Network of Networks: Approaches to Interoperability from Coast to Coast

Transcription

1 Network of Networks: Approaches to Interoperability from Coast to Coast Mariann Yeager, CEO, Healtheway, Inc. Laura McCrary, EdD, Executive Director, Kansas Health Information Network DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Mariann Yeager CEO, Healtheway

3 Conflict of Interest Mariann Yeager Has no real or apparent conflicts of interest to report. HIMSS 2015

4 Healtheway s Role Healtheway is the trusted, independent convener of industry and government Works to address the challenges of secure, interoperable nationwide health information exchange. SECURE INTEROPERABLE NATIONWIDE 4

5 Acting in the Public Interest As a nonprofit 501 (c) 3 organization operating in the public interest, our public-private governance process insures transparent oversight of this work. Healtheway serves as a neutral, third party convener. The practical application of our work: Enables consensus agreement on the policies and standards required to reduce barriers to data exchange Advances development and continued support for information exchange governance frameworks Provides services that enable data sharing networks to interoperate 5

6 Healtheway Initiatives Healtheway s independent initiatives each having their own Mission Governance Membership Structure Healtheway is an ideal home for projects that require collaborative environment where multiple parties with differing perspectives can work together. 6

7 Current Healtheway Initiatives The ehealth Exchange is a rapidly growing community of exchange partners who share information under a common trust framework and a common set of rules Carequality is a public-private collaborative building consensus among existing health IT data exchange programs on technical specifications and best practices, similar to the work required to create the nationwide ATM network by the banking industry 7

8 ehealth Exchange The Largest Data Sharing Network in the U.S. States Federal Govt HIEs Care Facilities Tech Vendors Payers Pharmacies Rapidly growing network of partners that securely share health information over the Internet 8

9 ehealth Exchange Growth (2015 Projections) Total Participants 4 ONC Initiative: NwHIN Exchange Total Participants 23 Operations supported by ONC Network matures Total Participants 44 Growth fueled by MU2 TOC measures Total Participants Network matures 81 Growth fueled by MU2 TOC measures Network adoption doubles New use case New types of participants / networks Enhanced capabilities Streamlined testing / onboarding Projected Participants

10 Largest Data Sharing Network in the U.S. The ehealth Exchange connects: All 50 states Four federal agencies (DoD, VA, HHS including CMS, and SSA) 30% of U.S. hospitals 10,000 medical groups 850 dialysis centers 5200 pharmacies Supporting more than 100 million patients 10

11 11 ehealth Exchange Value Benefits Participants Reduced costs legal fees, interfaces Improves clinical decision making Enables exchange with governmental providers Multi-purpose platform for interoperability adaptable / flexible Economic Impact National level ROI aggregate cost savings / efficiencies Example: Social Security Automates records requests (15 million / year) Efficiencies and cost savings for SSA and providers Faster determinations; expedites payment of cash benefits to disabled Recovery for uncompensated care Bon Secours - $2.2M / year Childrens Medical Center, Dallas Savings of $572K over five years ROI of 862%

12 Tipping Point for Nationwide Health Information Exchange There will be multiple data sharing networks to connect physicians, hospitals and other care providers There may be multiple ways to connect care settings using different standards We must build from what exists today and adapt over time We must interconnect networks and systems through a nationwide interoperability framework built through a public-private consensus process

13 Carequality for a Common Interoperability Framework Accelerating seamless, interoperable health information exchange

14 What if you had a cell phone plan that only allowed you to call other customers of your carrier? That s the situation for most healthcare providers today, when they join a data sharing network. 14

15 What is Carequality? Carequality is a public-private, multi-stakeholder collaborative that has come together to address this challenge. Carequality enables connectivity between data sharing networks, creating a web of interconnected networks 15

16 The Carequality Community Physicians Consumers Government Agencies Data Sharing Networks Payers Behavioral Health Acute Care Long Term/Post-Acute Care Hospice and Home Care Research Public Health Vendors Standards Development Orgs. Pharmacies EMS Services 16

17 Carequality Members 17

18 A Brief History Carequality Launch February 2014 Steering Committee Formed June 2014 Principles of Trust Adopted January 2015 May 2014 Operating Principles and Governance Model Aug/Sept 2014 Advisory Council and Work Groups Chartered 18

19 Essential Elements Common rules of the road: In order for the varied participants to trust each other with health information, everyone need to have a legal obligation to abide by the same rules. Well-defined technical specs: Shared rules are not enough; clear standards must be laid out in an implementation guide that all implementers can follow. A participant directory: To connect using the common standards, systems must know the addresses and roles of each participant. 19

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21 For more information HIMSS 2015

22 Laura McCrary Ed.D, Executive Director Kansas Health Information Network DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

