HIE, RHIOs and EHR Interoperability The Journey to Meaningful Use, Interoperable Health Care Delivery and Improved Quality of Care

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1 HIE, RHIOs and EHR Interoperability The Journey to Meaningful Use, Interoperable Health Care Delivery and Improved Quality of Care Christina Galanis Executive Director, Southern Tier HealthLink

2 Topics to be covered in this session From paper to meaningful use and beyond Understanding the landscape & terms: HIE and RHIO Southern Tier HealthLink sources & services RHIOs & Meaningful Use Where is all this interoperability going? How can REC can help you?

3 The Need for Health Information Exchange Hospital A Hospital Laboratories National Laboratories Hospital Imaging Hospital B Imaging Centers Independent Pharmacy Chain Pharmacy Cardiologist Orthopedist Ambulatory Surgery Primary Care Physician Home Health Care

4 Support for Southern Tier HealthLink Support for the Southern Tier HealthLink The staff at the Lourdes Emergency Department is very excited to gain access to the Southern Tier HealthLink HIE. Particularly for patients who are unconscious or have difficulty remembering things like their medications and allergies, our ED personnel can rapidly gain access to this critical information. This STHL tool will allow us to provide better treatment and perhaps even save lives. Regina Pufky, Lourdes Hospital Emergency Department Nurse Manager The rapid transfer of medical information enables the Broome County Health Department to conduct ongoing disease surveillance through the ordering, analyzing and weighing of data to determine risk for illness and injury. This cannot be possible without sharing information through robust, reliable, and secure computing and communication products. Claudia Edwards, Broome County Public Health Director, NY DoH

5 The Alphabet Soup EHR (Electronic Health Record): a computerized record keeping system at your hospital or doctor s office HIE (Health Information Exchange): the system of sharing (exchanging) medical information from one EMR system to another RHIO (Regional Health Information Organization): the not-for-profit group that manages the HIE, ensuring it works properly and securely PHR (Personal Healthcare Record): a computerized collection of medical information about a particular person, viewable via the internet STHL (Southern Tier HealthLink NY): our central NY RHIO that makes sure the HIE works like it is supposed to 5

6 The Alphabet Soup STHL is the local RHIO which oversees the HIE which stores EHR information from different sources that you can see in your PHR. 6

7 RHIOs Are Statewide

8 Southern Tier HealthLink Background Founded as a partnership between UHS, Lourdes hospital and local physicians. Board of Directors represents founding stakeholders, physician practices, long-term care, public health, rural health, and the patient community Has a patient centric view of clinical information informed by multiple sources Funded by NYDOH and as part of the SHIN-NY, STHL acts as a public/private entity As funded by NYDOH, STHL must comply with state policy guidance Uses a Central Data Repository model: patient data is deposited and sealed until the patient consents to have records shared/accessed Provides a range of services to member hospitals, practices, and patients

9 Southern Tier HealthLink Board of Directors Rajesh Dave, MD (President) Christina Boyd, (Vice President) Mark McManus (Treasurer) Michael Rusnak (Secretary) Keith Chadwick, Long-Term Care Claudia Edwards, Public Health Merwyn Jones, Consumer John LaLiberte, Hospital Afzal Rehman, Physician Group Robert Taylor III, MD, Hospital Jack Salo, Rural Health

10 Southern Tier HealthLink Objectives Higher quality patient care Improved coordination between ALL care providers Cross institutional patient centric care More efficient delivery of care Value occurs across the regional health system Patients Access to medical records Less time gathering records Reliable source for medical history Easier medication reconciliation Health care providers More complete clinical profiles of patients Better documentation at point of care Less time gathering results Improved patient care Hospitals & Health Centers More complete clinical profiles of patients Better distribution of results Simplified EMR integration Improved care coordination Easier medication reconciliation Payers Higher member satisfaction More informed disease management programs Improved care coordination Fewer duplicate tests Enhanced formulary compliance Employers Improved employee health Reduced costs through administrative efficiency and fewer redundant services Employees engaged as active participants

11 Southern Tier HealthLink Data Sources UHS Binghamton General Hospital UHS Wilson Memorial Hospital UHS Chenango Memorial Hospital Lourdes Hospital UHS Primary Care & Medical Group Southern Tier Imaging Demographics X X X X X X X Contact Info X X X X X X X PCP Info X X X X X X X Insurance X X X X X X X Allergies X X X X X Medications X X X X X Problem List X X X X X Diagnosis X X X X X X Procedures X X X X X Immunizations Lab Results X X X X X S Radiology Images X X X X X Radiology Reports X X X X X X S X Delaware Valley Hospital Hospital Discharge Summary X X X X X Transcription S S S X S General CCD X X

12 Southern Tier HealthLink Services Current Products/Services Clinical results delivery Patient portal and access to tethered PHR Radiology image exchange Bi-directional connected EHR Physician portal Training and HIE adoption Master Patient Index SHIN-NY on-ramp Emerging Interoperability Services Medicaid Medications EMS Connectivity Advanced EHR interoperability Referrals (CCD exchange) CCD Query RHIO-to-RHIO exchange Provider Registry Public Health reporting

