Electronic Health Information Exchange in Illinois

John Lekich, Project ManagerIllinois Office of

Health Information Technology

Illinois at a Glance

• 13 million patients

• > 50,000 physicians

• > 200 hospitals

• Urban and rural

• Statewide Exchange

• 5 Regional Exchanges

Goals of the Illinois Health Information Exchange

• Improve health care quality and outcomes

• Control the cost of health care and enhance value for patients and payers

• Maximize federal health information technology funding to Illinois and its health care providers

• Enhance public health and disease surveillance; reduce disparities

Key Drivers of ILHIE Implementation

• State health care transformation agenda

– Medicaid Care Coordination

• State law creating a statewide HIE network

• Federal HITECH Act

– EHR incentives for physicians and hospitals

– HIE infrastructure funding

– Broadband funding

• Affordable Care Act Implementation

ILHIE Authority

Established, April 2011

ILHIE Direct Statewide Go-live,

Dec 2011

ILHIE Executive Director Hired,

Sept 2012

ILHIE Phase II Go-live,

July 2013

ILHIE Operating as Public-

Private Entity,

Feb 2014

ILHIE Timeline

Infrastructure for Health Care Reform

Better Care, Health, &

Cost

Care Coordination

Information Sharing

ILHIE Network

Implementation Phase I: ILHIE DIRECT

• 1,700+ health care professionals statewide

• Approximately 75% are Medicaid providers

• State agencies for programs that require secure exchange with entities outside State government

• Participating providers include:– Individual physicians and nurses– Hospitals– Long term care facilities– Community mental health providers– Dentists

ILHIE Direct Participation

Implementation Phase II

• Public Health Node Access for electronic reporting to the Illinois Department of Public Health

• Enterprise Direct – integration of ILHIE Direct into an EHR system

• Care Summary Exchange – bi-directional, query- based records exchange

• Approximately 50 health care entities will be on-boarded for Phase II services by the end of 2013

Ongoing Challenges

• EHR adoption rates increasing but still low among some providers

• Competing priorities for technical staff and resources

• Evolving standards and market options

• Patient consent management

California eHealth Stakeholder Webinar

June 5, 2013

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California’s eHealth Vision:

Improve the health and

well-being of all Californians

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Integrated components for Appropriate HIE

HIE Governance

Legal

Technology

OCM

Trust

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Connecting Michigan for Health 2013

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Summary stats for Massachusetts

• 6.5 million citizens• 4,500 care delivery

organizations• 39,000 providers

– 27,000 physicians– + nurse practitioners, physician

assistants, nurse mid-wives, dentists

• Health IT snapshot– 70% EHR adoption– 97% e-prescribing– 68% labs sending structured

lab results– $150M+ Medicaid EHR

incentive dollars paid

Healthcare Reform Health IT enabler: HIX &

accountable care Legislative action (c. 305, c. 224)

‘Opt in’ state Physician Licensing Requirement

Starts - January 2015 All Providers on EHRs and HIE

Connection - January 201718

Adoption

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The Statewide Health Information Exchange…the Mass HIway

State Designated Entity for Health IT

Region Extension Center

MEDICAID Incentive Payment Program

Health Information Exchange

Operation

Phase 1 Phase 2

2012-2013• State assumes HISP role• ‘Directed’ exchange• Provider ‘push’

2013-2014• Query-based exchange enabled • Development of registries• Patient-directed exchange

Executive Office of Health & Human Services

………….. …………..

Design, Development, Implementation - Federal Medicaid/MMIS funds & Federal ARRA HITECH; state match contribution from the State eHealth Institute Fund

Operation, Maintenance - Medicaid/MMIS funds, G&A funds & private/commercial subscription fees

Catalyzing connections & advancing toward impact

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HIway Implementation Grantsgrantees & their trading partners by location

Discharge summaries from acute care to SNF and

Home Health

Pre-hospital transportcare coordination for homeless

Care management forHeart Failure patients

Referrals from specialty care to

home health

Decision support through 2-way

exchange of data

Coordination of care for elderly psychiatric patients

• Grantees (32)• Trading partners (50)

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Lessons Learned

Stick with standards – invent when needed, then keep it simple

Plan for sustainability early – funding takes time Engage with carrots rather than sticks Make it real – identify a use case Test network is important Clinical champions make things happen The impact on clinical workflow cannot be underestimated Security and consent matters take time

