Presented by: DV-NJ HIMSS Fall Event 10/22/2009. Colleen Woods, Chief Information Officer, State of NJ Department of Human Services

Transcription

1 Overcoming the interoperability challenges between a health plan and a provider as payers have been reluctant to participate in traditional clinical exchanges DV-NJ HIMSS Fall Event 10/22/2009 Presented by: Colleen Woods, Chief Information Officer, State of NJ Department of Human Services Tom Gregorio VP and CIO Newark Beth Israel Medical Center

2 Topics to be Presented NJ Medicaid s and the States Interoperability goals Demonstrating Meaningful Use and true interoperability in a highly concentrated Medicaid population Outline of Healtheciti s key initial use cases that focus on providing exchange data to less sophisticated trading partners. Accelerating Clinical Interoperability: Reduce the time to achieve meaningful clinical value and implement clinical initiatives across legacy systems through use of an open portal framework and service oriented architecture. Leverage Existing and Future Investments: Protect IT investments by leveraging existing data marts and patient indexes in order to share clinical data with external trading partners.

3 The Challenge Faced by Payers and Health Systems Facility 1 Facility 2 Facility 3 Interoperability Nightmare FQHCs Absolute chaos on adoption of standards Physician Obstacles to unified reporting for care givers State and Health Plans Home Care Facility 4 Health Plans sitting on sidelines deciding if they will participate in health exchanges Consumers relegated to passive participants Patient Ambulance Nursing Home

4 Everyone s Interoperable Goal Improved outcomes Stay competitive Increase revenue Meet legal requirements Make more informed decisions Meaningful use of EHRs ARRA Meaningful Use Timelines fixed: 2011 is only 14 months away Funding rules defined Applications were due to ONC on October 16th Front-loaded incentives and penalties up to $44k per physician Ultimately linked to achieving measurable outcomes Capturing and sharing data is the first step

5 The State s Interoperability Goals Long Term Goals: 1. Ensure that all providers have access to health IT regardless of size, financial capacity or location. 2. Promote clinical information exchange between providers. 3. Develop framework to empower patients with access to their health records and to actively participate in health management. 4. PHI to be in private and secure network that will promote healthcare provider access. 5. Crete a sustainable state-level entity to convene stakeholders, coordinate planning, monitor progress and report to Governor, Legislature and all health care stakeholders.

6 The State s Interoperability Goals Immediate Goals 1. State Meaningful Use and interoperability will be totally consistent with evolving federal standards. 2. Change manual workflows to automated access where we see possible and logical use cases: Access to medication histories Patient tracking Leverage claims data Reduce duplicate and unnecessary tests Manage immunizations improve patient care while managing costs Share public health data, when permitted Offer more access to Medicaid systems

7 The State s Interoperability Goals HITC and Office for e-hit to convene stakeholders on all levels (Next Steps): 1. Privacy and Security 2. Use of State s Regulatory Authority over payers 3. Consumer and Provider involvement. 4. Consent, authorization, common statewide forms, consolidated privacy laws. 5. Identifying and engaging those stakeholders that do not want to voluntarily share clinical health information. 6. Immediate and long term funding needs and solutions. 7. Provider conferences on federal funding opportunities.

8 Medicaid s Interoperability Goals Demonstrate Meaningful Use and true interoperability in a highly concentrated Medicaid population to achieve goals of the transformation grant How Medicaid is planning to leverage the investment made by CMS to support statewide data exchange Medicaid s intent to leverage existing Medicaid infrastructure to make it available to state care givers Improve patient care while managing costs Change manual workflows to automated access where we see possible and logical use cases Access to medication histories Patient tracking Leverage claims data Reduce duplicate and unnecessary tests

9 Case Study 1st Facility in HealthecITi Medical Center Background 673-bed regional care, not for profit teaching hospital Major referral and treatment center for northern NJ 300,000 outpatient visits and 25,000 admissions annually Top level Objectives Single look and feel for clinicians Interoperability between partner institutions Comprehensive patient record Flexible and scalable platform Meaningful use cases with Medicaid and the State

10 The Solution Portals from IGI Health and an Interface Engine from Intel Physician Facilities Provider Portal Hospital/IDN FQHC Nursing Home API Connectors Clinical Data Repository Ambulance Home Care Health Information Gateway Patient Patient Portal Payer and State Services Patient Index Medication Histories Claim Data

11 Provider and Patient Portal Using the portal framework, Care Givers can deliver a broad set of services: Access virtual EMRs & sharing of longitudinal patient data Provide instant access to lab, claims, and medication data Capture patient consent for data sharing Verify patient insurance eligibility & benefits Transfer Patients between internal and external facilities Seamlessly interface with facility, State, Federal & Health Plans Repositories Interface with clinical data repositories and EMR s Manage patient care by knowing whereabouts Establish referral workflows & continuity of care Use e-prescribing to fill prescriptions Increase member satisfaction with PHR Eliminate duplicate tests

12 Interface Engine Healthcare Information Gateway Uses Service Oriented Architecture (SOA) Solution will overlay existing legacy systems Pre-built data maps, web services and integration workflows Integration engine with out of the box semantic mapping HL7, EDI, X12, HIPAA and IHE XDS support Processing speed of 400 transactions per second Codeless Designer Visual IDE for workflow & data map design-eliminates coding High Performance Runtime Optimized for Intel Multi-Core. Scales on standard Intel servers Soft-Appliance Software delivers appliance-like manageability, upgrade flexibility and Mgt UI Protects, Secures, Governs, & Accelerates Healthcare transactions 12

