New Hampshire Stakeholder Meeting May 5 th 2015
The NHHIO Resources www.nhhio.org - 1 -
Why are we here? The NHHIO was founded in 2011 as a non-profit, state instrumentality to foster health information exchange across the Granite State Much has been accomplished despite many unpredictable changes in health care delivery, the technology industry, and the state legal/regulatory environment The NHHIO is now at a crossroads and needs to decide whether to shrink, stay the course, or grow As a non-profit collaboration, we need the input of our partners and stakeholders in order to make this strategic decision - 2 -
Bring together the NHHIO community Goals for the Day Share with the NHHIO community our progress to date and the challenges ahead Describe the areas of opportunity for NHHIO Understand the needs and concerns of the NHHIO community Illuminate the key strategic questions facing NHHIO Solicit community engagement to assist NHHIO in this process - 3 -
Agenda The NHHIO in the New Hampshire Community National, Regional, and State Changes in the Health IT Environment The NHHIO Strategy and Service Options Responding to the needs of New Hampshire s Patients and Providers Questions and open discussion - 4 -
CHAPTER 332-I MEDICAL RECORDS, PATIENT INFORMATION, AND THE HEALTH INFORMATION ORGANIZATION CORPORATION 332-I:7 Corporation Established The corporation is hereby deemed to be a public instrumentality and shall be deemed and held to be the performance of essential health information organization functions which shall, among other things, promote the general health of the citizens of the state of New Hampshire. The corporation shall be the state's designated provider of health information exchange services. - 5 -
Who is the NHHIO? It s our Board of Directors Board Member Representation Board Member Representation Mary Beth Eldredge IT Director Dartmouth Hitchcock Deb Mullen Concord VNA Kirsten Platte CHAN Carol LaCross CFO - Retired Denise Purington CIO Elliot Hospital NHHIO Chair, Board Member at Large Hospitals NHHIO Vice Chair, Homecare Association NHHIO Secretary, Bi-State Primary Care Association NHHIO Treasurer, Volunteer & Consultant Past Chair Board Member at Large David Briden, CIO Exeter Hospital Patricia Witthaus IT Director Valley Regional Hospital Dr. Richard Lafleur, Anthem BC/BS Michael Lehrman, Catholic Charities Lorraine Nichols IT Consultant NH Hospital Association, Large Hospitals NH Hospital Association, Critical Access Hospitals Board Member at Large, Health Plans Board Member at Large, Skilled Nursing Providers and NH Health Care Assoc. Board Member at Large, Dr. Daniel Waszkowski Derry Medical Center William Baggeroer NH DHHS Office of the Commissioner NH Medical Society David Querusio, Harvard Pilgrim Healthcare Board Member at Large, NH DHHS, Office of the Commissioner Dr. Christine Rosenwasser Dartmouth Hitchcock Pediatrics Board Member at Large, Health Plans Board Member at Large, Physicians Victor St. Pierre Consumer Advocate Board Member at Large, Consumers Mark Guptill Community Partners NH Community Behavioral Health Association Charles J. Fanaras, RPh Retail Pharmacy Pharmacy Board - 6 -
Who is the NHHIO? It s our Staff 125 Airport Road, Concord, New Hampshire, 03301 Office. (603) 219-0184 Fax. (603) 218-6126 www.nhhio.org Jeff Loughlin Executive Director c: (508) 326-3944 jloughlin@nhhio.org Nancy Fennell Adoption Support c: (603) 717-5021 nfennell@nhhio.org Jackie Baldaro Operations Manager c: (339) 223-0888 jbaldaro@nhhio.org Jaime Dupuis Adoption Support c: (603) 717-5225 jdupuis@nhhio.org Micky Tripathi Senior Advisor o: (781) 434-7906 mtripathi@maehc.org - 7 -
Who is the NHHIO? It s our Customers and Stakeholders Participants Type Participants Type Participants Type Androscoggin Valley (CAH) CAH Derry Medical Center Private Catholic Medical Center Hospital Cottage Hospital (CAH) CAH Dover Women's Health Private Cheshire Medical Center Hospital Huggins Hospital (CAH) CAH Gastroenterology, PA Private Concord Hospital Hospital Memorial Hospital (CAH) CAH George Bower, MD Private Dartmouth Hitchcock Medical Center Hospital Monadnock Community Hospital (CAH) CAH Harbor Women's Health Private Elliot Hospital Hospital New London Hospital CAH Jennifer Madden, MD Private Exeter Hospital Hospital Speare Memorial Hospital (CAH) CAH Life Long Care Private Frisbie Memorial Hospital Hospital Valley Regional Hospital (CAH) CAH My Friend's Gynecologist LLC Private Southern New Hampshire Medical Center Hospital Weeks Medical Center CAH NE ENT & Allergy Private St. Joseph Hospital Hospital Central