Community Health Information Network (CHIN)

Medical Economics Data May 09, 1994 [draft]

Author: Carol Sansone, Business Development Manager

Community Health Information Network (CHIN) Definition Integrated collection of computer and

telecommunications capabilities that facilitates communication of clinical and financial patient information among multiple providers, payers, employers, pharmacies, and related healthcare entities

Variables CHIN will live within a health plan Ownership Number of participants Transaction volume Level of integration with other systems Range of applications Model of CHIN ARCHITECTURE

Community Health Information Network (CHIN) Migration Path

Transaction switching from station to station Universal implementation of clinical communications linking

hospitals and physicians Payer communication offering electronic data interchange and

insurance eligibility information Creation of clinical information (virtual) repositories Utilization of outcome database ORGANZATION

Community Health Information Network

Three Phases of CHIN Automation Electronic Ordering – Single Institution Electronic Medical Record – Multiple/Single

Institutions Lifetime Health Record/CHIN

Development – Multiple Encounters/Multiple Institutions

Community Health Information Network (CHIN)

CLINTON’S HEALTHCARE INITIATIVES Cut the cost of healthcare administration. Govern healthcare administration simplification through

Federal regulation. Expressed interest in the CHIN marketplace by large

Hospital Information Systems (HIS) vendors. Drive outcome measurements through CHIN users

(payers, government, research/education, providers, patients, employees, accreditation agents/regulators).

MARKET FORCES

ENVISIONED CHIN BENEFITS

PATIENT BENEFITS Reduce redundancy in forms, exams, tests Facilitate continuity of care Promote knowledgeable choice Lower cost of carePROVIDER BENEFITS Improve quality of care Reduce isolation of rural physicians Reduce litigation exposure Manage total cost of therapy Build a competitive marketplace advantage

ENVISIONED CHIN BENEFITS (CONT’D) Employer Benefits

Evaluate plan benefit characteristics Compare provider performance Reduce costs of health benefits Improve employer/employee satisfaction with

selected healthcare service options

Potential CHIN Fee Structures

All participants will pay fees for installation, systems integration, transmission, maintenance, service charges such as flat fees, eligibility fees and transactions fees.

Current systems usually omit physician fees to encourage participation.

Longer term, physicians will be charged for incremental services.

The network is largely transparent to the patient, who pays nothing.

UNRESOLVED CHIN ISSUES

Data and image transmission standardization Data standards are evolving

(HL7/IEEE/MEDIX) Industry imagery transmission standards are

in their infancy stage of development

UNRESOLVED CHIN ISSUES (CONT’D) Data ownership once (value-added) data is

on the network Data access role within a local network Data security to both code and protect

lifetime health records

Community Health Information Network (CHIN)

1) AMERITECH/WHIN/AHC

(AMERITECH HEALTH CONNECTIONS, INC.) Area of Service

7 hospitals with 750 physician users targeted 5 payers targeted for claims 5 billing services 3 labs and 4 clinics interested MILWAUKEE AREA WITH COMMUNITY

FOCUS

Community Health Information Network (CHIN)

1) AMERITECH/WHIN/AHC Features

Open system architecture Host systems include IBM, Tandem, HP,

DEC, and Unisys User interface with Windows, so all data can

be presented on one screen ARCHITECTURE DESIGNED FOR

GROWTH

Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Analysis

User functionality includes both payer and provider clinical communications

Specific applications include the following: E-Mail Bulletin board Deferred results Integrated with practice-management systems STRENGTHS

Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Future Applications Insurance enrollment Eligibility Verification Claim payment notifications Radiology images Rx notification Pre-admit Good financial stability Security through a card with microchip-encoded password/ID STRENGTHS

Community Health Information Network (CHIN)1) AMERITECH/WHIN/AHC Analysis Future applications (continued)

Scheduling inquiry Orders Medical library Credit histories Insurance change notifications Integrated community database STRENGTHS

Community Health Information Network (CHIN)

1) AMERITECH/WHIN/AHC Analysis

Limited payer functionality at present Development of clinical database in early

stage of development Not fully proven line

WEAKNESSES

Community Health Information Network (CHIN)

1) AMERITECH/WHIN/AHC Analysis

How and when all interfaces will be accomplished

Time to market concept Proving cost-justification Development of outcomes/utilization

database CHALLENGES

Community Health Information Network (CHIN)

2) CHMIS/HARTFORD FOUNDATION Test site in Memphis Comprehensive design created by New

York based Benton International (consultants)

Features User and payers ATM-style efficiency Not-for-profit John A. Hartford foundation

Community Health Information Network (CHIN)

2) CHMIS/HARTFORD FOUNDATION Analysis

Combine EDI/WEDI concept of electronic processing and transactional facilitation

Meeting shared information needs through community-controlled database

Focus on community/cost/quality as goals Straight-forward design Ride the back of existing claims structure and build on an

embedded base rather than a perfect system concept

STRENGTHS(WEDI/Workgroup Electronic Data Interchange)

Community Health Information Network (CHIN)2) CHMIS/HARTFORD FOUNDATION Analysis

Unproven Database issues of security and

confidentiality because of size Focusing on claims and insurance rather

than larger vision

WEAKNESSES

Community Health Information Network (CHIN)2) CHMIS/HARTFORD FOUNDATION Analysis

Community support because of size Operational complexity Time to market System integration and interface issues

CHALLENGES

Community Health Information Network (CHIN)3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS) Area of Service

Approximately 22 networks are growing reaching more than 40 percent of Colorado hospitals.

