Transcript Building Our Community Repository

“From Interaction
to Integration
to Transformation:
Healthcare’s Journey &
Information’s Role”
HealthBridge is one of the nation’s
largest and most successful health
information exchange organizations.
Mike Mote
Vice President
Product & Service Strategy
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HealthBridge
Background
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HealthBridge
 One of the nation’s oldest, largest, most advanced
and successful health information exchanges
 In operation since 1997
 501c3 Not for Profit
 One of only a handful of HIE/RHIOs nationwide with
a sustainable business model
• (Pre ARRA) 97% of revenue from fees; <3% grants
• 5-12% annual return for last eight years
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HealthBridge
 Delivers more than 3.5 million clinical messages PER MONTH;
more than 35 million messages for 2010
 Total of 50+ hospitals, 7500 physicians
 Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors,
60+ versions
 Provide technology infrastructure for four other HIEs – Dayton
HIN, CCHIE, HealthLINC, NEKY RHIO
 Cincinnati Network
• 26 local hospitals in Kentucky, Ohio and Indiana
• 5500+ physicians
• 17 local health departments
• Large commercial, hospital, & physician office labs
• Diagnostic centers
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HealthBridge
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HealthBridge HIE Value Progression
Meaningful Use, Medical Home and Payment Reform
• Stage 1 MU
• EHR Adoption (REC Services)
• Basic Electronic Messaging (NHIN DIRECT)
• Community Portal
• Web-Based Results Delivery
• Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency
Basic HIE
• Stage 2&3 MU
• Structured Data Delivery to EHRs
• Results Delivery (Lab, Rad, ADT, etc.)
Intermediate • ED, Admission, & Discharge Alerts & Notices
HIE
• Summary Record Exchange (CCD)
• Value: Necessary to achieve truly electronic workflows; Dramatic increase in
efficiency
•
Advanced
HIE
PCMH, ACO & Payment Reform Readiness
•Data Warehouse & Analytics
• Disease Registry
•Quality Reporting Support
•Full Integration Services & Bidirectional Exchange
•Value: Dramatic improvements in quality and performance
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HealthBridge – HIE Services
 EHR Integration/Interfaces
 Electronic Results Delivery –
• Labs, Radiology, ADT, etc.
 Electronic Order Entry
 E-Prescribing
 HIE Portal & User Management
 HIE Technology Support – Master Patient Index, Provider
Directory and Record Locator Service
 Summary Record Exchange
 Nationwide Health Information Network Direct and CONNECT
Gateway & Connectivity
 Public Health Reporting & Syndromic Surveillance
 Billing and Eligibility Verification
 HIE Consulting, Outsourced Technology & Implementation
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HealthBridge – Future Plans
 REC - Expanded Meaningful Use Assistance for Stages 2-3
 Beacon - Enhanced Suite of Quality Improvement, Care
Transformation and Accountable Care Services and Tools (Data
Warehouse, Data Analytics, Summary Patient Records, etc.)
 Patient Engagement - Connectivity to Personal Health Records,
Mobile Technologies and Consumer Technologies (Beacon, IN
Challenge Grant)
 HIE Expansion –
• Connect to new providers and stakeholders for improving
continuity of care (home health, long-term care, payers, etc.)
• Connect with State HIEs and Provider Networks (IN, KY, OH)
• Use Nationwide Health Information Network (NwHIN) Direct and
CONNECT platforms
• Spread of Advanced Technologies to Other Communities
• Community Credentialing
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“From Interaction
to Integration
to Transformation:
Healthcare’s Journey &
Information’s Role”
Creating a Community
Data Repository
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Healthcare’s Journey
 Whether or not you believe that REFORM is coming here are some
thoughts to ponder:
• The US healthcare system is broke; the current rate of growth
can not be sustained; 1/6th of the US economy is based upon
healthcare
• New York Times article claims “By 2020 the American health
insurance industry will be extinct.”
