e-Health Overview:Findings and Recommendations for the

Kentucky e-Health Network Board

Presented by: Benjamin Beaton & Trudi Matthews

Cabinet for Health and Family Services April 18, 2006

Presented by: Benjamin Beaton & Trudi Matthews

Cabinet for Health and Family Services April 18, 2006

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Overview

1) Kentucky in the National e-Health Framework

2) Introduction to e-Health Efforts in Six States

3) Summary of Lessons Learned from Other States

4) Recommendations and Next Steps

Glossary of Terms– AHIC = American Health Information Community– EMR = Electronic Medical Record (clinical record system)– HIE = Health Information Exchange– HIT = Health Information Technology– NHIN = National Health Information Network– ONC = Office of the National Coordinator for HIT (Dr. Brailer)

– RHIO = Regional Health Information Organization

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Role of KY in National e-Health Framework• National efforts:

– National architecture: National Health Information Network (NHIN)

– Standards development: HIT Standards Panel

– Technology certification: Certification Commission on Health Information Technology (CCHIT)

– Federal board: American Health Information Community (AHIC)

• State-level efforts: – Regional and state information sharing projects

– Shared infrastructure

– HIE organization and governance

– Encouragement of increased EMR and HIT adoption

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Role of KY in National e-Health Framework

• Federal-state partnership efforts: – Security & Privacy collaboration (HISPC)– 4 AHIC workgroups, 5 breakthrough projects:

1) Biosurveillance: ER data for public health

2) Chronic Care: Secure messaging

3a) Consumer Empowerment: Electronic registration summary

3b) Consumer Empowerment: Electronic medication history

4) Electronic Health Records: Lab data

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Arizona

• August 2005: Governor signs Executive Order establishing “Arizona Health-e Connection”

• Nov. 2005: Statewide summit held, Steering Committee & Task Groups created

• April 5, 2006: Released Roadmap featuring priority projects – State-wide Web portal– Patient health history (Rx, Dx, tests)– Regional clinical messaging – Grant funds for small and rural providers for EMRs

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Indiana

• Indiana Network for Patient Care: First e-Health initiative in IN lead by health informatics institute and univ. hospitals; allowed ED staff to request electronic patient clinical abstract (5 major Indianapolis hospitals)

• Clinical leaders saw that e-Health could work and offer real value

• Feb. 2004: Indiana Health Information Exchange (IHIE) incorporated

• Stakeholder-governed, little state involvement, not statewide but planning to build a statewide network

• IHIE uses Docs4Docs - clinical messaging service (labs, radiology, other tests)

• Self-supporting: IHIE cash-positive in 2006

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Florida

• May 2004: Established Governor’s Health Information Infrastructure Advisory Board – Florida Health Information Network (FHIN): non-profit entity

to facilitate statewide health information exchange– State record locator will assemble patient information from

multiple servers based in RHIOs across state

– Drawing on existing electronic information sources

– Grants to support 8 of 12 developing RHIOs ($1.5M total)

• State-led efforts encouraging and utilizing additional private sector efforts – Availity: Multipayor Web portal for administrative & financial

transactions between providers, payors; part of FHIN– Will soon offer Payor-Based Health Record (PBHR) to

providers

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Minnesota

• Minnesota e-Health Initiative established by legislation in 2004

• Established Advisory Committee and subgroups to tackle work plan for statewide e-Health network

• Held statewide summit and released Roadmap to Legislature in 2005

• State created Minnesota Healthcare Connection – nonprofit entity to connect community e-Health efforts, including short term projects– Medication history– Enhanced disease reporting– Immunization registry– Electronic lab reporting

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Utah

• 1993: Utah Health Information Network (UHIN) established as state-owned nonprofit entity

• One of the only states to see long-term success of its Community Health Information Network (CHIN) effort

• Common standards & shared technology used for electronic exchange (EDI) of administrative & financial information – claims submission & status, adjudication, eligibility

• State law requires Utah Insurance Department to adopt standards for health care claims if UHIN adopts them

• Working to expand into clinical areas (medical and Rx histories, labs, discharge summaries)

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Categories of Common e-Health Projects

Record Locator &

Master Patient Index

Record Locator &

Master Patient Index

Clinical Messaging

Clinical Messaging

Medical and/or Drug History

Medical and/or Drug History

Disease Reporting

or Registries

Disease Reporting

or Registries

Hub for

Administrative & Financial

Transactions

Hub for

Administrative & Financial

Transactions

HITGrant

Programs

HITGrant

Programs

Electronic Prescribing

Electronic Prescribing

Regional/State

Health Data Exchange

Regional/State

Health Data Exchange

Creation of Statewide e-Health Network

Creation of Statewide e-Health Network

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Summary of Lessons Learned

• Funding– Major external funding has waned– Smaller funding opportunities mean narrowly-

tailored projects with near-term ROI– Build toward overarching goal through

smaller, incremental projects

• Organizational/Leadership Structures– State-led (Governor’s Exec Order – AZ, FL;