23 Conflict of Interest Laura McCrary, Ed.D Has no real or apparent conflicts of interest to report. HIMSS 2015

24 Kansas Health Information Network, Inc. 1. Over 2 Million + Unique Patients in KHIN Exchange 2. Access to 5 Million + patients across exchange connections 3. 1,200+ KHIN Member Organizations Organizations in Production (584 facilities) 320 testing 5. Average 100,000 queries per month 6. Personal Health Record-38 organizations 7. Public Health Transmissions Syndromic Surveillance Immunizations Electronic Lab Reporting Cancer KS Infectious Disease Registry

25 Kansas HIE Environment 1. Opt-Out state-patient Consent managed at the state level 2. Two competitive HIOs in Kansas 3. Enabling legislation and corresponding regulations 4. Heavily regulated by the Kansas Department of Health and Environment (KDHE) Year Certificate of Authority Process 2. Regulation of Technology Products and Services 3. Dispute Management/Security/Complaints

26 1400 Growth in KHIN Membership Total Number o KHIN Members Snapshot of the number of KHIN Participating Hospitals and Ambulatory Facilities at a given point in time. 0 Q Q Q Q Q Q Q Q Q JAN/FEB 2015 Point in Time

27 Growth in KHIN *LIVE Hospitals and Clinics 584 Total Number of *Live KHIN Members Snapshot of the number of KHIN Participating Hospitals and Ambulatory Facilities that are *Live, in production, at a given point in time Q Q Q Q Q Q Q Q Q JAN/FEB 2015 Point in Time

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29 KHIN HIE Products/Services Secure Clinical Messaging/DIRECT 2. Provider Portal Full HIE Query functionality Web based access 3. Personal Health Record 4. State level interfaces Immunizations Syndromic Surveillance Reportable Diseases Cancer Registry Infectious Disease Registry 5. Alerts and Data Extracts

30 Types of DATA Sharing Network Connections DIRECT HISP to HISP XDR Provider Directory Query HL7 Discrete Data XCA ehealth Exchange

31 DIRECT/HISP Connections Covisint Cerner DataMotion eclinical Direct Inpriva MaxMD Medicity MedAllies NextGen Share Nitor Group Relay Health Secure Exchange Solutions SureScripts Updox Bright EHR Askesis, Cerner Foxfire/Medflow, Meditech, Success EHS ecw CPSI, Netsmart Phoenix Ortho, Prognosis Medicity Allscripts, Qvera NextGen Crystal Practice Management PDS/Practice Partners HMS/Medhost, Management Plus, Revolution, Visionweb SureScripts, SOAPware Compulink, emd's, Eyefinity, Greenway, Maxim Eyes, MacPractice, Modernizing Medicine, Practice Fusion, Vitera, Healthland

32 KHIN Active connections to other HIE/Data Sharing Networks 1. Lewis and Clark Health Information Exchange (LACIE) 2. CORHIO 3. Missouri Health Connection (MHC) 4. Veterans Administration 5. HIETexas

33 LACIE First discussions Fall 2012 Data sharing agreement Fall 2013 Data Testing Spring 2013 and Fall 2013 Data Types Shared On-demand CCD of discrete HL7 data Production December 2013 Data Transport Method XCA Challenges Improperly formatted CCD/CCDA cause LACIE errors Upgrade issues

34 CORHIO First discussions 09/10/12 Data sharing agreement 8/15/13 Data Testing Data Types Shared Production Data Transport Method Challenges 10/01/14 for HL7 CCD/CCDA, HL7 Discrete data N/A HL7 and XCA 1. Resource Assignment from HIE vendor 2. Upgrades Necessary 3. Patient consent issues on HL7/no security override in CORHIO

35 MHC First discussions 02/05/13 Data sharing agreement 8/22/13 Data Testing Data Types Shared Production Data Transport Method Challenges CCD/CCDA XCA or ehealth Exchange 1. Resource availability 2. Data Sharing with Health Plans 3. Priority Status

36 VA First discussions 1/2014 Data sharing agreement Data Testing Data Types Shared Production Data Transport Method 3/10/2014-Readiness Survey ehealth Exchange Certification CCD/CCDA, On-demand CCD of discrete HL7 data 2011 ehealth Exchange Challenges 1. Unique specifications regarding patient matching- SSN required 2. Patient consent issues-va only has 2000 Kansas patients opt-in

37 HIETexas/eHealth Exchange First discussions 07/2014 Data sharing agreement Data Testing 01/2015 Data Types Shared Production Data Transport Method Challenges 3/10/2014-Readiness Survey ehealth Exchange Certification CCD/CCDA, On-demand CCD of discrete HL7 data 2011 ehealth Exchange Understanding requirements for ehealth Exchange Registered with certificates w/ehx for UAT and production Separate servers for UAT and production

38 Lessons Learned 1. Data Sharing Network Connections are impacted by the same factors as EHR to Network connections. Lack of Resources Lack of Technical Readiness Not a priority Too complex Each one is different 2. Data Sharing Network Connections are more difficult. Patient Consent Differences Trust Little Vendor Experience

39 Laura McCrary Ed.D Kansas Health Information Network Executive Director Office: