Redwood Health Information Collaborative 2-18-09
description
Transcript of Redwood Health Information Collaborative 2-18-09
![Page 1: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/1.jpg)
Redwood Health Information Collaborative2-18-09
![Page 2: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/2.jpg)
Session Overview
Health Information Exchange: Why? What? Who? How?
Challenges Along the Way
Results – Making a Difference
![Page 3: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/3.jpg)
Acronyms to Enjoy
RHIO = Regional Health Information Organization governance model / funding mechanism
HIE = Health Information Exchange clinical / consumer / claims / public health
NHIE = National Health Information Exchange (standardized interface, certified
technologiesNHIN: Nationwide Health Information Network “network of networks” EHR + PHR + HIE + PHIN + ???
![Page 4: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/4.jpg)
750,000 patients in multi-state region
2/3 of patients live in Tennessee
1/3 live in Virginia
5% in other states
Hospitals: 18
Physicians: 1200
Public Health: 7 regional, 2 state
Payor: 25% Medicare
20% Medicaid
18% uninsured
2-20% commercial
Small – Med Employers:
Eastman Chemical 7500
ETSU – 6500
Hospitals – 5500, 5400
![Page 5: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/5.jpg)
CareSpark’s Mission
CareSpark’s mission is to improve the health of people in NE Tennessee and SW Virginia
through the collaborative use of health information
Regional Population Has High Disparities of:• Diabetes
• Cardiovascular Disease
• Hypertension
• Lung Disease
• Cancer
• Premature Mortality
CareSpark region has $2,400 higher per capita patient care coststhan other regions of the country
![Page 6: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/6.jpg)
Regional Health Status
![Page 7: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/7.jpg)
![Page 8: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/8.jpg)
Trend are getting worse
![Page 9: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/9.jpg)
Drug Caused Death Rates 2002 - 2003
![Page 10: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/10.jpg)
Quality Measures For VACompared With Best Practices
0
20
40
60
80
100
120
Tob CounselB-block p MIMammogramPAP SmearChol ScreenChol p MI
LDLC <130 p MIColorectal ScreenHgbA1c annuallyHgbA1c < 9.5
DM Chol
DM Chol < 130DM eye examHTN controlledFlu vaccine, >65yoPneumovax, >65yo
MH f/u p D/C
Percent Goals Met
VABest Other
2002 Data17 Measures
![Page 11: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/11.jpg)
Source: SBCCDE, CITL, Gordian Project analysis
Redundancy
Treatment
Errors
Diagnostic
Electronic Medical Record
Clinical Data Sharing
Decision Support
Value is Derived from Better Medical Decisions
Patient Data
![Page 12: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/12.jpg)
What Will CareSpark Do?
Outcomes Improvement •Individual health outcomes Population health status
Decision Support(real-time, at point of care, across all systems)
Patient-specific info (Rx, Dx, Hx)
Clinical Best Practices
PHR / EMR / CCR
Cost-Efficient Use of ResourcesReduced duplication, errors, administrative costs
![Page 13: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/13.jpg)
CareSpark’s Strategic Outcomes
Population Health ClinicalPremature Mortality Adult Diabetics, Rx filled, vision / foot, HBA1C<7New Diabetes CasesLipid Panel LDL < 100Flu Vaccines for 65+ Pneumo Vax for ages 65+, <2ER Visits for Health Attack Stroke TherapyPost- MI followup Cancer Screenings (PAP, Mammogram, colorectal)
Financial Savings -- ROI• Patient• Clinician• Facilities• Purchaser (health plan, employer, taxpayer, individual)
![Page 14: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/14.jpg)
Awareness & Adoption of Best Practices
Public Health
Clinician Purchaser
(Payors / employers)
Individual
(patient / consumer)
Population Health Informaticist
Community
![Page 15: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/15.jpg)
Community-Wide Collaboration
Active, representative participation, including• Employers: Eastman Chemical Company, CGI, BAE Systems, City of Kingsport, • Payors: Blue Cross Blue Shield of Tennessee, John Deere Health / United Healthcare, Cariten PHP, Highlands Wellmont Health Network• Hospitals: Mountain States Health Alliance, Wellmont Health System, Johnston Memorial Hospital, Quillen V.A. Medical Center, Laughlin Memorial• Physician Practices: Holston Medical Group, Highlands Physicians, Health Alliance PHO, Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Frontier Health, Southwest Virginia Community Care Network, Blue Ridge NeuroScience, C-Health• Health Education: East TN State University School of Medicine / College of Nursing/ College of Public and Allied Health, University of Appalachia College of Pharmacy, University of Virginia• Public Health: Sullivan and Northeast Regional Health Departments in TN, Cumberland Plateau and Lenowisco Health Districts in VA, Tennessee Department of Health, Virginia Department of Health and Human Resources• Community Non-Profits: Kingsport Tomorrow, United Way of Kingsport, Rotary Club of Kingsport, Kingsport Chamber of Commerce, Bristol Chamber of Commerce, NETWORKS Sullivan County Partnership• Patient Advocacy Groups: American Cancer Society, Minority Health Coalition, Mountain Empire Older Citizens• Local Technology Companies: Intellithought, LucentGlow, Deliberare, Holston Technology, the Creative Trust, ntara
![Page 16: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/16.jpg)
Board of Directors
CareSpark ManagementClinical
Outcomes / Evaluation Population Health workgroup Financial Savings Workgroup
Technical
Finance
CareSpark RHIO Organizational Structure
Communications
Nominating Legal AuditPersonnel
Patient Physician Public Health PurchaserFacilitiesStakeholder Advisory Groups
Project Management Office
Partner Partner Partner Partner
Health Information Control
![Page 17: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/17.jpg)
CareSpark Board of Directors
Board Membership• Selected as individuals, not organizational rep’s• Expectation: put community good ahead of individual or organizational
agenda• Self-perpetuating (nominating process, board members elect successors)• 1-3 year staggered terms, two-term maximum• Balance of leadership experience, necessary skill-sets, network contacts to
achieve strategic goals, representative of stakeholder and regional demographic composition
Current Members include:CIO of large health system, CEO of independent pharmacy, CEO
of behavioral health provider, CEO of hospital-physician network, CFO of large insurer, Health Benefits director for large employer, President of large multi-speciality practice, CEO of community health center, Director of regional public health department, Chief of Staff for local V.A. hospital, Exec Director of regional seniors programs, VP for local university / rural health education
![Page 18: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/18.jpg)
CareSpark’s Core Strategies
Provide patient informationand decision support on
demand at the point-of-care
Align financial incentives to assure
fair return on investment
Empower patientsto make healthy
choices & informed decisions
Provide selected aggregate datafor population
health improvement
1. 2.
3. 4.
![Page 19: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/19.jpg)
Coordinating organization facilitates rules of engagement: • Data-sharing Agreement • Legal Framework• Standards• Interoperability• Transparency• Value• Quality/Cost
Framework for Trust and Collaboration
Broadband % of Access, Stakeholders, Automation
EMR / EHR/PHR Implementation
Structured Notes & Paper Records
Administrative Transactions (claims…)
ePrescribing Roll Out
Secure Clinical Messaging (labs, imaging, email…)
H.I.E.
Com
mon
Por
tal
Tennessee State-level leadership
![Page 20: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/20.jpg)
Virginia Health IT Framework
![Page 21: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/21.jpg)
Virginia RHIO initiatives
![Page 22: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/22.jpg)
Key Strategic Decisions
1. Enable participation by all patients and providers in region
2. Enroll patients through default Passive Enrollment (“opt-out”) with option for Active Enrollment (“opt-in”)
- Passive or Active enrollment managed through Master Patient Option Preference (MPOP) and Local Patient Option Preference (LPOP)
3. Hybrid Model, combining Federated Repositories and Centralized Repository for limited clinical data- Enabling decision support, monitoring and aggregate data analysis where regionally approved
4. Data Access and UsesPatient: view content of records, view access logProvider: payment, treatment, operations Public health: required reporting and authorized queriesPayers: de-identified aggregate dataResearch: IRB-approved studies
5. Fee-Based Revenue Model- Contracts with insurers and employers- Transaction fees for data providers (labs, hospitals, large practices)- Contributions (cash and inkind)
6. Commitment to standards (IHE / HITSP, ISO)
![Page 23: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/23.jpg)
Convergence of Data
Administrative
Billing & Claims
Clinical
Personal Health Record
Research
Best Practices
Patient-Centered
Care
![Page 24: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/24.jpg)
From Patient Perspective
Perceived Risks• Privacy
(unauthorized access or release)
• Use of data (denial of care, coverage, or employment)
• Identity theft• Government as “big
brother”• Incorrect matching of
records• Incorrect data entry
Perceived Benefits• Convenience• Access to critical
information (allergies, rare diseases)
• Reduced duplication = reduced cost
• ability for proxy to manage care (adults caring for elderly parents from a distance)
• Advanced directives
![Page 25: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/25.jpg)
The Importance of Standards
Standards for data content (what are the important pieces of information necessary? Is terminology consistent?)