• Accountable care is coming; Value based payments are coming;
Volume based payments will continue to decline
• Missing data today results in missed opportunities to:
•
•
•
•
•
Prevent complications
Ensure better outcomes
Reduce unnecessary costs
Reduce patient’s safety risks
Improve transitions in care
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The “Journey”
Business
Realities
Penalties
Incentives
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Care Delivery’s Journey
Care
Transactions
Care
Integration
Care
Transformation
Individual Provider
Care Plans with some
coordination via
referrals
Coordinated
Care Plans &
Early stage PCMH
Single Care Plan &
Advanced stage PCMH;
the
Medical Community
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Quality Metrics’ Journey
Care
Transactions
Care
Integration
Care
Transformation
Patient Outcomes
Measures
Population based
metrics & health status
measurements
Demonstrable
Improvement in
Population Health with
ongoing refinement
of the metrics
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Payment Reform’s Journey
Care
Transactions
Care
Integration
Care
Transformation
Fee for Service
Pay for Performance &
Shared Savings
Providers at Partial to
Full Risk
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Data Analytics’ Journey
Care
Transactions
Care
Integration
Care
Transformation
Provider-centric
reporting based upon
productivity & patient
care protocols
Population based
quality & performance
analysis, health status
analysis, & risk analysis
Predictive modeling &
performance
forecasting, outcomes
analysis, & incentive
modeling
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Information’s Journey
Care
Transactions
Care
Integration
Care
Transformation
Individual EHR or paper
medical records;
individual vendor or
provider application of
standards & codes
Clinical information
sharing with standards
based interoperability
moving to data
integration with
semantic normalization
Community based
clinical & claims data
repository with
community data and
coding standards
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Information’s Role
Care
Transactions
Support Provider
delivered care; support
patient level quality
reporting
Care
Integration
Care
Transformation
Longitudinal patient
record, ED & Public
Health alerts; Point-ofcare decision support,
PHR, & remote patient
monitoring
Enable predictive
modeling, risk adjusted
analytics, accountable
care business &
operational modeling
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Information’s Role – Domain Requirements
Encounters
Referrals & Authorizations
People &
Organizations
Lab Orders & Results
Appointments
Patient
Revenues (Charges, Grants ..)
Medications & Prescription Information
Provider
Expenses (Payroll, Supplies,
Infrastructure, …)
Immunizations
Payer
Products
Radiology & Transcribed Reports
Staff
Member Enrollment
Master Data (ICD, CPT, DRG, HCPCS,
CCS, CRG …), Geography
Medical & Rx Claims
Facility
Medical Conditions (Allergies, Familysocial-medical history)
Revenue, Billing, & Payment
Data
Clinical Observations & Vital Signs
Utilization
Legend:
Provider
Payer
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Creating a Community
Data Repository
&
Establishing a
Community
Data Trustee
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HealthBridge’s Data Infrastructure
 New Suite of Health Care Innovation & Quality Improvement
Tools and Services funded through Beacon Program:
• Disease Registry
• Clinical & Claims Data Warehouse
• Data Analytics and Business Intelligence
• Alerts & Notifications
• Transitions in Care Assistance
• Quality Reporting Support
• Process Improvement and Workflow Redesign Support
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HealthBridge’s Solution Components
 Enterprise Master Patient Index (eMPI)
• IBM’s Initiate™
 Clinical & Claims Data Repository & Clinical Analytics
• PluralSoft’s CareQuotient™
 Semantic Data Normalization
• Clinical Architecture’s Symedical™
 Claims Data Grouping Engines
• OPTUMInsight’s Symmetry™
 Patient Registry
• WellCentive’s Registry™
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Why?
 Today this enables
• Identification of gaps in care
• Point-of-Care Decision Support
• Patient engagement
• Longitudinal Patient Record
• ED, Admission, & Discharge Alerts & Notices
• Information exchange at the point of Transitions in Care
• Intra-practice comparative performance analytics
• Interoperability between organizations (“Rosetta Stone”)
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Why?
 Tomorrow this will enable:
• Population-based performance measurement
• Risk adjusted comparative performance analytics
• Risk adjusted comparative cost analytics
• Predictive modeling & performance forecasting
• Service demand forecasting
• Payment incentive modeling
• Revenue versus cost modeling
• ACO business and operational modeling
• Best practice identification & modeling
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