said the hie: reports of our death are greatly exaggerated · 16 •secure data access and...
TRANSCRIPT
1
Said the HIE: "Reports of Our Death Are Greatly Exaggerated"
Session #269, February 14, 2019
John P. Kansky, President & CEO, Indiana Health Information Exchange
Keith W. Kelley, Chief Operating Officer, Indiana Health Information Exchange
2
John P. Kansky, MSE, MBA, CPHIMS, FHIMSS
Keith W. Kelley, MBA
Have no real or apparent conflicts of interest to report.
Conflict of Interest
3
• Part I: The Perception of HIEs
• Part II: Defining (and Redefining) Interoperability
• Part III: What’s the Future of Interoperability?
Agenda
4
• Describe the historical role of HIEs in the health information and
technology industry
• Analyze common successes and failures of HIEs and how they
have impacted the market
• Assess the impact of HIEs to providers and other national
interoperability approaches
• Recognize how HIEs can be sustainable in a rapidly evolving
healthcare industry
Learning Objectives
The reports of [our] death have
been greatly exaggerated.
- Mark Twain
6
Part I: The Perception of HIEs
7
A Tarnish on the Brand
HIEs do not have
sustainable
business models
HIEs do not have
sustainable
business models
HIEs are complex,
expensive and require
providers to pay twice
for interoperability
solutions
HIEs are complex,
expensive and require
providers to pay twice
for interoperability
solutions
HIEs are not
evolving with the
rapidity of the
market
HIEs are not
evolving with the
rapidity of the
market
8
HIEs in the Media
Report: HIEs failing at true
interoperability (May 14,
2012)Public HIEs Failing
(January 30, 2014)
Are we witnessing the death of
public HIEs? (April 13, 2016)
HIE Numbers Declining
(August 1, 2016)
9
HIEs in Research
Reducing Medicare Spending Through
Electronic Information Exchange: The
Role of Incentives and Exchange
Maturity (April 2016)
New study shows evidence that
health information exchanges
improve care, reduce costs
(May 2018)
The benefits of health information
exchange platforms: Measuring the
returns on a half a billion dollar
investment (May 2015)
10
Let’s Dissect…
11
HIE Closures
December 2006
The Santa Barbara
Co. Care Data
Exchange
(SBCCDE) closes
October 2011
CareSpark in
East Tennessee
closes
February 2014
The Nevada Health
Information
Exchange (NV-HIE)
closes
February 2019
Communities of
Illinois HIE
(CIHIE) closes
Like any kind of business,
some HIEs flourish while
others fail
12
HIE Consolidation
Microeconomics tells us that
the optimal size of an HIE is
larger than most HIEs are
today. Hence consolidation
was expected and more will
occur.
January 2017
The Inland Empire
Health Information
Exchange (IEHIE) and
California Integrated
Data Exchange (Cal
INDEX) combine
May 2015
North Texas
Information
Exchange and
Texas Health
Resources mergeJuly 2014
Great Lakes Health
Information Exchange
and Michigan Health
Connect merge to form
Great Lakes Health
Connect (GLHC)
December 2013
Healthix, INC.
and Brooklyn
Health Exchange
(BHIX) merge
13
Regionalization Represents Progress
Economies of scale opportunities will result
More dollars and resources can be dedicated to innovations that can benefit more customers
Regionalization gives HIE a stronger value proposition in markets that cross state lines
Strengthens HIE sustainability foundation
Regional, multi-state HIE organizations are expected to be eligible to serve as Qualified Health Information Networks (QHINs) under TEFCA
15
Part II: Defining (and Redefining) Interoperability
16
• Secure data access and electronic exchange of health information
• Ability of systems to exchange and use information
• Technology that allows for complete access, exchange, and use of all electronically accessible health information as authorized by State or Federal law
What is Interoperability?