Standards for data transmission (how is data sent?)CDA = (clinical document architecture) exchange of fixed, legally defensible document upon requestCCR = (continuity of care record) assembly “on the fly” from discrete data elements in multiple systemsCCD = (continuity of care document) standard document that includes common discrete data elements
Standards for security (access, authorization, audit)use existing international standards from other industries
Standard policies (who decides what to share, with whom and for what use?consumer-directed permissions for access to / useaddress issues of liability and enforcement
Funding / sustainability (who benefits, so who pays?)savings accrue mostly to purchasers (insurers, employers, taxpayers, self-pay consumers)“transparency” for capital and operating costs, ROI, quality outcomes
![Page 26: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/26.jpg)
CareSpark RHIO Consortium PartnersNational / International: Local / Regional:
ActiveHealth the Creative Trust AllScripts DeliberareAnakam Holston TechnologyCisco IntellithoughtCGI LucentGlowDell OnePartnerGE HealthcareHealthvision / Quovadx State:Initiate Systems TennesseeIntel Virginia MisysOracle Federal:Siemens DHHS / ONCWellogic
Market / thought leaders committed to interoperability, collaboration and results
![Page 27: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/27.jpg)
CareSpark IHE Architecture
Data Participants
CareSpark Data Store
XDSDocumentRegistry
XDS PatientIdentitySource(MPI)
Portal
Hospital 1 Phys PortalIHE
DocConsumer
Hospital 1
IHE DocSource/ DocConsumer
Physician Practice 1
IHE DocSource/ DocConsumer
Document Repository
Document Repository
FILTER
Clinical DataRepository
Public HealthData Mart
De-IdentifiedData Mart
Car
eSpa
rk X
DS
Dat
a St
ore
-
Fo
r Pat
ient
Car
e
Clin
ical
Dat
a
Rep
osito
ry -
F
or
Pub
lic H
ealth
Im
prov
emen
t
XDS PIXService
CT TimeService
XDS PDQService
ATNA AuditRepository
XDSDocumentRepository
XDSKey Store
Public Health Department 1
Additional Providers and other data participants
IHE DocSource/ DocConsumer
IHE DocSource/ DocConsumer
Document Repository
DataTransformation
![Page 28: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/28.jpg)
Technical Architecture
Internet
Provider 1
Active Health
Data BaseServer
ApplicationServer
`MPI Client
Filters and Encryptions
Application Server
Data BaseServer
CareSpark Secure & Redundant
Network A
CareSpark Secure & Redundant
Network B
Note 1: Patient access will be via the internet thorough Https Protocol (SSL)
LoadBalancer
AppFirewall
Note 2: Although not pictured , the Internet connectivity , the Application Firewall and the Load Balancer will all be redundant , to avoid a single point of failure .
See Note 2.
See Note 3
NHIN
Patient
Https
`
See Note 1.
Note 3: All non -patient connections to the Internet are secured connections , via SSL .
