Health Information Technology

Interoperability of Electronic Health Records (EHRs)April 17, 2015Bill Manlove

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Focus of Talk

•The technology environment,•the data systems we are working with,•the state of sharing of those systems,•the direction in which we appear to be going.

Health Information Technology (HIT) describes the management and interoperability of health information within and between information systems, providers, government, and consumers.

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Vision• Better health care through smarter spending, leading to healthier

people.

Issues•Advancing use of standards•Improving the trust environment•Improving governance

http://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf

Federal HIT Roadmap (Draft)4/17/2015

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State HIE LandscapeThe Texas Health Services Authority (THSA) was created by the Texas Legislature in 2007 as a public-private partnership, legally structured as a nonprofit corporation, to support the improvement of the Texas health care system by promoting and coordinating HIE and health information technology (HIT) throughout the state to ensure that the right information is available to the right health care providers at the right times.

There are both public HIEs in Texas, who received funding through a cooperative agreement between the state and Office of the National Coordinator for HIT and private HIEs, which did not receive funding.

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Texas HIE Four Principles (THSA)Patient Centric• The patient and consumer should be the focus of all our efforts in health

information technology. Patient control and ownership of personal health information must be protected and patient privacy must be respected. Health information technology has great potential to benefit health outcomes for consumers but not at the risk of violating personal privacy.

Market-Based• Market-based solutions should be sought whenever possible. In the case of

heath information technology, there is a large and growing body of research suggesting that there is economic value to be recognized at every stage in the evolution of the electronic health information infrastructure. With respect to health information technology, government participation should generally be limited to catalyzing relevant markets, facilitating collaborations, easing regulatory burdens, and assisting in the appropriate alignment of incentives.

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Texas HIE Four Principles cont’d (THSA)Leveraging Existing Resources• To the maximum extent possible, Texas will leverage existing

resources and coordinate with other health information technology and health information exchange (HIE) initiatives, such as the Medicaid electronic health record incentive payment program, other state agency HIE initiatives, HIE initiatives developed and administered by private payers, and local/regional HIE initiatives.

Focus on Regional Solutions• Regional solutions that fit within the statewide framework should

be pursued whenever possible. Every region of Texas is different and should be given the freedom to fit into the emerging electronic health information infrastructure in the most appropriate way.

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Data Standards

•Current base standard for patient data exchange is the Continuity of Care Document.

•Technically, this can be implemented as a “consolidated continuity of care document”, C-CDA.

•Exchange standard specified by HL7•C-CDA may not provide all information necessary for

coordinating behavioral health care•HL7 workgroup has been working to advance standard•LMHAs have made recommendations to extend standard

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http://hietexas.org/how-to-connect/hie-networks

• FirstNet Exchange• Greater Houston HEALTHCONNECT

 (GHH)• Health Information Network of South T

exas (HINSTx)

• Healthcare Access San Antonio (HASA)• Integrated Care Collaboration (ICC)• North Texas Accountable Healthcare P

artnership (NTAHP)

• Paso del Norte HIE (PdN HIE)• Rio Grande Valley HIE (RGV HIE)• Rio One Network• Southeast Texas Health Systems

(SETHS)

Public HIEs in Texas4/17/2015

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DSHS Technology and Policy Infrastructure

The agency is enhancing its technical and policy infrastructure to advance interoperability.

Agency HIT VisionAn integrated Health Information Technology (HIT) and policy system that improves service delivery, health outcomes, and decision-making.

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DSHS HIT Strategic Priorities I Support the Agency Mission and Objectives • Align and optimize business processes and information resources to support

overall DSHS strategic objectives.Data Sharing and Exchange Standards • Use agency-wide standards for data, interoperability, and quality assurance that

meet business needs and support information exchange across DSHS programs, with authorized trading partners, and with other DSHS stakeholders.

Utilize Advanced Data Analytics • Collect, validate, integrate, and analyze a wide variety of data, using standard

and custom tools, to support evidence-based strategies that meet Texas' health needs.  