New Hampshire VNA & Hospice VNA New Creations Healing Center Private Center for Life Management MHC Concord Regional Visiting Nurses Association VNA Pain Care & Salmon Falls Health Private Developmental Services of Stafford County MHC Conneticut Valley Home Care VNA Saco River Medical Group Private Greater Nashua Mental Health Center MHC Corners tone VNA VNA Dermatology & Skin Health Private MHC of Greater Manchester MHC Home Health & Hospice Care of Keene VNA Wright and Associates, Family Health Private Monadnock Family Services MHC Home Health & Hospice Care of Merrimack VNA Ammonossuc Comm Health Services FQHC Northern Human Services MHC Lake Sunapee Region VNA & Hospice VNA Community Health Access Network FQHC Seacoast Mental Health Center MHC VNA and Hospice of Carroll County VNA Coos County Family Health Servcies FQHC West Central Behavioral Health MHC VNA & Hospice of Franklin VNA Mid-State Health Center FQHC Anthem Blue Cross Pa yer VNA and Hospice of NH and VT VNA Hillsboro House LTC Harvard Pilgrim Pa yer NH DHHS State Genesis Healthcare LTC - 8 -
The NHHIO Across the State
What does the NHHIO do? A secure, end-to-end, clinical messaging service A statewide Provider Directory A ready resource to help New Hampshire providers figure out health IT A secure network option for small and less well-resourced providers across the care continuum - 10 -
The NHHIO Strategic Road Map Mission: Securely connecting healthcare communities to share patient health information needed for informed care decisions. Vision: NH s trusted resource for health information exchange, improving quality, efficiency, and patient safety, while reducing healthcare cost. Integration Adoption Expansion Get to Green Support ticket management and integration of Direct Standards Create Electronic Master Patient Index (EMPI) & Record Locator Service (RLS) Increase community awareness with expanded website, newsletters and press Expand marketing and outreach Moving Health Information with Confidence Provide Healthcare Provider Directory (HPD) management and distribution Explore new markets and business opportunities. Facilitate user group identification and expanded board advisory groups. - 11 -
Secure Internet-based Direct Communications Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet. Simple. Connects healthcare stakeholders through universal addressing using simple push of health information. Secure. Users can easily verify messages are complete and not tampered with in travel. Scalable. Enables Internet scale with no need for central network authority or centralized data repository. Standards-based. Built on common Internet standards for secure e- mail communication. - 12 -
Message Formats and Transport Protocols Providing summaries of care, and the ability for patients to view, download and transmit their medical information requires data to be sent using Direct. Consolidated Clinical Document Architecture (CCDA) care summaries must contain at least problem lists, medications, and medication allergies. SMTP-S/MIME (required for Office of the National Coordinator (ONC) certification) Sends CCDA as an email attachment Provides ability for text component in the message XDR-SOAP (optional of ONC certification) Directly sends CCDA to recipient with text component Like any email product, both require a secure network to transport: Health Information Service Provider (HISP) - 13 -
Direct Secure Messaging (DSM) Options NHHIO Trust Network DSM Web Web-based email client access Client-deployed hardware device (LAND) DSM Connect HPD DSM Direct EHR System integration - 14 -
The NHHIO as Heath Information Service Provider (HISP) Pending ONC 2014 Certification - 15 -
3 rd Party HISP Connections - 16 -
Healthcare Provider Directory The Healthcare Provider Directory (HPD) is a searchable directory of individual and organizational healthcare providers Individual Provider A person who provides healthcare services, such as a physician, nurse practitioner, physician assistant or nurse Organizational Provider An organization that provides or supports healthcare services such as hospitals, health centers, or practices The NHHIO aggregates information from all participating HISP vendors - 17 -
Current Primary Use Cases (i) - 18 -
Current Primary Use Cases (ii) - 19 -
