HIE, RHIOs and EHR Interoperability The Journey to Meaningful Use, Interoperable Health Care Delivery and Improved Quality of Care

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Christina Galanis

Executive Director, Southern Tier HealthLink

HIE, RHIOs and EHR Interoperability

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From paper to meaningful use and beyond

Topics to be covered in this session

Understanding the landscape & terms: HIE and RHIO Southern Tier HealthLink sources & services

RHIOs & Meaningful Use

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Hospital B

Independent Pharmacy

Hospital A

Hospital

Laboratories LaboratoriesNational Hospital Imaging Orthopedist Imaging Centers Chain Pharmacy Cardiologist Primary Care Physician Home Health Care Ambulatory Surgery

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Support for the Southern Tier HealthLink

“The rapid transfer of medical information enables the Broome County Health

Department to conduct ongoing disease surveillance through the ordering, analyzing and weighing of data to determine risk for illness and injury. This cannot be possible …without sharing information through robust, reliable, and secure computing and communication products. ”

Claudia Edwards, Broome County Public Health Director, NY DoH

“The staff at the Lourdes Emergency Department is very excited to gain access to the Southern Tier HealthLink HIE. Particularly for patients who are unconscious or have difficulty remembering things like their medications and allergies, our ED personnel can rapidly gain access to this critical information. This STHL tool will allow us to provide better treatment and perhaps even save lives.”

Regina Pufky, Lourdes Hospital Emergency Department Nurse Manager

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

EHR (Electronic Health Record): a computerized record keeping

system at your hospital or doctor’s office



HIE (Health Information Exchange): the system of sharing (exchanging)

medical information from one EMR system to another



RHIO (Regional Health Information Organization): the not-for-profit

group that manages the HIE, ensuring it works properly and securely



PHR (Personal Healthcare Record): a computerized collection of

medical information about a particular person, viewable via the internet



STHL (Southern Tier HealthLink NY): our central NY

RHIO that makes sure the HIE works like it is supposed to

5

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6

The Alphabet Soup

STHL is

…the local RHIO

…that you can see in your PHR.

…which oversees the HIE

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Southern Tier HealthLink Background

 Founded as a partnership between UHS, Lourdes hospital and local physicians.

 Board of Directors represents founding stakeholders, physician practices, long-term care, public health, rural health, and the patient community

 Has a patient centric view of clinical information informed by multiple sources

 Funded by NYDOH and as part of the SHIN-NY, STHL acts as a public/private entity

 As funded by NYDOH, STHL must comply with state policy guidance

 Uses a Central Data Repository model: patient data is deposited and sealed until the patient consents to have records shared/accessed

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Southern Tier HealthLink Board of Directors

Rajesh Dave, MD (President)

Christina Boyd, (Vice President)

Mark McManus (Treasurer)

Michael Rusnak (Secretary)

Keith Chadwick, Long-Term Care

Claudia Edwards, Public Health

Merwyn Jones, Consumer

John LaLiberte, Hospital

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

Higher quality patient care



Improved coordination between ALL care providers



Cross institutional patient centric care



More efficient delivery of care



Value occurs across the regional health system

Patients

• Access to medical records • Less time gathering records • Reliable source

for medical history • Easier medication reconciliation

Health care

providers

• More complete clinical profiles of patients • Better documentation at point of care • Less time gathering results • Improved patient care

Hospitals &

Health Centers

• More complete clinical profiles of patients • Better distribution of results • Simplified EMR integration • Improved care coordination • Easier medication reconciliation

Payers

• Higher member satisfaction • More informed disease management programs • Improved care coordination • Fewer duplicate tests • Enhanced formulary compliance

Employers

• Improved employee health • Reduced costs through administrative efficiency and fewer redundant services • Employees engaged as active participants

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UHS Binghamton General Hospital UHS Wilson Memorial Hospital UHS Chenango Memorial

Hospital HospitalLourdes

UHS Primary Care & Medical

Group Southern Tier Imaging

Delaware Valley Hospital Demographics X X X X X X X Contact Info X X X X X X X PCP Info X X X X X X X Insurance X X X X X X X Allergies X X X X X Medications X X X X X Problem List X X X X X Diagnosis X X X X X X Procedures X X X X X Immunizations X Lab Results X X X X X S Radiology Images X X X X X Radiology Reports X X X X X X S Hospital Discharge Summary X X X X X Transcription _S _S _S _X _S General CCD X X

