AAFP Southeast Family Medicine Forum

Lessons Learned About Health Information Exchange

Michele Grinberg

Flaherty Sensabaugh & Bonasso PLLC

Technology-Not to Create Problems-

Technology-To Solve Problems-

Problems Answers• WV’s Personal Health

Issues • WV’s Health Care

System Issues• WV’s Technology

Issues• WV’s Geography

• State-of-the-art communication among all providers and patients

• Viable, affordable technology that meets all providers at any stage

• Lack of Access to Care

West Virginia’s Health Problems

– The 2nd oldest population – with all the co-morbidity problems of aging

– Chronic disease management– Patient compliance– Medication and drug management– High ER usage– All-age obesity– Low birth weight babies

West Virginia’s Health Care Systems Problems

• Continuity and Coordination of Patient Care

• Lack of complete patient data at the time and place of care delivery: accepting this as an inevitable part of the system

• Extensive patient histories; multiple providers

• Limited Private Payers

West Virginia’s Tech Problems– Limited broadband connections– 17 percent adoption of EMR systems

- multiple EMR brands

- varying levels of satisfaction

- slow uptake among all providers

- High costs– Multiple portals– More than one interface – “Wait and See” philosophy

-Technology –The Easy Part

-Technology Solutions -

• Limited broadband connections WV Telehealth Alliance FCC grant• Low and Slow EMR Adoption Top HIN vendor companies offer lower cost, less

complex entry point systems. Can connect almost all EMR systems• High Costs WVHIN = 1 portal 1 interface

1 format

O -T - T - C!

Health Information Network in a Box

HIN in a BoxHealthBridge Delaware Health

Information Network

Delaware Health Information Network (DHIN)

• Public/Private Partnership

• First Statewide Health Information Network. DHIN went live Spring 2007

• Secure network for distributing clinical results and reports from the hospital, lab or radiology center to the treating physician

• Data is managed by those who order and perform the tests

• Supported by Medicity

HealthBridgeCited extensively

in the health information

literature as a sustainable,

replicable and successful HIN

HealthBridge – Since 1997• Serves 2.2 million patients• Connects 4,400 physicians• More than 1.7 million clinical messages per

month• Connects 17 Health Departments• Quest, Labcorp, Proscan Imaging, KY Diagnostic • St. Elizabeth’s; St. Luke’s; The Health Alliance;

TriHealth; Mercy Health Partners; Children’s; Deaconess; McCullough Hyde; Christ Hospital and Adams County

HealthBridgeWorking with independent exchanges

includingeHealth Collaborative, Bloomington, IndianaClark and Campaign County HIE, Springfield,

Ohio

Built on pushing out clinical resultsUpcoming additions to include disease

registry and biosurveillance

-Touch –The Hard Part

Touch Issues

• Scorched Earth reactions to HIT

• Change - work habits work flow staffing patterns and job descriptions

• Fear of the New

• Wait and See Philosophy

• Cost

• ROI

Touch Issues

• Enabling a new paradigm of patient care where complete, timely and accurate information can be expected by both providers and consumers at the time and place where care is delivered via a private and secure electronic network.

How?

Meeting the Challenges Through WVHIN

• Creating a community of a sufficient mass of data users and senders who can “converse” with each other electronically

• Provide the most viable technology solutions for our state and for all providers

• Maintain technology to optimize ease of entry, use and minimize costs

• Coordinate with related

projects

Technology

• RFI and RFP Process

• Staggered Roll-out of Services

• Substantial Input from Users

• Lessons Learned from NHIN Projects

NHIN Lessons

• National NHIN CareSpark, TNDelaware HINIndiana UniversityLong Beach Network for Health,

CALovelace Clinic, NYMedVirginiaNew York eHealth CollaborativeNC Healthcare Information &

Communications AllianceWVHIN

• WVHIN ProvidersCabin Creek Health

SystemsAppal. Regional Healthcare,

Beckley and Summers County

Amer. Medical Facilities Management

WVU Physicians of Charleston

Charleston Area Medical Center

NHIN 2- Lessons

• Varying state practices & laws

• Varying HIE/RHIO governance

• Varying development stages

• ALL PARTICIPANTS COMMITTED

LEGAL ISSUES

• Consent/authorization laws vary from state to state, and state vs. HIPAA – What governs when data sent across state lines?

