HIE: The Vermont Version
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1 HIE: The Vermont Version David Cochran, MD President and CEO Vermont Information Technology Leaders, Inc.
2 Topics VITL Overview Vermont Health Reform Blueprint for Health Health Information Exchange
3 Snapshot of Vermont 637,000 population 9615 square miles 13 Health Service Areas Few large employers (IBM, State Government, University of Vermont) Little industry Dairy and Tourism
4 VITL Background Started as a project within the Vermont Association of Hospitals and Health Systems Spun off as independent entity in July 2005 Received 501(c)(3) non-profit status in March 2009 A public-private partnership with participation from health care providers, government, employers, consumers, and health plans Shared public investment supporting IT requirements of Vermont s health care reform efforts 4
5 VITL Programs Vermont REC Statewide HIE Blueprint Support eprescribing 5
6 Support Based on Practice s Technology Maturity Paper EHR Labs Blueprint Meaningful Use Advanced HIE Paper (clinical) practice May have a PMS EHR installed Standard workflows entry is manual Lab results update EHR May also have immunization Patient demographics and clinical summary sent to Registry Clinical, structured data captured Quality measures are automatic Clinical data sharing with consent 6
7 Vermont Health Care Reform 60+ Discrete, Active Initiatives which combine to Increase Coverage New Coverage Options Premium Assistance H202 Roadmap to Single Payer Improve Quality Provider Access, Transparency Promote Wellness / Prevention Blueprint for Health integrated & Community Health Team Health Information Technology Accountable Care Organizations Contain Cost Growth All of Above PLUS Cost Transparency Statewide Health Resource Planning and Review Prescription Drug Cost Containment Administrative Simplification 7
8 HIT & HIE Fully Integrated in Health Care Reform from start In 2005, VT authorized and funded a single statewide Health Information Exchange VITL (Vermont Information Technology Leaders), a 501(c)3 public/private partnership, developed standards based architecture for statewide HIE and began operations. Investment in EHR adoption and deployment included in HCR legislation, starting with a primary care EHR pilot, expanded through creation of HIT Fund (fee of of 1% on each health care claim) in
9 Blueprint for Health Advanced Primary Care Practices Community Health Teams Payment Reforms Health Information Infrastructure Expansion & Quality Improvement Program (EQuIP)
10 Advanced Primary Care Practice Doc Site Centralized Registry Community Health Team
11 NCQA Score & Payment $3.00 $2.50 $ PPPM per provider $2.00 $1.50 $1.00 $0.50 $ NCQA PCMH Score
12 Continuum of Health Services - General Specialized & Targeted Services Level of Need Higher Acuity & Complexity Lower Acuity & Complexity Advanced Primary Care Practice Health Maintenance Prevention Access Communication Self Management Support Guideline Based Care Coordinate Referrals Coordinate Assessments Panel Management Community Health Teams Support Patients & Families Support Practices Coordinate Care Coordinate Services Referrals & Transitions Case Management o DVHA Care Coordinators o SASH Coordinators Self Management Support Counseling Population Management Specialty Care Advanced Assessments Advanced Treatments Advanced Case Management Social Services Economic Services Community Programs Self Management Support Public Health Programs Level of Service & Support 6/15/
13 Blueprint for Health: Practice Transformation Engine Blueprint for Health s integrated platform: web-based registry, clinical data repository, population-based management tool Populated through the HIE for bi-directional feeds from practice and hospital EHR systems, labs, public health registries, other sources to support: clinical messaging, care coordination, patient and panel management functions 13
14 Hospitals Self-Help Recovery Communities Social, Economic, & Community Services Mental Health & Substance Abuse Programs Long Term Care Community Health Team Nurse Coordinator Social Workers Nutrition Specialists SASH Coordinator MCAID Care Coordinators Public Health Programs & Services Health IT Framework Evaluation Framework 6/15/
15 Federal HIT/HIE Policy, Oversight, & Standards - Office of the National Coordinator (ONC) State HIT/HIE Policy, Oversight, & Standards OVHA/HCR State Government & Public Health Vermont Health Care Providers & Institutions Public Health surveillance, registries, & other public health functions Medicaid health programs case management functionality and connectivity Other Medicaid & AHS case management functionality and connectivity Other state agency & dept. case management functionality and connectivity Law Enforcement, Corrections, & Court System NHIN Connectivity Health Information Exchange Cloud for secure, privacy protected interchange of health records, demographic data, image files, clinical messaging, & other digitized health information Statewide HIE Operated by VITL Individual Vermonters: connectivity to EHR Portals, Personal Health Records (PHR), Health 2.0 applications and Ix Services Tertiary and Community Hospitals Primary Care & Specialty Providers Federally Qualified Health Centers & Rural Health Clinics Free Clinics Mental Health/BH/SA Providers Long Term Care Providers Health & Hospice Providers Community Human Service Agencies (Family Centers, Area Agencies on Aging, etc.) 15
