Post on 11-Jan-2016
description
HealthBridge is one of the nation’s largest and most successful health
information exchange organizations.
“From Interactionto Integration
to Transformation: Healthcare’s Journey &
Information’s Role”
Mike MoteVice President
Product & Service Strategy 1
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HealthBridge
Background
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HealthBridge
One of the nation’s oldest, largest, most advanced and successful health information exchanges
In operation since 1997
501c3 Not for Profit
One of only a handful of HIE/RHIOs nationwide with a sustainable business model
• (Pre ARRA) 97% of revenue from fees; <3% grants
• 5-12% annual return for last eight years
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HealthBridge
Delivers more than 3.5 million clinical messages PER MONTH; more than 35 million messages for 2010
Total of 50+ hospitals, 7500 physicians Connectivity with 40+ HIS/LIS; 27 different ambulatory vendors,
60+ versions Provide technology infrastructure for four other HIEs – Dayton
HIN, CCHIE, HealthLINC, NEKY RHIO Cincinnati Network
• 26 local hospitals in Kentucky, Ohio and Indiana• 5500+ physicians• 17 local health departments• Large commercial, hospital, & physician office labs• Diagnostic centers
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HealthBridge
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HealthBridge HIE Value ProgressionMeaningful Use, Medical Home and Payment Reform
Basic
HIE
• Stage 1 MU • EHR Adoption (REC Services)• Basic Electronic Messaging (NHIN DIRECT)• Community Portal • Web-Based Results Delivery • Value: Dramatic reduction in redundant paper, phone contacts; Greater efficiency
Intermediate HIE
• Stage 2&3 MU• Structured Data Delivery to EHRs• Results Delivery (Lab, Rad, ADT, etc.)• ED, Admission, & Discharge Alerts & Notices• Summary Record Exchange (CCD)• Value: Necessary to achieve truly electronic workflows; Dramatic increase in
efficiency
Advanced HIE
• PCMH, ACO & Payment Reform Readiness•Data Warehouse & Analytics • Disease Registry•Quality Reporting Support•Full Integration Services & Bidirectional Exchange•Value: Dramatic improvements in quality and performance
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HealthBridge – HIE Services
EHR Integration/Interfaces Electronic Results Delivery –
• Labs, Radiology, ADT, etc. Electronic Order Entry E-Prescribing HIE Portal & User Management HIE Technology Support – Master Patient Index, Provider
Directory and Record Locator Service Summary Record Exchange Nationwide Health Information Network Direct and CONNECT
Gateway & Connectivity Public Health Reporting & Syndromic Surveillance Billing and Eligibility Verification HIE Consulting, Outsourced Technology & Implementation
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HealthBridge – Future Plans
REC - Expanded Meaningful Use Assistance for Stages 2-3 Beacon - Enhanced Suite of Quality Improvement, Care
Transformation and Accountable Care Services and Tools (Data Warehouse, Data Analytics, Summary Patient Records, etc.)
Patient Engagement - Connectivity to Personal Health Records, Mobile Technologies and Consumer Technologies (Beacon, IN Challenge Grant)
HIE Expansion – • Connect to new providers and stakeholders for improving
continuity of care (home health, long-term care, payers, etc.) • Connect with State HIEs and Provider Networks (IN, KY, OH) • Use Nationwide Health Information Network (NwHIN) Direct and
CONNECT platforms• Spread of Advanced Technologies to Other Communities • Community Credentialing
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“From Interactionto Integration
to Transformation: Healthcare’s Journey &
Information’s Role”
Creating a CommunityData Repository
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Healthcare’s Journey Whether or not you believe that REFORM is coming here are some
thoughts to ponder:
• The US healthcare system is broke; the current rate of growth can not be sustained; 1/6th of the US economy is based upon healthcare
• New York Times article claims “By 2020 the American health insurance industry will be extinct.”
• Accountable care is coming; Value based payments are coming; Volume based payments will continue to decline
• Missing data today results in missed opportunities to:
• Prevent complications• Ensure better outcomes• Reduce unnecessary costs• Reduce patient’s safety risks• Improve transitions in care
2012
2015
2020
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Incentives
Penalties
Business Realities
The “Journey”
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Care Transactions
Individual ProviderCare Plans with some
coordination via referrals
Care Integration
Coordinated Care Plans &
Early stage PCMH
Care Transformation
Single Care Plan &Advanced stage PCMH;
theMedical Community
Care Delivery’s Journey
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Care Transactions
Patient Outcomes Measures
Care Integration
Population based metrics & health status
measurements
Care Transformation
Demonstrable Improvement in
Population Health with ongoing refinement
of the metrics
Quality Metrics’ Journey
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Care Transactions
Fee for Service
Care Integration
Pay for Performance & Shared Savings
Care Transformation
Providers at Partial to Full Risk
Payment Reform’s Journey
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Care Transactions
Provider-centric reporting based upon productivity & patient
care protocols
Care Integration
Population based quality & performance analysis, health status
analysis, & risk analysis
Care Transformation
Predictive modeling & performance
forecasting, outcomes analysis, & incentive
modeling
Data Analytics’ Journey
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Care Transactions
Individual EHR or paper medical records;
individual vendor or provider application of
standards & codes
Care Integration
Clinical information sharing with standards based interoperability
moving to data integration with
semantic normalization
Care Transformation
Community based clinical & claims data
repository with community data and
coding standards
Information’s Journey
Information’s Role
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Care Transactions
Support Provider delivered care; support
patient level quality reporting
Care Integration
Longitudinal patient record, ED & Public
Health alerts; Point-of-care decision support, PHR, & remote patient
monitoring
Care Transformation
Enable predictive modeling, risk
adjusted analytics, accountable care
business & operational modeling
Information’s Role – Domain Requirements
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People & Organizations
Lab Orders & Results
Medications & Prescription Information
Patient
Provider
Payer
Staff
Facility
Immunizations
Radiology & Transcribed Reports
Referrals & Authorizations
Medical Conditions (Allergies, Family-social-medical history)
Encounters
Appointments
Master Data (ICD, CPT, DRG, HCPCS, CCS, CRG …), Geography
Revenues (Charges, Grants ..)
Products
Member Enrollment
Medical & Rx Claims
Revenue, Billing, & Payment Data
Utilization
Provider PayerLegend:
Clinical Observations & Vital Signs
Expenses (Payroll, Supplies, Infrastructure, …)
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Creating a CommunityData Repository
&Establishing a
Community Data Trustee
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HealthBridge’s Data Infrastructure
New Suite of Health Care Innovation & Quality Improvement Tools and Services funded through Beacon Program: • Disease Registry • Clinical & Claims Data Warehouse• Data Analytics and Business Intelligence• Alerts & Notifications • Transitions in Care Assistance• Quality Reporting Support • Process Improvement and Workflow Redesign Support
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HealthBridge’s Solution Components
Enterprise Master Patient Index (eMPI)
• IBM’s Initiate™
Clinical & Claims Data Repository & Clinical Analytics
• PluralSoft’s CareQuotient™
Semantic Data Normalization
• Clinical Architecture’s Symedical™
Claims Data Grouping Engines
• OPTUMInsight’s Symmetry™
Patient Registry
• WellCentive’s Registry™
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Why?
Today this enables
• Identification of gaps in care
• Point-of-Care Decision Support
• Patient engagement
• Longitudinal Patient Record
• ED, Admission, & Discharge Alerts & Notices
• Information exchange at the point of Transitions in Care
• Intra-practice comparative performance analytics
• Interoperability between organizations (“Rosetta Stone”)
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Why?
Tomorrow this will enable:
• Population-based performance measurement
• Risk adjusted comparative performance analytics
• Risk adjusted comparative cost analytics
• Predictive modeling & performance forecasting
• Service demand forecasting
• Payment incentive modeling
• Revenue versus cost modeling
• ACO business and operational modeling
• Best practice identification & modeling
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Q & A