Direct EHR Exchange A New Reality with National HIT Promise

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1 Direct EHR Exchange A New Reality with National HIT Promise December 1, 2011 New York ehealth Collaborative Digital Health

2 Objectives To share the understanding that: Patient care can be enhanced by enabling EHRcentric workflow data exchanges that are physician useable. EHR exchanges can occur due to technology advances and EHR vendor collaboration. Standards-based patient data exchanges as a health Internet-based services provider is a nearterm scaleable solution. 2

3 Presenters George T. Hickman, FCHIME, FHIMSS, CPHIMS Executive Vice President and Chief Information Officer (CIO) for Albany Medical Center Past partner Ernst & Young LLP Third academic CIO post Worked with health provider organizations across the U.S. as well as for the Ministry of Health in Singapore and the U.K Health Authority 2007 CHIME/HIMSS John E. Gall, Jr. CIO of the Year Board member and a charter member of the College of Healthcare Information Management Executives (CHIME), a CHIME Fellow and a New York CHIME StateNet representative Past board chair, past executive compensation committee chair, and a Fellow for the Healthcare Information and Management Systems Society (HIMSS) and a past HIMSS Analytics board member Sits on the HIXNY Board and Executive Committee, the editorial advisory board for healthsystemcio.com as well as several associational, local, state and vendor industry committees Frequent speaker and lecturer Co-authored, The Healthcare IT Planning Fieldbook. Holds a BS and an MS in engineering from the University of Tennessee. A. JOHN BLAIR, III, M.D., F.A.C.S. Health care and technology executive and the CEO of MedAllies MedAllies facilitates physician adoption of health information technology MedAllies built and operates the Hudson Valley Community Health Integration Platform (CHIP) Operates under the direction of the Taconic Health Information Network and Community (THINC), one of the nation s leading regional health organizations and a Regional Extension Center agent for the Hudson Valley Serves on the Privacy and Security Workgroup and the NHIN Workgroup of the Policy Committee of the Office of the National Coordinator for Health Information Technology Member of the National Committee on Quality Assurance (NCQA) Committee on Performance Measurement Serves on the Health Information Technology Advisory Committee (HITAC) for the National Quality Forum Board-certified general surgeon President of the Taconic Independent Practice Association Medical degree from Rush Medical School in Chicago Surgical training at the University of Texas Medical Center in Dallas Gastrointestinal fellowship at the Middlesex Hospital in London, England 3

4 Presenters (continued) Faisal Mushtaq, Senior Vice President, Product Development. 20 years of Product development & Technology management experience Took over Product Development across Allscripts at the time of the merger with Misys. Ran the Development for Misys Healthcare CTO of Biz360 Vice President of Product Development and Support for Neoforma. Proven expertise in managing global technology and engineering teams New approaches in applications development that leverage Software as a Service, Open Source, and web-based capabilities Serves on the board of directors of the North Carolina Technology Association, board of directors of CED and on the HCL Technology Advisory Board Active supporter of American Heart Association of Triangle and recently served on the Leadership team of Triangle Heart Ball Bachelor of Science degrees in both computer science and electrical engineering from the University of Wisconsin Post Graduate Diploma in business administration from the University of Karachi Charlene Underwood, MBA, FHIMSS, Chair, HIMSS Board of Directors Senior director of Government and Industry Affairs for Siemens Healthcare Health Services Nationally recognized expert in the field of healthcare informatics Directs Siemens outreach and advocacy activities in emerging market initiatives, specifically those related to government and industry activities in healthcare information technology Member of the Health Information Policy Meaningful Use Workgroup and the HL7 Advisory Committee. Chair on the HIMSS Board of Directors. Served as the first chair of HIMSS EHR Association and is a past board member of the HIMSS Delaware Valley Chapter Board as well as National Quality Forum Health Information Technology Expert Panel Ms. Underwood has held leadership roles in influential organizations including HL7, in which she participated in defining the organization s EHR functional standards and model; and in the Computerized Patient Record Institute 4

5 Direct EHR Exchange How it works Albany Medical Center is preparing its internal capability to exchange patient clinical data between its EHR and those of its affiliated physicians. A patient s clinical data can be securely moved over the Internet and "land" in the workflow tasking features of a provider's patient-specific EHR, allowing both parties to do away with paper faxes and mail copies, and the extra steps required to also scan the associated paper document into the patients EHR. 2. Direct network routes referral to specific EHR 1.Physician refers patient to hospital or specialist 3. Hospital or specialist treats patient 5 4. Direct network routes care summary to specific EHR