Consider this..Industry Definitions:
Interoperability is not one
thing. It is a broad combination
of use cases that is specific to
your organization’s needs
None of these industry
definitions limit interoperability
to a narrow use case
Definitions: HIMSS, CMS, 21st Century Cures Act
17
The Single Network Model…
ATM Network
Comparison
PRIMAR
Y ATM
Network
18
…Is Not Actually a Single Network
Ban
k
PRIMAR
Y ATM
Network
Primary
Wire
Transfer
Network
Primary
ACH
Network
19
Source: “A User’s Guide to Understanding the Trusted Exchange Framework,” ONC
20
Broadcast
Query
(QHIN)
Broadcast
Query
(QHIN)
Directed
Query
Directed
Query
Population
Level
Data
Population
Level
Data
Use or
Disclosure
for
Treatment
Use or
Disclosure
for
Treatment
PaymentPayment
BenefitsDetermination
BenefitsDetermination
Individual
Access
Individual
Access
Public
Health
Public
Health
Healthcare
Operations
Healthcare
Operations
TEFCA (2018 Draft)
Use
Cases
Permitted
Purposes
21
Interoperability is Comprised of Many Use Cases
1. Clinical results delivery (lab, radiology, etc.)
2. Medication history, summaries, alerts, etc.
3. Notification of clinical events for patients in a defined population
4. Immunizations, syndromic surveillance and public health data
5. Electronic prescribing and refill information
6. PHRs, patient-reported data
7. Claims transaction/electronic eligibility information
8. Data quality and research support
9. Connectivity to electronic health records
10. Alerts to providers
11. Enrollment or eligibility checking
12. Electronic referral processing
13. Clinical decision support
14. Disease or chronic care management
15. Quality improvement reporting for clinicians
16. Ambulatory order entry
17. Disease registries
18. CCR/CCD summary record exchange
19. Quality performance for purchasers or payers
20. Public health surveillance
21. Electronic prescribing and refill information
22. Alerts to providers
23. Query for documents
24. ADT notification
25. Claims processing
26. Population health management
27. Public health data
28. Research support
29. Syndromic surveillance
30. Eligibility checking
31. Ambulatory order entry
32. Patient-reported data
33. Connectivity to EHRs
*For illustrative demonstration only
22
Part III: What’s the Future of Interoperability?
23
One National Interop Approach(for point of care CCD exchange)
National EHR ApproachNational EHR Approach
24
Expansion of EHR Framework to include additional use cases
National EHR ApproachNational EHR Approach
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
25
Large Regional HIEs or Collaborations
National EHR ApproachNational EHR Approach
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
Use
Case
HIEHIE HIEHIE
HIEHIE HIEHIE
HIEHIE
The more you explain it, the
more I don’t understand it.
- Mark Twain
27
• Increased interest from the Federal Government
• Increased EHR vendor capabilities
• Increased complexity
• Industry interest (Apple, Google, Amazon-JP Morgan-Berkshire)
The Business Case for HIE has never been stronger
28
HIEs Must Evolve
Embrace, complement, and supplement
Carequality/CommonWell/eHealth Exchange
Advocate and advise at a regional and state level
Carequality
CommonWell
eHealth Exchange
Carequality
CommonWell
eHealth ExchangeTEFCATEFCA
Become the trusted, vendor-neutral, interoperability expert for
your membership
Meaningful Use/
Promoting Interoperability
Meaningful Use/
Promoting InteroperabilityValue-based care
performance
Value-based care
performanceIndustry solutions
(e.g. Apple)
Industry solutions
(e.g. Apple)
29
Providers Must Also Evolve
Develop an interoperability plan
Engage your HIE as a trusted interoperability expert
Give your HIE a seat on your interoperability steering committee
If you don’t have an HIE in your market, form one or recruit one to prevent duplicating efforts
30
Takeaways
HIEs are still key to national interoperability
We have a continued need to have interoperability solutions at a national AND regional level
Interoperability is not only point of care; it’s many different things
HIE capability becomes more critical as the complexity of interoperability increases
31
John Kansky
President and CEO
QuestionsKeith Kelley
Chief Operating Officer
Please remember to complete the online session evaluation
@jkansky @IndianaHIE