13 Healthcare Standards to make connections to EMR CLINICAL HL7 ADMINISTRATIVE HIPAA ADT, ORR and ORX Continuity of Care (CCD) Clinical Data Architecture (CDA) Patient Transfers (UT) Order Entry and Results MEDICATIONS New Rx and Refill Medication history DOCUMENT SHARING NCPDP Document Attachments Pre/Post Operative Documents Lab Reports & Images Secure Messaging (Level A4) Real-Time Transactions: Eligibility & Member Benefits Referrals & Authorizations Claim Status & Remittance Advice Profession/Dental Claims WC, P&C, Secondary UB inpatient, outpatient, LTC, AMC Batch Transactions: Claims, Referrals, Eligibility Enrollment, Electronic Remittance Advice (ERA) FINANCIAL Co-payments Credit Card payments Check guarantee Electronic Funds Transfer (EFT) FSA/HSA Account Link

14 Shovel Ready ARRA Solution ARRA Criteria E-prescribing Efficiency measures/quality reporting Patient access to e-health records Support health information exchange Payer transactions Security, privacy, consent Intel/IGI Solution NewRx, Re-fills, History Universal Transfer Form tracks lab results, allergies immunizations and more interoperable, connects stakeholders, scalable claims processing, eligibility verification, remittance advice HIPAA compliant Most cost effective way to address Meaningful Use Criteria

15 The Community Solution State and Health Plans Patient Portal Shared Service Data Marts Physician Portal Allow for interoperability among legacy ambulatory EMR systems Deploy meaningful clinical value in less than 6 months Offer an affordable, cost-effective and highly-valued solution Use an open architecture product reducing development costs Trade Clinical data with NJ Medicaid to show Statewide interoperability Newark Beth Israel Medical Center VPN Newark s Federally Qualified Health Centers (8 Locations) Other Healtheciti facilities Other Healtheciti facilities

16 Use Case: Medication History from New Jersey Medicaid Provider logs on to health-e-citi enters one of the 3 approved patient identifiers in order to request the medication history. The request is transmitted and processed. Health-e-cITi HIE service formulates a response from the following information. Provider views the medication history through the Health-e-cITi Provider Portal. Patient First Name Patient Middle Initial Patient Last Name Service (dispense) Date Drug Name Dosage Form - (i.e. Tablet, Patch, Drops) Days Supply Quantity Dispensed Pharmacy New Jersey Medicaid Provider # Pharmacy Name Pharmacy Telephone Number Prescribing Physician New Jersey Medicaid # Prescribing Physician Name Prescribing Physician Telephone Number Prescription Number Care giver desires medication history and claims data from New Jersey Medicaid and other health plans. 16

17 Medication History Results Screen 17

18 Use Case: Immunization Records Patient requests immunization verification from physician. Provider logs on to Health-e-cITi enters patient demographic search information and captures patient consent to release information. Provider submits request for immunization data. The request is transmitted and processed. Health-e-cITi HIE service formulates a query in HEDIS format and sends request to the State immunization system. Provider views Intra-State immunization data of the patient through the Health-e-cITi Provider Portal. Provider can also append the patient record with new immunization details from the encounter. 18

19 Immunization Results Screen 19

20 Use Case : Universal Transfer Form (UTF) Patient Transfer/ Discharge - Pending State mandate to use common form for all patient transfers out of licensed facilities. Form contains Continuity of Care (CCD) information and can help track patients Emergency Facility Inpatient Facility Rehab Facility Patient 1. Treatment & Testing transfer patient & UTF Patient 3. Only necessary treatment provided and UTF updated transfer patient & UTF 4. Only necessary treatment Labs and Imaging Reviewed Case Worker/ Nurse Identifies Health Plan Lab results Radiographs Advanced Directives 2. Nurse creates attachments to UTF Improved patient care and tracking for facilities and health plans. 20

21 Universal Transfer Screen (CCD) 21

22 Current Accomplishments Infrastructure is up running for clinical data sharing Pilot site NBI with 1 st FQHC site on Sept 21 st Medicaid medication history (1 st Meaningful use delivery under Medicaid Transformation Grant) Able to access ER, Lab, Radiology records Synchronization with State immunization system (NJIIS) Live Interface to facility internal patient medical record and data warehouse Healthcare Information Exchange Grant submitted on Sept 25 th 2 nd Pilot site East Orange FQHC went live on Oct 5 th Hospital staff in several departments now accessing portal services Continuation of Rollout through the end of the year

23 Other Potential Use Cases Patient Health Preventive Programs Lead Screening Electronic interface with Child Lead System Early Hearing Detection and Intervention (EHDI) Electronic interface with EBC On-line data entry by audiologists, EHDI program and HCP Vaccines For Children (VFC) On-line data entry by HCP and vaccine preventable disease program Inventory Management, Order and Distribution System (IMODS) Payer Data Based on Medicaid s lead, other payers are considering sharing medication histories, claims data and other logic clinical data