13 Interoperability Footprint EHR Connections established with DOH funding through HEAL Cerner Millennium Emageon PACS Fugi PACS HMS ITL PACS McKesson PACS Medent Meditech MedSeries 4 Microsoft HealthVault NextGen Siemans Invision Siemans Signature Softlabs Conversations with: Multiple EHR vendors ehealth Global Technologies (ehgt) PACS Six-county service area Broome, Chenango, Delaware, Cortland, Otsego and Tioga Cortland Tioga Chenango Broome Otsego Delaware

14 Southern Tier Healthlink Program Status Receiving patient information from 5 area hospitals 37 area medical practices 1 independent radiology practice Accessing patient information (Connected EHR/Web Portal) 3 area Emergency Departments 40 area medical practices ~ 200 physicians or other providers ~ 800 clinical staff (nurses, etc.) Have collected patient consent forms from 40,000 patients only about 3% choose not to participate Via 60 collection sites

15 Southern Tier HealthLink s Privacy and Security Technical safeguards exceed industry standards: Access is need to know based on user s role Level 2 Assurance on user authorization and authentication Health information transactions are encrypted Access is subject to HIPAA and HITECH regulations STHL actively monitors HIE utilization: Periodic audits, in partnership with Participants Access reports available at patient request

16 EHR Interoperability Variability EHR interoperability can vary by HIE or RHIO & EHR Results/Reports delivery Patient summary exchange with CCD Referrals Ordering Care alerts or subscription Results delivery can vary too by Practice Selecting data to receive/filter (for example preliminary and/or inpatient result) Assist with turning off paper/faxes process at various data providers Results delivery can surface issues that may have been addressed differently in the paper world Getting results from patients that are no longer yours Not getting results as a primary care physician that you used to get by paper/fax Combining results to one report Results/Reports volumes Other Support issues

17 Overview of Meaningful Use The American Recovery and Reinvestment Act (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to offer a financial incentive to physician and hospital providers who demonstrate the meaningful use of an EHR. According to the CMS, a provider uses an EHR meaningfully when he or she: 1. Improves quality, safety, efficiency, and reduce health disparities 2. Engages patients and families 3. Improves care coordination 4. Improves population and public health 5. Ensures adequate privacy and security protections for personal health information

18 Where Is All This Interoperability Heading? New York is ahead of the curve in building patient centric HIE services through RHIOs At the federal level, efforts such as the NHIN direct are seeking to provide interoperability for those that don t have any local HIE or RHIO services It is a very dynamic environment but interoperability will continue to expand and get more sophisticated Workflows will improve, new data sources will be added Quality improvement efforts will advance with more complete patient information and improved analytics We have solutions today that work today & are here to support your interoperability needs in the future

19 The Vision for Meaningful Use Each stage gets progressively harder to drive toward the ultimate goal 3 Stages of Meaningful Use Improved quality of care Stage 2 Stage 3 Stage 1

20 The New York ehealth Collaborative Regional Extension Center (REC) Is the federally designated entity to help providers adopt EHRs and qualify for incentives by achieving Meaningful Use Partners with local health groups in your community to get you the support you need Negotiates on your behalf with EHR vendors and IT suppliers Will be with you every step of the way

21 NYeC REC is the Sum of Many Parts NYeC works with a statewide network of highly qualified organizations Our collective mission: Provide the training and support services providers needed for doctors and other providers to adopt and meaningfully use of EHR systems Southern Tier HealthLink will connect you to the REC program.

22 There are 9 Stops on the Full Journey For Those Who Have Already Adopted, The Journey Starts Further Down the Line Select an EHR Purchase Implement Achieve Meaningful Use Join the REC Assess & Plan Design Infrastructure Prepare For Launch Use Receive Federal Incentives!

23 Stop Eight: Achieve Meaningful Use With the REC The REC is the federally-designated Meaningful Use expert for New York We ll walk you through what your practice needs to do We ll help you measure your readiness so you re prepared for your 90-day Meaningful Use evaluation period Without the REC The federal definition is over 800 pages long! Try to measure whether you re ready for evaluation Try to organize your federal 90-day evaluation period Page 23

24 Final Stop: Receive Federal Incentives With the REC Without the REC Hopefully this: Maybe: Page 24

25 Regional Extension Center Eligibility MD, DO, NP, PA practicing in typical primary care specialties including OB-GYN and Pediatrics, and practice size is 10 clinicians (with prescriptive privileges) or fewer - or - Practice is a federally-qualified health center or public or critical access hospital or primarily serves medically underserved populations You are eligible for the program even if you already have an EHR. If you do already have an EHR, the REC will assist you with postimplementation services to get your practice ready for Medicare and Medicaid incentive programs If qualified, the federal government is subsidizing your participation up to $5,000 per provider If you already have an EHR and need services to get to Meaningful Use, the standard program cost to you is $750 for one year of participation. If you already are going from a paper based business through to Meaningful Use, the standard program cost to you is $1,500 for 2 years of participation.

26 For more information about STHL services: - Call STHL at Visit For more information about the Regional Extension Center (REC) visit: Christina Galanis, Executive Director Marc Andiel, Technical Director Paul Almy, Project Coordinator, Technical John Hayek, Project Coordinator, Community Outreach Emily Pape, Project Coordinator, Privacy and Research

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