Business Process will Drive Information Resource Solutions • Develop agile business processes that specify information technology

requirements which address the needs of a changing health system.  • Conduct due diligence to evaluate re-use or modification of existing information

resources when addressing business processes.

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DSHS HIT Strategic Priorities IIInformation Resources will be Flexible • Design information resources to be quickly and effectively adapted to

evolving needs and business processes.Collaborate with Trading Partners and Stakeholders • Engage trading partners and stakeholders in discussions regarding HIT

and coordinate data collection and exchange efforts with other entities.Facilitate Timely Decision-making at the Individual and Systems Level • Provide timely information to authorized internal and external entities to

support decision-making.Ensure Compliance with Laws and Regulatory Requirements • Manage and utilize accurate data and tools to ensure compliance with

applicable rules and regulations including those addressing privacy and confidentiality.

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DSHS HIT Goals•Improve population health and reduce costs through the

use of HIT •Support meaningful use and health  information

exchange with partners •Empower individuals to improve their health •Achieve technology advancement           • Inspire confidence and trust in DSHS HIT

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Categories of Data

•Clinical•Administrative Data

▫Claims▫Management

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Timely

Detailed

Comprehensive

Related to the care of the patient

What is Clinical Data?What is clinical data?

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For financial purposes

Rolled-up information

What is Claims Data?Claims data

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DSHS Current Data Submission Overview

ImmTrac

ELR

Lab

HIV/STD

Birth Defects

Lead

Hospitals(n >600)

ASC’s (n=400+)

ContractedMental Health

Providers

ER providers

TMHP

Other data

provider

EMT

Local Health Depts CMBHS

HHSC

Private Primary Care

Providers

TraumaMidwivesContracted

Substance Abuse Care Providers

WIC Clinics

ContractedMental Health

Providers

ContractedSubstance Abuse Care Providers

Cancer

Specialty Provider

Other Entities

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*Bi-directional capability dependent on DSHS program needs, capabilities, and legal restrictions

• DSHS has developed a Health Services Gateway which provides DSHS with the capacity to exchange (bi-directional*) data through a managed, centralized platform.

▫The data exchange platform meets requirements of the Center for Medicaid and Medicare Services (CMS) Electronic Health Record Incentive Payment Programs to support Eligible Providers and Eligible Hospitals submitting data to DSHS.

▫The Gateway is expanding in scope beyond Meaningful Use to EMS/Trauma, Family and Community Health data exchanges, and coordination of care between inpatient and outpatient mental health services.

DSHS Health Services Gateway (HSG)4/17/2015

OtherDSHS

Systems

HIV/STD

Birth Defects Registry

DSHSBehavioral Health

ImmTrac

Trauma Registry

Lab

Texas CancerRegistry

ELR

DSHS Health Services Gateway

External Trading Partners

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HSG when Fully Deployed for Public Health

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HSG Benefits•Consolidated help desk for technical support allows DSHS

program areas to focus on business-specific activities

•Central data validation service ensures data received through Gateway meets program-specific criteria

•Reduces IT costs for both DSHS and trading partners by limiting redundant, multiple instances of connection services and technologies

•Automation of processes currently done manually

•Reduces security risk by limiting points of exposure

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MHSA Recognizes the Value of Interoperability

•Continuity of care between Hospitals and Local Mental Health Authorities (LMHAs)

•Sharing of clinical information among Hospitals•Sharing of clinical information among LMHAs•Sharing of information between Mental Health and

Substance Abuse•Sharing of information between Behavioral Health and

Criminal Justice•Sharing of information between Behavioral Health and

Physical Health

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Major Data Systems and Myriad Others•CARE – Client Assignment and Registration•CMBHS – Clinical Management for Behavioral Health Services•Avatar – Electronic Medical Record for the Hospitals•LMHA Electronic Health Records•HHSC Medicaid•TLETS – Texas Law Enforcement Telecommunications System•THCIC - Texas Health Care Information Collection•Various other, smaller (often paper) data collection/storage

systems such as county courts and local labs

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Clinical Data • Continuity of Care between the Hospitals and the LMHAs

