Christina Galanis Executive Director, Southern Tier HealthLink

HIE, RHIOs and EHR Interoperability

The Journey to Meaningful Use, Interoperable Health Care Delivery and Improved Quality of Care

From paper to meaningful use and beyond

Topics to be covered in this session

Understanding the landscape & terms: HIE and RHIOSouthern Tier HealthLink sources & servicesRHIOs & Meaningful UseWhere is all this interoperability going?How can REC can help you?

Hospital B

Independent Pharmacy

Hospital A

Hospital Laboratorie

s

National Laboratories Hospital

Imaging

Orthopedist

Imaging Centers

Chain Pharmacy

Cardiologist

Primary Care Physician

Home Health Care

Ambulatory Surgery

The Need for Health Information Exchange

Support for the Southern Tier HealthLink

“The rapid transfer of medical information enables the Broome County Health Department to conduct ongoing disease surveillance through the ordering, analyzing and weighing of data to determine risk for illness and injury. This cannot be possible …without sharing information through robust, reliable, and secure computing and communication products. ”

Claudia Edwards, Broome County Public Health Director, NY DoH

“The staff at the Lourdes Emergency Department is very excited to gain access to the Southern Tier HealthLink HIE. Particularly for patients who are unconscious or have difficulty remembering things like their medications and allergies, our ED personnel can rapidly gain access to this critical information. This STHL tool will allow us to provide better treatment and perhaps even save lives.”

Regina Pufky, Lourdes Hospital Emergency Department Nurse Manager

Support for Southern Tier HealthLink

EHR (Electronic Health Record): a computerized record keeping system at your hospital or doctor’s office

HIE (Health Information Exchange): the system of sharing (exchanging) medical information from one EMR system to another

 RHIO (Regional Health Information Organization): the not-for-profit group that manages the HIE, ensuring it works properly and securely

PHR (Personal Healthcare Record): a computerized collection of medical information about a particular person, viewable via the internet

STHL (Southern Tier HealthLink NY): our central NY RHIO that makes sure the HIE works like it is supposed to

5

The Alphabet Soup

6

The Alphabet Soup

STHL is…the local RHIO

…that you can see in your PHR. 

…which oversees the HIE

…which stores EHR information from different sources

RHIOs Are Statewide

Southern Tier HealthLink Background

Founded as a partnership between UHS, Lourdes hospital and local physicians.

Board of Directors represents founding stakeholders, physician practices, long-term care, public health, rural health, and the patient community

Has a patient centric view of clinical information informed by multiple sources

Funded by NYDOH and as part of the SHIN-NY, STHL acts as a public/private entity

As funded by NYDOH, STHL must comply with state policy guidance

Uses a Central Data Repository model: patient data is deposited and sealed until the patient consents to have records shared/accessed

Provides a range of services to member hospitals, practices, and patients

Southern Tier HealthLink Board of Directors

Higher quality patient care Improved coordination between ALL care providers

Cross institutional patient centric care More efficient delivery of care

Value occurs across the regional health system

Patients•Access to medical records•Less time gathering records •Reliable source for medical history•Easier medication reconciliation

Health care providers•More complete clinical profiles of patients•Better documentation at point of care•Less time gathering results•Improved patient care

Hospitals &Health Centers•More complete clinical profiles of patients•Better distribution of results •Simplified EMR integration•Improved care coordination•Easier medication reconciliation

Payers

•Higher member satisfaction•More informed disease management programs•Improved care coordination•Fewer duplicate tests•Enhanced formulary compliance

Employers

•Improved employee health•Reduced costs through administrative efficiency and fewer redundant services•Employees engaged as active participants

Southern Tier HealthLink Objectives

UHS Binghamton General Hospital

UHS Wilson

Memorial

Hospital

UHS Chenango Memorial Hospital

Lourdes Hospital

UHS Primary Care & Medical Group

Southern Tier

Imaging

Delaware Valley

Hospital

Demographics X X X X X X X

Contact Info X X X X X X X

PCP Info X X X X X X X

Insurance X X X X X X X

Allergies X X X X X

Medications X X X X X

Problem List X X X X X

Diagnosis X X X X X X

Procedures X X X X X

Immunizations X

Lab Results X X X X X S

Radiology Images X X X X X

Radiology Reports X X X X X X S

Hospital Discharge Summary

X X X X X

Transcription S S S X S

General CCD X X

Southern Tier HealthLink Sources Data

Current Products/Services

Clinical results delivery Patient portal and access to

tethered PHR Radiology image exchange Bi-directional connected EHR Physician portal Training and HIE adoption Master Patient Index SHIN-NY on-ramp

Emerging Interoperability Services

Medicaid Medications EMS Connectivity Advanced EHR interoperability Referrals (CCD exchange) CCD Query RHIO-to-RHIO exchange Provider Registry Public Health reporting

Southern Tier HealthLink Services

EHR Connections established with DOH funding through HEAL

Cerner MillenniumEmageon – PACSFugi – PACSHMS ITL – PACSMcKesson – PACSMedentMeditechMedSeries 4Microsoft HealthVaultNextGenSiemans InvisionSiemans SignatureSoftlabs

Conversations with:Multiple EHR vendorseHealth Global Technologies (eHGT) –PACS

Six-county service area

Broome, Chenango, Delaware, Cortland, Otsego and Tioga

BroomeBroomeDelawareDelaware

CortlandCortland

ChenangoChenango

TiogaTioga

Interoperability Footprint

OtsegoOtsego

Receiving patient information from 5 area hospitals 37 area medical practices 1 independent radiology practice

Accessing patient information (Connected EHR/Web Portal) 3 area Emergency Departments 40 area medical practices

~ 200 physicians or other providers~ 800 clinical staff (nurses, etc.)

