roger l. holloway co-director, il-hitrec president & ceo ... · closer look at public health...

Roger L. HollowayCo-Director, IL-HITREC President & CEO, Illinois Rural HealthNet

1. Progress on the Illinois Rural Health Network

2. Snap Shot of Health Information Exchange in Illinois

3. Comparison of Stage 1 to Stage 2

4. Close-up of some of the Major Changes in Stage 2

5. Closer Look at Public Health Objectives for Stage 2

6. Immunization & Syndromic Reporting

7. Q&A

IRHN provides the high-speed connection that is necessary to

improve access to medical applications for rural hospitals and clinics

Hospitals and clinics connected to the IRHN can transmit data four

ways:

Locations on the IRHN can transmit directly to and from other IRHN

locations with no exposure to the public Internet.

Locations on the IRHN can transmit directly to and from Internet2

addresses.

Locations on the IRHN can transmit directly to and from the public

Internet.

Cloud services.Source: http://illinoisruralhealthnet.org/irhn/index.shtml

The IRHN currently charges per the following schedule:

1. 1Gbps upstream and downstream $1200 month

2. 100Mbps upstream and downstream $1000 month

The above pricing is for connection to all IRHN members with no cost for traffic load. Data traffic to/from IRHN locations does not use the Internet. 3. For data traffic that needs to utilize the public Internet: ISP Bandwidth $4/Megabit

The IRHN is exploring additional pricing options for small clinics.

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Cloud Computing and Virtualization enables proliferation of commercial andconsumer applications across public and private clouds. Enabling millions offixed and mobile devices to have access to the same applications and services.

Examples: Over-The-Top-Applications/Video/Services

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Evolution of standard definition to High Definition (1080P), 4K and 8K Ultra HighDefinition. 4K already in markets.Move to uncompressed high definition for telemedicine, machine/process analytics, useof big data visualization, telepresence, interactive and immersive education

Examples:3D Video, Uncompressed Video, Visualization

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Source: The FTTH Council, Broadband Communities 2012

Bandwidth Comparisons

200 Mbps: Cable maximum per user with current technology

100 Mbps: DSL maximum per user with current technology

20 Mbps: Wireless maximum per user with current technology

1.5 Mbps: Modern T1 Line

128 Kbps: ISDN64 Kbps: Phone Line

1 GBPS

Only the beginning…

In a few years, even one Gbps will look small. Soon, most content will be 3D and ultra-high-definition.

Fiber bandwidth is orders of magnitude bigger than other technologies. As the new generation of 10 to 100 Gbps equipment is deployed, the fiber bandwidth circle moves off this page.

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10 1050100 50 1001000 1000

CATVFTTH/100M

FTTH/1G Plus

Access Network Technology

VDSLADSL

Upstream Capacity (Mbps) Downstream Capacity (Mbps)

For Institutional Services

Big Data AnalyticsPACs/BigData Backup/TeleHealth Informatics/Pathology

“Hospital/University/BigData Corporate Research”

10,000 10,000

Corporate HD ConferencingEmergency Management Geographic/Weather Mapping

Typical Health Institution Remote Diagnostics, X-Ray, MRI Analysis, Health Information Exchange, Wellness Training

Typical University, K-12 SystemDistance Learning, Collaborative Learning,Multi-Classroom/Lab,Multi-HD Video Conferencing, BigData

Institutional Internet

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Health Information Exchange?

Currently 3 key forms of Exchange:

1. Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care. This is accomplished with Direct Project protocols.

2. Query Based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care

3. Consumer Mediated Exchange - ability for patients to aggregate and control the use of their health information among providers. The VA’s Blue Button program is a prime example of this type of exchange

Source: www.healthit.gov/providers-professionals/health-information-exchange/what-hie

The Health Information Exchange and the Emerging Vision

The Future Statewide HIE suggests:

Helps Providers achieve Stage 2 Meaningful Use Direct secure messaging in network and out of network

Serves as CEHRT for purposes of exchange dependent

Meaningful Use requirements

Will provide opportunities for many in the supply chain to gain andadd value


HIE Development in Illinois includes the following initiatives:

Central Illinois Health Information Exchange (CIHIE)

Serves 20 counties in central Illinois with a population of approximately 1.3M including Peoria, Bloomington, Champaign, and Decatur. The area contains 27 hospitals, 20 health departments, 2,800+ Physicians, 280+ Pharmacies and other healthcare related services. Their Technology Partner is ICA, Informatics Corporation of America. Which features all necessary EHR interfaces to comply with Meaningful Use Stage and if founded on their CareAlign platform which features AllChartssoftware.



Metro Chicago Health Information Exchange (MCHIE)

Serving: The Chicago Metro Area: 9.4 Million people 93 HospitalsTechnology Platform: Microsoft Amalga and Health Unity applications



Lincoln Land Health Information Exchange (LLHIE) and Illinois Health Exchange Partners (IHEP)

LLHIE serves Springfield, Quincy and surrounding areas. IHEP serves Metro east to Effingham and the surrounding areas. The goal is to create a regional HIE system for the 31 southernmost counties of Illinois. Their Technology Partner is Medicity Novo Grid.

Meaningful Use Objectives is a Process for Staggered Change Management in

Healthcare Delivery

2011-2013Stage 1

Data capture and sharing

2014Stage 2

Advanced clinical Processes

2016Stage 3

Improved outcomes

Adopt Certified EHR Technology Demonstrate Core and Menu Set Requirements Report on Clinical Quality Measures

Demonstrate cross vendor interoperability

Stage 1 Requirements Stage 2 Requirements

15 core objectives5 of 10 menu objectives

3 CQM Objectives3 CQM Alt. Objectives

17 Core Objectives3 of 6 Menu Objectives

For 20133 CQM Objectives 3 CQM Alt.