EMPIFilters and Encriptions
EMPIFilters and Encriptions
Data BaseServer
Data BaseServer
Router
Provider 2`
MPI ClientFilters and Encryptions
` Small Doctors Office
`Provider using
ASP
Application Server
Provider
MPI ClientFilters and Encryption
![Page 29: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/29.jpg)
Nationwide Health Information Network: “network of networks”
NHIN Prototype Demonstration 2006-07
design for exchange between
CareSpark, West Virginia, Kentucky providers,
federal agencies
NHIN Trial Implementation 2008
* Core Services:
Consumer permissions
Security exchange
Standardized interfaces
Summary medical record
* Medication Management
eRx, med history, decision
support
* Consumer Empowerment
personal health record, registration
and medication history
![Page 30: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/30.jpg)
CareSpark NHIN ArchitectureCareSpark(Hosted at CGI)
Oracle
XDS PatientIdentitySource(MPI)
PortalWellogic
Cloverleaf
XDS PIXService
CT TimeClient
ATNA AuditRepository
XDSDocumentRepository
XDSKey Store
XDS PDQService
XDS RegService
XDS RepService
Two FactorAnakam
EMPIInitiate
PostGreSql
XDSDocumentRegistry
XDSRegistry
NIST
ATNAWinSysLog
ADTService
Web Server
DB Server
VersionControl
Subversion
MPOP
MPOPConsent
CustomInterfaces
AnakamESB
NHIN request/response
Providers
Any other inbound/outbound end point
Socket TCP
SOAP/HTTP
Flat File
DataTransformation
ProtocolTransformation
MessageEnhancement
SecurityValidation
Routing
Orchestration
Anakam
Two FactorAnakam
Web Server
PHRActiveHealth
Web Server
e-PrescriptionAllScripts
![Page 31: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/31.jpg)
Jun 07
Technical/Financial Timeline
Jun 08 Jun 09Jan 08 Dec 09Jan 09Jan 07
Enrollment of 25,000members
MPI build
document registry andRepository
Build clinical data repository
Physician Portal,
authentication
Real-time Decision support integrated
with HIE
Data-sharing
agreements
Enrollment 250,000 patients
Claims-based Decision support
implemented
Enrollment 35,000
members
Clinical documentExchange
NHIN Trial Implementatio
n
![Page 32: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/32.jpg)
Operating Operating SupportSupport
April 2008 – June 2009April 2008 – June 2009
Infrastructure Infrastructure DevelopmentDevelopment
July 2005 – March 2008July 2005 – March 2008
Strategic Business Strategic Business PlanningPlanning
July 2004 – June 2005July 2004 – June 2005
Grassroots Sustainability
$100,000 grant from eHealth Initiative
$462,000 match from local partners
$250,000 Commonwealth of Virginia
$308,000 Accenture NHIN Prototype
$1,450,000 Consortium Partners (cash/inkind)
$1,000,000 State of Tennessee
$750,000 contributions and donations
$3,688, 622 NHIN Trial Implementation
$150,000 transactional fees for services
$450,000 contributions and donations
$1,055,225 enrollment of members
![Page 33: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/33.jpg)
Revenue Sources July 2005 – Dec 2008
Employers:Eastman Chemical Company $ 600,000King Pharmaceuticals $ 60,000Cariten PHP $ 8,000Johnston Memorial Hospital $ 10,000
Contracts:State of TN $1,016,900Accenture (NHIN prototype) $ 308,000Commonwealth of Virginia $ 250,000NHIN Trial Implementation $3,988,622
Consortium Partners $1,250,000cash and inkind
Enrollment Fees (CareEngine Services) $ 431,640
Transaction Fees $ 0
Total $7,923,162
![Page 34: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/34.jpg)
CareSpark Data-Sharing Options
Data Sharing Option Intended Data Use Data Sharing Result
Identified Data Patient Care and Treatment
All data sent to CareSpark will be identified data in order to match patient records from multiple providers. Identified data will be available to authorized providers for access of additional healthcare information about the patient.
De-Identified Data Anonomized – patient data can never be re-identified
Approved Population Health Improvement activities
Identified data available to CareSpark will be de-identified according to the approved requirements and stored separately.Pseudo-Anonomized –
Patient data can be re-identified, if necessary, but only by the party who provided the pseudo-anonoymized data
Limited Public Health Identified data available to CareSpark will be de-identified with the specified additional fields required for a limited dataset according to the approved requirements and stored separately.
![Page 35: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/35.jpg)
Future Initiatives
• National – connect with V.A., CDC and personal health records
• Tennessee – connect with state agencies (public health immunization registry, Tn eHealth Council efforts)
• Virginia – connect with immunization registry, prescription management program
• Local / Regional – support aggregation and analysis of data to address public health issues for region (chronic disease, prescription drug overdose)
![Page 36: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/36.jpg)
Lessons Learned – Regional HIE
• Health care market does not conform to political boundaries
• Evolving standards will assure interoperability across jurisdictions and between systems (clinical, payer, public health, personally-controlled, research-oriented)
• Leverage existing resources and investment through incremental transition
• Build for maximum flexibility to accommodate change (technical, policy, funding, users, evidence-base on outcomes)
![Page 37: Redwood Health Information Collaborative 2-18-09](https://reader035.fdocuments.net/reader035/viewer/2022081515/56816832550346895ddde37e/html5/thumbnails/37.jpg)
Better Health for Central Appalachia
www.carespark.comLiesa Jenkins, Executive Director