First alpha site at St. Anthony, Denver

EXPANSION THROUGH ACQUISITION STRATEGY FOR NATIONAL COVERAGE

Community Health Information Network (CHIN)3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)• Features

• For-profit corporate venture• Batch system in the works for approximately 3 years• Mature clinical messaging capability

• Transmits voice, data and image• Store and forward technology to send messages ARCHITECTURE

Community Health Information Network (CHIN)

3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)

• Analysis• Proven capability• Simplicity of use• Low costs with batch interfaces means less

worry about data loss

STRENGTHS

Community Health Information Network (CHIN)

3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)

• Analysis• Limited payer capacity• Batch architectural design• Limited system integration• Costs can be high depending on service and

transaction volume WEAKNESSES

Community Health Information Network (CHIN)

3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)

• Analysis• Transaction switch in development stage• Company growing rapidly so resources may

be stretched• Clinical and outcomes databases planned for

the future CHALLENGES

Community Health Information Network (CHIN)

4) SMS/HDX• Area of Service

• Community focus and open to all participants• Total view is national in scope

CURRENTLY DIFFERENT STAGES OF DEVELOPMENT IN OHIO, NEW HAMPSHIRE, NEW YORK, AND CALIFORNIA

Community Health Information Network (CHIN)

4) SMS/HDX• Features

• For-profit effort by subsidiary of major HIS system vendor with extensive client list nationwide

ARCHITECTURE

Community Health Information Network (CHIN)

4) SMS/HDX• Analysis

• Extensive design with proven capability in payer-clinical communications

• Transaction switch scope to be expanded over 4 to 6 years

• Includes new captive membership, utilization monitoring, payment settlement, and eventually, managed-care functionality

STRENGTHS

Community Health Information Network (CHIN)

4) SMS/HDX• Analysis

• Data processed from national center in Malvern, PA, rather than regionally

• Not fully proven in concept• Database ownership issues exist for

proprietary vendor

WEAKNESSES

Community Health Information Network (CHIN)

4) SMS/HDX• Analysis

• Developing clinical/outcomes database• Physicians want a range of functions• How proprietary vendors will interface to

foreign systems

CHALLENGES

Community Health Information Network (CHIN)

5) UNITED HEALTHCARE• Area of Service

• Minnesota is test site

REGIONAL GEOGRAPHY

Community Health Information Network (CHIN)

5) UNITED HEALTHCARE• Features

• Payer-focus called Providerlink• Sponsored by Minnesota-based managed-

care company for EDI claims

ARCHITECTURE

Community Health Information Network (CHIN)5) UNITED HEALTHCARE• Analysis

• Proven system processing more than 40 million claims from United’s 18 plans and more than 500 hospitals with 2 million vendors ?

• Architectural design is good for growth and flexibility• Users have flexibility in hardware and workstation

devices• Substantial savings have been shown (more than $1

per claim) STRENGTHS

Community Health Information Network (CHIN)

5) UNITED HEALTHCARE• Analysis

• Limited clinical capability• Payer owned, so participation by others may

be guarded

WEAKNESSES

Community Health Information Network (CHIN)

5) UNITED HEALTHCARE• Analysis

• Not currently a database repository for clinical data

• Data ownership issues• Plan lab and results reporting

CHALLENGES

Community Health Information Network – Other Emerging Chins Inova Health Systems of Falls Church, VA San Antonio Healthcare Partnership NO/HIN in New Orleans Henry Ford Health Alliance Plan in Southeastern Michigan Metropolitan Chicago Healthcare Council Praxis, based in Nashville 6 states now receive funding from the Hartford Foundation, with

another 9 states applying in the coming months. POPULATION SAMPLING OF CHIN(S) NATIONWIDE

Community Health Information Network (CHIN) Topology Models

STRATEGIC ALLIANCES INTEGRATION

(demonstrate access points) (demonstrate linkages)

Community Health Information Network (CHIN) B2B Linkages

Banker, Hospital, Physician’s Office or Community Health Center Other Chins

Community Healthcare Information Network (CHIN) B2B Applications

Computerized Patient Record Case Management Results Reporting

Physician Direct Order Entry Alerts

Nursing Documentation Physician Documentation

Community Health Information Network (CHIN) B2B Applications (cont’d)

Scheduling Patient Accounting Radiology Laboratory Cardiology Anesthesia Pharmacy Medical Records Abstracts

Community Health Information Network (CHIN) B2B Applications (cont’d)

Corporate Financials Network ADT Interface Engine E-mail/EDI Imaging Forms Automation Master Patient Index

Community Health Information Network (CHIN) What next!