health information exchange (hie) in new hampshire nh hospitals partner symposium 2013 may 14, 2013

Health Information Exchange (HIE) in New Hampshire

NH Hospitals Partner Symposium 2013

May 14, 2013

- 2 -New Hampshire Health Information Organization © NHHIO. All rights reserved.

Agenda

Understanding the Current Environment

New Hampshire Health Information Exchange (HIE) Plan

New Hampshire Health Information Organization (NHHIO)

HIE Architecture and Services

HIE Value Propositions

NHHIO Participants and Implementation Timeline

NHHIO Participant Information

Contact Information


Many Current Practice Models Isolate Information

Provider

Patient

HIT

Families

Payer


American Recovery and Reinvestment Act (ARRA)


HITECH: Catalyst for Transformation

Pre 2009 2009 2014A system plagued by inefficiencies

EHR Incentive Program and 62 Regional Extension Centers

Widespread adoption & meaningful use of EHRs

Three-Part Aim:Better Healthcare Better Health Reduced Costs

Paper Records HITECH Act EHRs & HIE

ARRA Changed the Playing Field


New Care Team Model Extends the Reach and Need for Data

Patient & Families

PCP

Home Health / LTC

eHealth Portals

Mobile Technology

Diagnostic Testing

Specialty Care

Acute Care

ACO

PQRS

eRX

CQM


Medicare and Medicaid Incentives and Penalties

Improved Individual & Population HealthOutcomes

IncreasedTransparency & Efficiency

ImprovedAbility to Study &Improve Care Delivery

ADOPTIONADOPTION

EXCHANGEEXCHANGE

State Grants forHealth Information Exchange

Standards & Certification Framework

Privacy & Security Framework

Regional Extension Centers

Workforce Training

MEANINGFUL USEMEANINGFUL USE

7

Health Information Technology for Economic and Clinical Health (HITECH) - Framework


Estimated ARRA funding for Health Information Technology

$30B

Direct payments to individual providers

0

5

10

15

20

25

30

35

$28B

0

50

100

150

200

250

$1.2B

$1.1B Medicaid 90/10 funds

$211M

$11.8M

$223M

$1.1M

US total New Hampshire

Health information exchangesRegional health IT extension centers

Health Information Technology for Economic and Clinical Health

(HITECH)

$13,781,320 EP$13,098,698 EH

Paid to NH


New Hampshire Health Information Exchange (HIE) Plan

June 2010 created multi-stakeholder groups

The plan is the result of collaborative planning among over 80 stakeholders

380 stakeholder comments were addressed in the current version

Approved by ONC September 2010

The plan will continue to evolve as we refine the strategy, obtain broader stakeholder input, and add more detail

Current strategic plan is posted at http://www.dhhs.nh.gov/hie/strategic.htm

http://www.dhhs.nh.gov/hie/strategic.htm


HB #489 (July 2011) created the New Hampshire Health Information Organization (NHHIO)

NHHIO Governed by a broad community based governance structure with accountability to a multi-stakeholder, public-private Board of Directors.

501(c)(3) Public Charity organization, NHHHIO complies with RSA 91-A, New Hampshire’s Right to Know law to ensure the public’s right of access to meetings and to records to “ensure the greatest possible public access to the actions, discussions and records of all public bodies, and their accountability to the people.”

Establishing Governance

http://www.gencourt.state.nh.us/rsa/html/NHTOC/NHTOC-VI-91-A.htm


NHHIO Board of DirectorsBoard Member Representation Board Member Representation

Denise Purington CIO Elliot Hospital

NHHIO Chair, Board Member at LargeHospitals

David Briden,CIO Exeter Hospital

NH Hospital Association, Large Hospitals

Mary Beth EldredgeIT DirectorDartmouth Hitchcock

NHHIO Vice Chair, Board Member at Large

Lorraine NicholsIT DirectorAlice Peck Day Hospital

NH Hospital Association, Critical Access Hospitals

Kirsten PlatteCHAN

NHHIO Secretary, Bi-State Primary Care Association

Dr. Richard Lafleur, Anthem BC/BS

Board Member at Large, Health Plans

Carol LaCrossCFO - Retired

NHHIO Treasurer, Volunteer & Consultant

Michael Lehrman, Catholic Charities

Board Member at Large, Skilled Nursing Providers and NH Health Care Assoc.