Health Care Provider Definitions Health care provider means any person, corporation, facility, or institution either licensed by this state or otherwise lawfully providing health care services, including, but not limited to, a physician, advanced practice registered nurse, physician assistant, hospital, office, clinic, health center or other health care facility, dentist, nurse, optometrist, pharmacist, podiatrist, physical therapist, mental health professional, care coordinator, managed care provider, or the department of health and human services, and any officer, employee, or agent of such provider acting in the course and scope of employment or agency related to or supportive of health care services. Only a health care provider or a business associate of a health care provider or a patient or patient s legal representative may transmit the patient s protected health information through the health information organization. - 20 -
The NHHIO Use and Disclosure Requirements Only a health care provider, for purposes of treatment, care coordination, or quality assurance, or a patient or a patient s legal representative with respect to the patient s protected health information, may have access to protected health information transmitted through the health information organization. Health care providers otherwise required or authorized by law to submit data to the department of health and human services may do so through a health information organization; provided, that such transmissions meet the same standards for privacy and security of protected health information that apply when such information is exchanged between providers. No person shall require a health care provider to participate in the health information organization as a condition of payment or participation. - 21 -
The NHHIO Powers and Duties Establish and maintain a health information organization that facilitates the private and secure electronic exchange of health information that promotes quality and patient safety, and increases efficiencies in health care delivery. Except as provided in RSA 332-I:3, VI, the health information organization may retain patient demographics, including patient name, address, date of birth, gender, medical record numbers, and location of medical records, which shall be used solely to ensure consistent patient identification between health care providers and enable electronic query for patient health information. The health information organization shall otherwise act solely as a conduit for such electronic exchange and shall neither access nor retain, in a database or otherwise, the clinical content of any medical record. The information retained by the health information organization or its agents or business associates shall not be sold or disclosed. An individual shall be given an opportunity to opt out of sharing his or her name and address and his or her protected health care information through the health information organization. Such an opportunity shall be provided in a clear and conspicuous manner, including, but not limited to, simple opt out language in a font and size easily readable by the average adult reader so that the individual may make his or her decision known. - 22 -
The NHHIO Business and Pricing Model Non-profit charitable trust organization without defined state or federal funding Initial federal funds from Health Information Exchange (HIE) grant used to cover cost of initial design, set-up, installation, and purchase of software licenses On-going fees limited to hosting and support & maintenance Participant fees based on an equitable revenue based tiered pricing model with payment caps based on organization type Early adopters received HIE grant funding to support connectivity and interoperability Current participants receive discounts based on method of integration - 23 -
Advance Interoperable Health Information Technology Services to Support Health Information Exchange Grant - 24 -
Advance Interoperable Health Information Technology Services to Support Health Information Exchange Grant The NHHIO Requested $1.8M in funding for: 1. Awareness, expertise, and engagement: The NHHIO will expand education and outreach activities through the use of remote webinar training, as well as on-site local expertise, directly engaging provider and staffs at the point-of-care. 2. Capacity-building: HIE grants will be offered to motivated and well-prepared organizations to allow them to mobilize internal staff to collaborate with the NHHIO team to operationalize advanced electronic care coordination activities. Best practices will be shared and disseminated through the development of a Peer Learning Network (PLN) and Communities of Practice (CoP). Primary Focus: Long Term and Post Acute Care Community, Behavioral Health, Federally Qualified Health Centers and Community Health Centers - 25 -
