HIEs, CommonWell, Carequality Can Work Together: Here's How

Transcription

1 HIEs, CommonWell, Carequality Can Work Together: Here's How Session 83, March 6, 2018 John P. Kansky, President & CEO, Indiana Health Information Exchange Keith W. Kelley, Chief Operating Officer, Indiana Health Information Exchange 1

2 Conflict of Interest John P. Kansky, MSE, MBA, CPHIMS, FHIMSS Keith W. Kelley, MBA Have no real or apparent conflicts of interest to report. 2

3 Agenda I. Current State of Interoperability II. TEFCA and Interoperability Approaches III. AND not OR IV. What s Next Questions and Discussion 3

4 Learning Objectives Describe the existing national interoperability approaches. Identify the opportunities and challenges within each national interoperability approach. Assess the current competition/cooperation among interoperability approaches. Analyze how the interoperability approaches can and do work together today. Discuss how interoperability approaches can work together even more effectively in the future. 4

5 Relevant Board and Committee Participation HIMSS North America The Sequoia Project ehealth Exchange Coordinating Committee Strategic Health Information Exchange Collaborative (SHIEC) Integrating the Healthcare Enterprise USA (IHE USA) ONC s Health Information Technology Advisory Committee (HITAC) 5

6 Current State of Interoperability PART I 6

7 We still have a lot of work to do. We ve made little progress on interoperability from a patient outcome perspective. AND The HIT Industry is wasting time and resources in the process. BECAUSE There is no clear understanding of the various national approaches. AND There is an unsupported belief that one approach is the correct one. 7

8 Interoperability 2017: First Look at Trending Some Progress Toward a Distant Horizon Moving Past the EHR Interoperability Blame Game Tackling [interoperability] issues requires multi-stakeholder coordinated action, and that action will only occur if strong incentives promote it. The point of the blame game is not to punish the players. It is to understand the dynamics at play and plot a path forward Once the business case for interoperability unambiguously outweighs the case against it, both vendors and providers can pursue it without undermining their best interests. KLAS, Perception Report October 2017 Julia Adler-Milstein, PhD NEJM Catalyst, July 2017

9 The World is Flat Industry professionals believe an oversimplified explanation based on a seemingly rational observation. 9 Art Credit: Kansas, Peter Lloyd, Point of Know Return [cover album]

10 The truth: It s complicated and confusing. There are multiple interoperability approaches No one approach will work for all interoperability use cases Different types of organizations have different interoperability needs But using multiple interoperability approaches in our current environment is hard 10

11 We don t commonly define interoperability. HIMSS Secure, appropriate, and ubiquitous data access and electronic exchange of health information CMS The ability of two or more systems or components to exchange information and use the information that has been exchanged 21 st Century Cures Act It s not one thing. Technology that enables the secure exchange of electronic health information with, and use of electronic health information from, other HIT without special effort on the part of the user; allows for complete access, exchange, and use of all electronically accessible health information as authorized by State or Federal law 11

12 But 2018 looks promising! 21 st Century Cures Act and TEFCA CommonWell Carequality implementer ehealth Exchange Carequality implementer Interoperability SHIEC PCDH live with national expansion 12

13 TEFCA and Interoperability Approaches PART II 13

14 Source: A User s Guide to Understanding the Trusted Exchange Framework, ONC

15 One On-Ramp VS And not Or Interoperability beyond TEFCA use cases TEFCA timeline (realistically years away) One on-ramp is a future state TEFCA believes will be helpful NOT a requirement on the provider Multiple on-ramps is YOUR prerogative No matter what, these concepts should inform your critical thinking about TEFCA 15

16 National Interoperability Approach ehealth Exchange (ehex) Carequality How it Aims to Connect the Whole Country Framework to enable participating providers, federal agencies, and HIEs to connect Framework to enable EHR vendors and networks to connect CommonWell DirectTrust SHIEC Patient Centered Data Home Network to connect EHR vendors, which gain participation of their customers Framework to enable participating providers, EHR vendors, and HIEs to connect Framework to enable HIEs to connect 16

17 National Interoperability Approaches aim to connect the whole country. ehealth Exchange Carequality CommonWell DirectTrust SHIEC PCDH HIEs and EHR Interoperability Platforms work with interoperability approaches to connect the regions and/or customers they serve. HIEs EHR Interop Platforms

18 Carequality/CommonWell Status CommonWell will become a Carequality implementer on behalf of its members and their clients, enabling CommonWell subscribers to engage in health information exchange through directed queries with any Carequality participant. * * From 12/13/16 Carequality/CommonWell press release 18

19 SHIEC/HIE Status

20 Carequality: Current State in Indiana* ~50 physician practices less than 1% ~18 hospitals about 15% (16 are Epic facilities) 0 Long-Term Post-Acute Care (LTPAC) facilities 0 Behavioral Health facilities 0 Payers 0 Self-Insured Employers/Employer Clinics 0 Accountable Care Organizations (ACOs) * Numbers are interpreted by organization names on Sequoia Project website for illustrative purposes (December 2018). 20