Massachusetts eHealth Institute617-371-3999MeHI Community - www.thehitcommunity.org/mehi/www.mehi.masstech.org kennedy@masstech.orgTwitter - @seankennedy6

Mass HIway Last Mile Program1.855.MA-HIWAY (1.855.624.4929) Option 1MassHIway@maehi.orgmehi.masstech.org/what-we-do/mass-hiway

Connect with MeHI & the HIway

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HIE Across Colorado

CORHIO’s Progress

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Number of Office-Based Physicians/Providers

Number of Hospitals (over 90% of beds)

Unique Patients With Clinical Info in the HIEGo to www.CORHIO.org for the most up-to-date info

1,700+

2,164,000+

115Number of Long-Term Facilities

12Number of Behavioral Health Orgs

3National/Regional Reference Labs

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Data Being Exchanged

• Laboratory & pathology test results• Hospital ADT information • Consult reports• Transcription notes• Radiology reports• Newborn screening results (public health)• CCDs (non-discrete data)• Reportable conditions (i.e. electronic lab reporting –

public health)• Immunization information (CIIS – Public Health)• Patient referrals w/ attachments (point to

point/DIRECT)• HIE to HIE with Quality Health Network

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In Development

• CCD uploads & CCDs w/ discrete data

• High-quality medical image sharing (using Colorado Telehealth Network VNA)

• IHE XCA interstate exchange

• Orders

• Syndromic surveillance (biosurveillance)

• Cancer registry

• Smoking cessation program(w/ Denver Public Health & National Jewish)

• Data analytics - support & partnering

• Healtheway/Direct Trust membership

• Patient data sharing

Florida Health Information

Exchange

Walt Culbertson President, Health Transactions, Inc. Host and Producer of Jacksonville Florida’s Medical Update Show Appearing on Comcast Cable Technical and Operations Lead, Florida Health Information Exchange

Founding Chair of the Southern Healthcare Administrative Regional Process (SHARP), a regional collaborative workgroup alliance of private and public health care organizations and HHS, HRSA and CMS

Founding Co-Chair of a CMS Sponsored Southern Insurance Commissioner Task Force Founding Security and Privacy Co-Chair for the Workgroup for Electronic Data Interchange (WEDi) Strategic

National Implementation Process (SNIP) Executive Board of the HIPAA Conformance Certification Organization (HCCO) Data Interchange Standards Association (DISA), and DISA XML-EDI Healthcare Information Management Systems Society (HIMSS)

Past Roles Former Adjunct Professor or eBusiness, Florida State University Interim Program Director, Center for the Advancement of Health IT, a Florida Regional Extension Center President, ePrescribe America, Inc. Founding Executive Director of ePrescribe Florida, a collaboration of Florida’s leading healthplans, provider

and pharmacy organizations, and electronic prescribing vendors Founding Chief Technology, Security and Privacy Officer, Webify Solutions (Subsidiary of IBM) Founding Chief Technology, Security and Privacy Officer of Availity, LLC Vice President of Healthcare for Computer Management Consultants Vice President of HIPAA Solutions for the TriZetto Group Director in the Healthcare Consulting Practice of PriceWaterhouseCoopers, LLC.

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1. Direct Secure Messaging (DSM) is a NHIN Direct complaint secure e-mail system that allows participants to push encrypted health information to other participants and to respond to requests for information

2. Patient Look-Up (PLU) is a NHIN CONNECT compliant service that allows clinicians to query for and retrieve patient records from other participating nodes on the Florida statewide network

Both services maintain the same policies and workflows around patient consent and authorization that exist in paper-based data exchanges today.

Two Florida HIE Services

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DSM Connections to Other States as of May 31, 2013

HISP connection completeTesting in progressOngoing discussions

DSM is connecting over

4,000 Florida users

Disaster Preparedness Use Care

• Dislocated patient presents in neighboring state emergency department

• Rendering provider or facility sends direct message to patient’s health plan or Florida care provider

• Clinical information is returned via direct message in structured or unstructured format

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Contact

• Website: www.florida-hie.net• Email: Walt.Culbertson@ahca.myflorida.com• Phone: Walt Culbertson @ 904-651-1805

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