Session # 13 Breaking the Barriers to HIE Learn from Minnesota s HIOs 2016 Minnesota e-health Summit June 7, 2016 2:15 PM 1
Today s Agenda Session info/description Moderator: Jeff Benning, Lab Interoperability Collaborative & Co-Chair of the Minnesota e-health HIE Workgroup Panel discussion by: Liz Cinqueonce, Southern Prairie Community Care Chad Peterson, Koble-MN Jonathan Shoemaker, Allina Health 2
HIE Barriers Addressed in Action Plans (in order of priority recommendation ranking) Barrier 11: Minnesota HIE approach is not fully implemented Barrier 8: Key transactions need to be prioritized (e.g., notification and alerting, care summaries) and supported statewide Barrier 9: Selecting an HIE service provider is complicated by rapidly evolving market Barrier 6: There are challenges to HIE implementation (e.g., workflow) Barrier 5: It is difficult to understand and execute legal and policy requirements (e.g., Minnesota privacy & consent) Barrier 3: Establishing partner relationships/agreements is often difficult, time-consuming and costly Barrier 2: There are competing organizational priorities 3
Minnesota HIE Approach Goal: Assuring the right information is available to the right provider, at the right time for individuals and communities. Approach: Vendor certification required Open market choices Standards for interoperability Market transparency Limited government oversight
Definitions Health Information Organization: an organization that oversees, governs, and facilitates HIE among health care providers that are not related health care entities to improve coordination of patient care and the efficiency of health care delivery. Health Data Intermediary: an entity that provides the technical capabilities or related products and services to enable HIE among health care providers that are not related health care entities. This includes but is not limited to: health information service providers (HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries.
Emerging Minnesota HIE and Supports Necessary for Interoperability Multi-State / National HIE e.g., ehealth Exchange, regional networks, e-prescribing Statewide HIE Limited # use cases/transactions (care summary, alerts) Direct Secure Messaging capability Public Health reporting Local & enterprise HIE Robust HIE based on local needs, analytic capabilities HIE framework for accountable Health; vendor-mediated HIE E.g., laboratory information, care plans, imaging, referrals Shared Support Services Infrastructure (e.g., directories, consent management), e-health guidance, technical assistance, assessment/monitoring HIE Oversight and Policy Levers to Enable HIE
Minnesota Health Information Network Private-public collaborative Support implementation of HIE services Includes State-Certified HIE Service Providers in collaboration with HIE stakeholders To improve infrastructure design and interoperability in MN
Certified Health Information Organizations: Allina Health System Koble-MN Southern Prairie Community Care Current State-Certified HIE Service Providers Certified Health Data Intermediaries: CenterX Cerner Eldermark Exchange Emdeon Inpriva IOD MaxMD MedAllies RelayHealth South Dakota Health Link Surescripts Wisconsin Statewide Health Information Network (WISHIN) Under review as of 5.25.16: Epic Secure Exchange Solutions (HISP) Medicity NEXTGEN Healthcare Information Systems
Minnesota e-health Summit JUNE 7, 2016
Southern Prairie Community Care SPCC is a virtual network focused on the Triple Aim Identified as an Accountable Community for Health 27 Provider Members - Clinics, Hospitals, Public Health, Mental Health, Human Services Focused on improving health of people in our communities Strength of SPCC is efficiently mobilizing the community around those with highest need Ability to leverage connections in governance of SPCC and area HHS agencies, MHCs, hospitals 10
Collaboration of 12 Counties Kittson Marshall Roseau Lake of the Woods Koochiching CHIPPEWA COTTONWOOD JACKSON KANDIYOHI LINCOLN LYON MURRAY NOBLES REDWOOD ROCK SWIFT YELLOW MEDICINE Polk Norman Clay Wilkin Grant Traverse Stevens Big Stone Lac qui Parle Lincoln Pipestone Pennington Red Lake Rock Mahnomen Becker Wadena Aitkin Carlton Crow Otter Tail Wing Pine Todd Mille Lacs Douglas Morrison Kanabec Benton Pope Stearns Isanti Sherburne Chisago Anoka Swift Kandiyohi Meeker Wright Washington Chippewa Hennepin Ramsey McLeod Renville Carver Scott Dakota Sibley Lyon Redwood Nicollet Le Sueur Goodhue Wabasha Rice Brown Murray Blue Waseca Dodge Cottonwood Watonwan Earth Steele Olmsted Winona Yellow Medicine Nobles Clearwater Beltrami Hubbard Cass Itasca Saint Louis Lake Martin Freeborn Jackson Faribault Mower Fillmore Houston Cook 11