ObjectivesFor 2014

9 of 64 CQMs (EPs only)

Stage 1 Requirements Stage 2 Requirements

13 core objectives5 of 10 menu objectives

15 CQM Objectives

16 Core Objectives3 of 6 Menu Objectives

For 201416 of 29 CQMs covering 3 of the

National Quality Standards Domains

1. New Criteria: Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meet Meaningful Use Stage 2 Criteria.

2. Improving Patient Care: Stage 2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement. There is an increased requirement for health information exchange and direct bi-directional patient communications.

3. Saving Money, Time, Lives: With this stage, EHRs will further save our health care system money, save time for doctors and hospitals, and save lives.

Source: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

1. Changes to Stage 1 of meaningful use

2. Requirements for Stage 2 meaningful use

a) New clinical quality measures

b) New clinical quality measures reporting mechanisms

3. Stage 2 introduces the concept of an EP or EH “version” of

a meaningful use measure when one version will be Core

for EPs and the same measure is Menu Set for EH and vice

versa

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1. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.

2. Reporting on Clinical Quality Measures (CQMs)3. Introducing a new age limit for capturing vital signs4. Introducing a new computerized provider order entry (CPOE)

measure5. Requiring a new document format for providing a summary of

care record at transitions of care6. Introducing additional exclusion criteria for the e-prescribing

requirements for EPs7. Eliminating the exchange of key clinical information objective8. Adding the clause “except where prohibited” to all population and

public health measures

Source: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf

0 20 40 60 80 100

1. CPOE for Medication Orders

eprescribing EP

Record Demographics

Record Vital Signs

Record Smoking Status

Provide timely electronic access

Stage 2

Stage 1

> 60% of medication 30% of lab & 30% of radiology orders

> 50% of prescriptions transmitted using EHR

> 80% of unique Patients recorded as Structured data

> 80% of uniquePatients recorded as Structured data

> 80% of uniquePatients 13 years old and aboverecorded as

Structured data

> 50% of unique patients seen during reporting period

> 30% of unique patients with one medication in their list

> 40% of prescriptions transmitted using EHR

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• Medication reconciliation moved to core

• Summary of care record moved to core, and electronic submission is required in 10% of cases

• Electronic notes, new measure menu set

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View, download and transmit replaces the e-copy of health information requirementSecure Messaging (EP only)

http://www.nationalehealth.org/patient‐engagement‐framework

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2014 represents CMS’s commitment to aligning quality measurement and reporting among programs, including Hospital IQR Program, PQRS, CHIPRA,

and Medicare SSP and Pioneer ACO’s

Unified Quality

MeasuresPQRS

IQR

VBPCHIPRA

ACO

MU

CDC

CHIPRA: Children’s Health Insurance Program Reauthorization Act

ACO: Accountable Care OrganizationMU: Meaningful UseCDC: Centers for Disease ControlVBP: Hospital Value Based PurchasingIQR: Hospital Inpatient Quality ReportingPQRS: Physician Quality Reporting System

1. Common MU Data Set Vocabulary

2. Single Standard for PH Transactions

3. Transport Standards for PH Transactions

4. Public Health Authority (PHA) capacity declaration to

accept electronic data as prescribed by ONC

5. Centralized PH Repository

6. Ongoing Data Submission to PHA

7. ILHIE connectivity to the public health node

8. Aggregation of Population Health and EHR Data

Source: http://www.cdc.gov/ehrmeaningfuluse/Docs/Summary%20of%20PH%20Objectives%20in%20Stage%202%20MU%20ONC%20and%20CMS%20Final%20Rules.pdf

Source: http://www2.illinois.gov/gov/HIE/Pages/publichealth.aspx


Objective Eligible Professionals (EPs) Measure Stage 1

Eligible Professionals (EPs) Measure Stage 2

Immunization Registries Core Set - Performed at least one test of certified EHR technologies capacity to submit electronic data to immunization registries and follow up submission if the test is successful (unless none of the immunization registries to which the EP submits such information have the capacity to receive the information electronically)*

Core Set - Successful ongoing submission of electronic immunization data from certifiedEHR Technology (CEHRT) to an immunization registry of immunization information system for the entire EHR reporting period (unless no registries are capable)

Reportable Lab Results (ELR) N/A N/A


Objective Eligible Professionals (EPs) Measure Stage 1

Eligible Professionals (EPs) Measure Stage 2

Syndromic Surveillance N/A Menu Set – Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a public health agency for the entire EHR reporting period (unless no PH agency is capable)

Cancer Reporting N/A Menu Set – Successful ongoing submission of cancer case information from CEHRT to a public health agency for the entire EHR reporting period (unless no PH agency is capable)

Reporting to Specialized Disease Registry

N/A Menu Set – Successful ongoing submission of specific case information from CEHRT to a specialized registry for the entire EHR reporting period (unless no PH agency is capable)

http://www.idph.state.il.us/health/vaccine/icare_HL7provider_info.htm

CMS Stage 2 Web Site http://www.cms.gov/Regulations-and-

Guidance/Legislation/EHRIncentivePrograms/Stage_2.html

IL-HITREC: www.ilhitrec.org [email protected] 815-753-1136

We encourage anyone interested in Stage 2 of meaningful use to review the Stage 2 of meaningful use and the rule for the 2014 certification of EHR technology at:

CMS Rule:http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-21050_PI.pdfhttp://www.gpo.gov/fdsys/pkg/FR-2012-09-04/pdf/2012-20982.pdf

ONC Rule:http://www.ofr.gov/(X(1)S(uzclbwrx5fwqm2w2mipkysrh))/OFRUpload/OFRData/2012-20982_PI.pdf

roger l. holloway co-director, il-hitrec president & ceo ... · closer look at public health...

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