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Florida Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

AcademyHealth Annual Research Meeting, Orlando FL Health Information Technology Interest Group Meeting, June 2, 2007

Update on the Florida Health Information Network

Christopher B. Sullivan, Ph.D.Florida Center for Health Information and Policy Analysis

Agency for Health Care Administration

AcademyHealth Annual Research MeetingHealth Information Technology Interest Group

Meeting

Orlando, Florida ~ June 2 , 2007



Nationwide Health Information Network

The Nationwide Health Information Network proposes to “link all health records through an interoperable system that protects privacy as it connects patients, providers and payers, resulting in fewer medical mistakes, less hassle, lower costs and better health.“

Department of Health and Human Services Secretary Mike Leavitthttp://www.hhs.gov/healthit/



Health information technology allows the comprehensive management of medical information and its secure exchange between health care consumers and providers. It will:

http://www.hhs.gov/healthit/

Framework for Strategic Action for the Nationwide Health Information Network

o Improve health care quality

o Reduce health care costs

o Decrease paperwork

o Expand access to affordable care



o Early detection of infectious disease outbreaks Improved chronic disease management; and

o Evaluation of health care based on quality information that can be compared.

Framework for Strategic Action

http://www.hhs.gov/healthit

Interoperable health information technology will improve individual patient care, but it will also bring many public health benefits including:



Nationwide Health Information Network



The Florida Health Information Network

The Florida Health Information Network vision calls for integrating clinical health information exchange in Florida through a statewide health information network that will empower physicians to access timely and accurate medical records in order to deliver the highest quality medical care for their patients.



Functions of the Florida Health Information Network The Florida Health Information Network will

facilitate communications and data exchange among the Regional Health Information Organizations (RHIOs) by coordinating requests for medical records across Florida and delivering those records to the physician

The Florida Health Information Network will also specify and maintain technical standards for interoperability among the RHIOs



The Florida Health Information Network Begins at the Local Level The Florida Health Information Network is

being built from the local community up

An essential element of the strategic plan is to empower local stakeholder collaborations focused on health information exchange

The driver of this plan is the FHIN Grants Program and Regional Health Information Organizations in the local community



Grants Program to Develop Regional Health Information Organizations

Planning Grants: Support engaging local health care stakeholders to develop a strategic plan for health information exchange

Implementation Grants: Support projects that demonstrate health information exchange among two or more competing providers

Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems



Grants Program, 2006-2007 In 2005 the Legislature appropriated $1.5 million

for grants awarded to nine projects Five Planning Grants Three Implementation Grants One Training Grant

In 2006 the Agency awarded six grants with another $2 million from the Legislature All six were Implementation Grants

The Legislature allocated $2 million for FHIN grants in 2007-2008



The Florida Health Information Network

1. BBRHIO

6. PBCCHA

9. SF HII

3.CHIO

8. SC HIN

5. Jax HIN

4. ESSHIN

7. Pinellas

RHIO

FHIN EMPI and

RLS Server

10. TB RHIO

2. CF RHIO

Florida’s Health Information Networks

1. Big Bend RHIO

2. Central Florida RHIO

3. Community Health Information Organization

4. Escambia HIN

5. Jacksonville Health Information Network

6. Palm Beach County Community Health Alliance

7. Pinellas RHIO

8. Space Coast Health Information Network

9. South Florida HII

10. Tampa Bay RHIO

See: http://ahca.myflorida.com/dhit



Some Examples of Florida’s RHIOs: Palm Beach County Community Health

Alliance Big Bend RHIO Tampa Bay RHIO Escambia Health Information Network South Florida Health Information

Infrastructure Community Health Informatics

Organization



What is a Regional Health Information Organization?



Palm Beach County Community Health Alliance

PBC Community Health Alliance(An Alliance of Funders and Providers

Serving Health Care Consumers)

Care Expansion

LanguageAccess

CommonEligibility

Shared EHR

ProjectAccess

PrivateFunders

Hospitals

PublicFunders Health

Dept.