The Four Pillars of SPCC Health equity - access to care and services Southern Prairie Community Care Integrated Community Care INTEGRATED COMMUNITY CARE HEALTH INFORMATION SERVICES POPULATION HEALTH IMPROVEMENT HEALTH EQUITY AND ACCESS Improved population health in our 12-county region Person and Population Quality of Life Information Strategies for Accountable Health 12
PILLAR 4: Health Information Services Focused on supporting Integrated Community Care Facilitating movement of clinical data among providers Providing access to more timely data and alerts Enabling clinical data to be gathered for analytics Delivering timely, actionable data and reports Expanding analytics to include social determinant data Leading Data Driven Intervention Strategies 13
HIE Services SPCC is a State Certified Health Information Organization (HIO) Business Line for HIE Services Offered as SPCLink Direct Secure Messaging Query Based Exchange Connects health care offices, hospitals, clinics, labs and other data sources Creates a two-way, push/pull interaction between care givers portal and EHR integration Result is a virtual medical record that follows the patient across the network Aggregates and normalizes clinical data for use in analytics Event Notifications/Alerts Real time emergency admission/discharge/transfer alerts for care coordination, quality improvement 14
Perspective on Statewide Strategy MN statewide strategy needs to expand beyond historical approach focused on: Movement of clinical data among providers, information available at the point of care New landscape requires focus on role of HIE in data aggregation to achieve transformation: Data at the ACO level for use in analytics, information to care managers to drive interventions Statewide Interoperability Requires State Level Infrastructure and Policy Changes MN should leverage CMS Meaningful Use 90/10 opportunity to build out infrastructure Requires heightened role of DHS in the statewide strategy Policy, Purchasing, Technical Infrastructure Support build of state-level architecture MN HIN Shared Service Bus Support for HIOs in connecting to architecture Support for connecting essential partners for Meaningful Use, Integrated Care, IHP Statewide Interoperability, Sustainability Requires Collaboration Among Communities 15
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Allina Health Connect HIE Jonathan Shoemaker
Allina Health Largest Non-for-Profit Healthcare System in the Twin Cities and Region 13 hospitals 1,789 beds 61 Allina Clinics, 23 hospital-based clinics 15 community pharmacies 2 ambulatory care centers 11 Clinical Service Lines Specialty Operations: Transportation, Pharmacy, Lab, Homecare/Hospice Over 27,000 employees Allina Integrated Medical Network representing over 3,000 employed & independent physicians Key statistics (2015) $3.8 billion in revenue 109,265 inpatient admissions 1.4 million outpatient admissions 4.3 million total clinic visits 18
Allina Health Mission We serve our communities by providing exceptional care, as we prevent illness, restore health and provide comfort to all those who entrust us with their care 19
Strategic Focus Allina Health pursuing a strategy of Connected Care Better connect and coordinate care (and support the caregiver s ability to do just that) Advance new payment systems that rewards outcomes Integrate data and knowledge to improve care and health 20
Allina Integrated Medical Network Overview AIM Network is a Clinically Integrated Network formed December 2010 A platform to link multiple disparate parts of the care system together to integrate care, improve quality, experience and decrease costs (Triple Aim) Supports Allina s strategy to partner with rather than employ independent providers Organizational structure that engages independent providers in shared leadership & decision-making Physician Led > 50 physicians involved in governance activities to date Wholly owned subsidiary of Allina Health 21
AIM Network Profile Current Membership: ~3,000 Physicians (1,300 Allina; 1,700 Independent) >60 Physician Groups 26 Hospitals 13 Allina Health 13 Independent Vision: The AIM Network aligns independent physicians and Allina to deliver marketleading quality and efficiency in patient care AIM NETWORK GOALS: Achieve clinical integration that enables AIMN participants to partner with each other to improve quality and reduce cost Build an infrastructure that supports effective care coordination Deliver consistent, evidence-based, best practice health care to the patients and communities we serve Position AIMN to jointly contract with payers for value based payment 22