Legislation – MN, OR, VT)– Public/Private (MN, RI)– Private Sector-led (CO, IN, MA)

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Summary of Lessons Learned

• Research Needs– Policy-oriented research; not technical, theoretical– Great strides coming from private sector innovation– Collaborative hurdles are greater than technological

challenges

• Progress most likely when parties…– Identify space where it makes sense to collaborate,

not compete– Frankly acknowledge proprietary interests &

competition in the room – Identify common goals and objectives of improved

quality, increased efficiency

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Recommendations

1. Be ambitious but practical2. Focus on facilitating health information

exchange, not financing HIT adoption

3. Leverage health data already available electronically& projects already underway

4. Respect provider needs & practice patterns5. Identify barriers to HIT adoption and HIE;

propose common solutions 6. Combine long-term vision with short-term

quality improvement and ROI

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Recommendations and Next Steps

1) Be ambitious but practical – Pursue projects that offer ROI and tangible quality

improvement – Incremental, rather than whole-scale, change– Build experience, trust, & knowledge base by

working together over time – Pursue collaborative and voluntary projects; don’t

force e-Health on KY providers – Identify common issues and agree not to compete in

that space: Move them from a competitive environment to a collaborative environment

*Next Step: Pursue common administrative project(s) that facilitate and fund sustainable clinical information sharing

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Recommendations and Next Steps2) Focus on facilitating health information exchange, not

financing HIT adoption– Health information cannot be exchanged electronically unless it

is first recorded electronically

– Policies and projects should always encourage smart HIT investment by KY providers

– The e-Health Board cannot subsidize statewide HIT adoption; neither should it prescribe the vendors and software providers should utilize

– Provider investment in EMRs and other HIT encouraged:– In a collaborative fashion whenever possible, and– Mindful of national certification and standards efforts

– HIE = Moving data from silos to the point of care; working toward accurate, interoperable records

*Next Steps: ePrescribing grant program; Partnerships with provider associations on HIT adoption

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Recommendations and Next Steps

3) Leverage available electronic health information & ongoing projects

– Projects should target data already available electronically (claims data, Rx, some labs)

– KY can’t afford to wait until all clinical data is digital – we must begin exchanging the most useful data available

– When possible, coordinate among & learn from various local & regional e-health efforts, e.g., Accenture NHIN prototype

*Next Step: Target health data available through claims histories

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Recommendations and Next Steps

4) Respect provider practice patterns, patient needs

– Providers will not utilize tools or information that does not integrate into their workflow

– All e-health projects should meet thresholds of usefulness and pervasiveness

– What information will help engage patients and providers in better health?

*Next Step: Work with provider & patient communities to identify current HIT utilization and biggest needs, challenges

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Recommendations and Next Steps

5) Identify barriers to HIT adoption and information exchange; propose common solutions to those barriers– Could include laws, regulations, incentives,

business practices, and reimbursement patterns– Continuous effort to improve the regulatory and

business climate in KY for HIE and HIT*Next Steps: HISPC Security & Privacy

Collaboration; Board should identify and vet marketplace barriers, then propose and pursue solutions

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Recommendations and Next Steps

6) Focus on projects with early ROI & quality gains that build toward long-term goals

– Develop and refine goals for statewide HIE and integration with NHIN

– Flexibility and feedback are necessary in fast-changing national and industry landscape

– Projects should be sustainable: KY cannot rely on large amounts of external funding

– Projects must be scalable to long-term goals: Initial collaborations may form foundation for larger network, with shared experience generating trust & benefits

*Next Step: Appoint multi-stakeholder Advisory Group tasked with exploring best models for statewide HIE in KY and how KY will interface with the NHIN

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Recommendations and Next Steps

7) Role of the state government in development of KY e-Health Network

– Major force in health care market through purchase, use, and reimbursement of HIT by state agencies

– Facilitator and convener of community and statewide initiatives

– Partner with associations in encouragement of HIT investment

– Policy development and support of e-Health Network Board– Interface with federal government (ONC) and other states’ e-

Health efforts– NOT the builder/purchaser/owner/operator of large HIE

infrastructure, or record keeper for patient health information*Next Steps: Partner with provider associations; Link Board liaisons to

4 AHIC workgroups; Examine regulatory issues that help or hurt HIE or HIT investment

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CHFS Action Items

May Meeting:• Develop proposed 2006 Work Plan based on

feedback of e-Health Network Board• Work with co-chairs to configure Advisory Group for

Board approval• Identify and research potential projects based on

Board feedback• HISPC Security & Privacy Collaboration• ePrescribing grant opportunity • Link board member liaisons to AHIC workgroups

1) Biosurveillance2) Chronic Care3) Consumer Empowerment

4) Electronic Health Records