FreeClinics

SocialServices



Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project

The Glades Community 28% uninsured rate Glades General

Hospital is the only Acute Care facility

17,753 ER visits; 1,900 Medicaid discharges in 2002

Prevent duplication between hospital and clinics



Big Bend RHIO



Tampa Bay RHIO



EscambiaHealthInformation Network



Community Health Informatics Organization



VPN for HX servers toAccess the

Hospitals andWeb to access Availity service

Internet

Miami, FL

ProductionEnvironment

Web

TerremarkAccessNetwork

Master Patient Index Back End

Firewall

Web

Management Network

Front EndFirewall

H1 Repository

Back EndDMZ

Firewall

H2 Repository

H3 Repository

Hospital1

Hospital2

Hospital3

VPN With Availity for WEB authentication

Backup

_______ Customer public Network_______ Out of Band Network_______ Dedigate Network_______ Public IP Space_______ VPN

South Florida Health Information Initiative



Technical Standards for the Florida Health Information Network Florida Health Information Network

Architectural Considerations for State Infrastructure - Draft White PaperMinimal Clinical DatasetAuthentication of end users and transaction

audit trails to ensure network securityMaster Patient Index and Record Locator

ServicePrivacy and Confidentiality of patient records



Functions of the Florida Health Information Network The FHIN will facilitate communications and

data queries among Regional Health Information Organizations

The FHIN will take the lead in specifying technical standards

The FHIN will provide a portal for state agency health care data and other databases



Florida Health Information Network

FHIN EMPI and

RLS Server

RHIO Server: Maintains Minimal Clinical Dataset,

Certifies Providers, Handles Queries

DOH Physician Licensing Database

Data

Provider EMR/EHR System

Clinical Data from Providers, Labs, Pharmacies, etc.

AHCA & DOH Databases

Data

Other RHIO Servers

Data

Payor Databases

Desktop PCsPDAs

End-User Clinicians

Desktop PCs

Patients

Medicaid Florida Center DOH SHOTsVital Statistics

Certification of Physicians with DOH Licensing Database

1. Big Bend RHIO2. Tampa Bay RHIO3. Palm Beach County

Community Health Alliance

4. South Florida HII5. Escambia HIN6. Jacksonville HIN7. Community Health

Information Organization

8. Central Florida RHIO9. Pinellas RHIO10. Space Coast HIN



Technical Standards for the FHIN



Some Other Projects of the Florida Health Information Network

Agency for Healthcare Research and Quality Health Information Privacy and Security Project

FCC Rural Broadband Pilot Project Medicaid Transformation Grant 2007 Nationwide Health Information

Network Grant



HISPC Project Overview

Florida was one of 33 states and Puerto Rico awarded a contract from the Agency for Health Care Research and Quality and administered by RTI, Inc. to conduct a study of the variations in business practices and laws related to electronic health information exchange (E-Health Exchange)



Privacy and Security Project Objectives

To identify business practices and policies related to electronic health information exchange (HIE)

To analyze the policies and laws that are “barriers” to HIE

To identify solutions to the “barriers” To develop a plan for implementing the

solutions



Proposed Implementation Strategy

Vision:Efficient and Effective Health Care Delivery

Mission:Private and Secure Health Information

Network

Goal I:Uniform Privacy

Policies for e-Health

Goal II:Adopt a Secure Technological

Framework for e-Health

Goal III:Raise the

Community’s Awareness of e-

Health

Goal IV:Participate in the

Framing of e-Health National

Standards

Long Term Impact:Providers and

Consumers Rely on Timely and Secure

Transmission of Clinical Records

Outcome: Secure Health

Information Exchange

Long Term Impact:Providers and

Consumers Make Better Health Care

Decisions Based on Their PHI



The Agency for Health Care Administration and the Big Bend RHIO are pursuing a grant from the Federal Communication Commission to provide broadband connections to rural hospitals. The goal is to facilitate the creation of a nationwide broadband network dedicated to health care, health care providers in rural and urban locations.

Developing Connectivity through an FCC Telehealth Pilot Program



FCC Telehealth Pilot Program

The FCC grant will cover deploying transmission facilities and advanced telecommunications and information services, including any associated non-recurring and recurring costs.

The pilot program will also support construction of telehealth audio-visual facilities.

Participants will be free to use available technology.



Proposed Objectives of the Project:Connect rural hospitals located in the Big Bend and Panhandle with urban providers and pediatric specialists.