6 Direct EHR Exchange The key uses of our EHR Direct exchange capability are to eventually support our: Affiliate physician providing us with specific patient data that enable a referral request, including the reason for the referral, patient demographics, allergies, immunizations, active medications, problems, lab and other exam results, vital signs, HPI, and chief complaint. Medical Group practice physician group providing our affiliate with specific patient data that describes what occurred during a clinic visit, including the clinical summary from the encounter and other information as described above. Albany Medical Center Hospital providing our affiliate with specific patient data that describes what occurred during the hospitalization, including the discharge summary, problems, procedural notes/interpretations, medications at time of discharge, and lab results. 6

7 Direct EHR Exchange What it takes Albany Med has the capability to support this exchange for its Siemens Soarian and Allscripts Enterprise EHRs. Other EHRs as have been involved in efforts with MedAllies and state their ability to support such an EHR Direct exchange for the version/releases noted: Allscripts Enterprise 11.2 HF 9 Greenway PrimeSuite NextGen 5.7 Siemens Soarian Clinicals 3.2 with Advanced Interoperability Service eclinicalworks 9.0 7

8 Direct EHR Exchange Physician practices need to understand how the workflow elements of this exchange work for their respective vendors and do the necessary "build" work with the EHR to allow it to package and send the care document to Albany Med's EHR as well as to receive and display our care document upon receipt. Further, these services will be securely routed via the Internet with a service likely hosted by MedAllies, and an agreement with that party will be necessary. Additionally, the active physician rosters of the practices must be kept current with MedAllies record locator capability. 8

9 Direct EHR Exchange Governance and Project Structure 9

10 Direct EHR Exchange: A New Reality with National HIT Promise A. John. Blair, III, MD CEO, MedAllies Fishkill, NY

11 User Stories: Closed Loop Consultation 11

12 User Stories: Hospital Discharge 12

13 Direct Advantages 13 Scalable Inexpensive EHR Vendors Ready o Technology o Workflow Practice Provider Meaningful Use o Stage I o Stage II

14 Vision of a HISP Network Routing Directories Certificates National vs. Regional HISP-to-HISP Edge Applications EHR HIS Modules 14

15 Participation Regional Pilot National General Availability 15

16 Government Perspective Charlene Underwood, MBA, FHIMSS Senior Director, Government & Industry Affairs Siemens Healthcare Member, HIT Policy Meaningful Use Workgroup HIMSS Board Chair

17 American Recovery & Reinvestment Act (ARRA) HITECH February 17, 2009 First Steps Adoption of certified EHRs Meaningful use of EHRs Incentive payments to eligible professionals and hospitals Investment in nationwide HIT infrastructure Grant money for demonstration projects The Intended Destination High quality, safe, effective, and equitable care for all Seamless patient-centric care Realigned incentives and measures that foster prevention, intervention, coordination, effectiveness Regional clinical information interoperability on a national backbone The goals are quality and efficiency If we encourage better performance, then physicians are going to find ways to improve. And health information technology is one crucial way to do that. David Blumenthal MD, MPP Former National Coordinator for Health Information Technology, ONC 17

18 HITECH Framework for Meaningful Use of Electronic Health Records (EHRs) Blumenthal D. N Engl J Med 2009; /NEJMp

19 Meaningful Use Workgroup Recommendations Achieving Meaningful Use Meaningful Use Criteria SOURCE: HITECH Policies HIT-Enabled Health Reform 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) 19

20 Meaningful Use Workgroup Recommendations Health Outcomes Policy Priorities* 1. Increase quality, safety, efficiency, and reduce health disparities 2. Engage patients and families 3. Improve care coordination 4. Improve population health 5. Ensure privacy and security protections *Adapted from National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America s Healthcare. Washington, DC: National Quality Forum;

21 Meaningful Use at a High Level Requirements Store, display, and report on key patient data Support provider initiatives for safe medication management Assist in identification of problems Promote exchange of clinical information (interoperability) in a standard way that others can use Provide patients with clinical information electronically Protect security and privacy using standards Report on clinical quality measures 21

22 Trends In Year-To-Date Payments Trends In Year-To-Date Payments In Millions From May To October 2011 $1, $1,239 m $1, $1, $ $ $ $ $0.00 $190.4 m $273.2 m Data from CMS, as of October 31, 2011 $397.4 m $652.2 m May Jun Jul Aug Sep Oct Core HIS Components 389 $860.1 m Series2 Medicaid Series1 Medicare

23 Actual Year-To-Date Spending vs. Projections Medicaid and Medicare EHR Incentive Spending In 2011 Actual Year-To-Date Spending versus Projections $4.7B $1 to 2.8B $1,239B $860.1M Actual Spending In FY 2011 Data from CMS, as of October 31, 2011 Paid Thru 10/11 CMS Projection for FY 2011 Core HIS Components CBO Score For FY 2011

24 Rollout of Meaningful Use Stage 2 Timeline January 13 HIT Policy Committee (HIT-PC) Meaningful Use (MU) Workgroup issued a request for input on Draft Objectives/ Measures for Stage 2. June September HIT Standards Committee identifies standards and certification criteria. 1Q 2012 CMS and ONC prepare CMS Proposed Rule (Incentive Program with Objectives/Measures) and ONC Interim Final Rule (Standards & Certification Criteria). 2Q 2012 CMS and ONC publish Final Rules. Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Q1 Q March June MU Workgroup prepared recommendations to the HIT-PC which will then modify/ approve and send to CMS. Approved on June 8th. September 1Q 2012 CMS and ONC formulate proposed rules for objectives, measures, standards, and certification criteria.

25 Meaningful Use Stage 2/3 Recommendations Approved by HIT Policy Workgroup June 8, 2011 Changes to Stage 2 Timing Stage 2 objectives and measures (core & new) EH: ~30 EP: ~30 Stage 1 Core: Thresholds increased and objectives have more requirements 2 eliminated or merged Stage 1 Menu: 10 objectives moved to core New Stage 2 objectives Greater and deeper health information exchange and more patient engagement. 25

26 Meaningful Use WG Stage 2/3 Multiple Work Streams to Consider ONC Ongoing HITPC/ MU WG June 8, 2011 MU Stage 2 Definition (CMS) Sept./Oct Security/ Privacy Nov 2011 IOM Report August 3, 2011 Quality Measures Sept./Oct HITSC Standards & Interoperability Framework Patient Safety 26

27 ARRA and Health Reform ARRA (HITECH) February 19, 2009 Meaningful Use Certified EHRs Incentives Quality reporting Affordable Care Act (PPACA) March 23, 2010 Expanding coverage Reforming the delivery system Financing reform Medicare and Medicaid payment Building more primary care Wellness and prevention Quality and safety Regulatory oversight Information management making sure patients and all health care providers have the right information at the point of care will be a core competency of ACOs. Donald Berwick, MD CMS Administrator 27

28 Summary Trends Driving Information Exchange New payment models driving integration, including ACOs and Medical Homes Federal and state grants and incentives for Health IT Increased federal influence on information exchange through Meaningful Use and certification Increased EHR adoption by physicians and hospitals Increased focus on reducing variability in standards - a single set of standards with implementation guides Emphasis on data liquidity and patient-engagement 28

29 The Direct Project Allscripts EHR Integration Faisal Mushtaq, SVP, Product Development

30 The Direct Project establishes standards and documentation to support simple scenarios of pushing data from where it is to where it's needed 30

31 Agenda How It All Began Allscripts EHR Integration 31

32 How it All Began Allscripts & Albany Medical Center has a Long-term Strategic relationship George Hickman, CIO, AMC has been leading the vision to connect healthcare providers in Hudson Valley through Direct Standards Participants Multiple EHR vendor o Allscripts, Siemens, NextGen, Greenway, eclinicalworks, Epic MedAllies HISP Allscripts EEHR Participants o Albany Medical Center, Community Care Physicians 32

33 The Direct Project Allscripts Goals Support the Direct standards for data exchange between EHRs Support Clinical data exchange standards for the state of NY To enable Clinical workflows that o Allow physicians to do referrals among Allscripts and Other EMR o Support additional data exchanges within respective EMRs Leverage a HISP (MedAllies) to enable data exchange 33

34 It Has Been More than Software Development Participation in Working Groups: Best Practices, Communications, Implementation Geographies, Reference Implementation Design Clinical Workflows: that support large and small physician practices IDDUINEM (if doctors do not use it, nothing else matters) 34

35 Direct with XDS Communities EHR Community EHR Application HISP XDR endpoint EHR Application EHR Community XDR endpoint Provider with no EHR EHR Application 35

36 Allscripts in the Hudson Valley AMC Community Albany Medical Center (Hospital) SIEMENS MedAllies Direct HISP XDR endpoint AMC Enterprise EHR Application CCP Community XDR endpoint CCP Enterprise EHR Application 36

37 DIRECT Pilot Clinical Workflows Hospital Discharge: export CCD to one or more Intended Recipients (e.g., primary care) Ambulatory Referral o Referral to specialist: export CCD to an Intended Recipient (the referred to provider) o Specialist summary back to referring provider: export CCD to an Intended Recipient (the referring provider) 37

38 DIRECT Pilot - Allscripts EHR Scope Document Consumer (importing) make use of Intended Recipient o Receives inbound document, Matches to and saves to a patient record Document Source (exporting) o Selects to export a CCD List of targets comes from configuration work Intended Recipient(s) sent with Document to HISP for routing o Future work IHE Provider Directory ONC S&I work on Provider Directory 38

39 References Direct Project o o ONC S&I o Direct Demo, 2011 HIMSS using Hudson Valley o Files / Direct Demo folder 39

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