AIMN Clinical Integration Strategic Plan (2016-2018) Grow Perform Demonstrate Value Expand Risk-Based Membership in ACO Populations Our Vision: AIM Network aligns independent physicians and Allina to deliver market-leading quality and efficiency in patient care Build Population Health Management Capabilities and Optimize Network Activate and Engage Consumers through Differentiated Experience 250,000 200,000 150,000 100,000 Data Analytics & Reporting Operational Efficiency Network Alignment Care Transformation 50,000 0 2015 2016 2017 2018 23
Value Propositions 1. Reduce duplication of imaging and lab testing 2. Improve diagnosis and treatment plans 3. Gain in efficiency and productivity for providers 4. Enhance the patient experience 5. Reduce information gaps in care delivery 6. Replace manual workflows with automated information exchange 24
Hospital EHR Interface Engine Consent Management Family Practice EHR Patient Matching Point of Care Provider Portal Specialists EHR Allina & Affiliates EHR Data Mapping/ Normalization Secure Messaging Radiology Information System Library of Clinical Documents & Data Access Audits 25
Connect HIE Implementation Approach 1. Establish secure network connections & create patient demographics and clinical notes interfaces into HIE from each practice in AIMN 2. Provide AIMN clinic users access to the Point of Care Portal 3. Establish Query/Response connection with Excellian Care Everywhere to seek outside records CCD from Connect HIE 26
Koble-MN HIO CHAD PETERSON
Overview Sole focus is healthcare IT Health Information Exchange Management Experience with multiple vendors and implementations Professional Services Health Information Exchange Management/Consulting Health Information Exchange Integration and Engineering HIT Managed Services HIPAA Compliance Services Privacy, Security, Consent Certified as HIO in November 2015
Mission/Vision MISSION: Advance the adoption, use of technology and exchange of health information to improve healthcare quality, patient safety and overall efficiency of healthcare and public health services of Minnesota. VISION: To promote high quality and transform the health care experience of all Minnesotans. CORE GUIDING PRINCIPLES: Focus on better health, better care, lower cost Build collaboration & trust Enhance consumer engagement Protect privacy and security in all aspects of Information Exchange and use Recognize Regional Leadership Promote transparency & accountability Ensure innovation, efficiency, quality, safety, and value in health care Support health reforms to strengthen health of individuals, families, communities
KOBLE-MN Advisory Committee The Advisory Committee provides for the effectiveness and continued development of KOBLE-MN Koble Group KobleMN Health Information Organization KobleMN Advisory Committee KobleMN Participating Entities Kevin Schumacher, CIO, LifeCare Medical Center (Roseau) Greta Siegel, Budget & Finance Supervisor, Horizon Public Health (Alexandria) Shauna Reitmeier, CEO Northwestern Mental Health Center (Crookston) Nicole Sowers, COO, CHAMP Software (Mankato) Lori O Hara, OneCare Director, Fargo Region, Catholic Health Initiatives (Fargo) KobleMN Regulatory Compliance
Traditional HIE Core Services Push (Direct Secure Messaging) Web-Based XDR Direct Trust Certified HISP (Orion Health) Pull (Query/Connect) Discrete Data - HL7 Messages from Data Providers ADT ORU Lab (Including ELR MU Labs) ORU Rad MDM (Clinical Documents) VXU Bi-directional Immun. Interface CCD/C-CDA (XDS.B Repository and Query/Response capability)
Additional Services Care Coordination Data Analytics Population Health ACO/Payer Support Deliver HIE Solution to our Participants that meets/exceed these requirements Support communities that are working on care coordination or other interoperability initiatives by providing state of the art tools and support, while allowing those communities to keep their autonomy.
Timeline/Onboarding Process Direct Secure Messaging: June 2016 Clinical Portal/Query: September 2016 Engage with Koble-MN: Participation Agreement BAA www.koblemn.org
Discussion Questions (1) There are a number of organizations that might be considering becoming an HIO in Minnesota. What considerations would you give them when deciding whether to participate in an HIO or become an HIO? 34
Discussion Questions (2) Whether or not an organization chooses to become an HIO or connect to one, how does this Minnesota approach to HIE align with the movement toward value-based payments (e.g., IHPs and ACOs)? 35
Discussion Questions (3) As HIOs in the state, your organization is very central to helping MN have a viable HIE infrastructure. Tell us more about the challenges and opportunities you see as individual HIOs as well as part of the MNHIN working together? 36
37 Questions?