NH State Innovation Model (SIM II) Develop and use of Regional Healthcare Cooperative Extensions (RHCE) Champion health care systems engineering Expand the use of information technologies Lead local population health improvement 26-26 -
Environmental Challenges Delay of requirements of CMS EHR Incentive Programs has decreased urgency for HISP connectivity Majority of EHR vendors have already been certified with HISP vendors, minimizing need for the NHHIO HISP services Centrally hosted or limited EHR vendors, and some small practices, are not willing or able to utilize DSM Connect (LAND) appliance for results delivery The legislative constraints prevent the NHHIO from expanding needed services to effectively support quality reporting and population management tools Hospital business and clinical relationships have requested or required connections to other HIEs ME - HealthInfonet, VT VITL, MA - MAHiway - 27 -
The NHHIO Success Strong, continued enrollment and penetration into the provider community The NHHIO continues to facilitate Healthcare Provider Directory (HPD) and interoperability issues Collaboration with key healthcare transformation organizations: Regional Extension Center of New Hampshire Quality Improvement Organization NH Medical Society and NH Hospital Association Many others - 28 -
The NHHIO Key Decisions Shrink? Minimize staffing overhead Renegotiate Orion Health contracts Continue basic HISP services Stay the course? Maintain current resources Resource for EHR / HIT adoption and workflow redesign Centralized State resource Grow? New resources and services Increased presence and community value - 29 -
Agenda The NHHIO in the New Hampshire Community National, Regional, and State Changes in the Health IT Environment The NHHIO Strategy and Service Options Responding to the needs of New Hampshire s Patients and Providers Questions and open discussion - 30 -
Four National Trends Driving Health Information Exchange 1. HITECH: The Meaningful Use Program 2. Changes in commercial and government health care payment models 3. Evolution in the health information technology industry 4. Changes in patient and physician expectations and behavior - 31 -
As MU Ramps Down, New Business Models will Ramp Up Motivators for health information exchange HHS has set a goal of tying 30 percent of traditional, or fee-forservice, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018. HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs. This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments. MU Stage 1 MU Stage 2 CMS quality and value purchasing MU Stage 3 2011 2012 2013 2014 2015 2016 2017 2018-32 -
Meaningful Use as a motivator for HIE has barely kicked in MU was designed to be a staged program: Stage 1 get EHRs in place Stage 2 get push in place Stage 3 get pull in place Stage 1 has increased national EHR use from ~10% to ~70% in 4 years. Stage 2, though underway, is ramping up very slowly Stage 2 required that providers send 10% of their transitions of care electronically via Direct However.. 546K Medicare and Medicaid EPs registered in 2014 Only 41% (224K) were scheduled for Stage 2 But 76% of them (170K) did not attest to Stage 2 due to hardship exemptions for the flex rule And 86% of those who did attest met an exclusion for TOC leaving ~8K EPs across the entire country who attested for Stage 2 TOC in 2014 Most of these loopholes will be closed in 2015 and beyond, which should create greater demand for NHHIO services - 33 -
Meaningful Use Stage 3 Could Give Boost to NHHIO Services Patient engagement incentives 80% of patients can access record through VDT or an ONC-certified API 25% of patient do access record through VDT or an ONC-certified API Must incorporate data from patients or their non-clinical settings (ie, home health) from 15% of patients NHHIO can be single source to many non-clinical settings such as home health and physical therapists HIE incentives Send CCD electronic summary for 50% of transitions of care or referrals (not restricted to Direct protocol) Receive and incorporate electronic summary for 40% of transitions of care or referrals (not restricted to Direct protocol) Perform reconciliation on 80% of transitions of care or referrals for meds, med allergies, and problems Greater demand for secure messaging services Greater demand for secure messaging services; greater demand for RLS services - 34 -
Nationwide Interoperability Road Map - 35 -
ONC Roadmap: Principles of Interoperability - 36 -
As HIE Matures, it is starting to organize like other industries. ATM Networks HIE Networks - 37 -