21 CommonWell: Current State in Indiana* 62 physician practices 30 hospitals 2 Long-Term Post-Acute Care (LTPAC) facilities 0 Behavioral Health facilities 0 Payers 0 Self-Insured Employers/Employer Clinics 0 Accountable Care Organizations (ACOs) * Numbers are interpreted by organization names on CommonWell Alliance website for illustrative purposes (December 2018). 21

22 HIEs: Current State in Indiana* 3 HIEs connected to 12 HIEs across western and central US ~120 hospitals more than 90% ~7,000 physician practices receive data more than 90% ~50 LTPAC facilities Some Behavioral Health All Medicaid payers; 0 Commercial payers Some ACOs many of the largest Some self-insured employers/employer clinics * Numbers are estimates for illustrative purposes (December 2018). 22

23 Regional Information Exchange in California No large-scale, robust HIE presence Large integrated delivery networks Universityaffiliated academic systems Comprised of multiple institutions in the Bay Area that primarily use single EHR vendor for exchange Bi-directional sharing occurs EHR Vendor Platform + Carequality Network of community clinics Carequality enables more than one EHR vendor platform to successfully exchange data Healthcare systems Safety net health systems

24 AND not OR PART III 24

25 HIE Approach CIRCA 2012 Regional HIE Networks Provider HIE Provider Other Providers

26 HIE Approach CIRCA 2012 EHR Approach Provider Regional HIE Networks HIE Provider OR Provider EHR Vendor Framework (same EHR) Provider Other Providers HIE Other Providers

27 HIE Approach CIRCA 2012 EHR Approach Provider Regional HIE Networks HIE Provider OR Provider EHR Vendor Framework (same EHR) Provider ehex Approach Other Providers ehealth Exchange Framework HIE Other Providers Some Epic Providers HIE Fed Govt Other Providers

28 HIE Approach TODAY Regional HIE Networks Provider HIE Provider HIE Provider SHIEC Framework Other Providers

29 HIE Approach TODAY EHR Approach Provider Regional HIE Networks HIE Provider AND/ OR Vendor Carequality Framework. Vendor HIE Provider Other Providers SHIEC Framework CommonWell HIE Other Vendors

30 HIE Approach TODAY EHR Approach Provider Regional HIE Networks HIE Provider AND/ OR Vendor Carequality Framework. Vendor HIE Provider Other Providers SHIEC Framework Many Epic Providers ehealth Exchange Framework More HIE CommonWell HIE Other Vendors Fed Govt Other Providers ehex Approach

31 USE CASE: Exchanging data between VA and non-va providers Use Case Exercise INTEROP APPROACH(ES): 1. HIE + ehex 2. EHR vendor + ehex SOLUTION FOR MY ORG: Which is right for your organization? MY CONSTRAINTS: 1. Does my EHR vendor enable exchange with the VA? 2. Does my HIE enable exchange with the VA?

32 USE CASE: Patient information at point of care Use Case Exercise INTEROP APPROACH(ES): 1. HIE 2. Carequality + EHRIP* 3. EHRIP to EHRIP (Same vendor) 4. ehex to EHRIP or HIE SOLUTION FOR MY ORG: Which is right for your organization? MY CONSTRAINTS: 1. Onboarded to ehex? 2. Participate in HIE? 3. Is HIE robust? 4. Is my EHR vendor highly penetrated in my region? *EHRIP = EHR Interoperability Platform

33 USE CASE: Clinical event notifications Use Case Exercise INTEROP APPROACH(ES): 1. HIE 2. SHIEC Patient Centered Data Home 3. ehex SOLUTION FOR MY ORG: Which is right for your organization? MY CONSTRAINTS: 1. Participate in HIE? 2. Does your HIE offer notifications? 3. Does your HIE participate in Patient Centered Data Home? 4. Onboarded to ehex?

34 SHIEC Framework Patient Centered Data Home Santa Cruz HIE HIE as Content Manager?. SSA Carequality Framework Future Frameworks? ehealth Exchange Framework

35 What s Next PART IV 35

36 Acknowledge the Barriers Providers don t want it Paying for duplicate services Fee for service Education 36 Lure of silver bullet solution Changes in market Competin g priorities TEFCA uncertaint y

37 What s next in st Century Cures Act and TEFCA CommonWell Carequality implementer ehealth Exchange Carequality implementer Interoperability SHIEC PCDH live with national expansion 37

38 What s next in st Century Cures Act and TEFCA CommonWell Carequality implementer ehealth Exchange Carequality implementer Interoperability SHIEC PCDH live with national expansion 38

39 Questions John Kansky President and Keith Kelley Chief Operating Officer 39