Have collected patient consent forms from 40,000 patients—only about 3% choose not to participate Via 60 collection sites

Southern Tier Healthlink Program Status

Technical safeguards exceed industry standards: Access is “need to know” based on user’s role Level 2 Assurance on user authorization

and authentication Health information transactions are

encrypted Access is subject to HIPAA and HITECH

regulations

STHL actively monitors HIE utilization: Periodic audits, in partnership with

Participants Access reports available at patient request

Southern Tier HealthLink’s Privacy and Security

EHR Interoperability Variability

EHR interoperability can vary by HIE or RHIO & EHRResults/Reports deliveryPatient summary exchange with CCDReferralsOrderingCare alerts or subscription

Results delivery can vary too by PracticeSelecting data to receive/filter

(for example preliminary and/or inpatient result)Assist with turning off paper/faxes process at various data providers

Results delivery can surface issues that may have been addressed differently in the paper world

Getting results from patients that are no longer yoursNot getting results as a primary care physician that you used to get by paper/faxCombining results to one reportResults/Reports volumesOther Support issues

Overview of Meaningful Use

The American Recovery and Reinvestment Act (ARRA) authorizes the Centers for Medicare & Medicaid Services (CMS) to offer a financial incentive to physician and hospital providers who demonstrate the “meaningful use” of an EHR.

According to the CMS, a provider uses an EHR “meaningfully” when he or she:1. Improves quality, safety, efficiency, and reduce health disparities

2. Engages patients and families

3. Improves care coordination

4. Improves population and public health

5. Ensures adequate privacy and security protections for personal health information

New York is ahead of the curve in building patient centric HIE services through RHIOs

At the federal level, efforts such as the NHIN direct are seeking to provide interoperability for those that don’t have any local HIE or RHIO services

It is a very dynamic environment but interoperability will continue to expand and get more sophisticated

Workflows will improve, new data sources will be added

Quality improvement efforts will advance with more complete patient information and improved analytics

We have solutions today that work today & are here to support your interoperability needs in the future

Where Is All This Interoperability Heading?

The Vision for Meaningful Use

Stage 1

Stage 2

Stage 3

Improved quality of care

3 Stages of Meaningful Use

Each stage gets progressively harder to drive toward the ultimate goal

Is the federally designated entity to help providers adopt EHRs and qualify for incentives by achieving Meaningful Use

Partners with local health groups in your community to get you the support you need

Negotiates on your behalf with EHR vendors and IT suppliers

Will be with you every step of the way

The New York eHealth Collaborative Regional Extension Center (REC)

NYeC REC is the Sum of Many Parts

NYeC works with a statewide network of highly qualified organizations

Our collective mission: Provide the training and support services providers needed for doctors and other providers to adopt and meaningfully use of EHR systems

Southern Tier HealthLink will connect you to the REC program.

There are 9 Stops on the Full Journey

For Those Who Have Already Adopted, The Journey Starts Further Down the Line

Join the REC

Select an EHR

Design Infrastructure

Purchase

Prepare For Launch

Implement

Use

AchieveMeaningful

Use

Receive Federal

Incentives!

Assess & Plan

Stop Eight: Achieve Meaningful Use

With the REC Without the REC The REC is the federally-

designated Meaningful Use expert for New York

We’ll walk you through what your practice needs to do

We’ll help you measure your readiness so you’re prepared for your 90-day Meaningful Use evaluation period

The federal definition is over 800 pages long!

Try to measure whether you’re ready for evaluation

Try to organize your federal 90-day evaluation period

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Final Stop: Receive Federal Incentives

With the REC Without the REC Hopefully this:

Maybe:

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Regional Extension Center EligibilityMD, DO, NP, PA practicing in typical primary care specialties including OB-GYN and Pediatrics, and practice size is 10 clinicians (with prescriptive privileges) or fewer

- or -Practice is a federally-qualified health center or public or critical access hospital or primarily serves medically underserved populations

You are eligible for the program even if you already have an EHR. If you do already have an EHR, the REC

will assist you with post-implementation services to get your practice ready for Medicare and Medicaid

incentive programs If qualified, the federal government is subsidizing your participation up to $5,000 per

providerIf you already have an EHR and need services to get to Meaningful Use, the standard

program cost to you is $750 for one year of participation.If you already are going from a paper based business through to Meaningful Use, the

standard program cost to you is $1,500 for 2 years of participation.

For more information about the Regional Extension Center (REC) visit:

www.nyecrec.org

For more information about STHL services:- Call STHL at 651-9150- Visit www.sthlny.com

Christina Galanis, Executive DirectorMarc Andiel, Technical DirectorPaul Almy, Project Coordinator, TechnicalJohn Hayek, Project Coordinator, Community OutreachEmily Pape, Project Coordinator, Privacy

and Research