▫Continuity of care documents Fax Mail Secure File Transfer Protocol (FTP) Servers Clinical Data Exchange – Where we are going

• Lab Orders and Lab Results▫Some interoperability between the hospitals and the regional lab▫May be some local agreements between Hospitals and Local Labs

• Physician Orders and Pharmacy▫ Interoperability between Avatar, WORx (the pharmacy System used by the

hospitals, and MediMAR (an electronic Medication Administration Record)

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Clinical Resources for the State Hospital System

•Clinical Decision Support

▫UpToDate - Evidence-based clinical decision support ▫Adverse Drug Reactions - part of the pharmacy system

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Billing Services

•Hospitals▫Electronic Billing through TMHP

•Local Mental Health Authorities▫Electronic Billing

•Substance Abuse Providers

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Management Data▫Contract Measures▫Legislative Budget Board (LBB) Measures▫Policy and Planning▫Return on Investment (ROI)

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Contract Measures – Mental Health•Mental Health

▫Performance reports come from MBOW (Consumer Analysis Data Warehouse) and the data comes electronically from: CARE CMBHS

▫The individual LMHAs have their own EHRs and use batch processes to exchange data with CMBHS

▫The LMHAs have individual processes for entering data into CARE

▫The administrators of MBOW combine the necessary databases from the CARE system and from CMBHS

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Contract Measures – Substance Abuse

•Substance Abuse▫Performance reports come from CMBHS▫Substance Abuse providers enter data directly into CMBHS

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Contract Measures - NorthSTAR

•NorthSTAR▫NorthSTAR has its own database maintained by Value

Options▫The contract measures are created by Decision Support out

of the NorthSTAR database▫If there is a need to combine NorthSTAR data and the other

LMHAs then Decision Support Program Specialists combine them.

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Performance Measures – State Hospitals• All State Hospital related data that resides in CARE comes from

the interface with Avatar. • Data goes from Avatar to CARE five (5) times a day • The vast majority of performance measures for the Management

Plan uses data from CARE or directly from Avatar. A few reports get data from other divisions or on Excel spreadsheets from the hospitals

• The hospitals submit performance data to the Joint Commission (TJC) and the Commission for Medicaid and Medicare Services (CMS) through a Performance Measurement System, the NRI, and that is an electronic submission created by Decision Support.

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LBB Measures

•The LBB Measures, for the most part, replicate the processes used for the contract and performance measures.

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LMHA EHR Systems

•LMHAs self-select and self-administer EHR systems for local use.

•Support variety of lines of business, not exclusively state contracts.

•Interface with a variety of state systems

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Collaborative Activities

•DSHS has worked with the LMHAs to advance interoperability between locally-controlled EHRs and state systems▫CMBHS Mental Health▫Balancing Incentive Program (BIP)▫Clinical Data Exchange for Behavioral Health (CDE4BH)

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Balancing Incentive ProgramFederal law established the Balancing Incentive Program (BIP) which increases the Federal Matching Assistance Percentage to participating states through September 2015 in exchange for states making certain structural reforms to increase access to Medicaid community based long-term services and supports (LTSS).

These required structural reforms include• implementing a "no wrong door" eligibility and enrollment system; • developing core standardized assessment instruments; and • ensuring case management activities are conflict free.

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Clinical Data Exchange for Behavioral Health•Enable standards-based exchange of continuity of care

documents between state psychiatric hospitals and LMHAs

•Required adding technical capacity to Avatar•Avatar will be able to both send and receive continuity of

care documents•To take full advantage, LMHAs need to be able to both

send and receive C-CCDs•System may be extended to support other use cases•Ability to include attach PDFs, TIFFs

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Questions?

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