Deb MullenConcord VNA

Home Care Association of NH Vacant Board Member at Large

Dr. Daniel WaszkowskiDerry Medical Center

NH Medical Society David Querusio , Harvard Pilgrim Healthcare

Board Member at Large, Health Plans

William BaggeroerNH DHHS Office of the Commissioner

Board Member at Large, NH DHHS, Office of the Commissioner

Dr. Christine Rosenwasser Dartmouth Hitchcock Pediatrics

Board Member at Large, Physicians

Victor St. PierreConsumer Advocate

Board Member at Large, Consumers

Jay Couture,Seacoast Mental Health Center

NH Community Behavioral Health Association

Vacant Pharmacy Board


NH HIE Facts: (RSA 332-I:2)

A health care provider or business associate may disclose an individual's PHI and information about the location of an individual's medical records to a HIE – allows for Electronic Master Person Index (EMPI) (Phase 2)

Individual must be given an opportunity to opt out of sharing his/her name, address, and PHI through a HIE – information not sent to HIE (Phase 1)

Only a health care provider, for purposes of treatment, may access PHI in a HIE – does not include patients or payors

A HIE must maintain an audit log of health care providers who access PHI – central site will maintain transmission logs

When federal certification standards are established, a HIE must be certified to be in compliance with nationally accepted interoperability standards and practices – NHHIO is using Direct standards for message transport

SB288 – Required reporting to Department of Health and Human Services (DHHS) – AHEDD, Cancer Registry, Immunization Registry, Electronic Lab Reporting


Legislative Committee

Goal: Allow PHI to be accessed by other participants to include patients and payors, and used for additional purposes outside of treatment.

Allow for greater expansion of Care Coordination efforts

Enhance patient engagement as part of Meaningful Use requirements

Allow for potential data aggregation and reporting of CQMs

• Support ACO models

• Support pay-for-performance and other quality based contracts

• Meaningful Use reporting for CMS EHR Incentives, Patient Centered Medical Home, and Million Hearts campaign


NHHIO Architecture and Services

NH Statewide Network – “Backbone”

CHAN

Provider Practices

Hospital

Public Health (DHHS)

SecurityNode

addressingProvider

addressingAudit

MDMD MD

EMPIRecord Locator

Service

Long-term care

SNFs

Phase I:• Direct Secure Messaging

among participants, DHHS, and HIE partners

• Interstate gateway

Phase II:• Electronic Master Person

Index (EMPI)

• Record Locator Service for information queries

Payers

Health Centers

Behavioral Health

Diagnostic testing

Patients

NH Hospital

VNA / Homecare

MDMD

ASCC


Electronic Health Record (EHR) Integration

Provider directory

Certificate repository

DIRECT gateway

Web portal mailbox

HIE ServicesUser types

3 methods of accessing HIE services

EHR connects directly

Browser access to webmail inbox

Physician practice

Hospital

Long-term careOther providersPublic healthHealth plans

EHR connects through LAND Appliance


Value Propositions

“Broad but shallow” network in providing secure and auditable transactions

Can send “anything to anyone” – replaces traditional point-to-point communications (unsecure fax, mail, etc.) with electronic directed exchange streamlining workflow in the practice setting (including inter-state communications) – HIPAA compliant

Provides Public Health reporting mechanism and peer connectivity to comply with Meaningful Use requirements and possible future DHHS reporting requirements

Uses approved Direct standards being incorporated by EHR vendors for compliance with Meaningful Use and increases Coordination of Care with structured data sharing

Annual subscription fee for all transactions providing a “one to many” gateway with fixed budget projections to eliminate creation and management of multiple point-to-point connections (VPN tunnels, routers, TCP/IP and SSL connections)