16 Blueprint Integrated Pilots Health Information Infrastructure Hospital (hosted EMR) Core data elements data warehouse Visit planners for individual patients Reporting for panel management & outreach ( s, CHTs) Clinical information for care coordination (CHTs, OVHA CCs) Tracking for public health services (e.g. cessation counselors) Reporting for public health planning Reporting & comparative benchmarks to support program evaluation VITL HIE FQHC (hosted EMR) Core data elements Core data elements Central Registry EMR EMR Core data elements No EMR Web Access Web Access Community Health Team
17 Blueprint Integrated Pilots Health Information Infrastructure Hospital (hosted EMR) data warehouse Visit planners for individual patients Reporting for panel management & outreach (PCMHs, CHTs) Clinical information for care coordination (CHTs, OVHA CCs) Tracking for public health services (e.g. cessation counselors) Reporting for public health planning Reporting & comparative benchmarks to support program evaluation VITL HIE FQHC (hosted EMR) Central Registry EMR EMR Web Access Web Access Community Health Team
18 Blueprint Integrated Pilots Evidence Based Quality Improvement Source Processing & Storage Analysis Reports & Uses EMRs used for Individual Patient Care EMR bases transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite used for Individual Patient Care DocSite base DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement Claims from Commercial Insurers & Medicaid BISCHA Multipayer base BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP bases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability Public Health Surveys & Collection Public Health Registries & bases VDH Health Surveillance Analytic base VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning
19 Blueprint Integrated Pilots Evidence Based Quality Improvement Source Processing & Storage Analysis Reports & Uses EMRs used for Individual Patient Care EMR bases transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite used for Individual Patient Care DocSite base DocSite Reporting Tool Health Status Measures Population Management Contracted Analysis Services Healthcare Quality Measures & Standards Quality Improvement Claims from Commercial Insurers & Medicaid BISCHA Multipayer base BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP bases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability Public Health Surveys & Collection Public Health Registries & bases VDH Health Surveillance Analytic base VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning
20 Blueprint Integrated Pilots Evidence Based Quality Improvement Source Processing & Storage Analysis Reports & Uses EMRs used for Individual Patient Care EMR bases transmission & transformation VITL / GE EMR Reporting Tool or Analyst Clinical Process Measures Individual Patient Care & Support Services DocSite used for Individual Patient Care DocSite base DocSite Reporting Tool Health Status Measures Population Management UVM CCTS Health Informatics Platform Healthcare Quality Measures & Standards Quality Improvement Claims from Commercial Insurers & Medicaid BISCHA Multipayer base BISCHA Reports Healthcare Patterns & Resource Utilization Provider Payment for Quality VCHIP Chart Review & NCQA Scoring VCHIP bases VCHIP Analysis & Report Generation Healthcare Expenditures & Financial Impact Program Evaluation & Sustainability Public Health Surveys & Collection Public Health Registries & bases VDH Health Surveillance Analytic base VDH Health Surveillance Analyst Population Indicators & Risk Factors Community Prevention Planning
21 Outcomes & Effectiveness Reporting Guide Health Reform Policies & Programs Routine Intermittent Analytic data sets Academic Analyses & Studies Advanced analysis New analytic models Supportive reporting DocSite Clinical Multipayor Claims Public Health Other Sources HIPAA Compliant Environment Central Repository Storage Normalization De-identification Re-identification Analytics (Routine) Analytics (Exploratory) Workbench Reporting Analytic models De- Identified High Performance Computing Center Processing Query for experiments Sources UVM CCTS Health Informatics Platform
22 HIE Current State Infrastructure Connectivity Nine hospitals 54 practices 1 commercial lab Blueprint practices Meaningful Use
23 Learnings and Issues Vendor Challenges Capabilities Business model Focus Interoperability State of the standards Sustainability Beyond the public utility model Preparing for reimbursement reform
24 Questions? David Cochran, MD Vermont Information Technology Leaders, Inc. (VITL)
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