and adopt standards like other industries Growth in Open APIs 2016-38 -
Agenda The NHHIO in the New Hampshire Community National, Regional, and State Changes in the Health IT Environment The NHHIO Strategy and Service Options Responding to the needs of New Hampshire s Patients and Providers Questions and open discussion - 39 -
NHHIO Technology & Service Building Blocks Value-added applications/services Value-added applications/services Clinical and/or claims data repository (CDR) Subscription and notification service Query & retrieve support Record locater service Consent management Enterprise master patient index Admission Discharge Transfer (ADT) feeds Provider directory Secure messaging platform Core staff - 40 -
Record Locator Service (RLS) Data requester locates and requests patient information - Data holder responds Relationship Listing Service Patient name Local name Institution MRN Jones, Jennifer L Jones, Jennifer Hospital A 1234 Jones, Jennifer L Jones, Jenny PCP 5678 Jones, Jennifer L Jones, Jenifer Hospital B 9854 2. Send demographics to RLS 3. View Patient Relationships (constrained to patients with established relationships) 4. Request patient information Specialist N PCP Y Hospital A Y 3. Send discharge summary and individualized care plan VNA/Hospice Care Provider Y Jennifer L Jones Jennifer L Jones - 41 -
Current & Future Service Offerings Option F: Integrated supplemental services Option C: Supplemental services (Direct CCDA) Registries, data analytics Image exchange Image repository (VNA) Population health tools Registries, data warehouses Future Service Offerings Patient event repository & notification (Emergency Incident Management) Image exchange Image repository (VNA) Lab/Rad results repository Population health tools Clinical / Claims data repository Option E: CDR services Option D: Lab/Rad services Option B: ADT-based services (non-direct) Query & retrieve support (portal-assisted and/or point-to-point) Centralized Opt-Out EMPI / RLS (need full ADT fields) Secure Provider Texting Option A: HISP services (Direct) Centralized HPD, Inter-State Relations DSM Solution, HISP Services, Community Results Delivery - 42 -
5.0 Survey Results 4.5 4.0 3.5 3.0 2.5 2.0 1.5 Interest Value 1.0 0.5 0.0 A B C D E - 43 -
5.0 Survey Results 4.5 4.0 3.5 3.0 2.5 2.0 1.5 Interest Value 1.0 0.5 0.0-44 -
Agenda The NHHIO in the New Hampshire Community National, Regional, and State Changes in the Health IT Environment The NHHIO Strategy and Service Options Responding to the needs of New Hampshire s Patients and Providers Questions and open discussion - 45 -
Key Strategic Questions Should the NHHIO continue to offer HISP and provider directory services? Should the NHHIO continue to offer advisory and assistance services? Should the NHHIO develop query-and-retrieve shared services (ie, ADT-based services)? Should the NHHIO begin to plan for Supplemental Services? Which services are you willing to pay for? Which services are you willing to align your clinical workflow processes for? Which services are you willing to align your consent workflow processes for? - 46 -
Current Planning Process Analysis of community needs Key stakeholder interviews and meetings Advisory group discussion Board representation NH stakeholder session Environment review Analysis of service needs Board strategic planning Group session to analyze responses Financial model comparisons Legal analysis of service options Announcement of organizational structure and services Orion contract compliance for continuance Member notification of HISP services - 47 -
Process Timeline PA End - 48 -
How can you help? NHHIO Advisory Groups: HIM Clinical CEO/COO Local needs assessment Individual and regional trading partner mapping and use case development Local and regional education opportunities Send us your feedback - BOD public comment, letter, phone, fax, email or Direct secure message: nhhio@direct.nhhio.nhhio.com - 49 -
Agenda The NHHIO in the New Hampshire Community National, Regional, and State Changes in the Health IT Environment The NHHIO Strategy and Service Options Responding to the needs of New Hampshire s Patients and Providers Questions and open discussion - 50 -
Thank you! 125 Airport Road, Concord, New Hampshire, 03301 Office. (603) 219-0184 Fax. (603) 218-6126 www.nhhio.org Jeff Loughlin Executive Director c: (508) 326-3944 jloughlin@nhhio.org Nancy Fennell Adoption Support c: (603) 717-5021 nfennell@nhhio.org Jackie Baldaro Operations Manager c: (339) 223-0888 jbaldaro@nhhio.org Jaime Dupuis Adoption Support c: (603) 717-5225 jdupuis@nhhio.org - 51 -