39 Letters of Intent (LOI), ~1000 PPCPs* Dartmouth Hitchcock Medical Center - 225

Exeter Hospital - 43

Cheshire Medical Center - 25

Concord Hospital - 87

Elliot Hospital - 42

Southern New Hampshire Medical Center - 85

Wentworth Douglas Hospital - 43

Lakes Region General Hospital - 40

Frisbie Memorial Hospital - 51

Catholic Medical Center - 36

Franklin Regional Hospital (CAH) - 15

Valley Regional Hospital (CAH) - 12

Alice Peck Day Memorial Hospital (CAH) - 22

Monadnock Community Hospital (CAH) - 25

Speare Memorial Hospital (CAH) - 6

Cottage Hospital (CAH) - 9

Memorial Hospital (CAH) - 21

Androscoggin Valley Hospital (CAH) - 3

Huggins Hospital (CAH) - 21

(Pilot Only) Department of Public Health

Seacoast Mental Health Center

Greater Nashua Mental Health Center

The MHC of Greater Manchester

West Central Behavioral Health

Northern Human Services

Monadnock Family Services

Concord Visiting Nurses Association

Franklin VNA & Hospice

Rochester District VNA

Home Health & Hospice Care

Pemi-Baker Community Health

Central New Hampshire VNA & Hospice

Visiting Nurse Home Care and Hospice of Carroll County

Derry Medical Center - 25

Community Health Access Network - 65

COOS County Health Services - 21

Mid-State Health Center - 12

Access Sports Medicine

Southern NH Internal Medicine - 8

* RECNH enrolled PPCPs


On-Boarding Target Timeline

DRAFT


Active Discussions

NH Healthcare Association

Genesis Healthcare

Quest Diagnostics

Anthem BC/CS, Harvard Pilgrim

Regional Extension Center of New Hampshire

New Hampshire Medical Society

Surescripts Network

Interstate – MeHI, VITL, HealthinfoNet

New Hampshire Hospital, Glencliff Home

Expanded NH DHHS Reporting


Implementation Information


On-Boarding Documentation

NHHIO On-Boarding Document (~5 week on-boarding project plan)

Appendix A – Readiness Questionnaire (updated to identify multiple systems)

Appendix B - LAND Form (technical contacts and integration method(s))

Appendix C – Provider Directory Upload File Format (.CSV file to be updated)

Appendix D – LAND Appliance Documentation (specifications and integration)

NHHIO Solution Diagram (description of technical infrastructure and communications)

Available at www.nhhio.org

http://www.nhhio.org/


Participation Agreement Components

NHHIO Exchange Participation Agreement• Participation Agreement Fee Schedule Exhibit 1 (blank until revenue verified)

• First and second year discounts (60%, 25%) based on three year participation

ADDENDUM 1 - HIE SERVICE ADDENDUM (used to select connection method)

• HIE Services Addendum Exhibit 1 Support

ADDENDUM 2 - POLICIES AND PROCEDURES (“rules of the road”)

ADDENDUM 3 - DELEGATED ADMINISTRATION AGREEMENT (for Large sites only)

• ATTACHMENT 1 TO DELEGATED ADMINISTRATION AGREEMENT

ADDENDUM 4 - ACCESS ADMINISTRATOR AGREEMENT (agreement for administrator)

ADDENDUM 5 - BUSINESS ASSOCIATE AGREEMENT (NHHIO may also sign internal BAAs)

New Hampshire Health Information Exchange Technology Grants (as applicable)

• 125%-150% of annual dues based on eligibility and need


NHHIO contact information

NHHIO offices located within the New Hampshire Hospital Association 125 Airport Road, Concord, New Hampshire, 03301

Office. (603) 219-0184

Fax. (603) 218-6126

www.NHHIO.org

Jeff Loughlin, Executive Director c: 508-326-3944

o: 781-434-7751

[email protected]

http://www.nhhio.org/

mailto:[email protected]

health information exchange (hie) in new hampshire nh hospitals partner symposium 2013 may 14, 2013

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