  • Technical Architecture Models
  • Organization and Governance Models
  • Dealing with Key Legal Issues
  • Addressing Privacy and Security

What Does All of this Mean?
  • We are finally building momentumthe stars and
    planets are aligning
  • The focus has shifted from whether we should to
    how will we do this?
  • This work will create lasting and significant
    changes in the U.S. healthcare systemhow
    clinicians practicehow hospitals operate.how
    healthcare gets paid forhow patients manage
    their health and navigate our healthcare system

  • Never doubt that a group of thoughtful,
    committed people can change the world. Indeed
    its the only thing that ever has.
  • Margaret Mead

My Contact Information
  • Janet M. MarchibrodaChief Executive Officer,
    eHealth Initiative
  • Executive Director, Foundation for eHealth
    InitiativeExecutive Director, Connecting for
  • 1500 K Street, N.W., Suite 900
  • Washington, D.C. 20039
  • 202.624.3270
  • Janet.marchibroda_at_ehealthinitiative.org
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