• Liability & Insurance – States cannot indemnify others while private corps can.

• Dispute resolution – States cannot agree to binding alternatives while private corps can.

NHIN2-WVHIN Lessons• Demonstration accomplished between

June 15 -- July 30!

• Privacy and Security Policies confirmed

• Legal agreements in place

• Incident procedures in place

• Opt-out Consent process used with success BUT…..– Registration process critical (The Touch)

WVHIN’s Financial Benefits• 1 portal, 1 interface to maintain

• 1 call for support

• Low-cost or no-cost entry

• Reasonable subscriber fees for those benefiting from the Network

• Inclusion of all providers with respect to ability to pay

• ROI evaluation statements

Reduce the Paper Chase• Paper Storage• Paper Cost• Paper Retrieval• Paper Organization• Paper Handlers• Paper Reading• Paper Damage• Paper Lost Forever

A Day in the Life of One Doctor’s Fax Machine

1 day

1 doctor

115 faxes

10 ads

55 lab results

30 consult reports

19 pharmacy renewals

1 stat abnormal mammogram 1 stat abnormal mammogram that needs immediate attentionthat needs immediate attention

Touch• Extensive Community Outreach

• Hand holding Installation and support

• Vendor must demonstrate current ability to connect all but the most obscure EMR systems

• Scheduled, staggered roll-out of services

• Serving as a “hook-up” to link providers for informal help

Practice EMRs(Goal: 15% of docs)

Other DataReceivers

CommunityHIE

Sample Community-wide HIELogic Model – Provider Orientation

Hospitals Labs Radiology Other Senders

DATA SENDERS

PaperRecords

DATA RECEIVERS

-- Public Health

-- Research

-- Patients

-- Other HIEs

-- Others when ready

Practice ElectronicInboxes

(Goal: 85% of docs)

OTHER DATAEXCHANGE

Fax or Printer(Goal: Minimize)

PaperRecords

Phase 1

Messaging

Phase 2

Coordinated

Care

Phases 3+

Quality and

Value

Task Get everyone connected; achieve critical mass

Enable inquiry of data from multiple sources

Longitudinal analysis of data from multiple sources; patient engagement; quality performance

Big Win Efficiency; reduce costs by replacing paper

Reduce duplicate tests; improve coordination; save lives

Huge for all – right info at the right place at the right time

Major Winners

Providers

Public health

Health Plans, Providers; ED; Public Health

Health Plans, Providers, Public Health/Population Health, Researchers, Patients

“WVHINs” for Practices

• HIE diminishes the hassle of patient handoff

• One interface! One portal!

• Low cost ease of entry via an electronic inbox with workflow tools

• Can meet practices at any stage of electronic readiness

• Less paper!

Easier Patient Handoff

• Electronic Messages for

– Referrals, ED Visits, Hospital Discharges

– Accompanied by Labs / Meds / Allergies

– Prior Authorizations

– Insurance Information

Physician Benefits

• Phase I– Real-Time Access to Information– Better Organization of Information– Order, Result, and Referral Tracking– Improved Communication– Office Efficiencies

– Low Cost Entry Point – BETTER, MORE EFFICIENT PATIENT CARE

Staff Benefits

• Far fewer games of telephone tag

• Appropriate routing of routine requests

• Audit trails

• Less handwriting to decipher

• Tailor to each provider’s work habits

• Less paper!

Community Benefits

• Phase II– Disease Registries– Automated Public Health Reporting– Quality Indicator Measurements Easier– Sharing Clinical Data is Easier and Controlled

by Physicians– Reduce duplication in all areas – payers

benefit

www.wvhin.org