Extend Florida Health Information Network applications to rural providers.

Employ telehealth applications for chronic disease monitoring in the home.

Develop a funding formula for sustainability of services to eligible providers in rural counties or underserved areas.



Targeted Rural Areas in Florida’s Panhandle

Measures of population density, urbanization, and daily commuting are used to identify urban cores and adjacent territory that is economically integrated with those cores – Rural-Urban Commuting Areas, shown in purple.



Calhoun Liberty

JacksonCounty

Bonifay

Apalachicola

Port St. Joe

Graceville

Madison

Perry

GadsdenCounty



Medicaid Transformation Grant

Department of Defense

Armed Forces Health Longitudinal Technology

Application

Clinical Data AH

LTA

Inte

rfac

e

Florida Center for Health Information and Policy Analysis

Clinical data on military personnel and families from the Department of Defense AHLTA system available for queries from the Medicaid AHLTA Clinical Data Server in the Florida Center

The AHLTA clinical data repository stored on Medicaid AHLTA Clinical Data Server in the Florida Center. Interface with DOD AHLTA to query for clinical data on military personnel

Northwest Florida RHIOWeb Portal

Northwest Florida RHIO provides the sign-in screen for the Medicaid provider and access to the AHLTA EHR dashboard

`

Medicaid provider in clinic

accessing AHLTA EHR

Northwest Florida RHIO Interface

Medicaid physcian can log onto Northwest Florida RHIO and access the AHLTA EHR dashboard Physician can: 1) Query the system of health care records of a patient2) Add clinical records to the AHLTA EHR for storage in the Medicaid server3) Print out patient record

`

Medicaid provider in

hospital accessing

AHLTA EHR `

Medicaid provider in office

accessing AHLTA EHR

Go

ld S

tand

ard

Inte

rfac

e

AHLTA Clinical DataASP Server

Gold Standard Prescription Data from Medicaid

Medicaid Prescription Data from Gold Standard can be sent through the Florida Center server to the Medicaid providers in the pilot program



2007 Nationwide Health Information Network GrantsFocus on interfaces: Between health information service providers

and provider organizations Include specialty networks and systems Include government health systems Biosurveillance Consumer empowerment Medication history use case



Next Steps for Sustainability of Health Information Exchange in Florida The Florida Health Information Network and

the RHIOs must continue to work together on issues of common interest

Legislative appropriations for startup funding is still of great importance to the RHIOs

Developing a viable business model for the Florida Health Information Network and RHIOs is also essential for continued sustainability



eHealth Initiative Summary Roadmap for Florida eHealth Initiative evaluated the state of RHIO

development in Florida through an extensive set of interviews with RHIO representatives

eHealth Initiative provided a report on the status and future potential of health information exchange in Florida

eHI also published a roadmap for identifying and implementing exchange services that will drive utilization and long term sustainability



Blueprint for Building a Sustainable Health Information Exchange Organization Blue Cross Blue Shield of Florida donated a

business development team to work with the Florida Center in creating a business plan for the Florida Health Information Network

The BCBSF team created a revenue model based on subscription fees and transaction costs over a five year period The revenue model showed the Florida Health

Information Network becoming sustainable within five years if adequately funded in the first three years



Foundation for eHealth Initiative Value and Sustainability Model eHealth Initiative is also working with the Florida

Center and RHIOs to provide training in its Value and Sustainability Model

The model is based on a suite of tools, products, and services which provide analytical support, discipline, and rigor to planning Market Readiness Assessment Tool Value Tool Risk Estimation Business Plan Template and Pro Forma Tool© Foundation for eHealth Initiative



The Future of the Florida Health Information Network The Florida Health Information Network vision

anticipates integrating Florida’s RHIOs in a seamless health information exchange

The success of the statewide network also depends on reaching out to the Department of Health and working together to achieve the common goal of exchanging records electronically for the benefit of patients across the state



Christopher B. Sullivan, Ph.D.

Agency for Health Care AdministrationFlorida Center for Health Information and Policy Analysis

Office of Health Information Technology2727 Mahan Drive

Tallahassee, FL [email protected]

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better health

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public health benefits

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