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Current Products/Services

 Clinical results delivery  Patient portal and access to

tethered PHR

 Radiology image exchange  Bi-directional connected EHR  Physician portal

 Training and HIE adoption  Master Patient Index

 SHIN-NY on-ramp

Emerging Interoperability Services

 Medicaid Medications  EMS Connectivity

 Advanced EHR interoperability  Referrals (CCD exchange)  CCD Query

 RHIO-to-RHIO exchange  Provider Registry

 Public Health reporting

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 EHR Connections established with DOH funding through HEAL

Cerner Millennium Emageon – PACS Fugi – PACS HMS ITL – PACS McKesson – PACS Medent Meditech MedSeries 4 Microsoft HealthVault NextGen Siemans Invision Siemans Signature Softlabs Conversations with:

Multiple EHR vendors

eHealth Global Technologies (eHGT) –PACS

 Six-county service area

Broome, Chenango, Delaware, Cortland, Otsego and Tioga

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Receiving patient information from



5 area hospitals



37 area medical practices



1 independent radiology practice

Accessing patient information (Connected EHR/Web Portal)



3 area Emergency Departments



40 area medical practices

~ 200 physicians or other providers ~ 800 clinical staff (nurses, etc.)

Have collected patient consent forms from



40,000 patients—only about 3% choose not to participate



Via 60 collection sites

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Technical safeguards exceed industry standards:



Access is “need to know” based on user’s role



Level 2 Assurance on user authorization and

authentication



Health information transactions are encrypted



Access is subject to HIPAA and HITECH regulations

STHL actively monitors HIE utilization:



Periodic audits, in partnership with Participants



Access reports available at patient request

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EHR Interoperability Variability

 EHR interoperability can vary by HIE or RHIO & EHR

Results/Reports delivery

Patient summary exchange with CCD Referrals

Ordering

Care alerts or subscription

 Results delivery can vary too by Practice

Selecting data to receive/filter

(for example preliminary and/or inpatient result)

Assist with turning off paper/faxes process at various data providers

 Results delivery can surface issues that may have been addressed differently in the paper world

Getting results from patients that are no longer yours

Not getting results as a primary care physician that you used to get by paper/fax Combining results to one report

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Overview of Meaningful Use



The American Recovery and Reinvestment Act (ARRA)

authorizes the Centers for Medicare & Medicaid Services (CMS) to

offer a financial incentive to physician and hospital providers who

demonstrate the “meaningful use” of an EHR.



According to the CMS, a provider uses an EHR

“meaningfully”

when he or she:

1. Improves quality, safety, efficiency, and reduce health disparities

2. Engages patients and families

3. Improves care coordination

4. Improves population and public health

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 New York is ahead of the curve in building patient centric HIE services through RHIOs

 At the federal level, efforts such as the NHIN direct are seeking to provide interoperability for those that don’t have any local HIE or RHIO services

 It is a very dynamic environment but interoperability will continue to expand and get more sophisticated

 Workflows will improve, new data sources will be added

 Quality improvement efforts will advance with more complete patient information and improved analytics

We have solutions today that work today &

are here to support your interoperability needs in the future

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The Vision for Meaningful Use

Stage 1

Stage 2

Stage 3

Improved

quality of care

3 Stages of Meaningful Use

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

Is the federally designated entity to help providers adopt EHRs

and qualify for incentives by achieving Meaningful Use



Partners with local health groups in your community to get you

the support you need



Negotiates on your behalf with EHR vendors and IT suppliers



Will be with you every step of the way

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NYeC REC is the Sum of Many Parts



NYeC works with a statewide

network of highly qualified

organizations



Our collective mission: Provide

the training and support services

providers needed for doctors and

other providers to adopt and

meaningfully use of EHR systems

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There are 9 Stops on the Full Journey

For Those Who Have Already Adopted, The Journey

Starts Further Down the Line

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Stop Eight: Achieve Meaningful Use

With the REC

Without the REC



The REC is the federally-designated

Meaningful Use expert for New York



We’ll walk you through what your

practice needs to do



We’ll help you measure your readiness

so you’re prepared for your 90-day

Meaningful Use evaluation period



The federal definition

is over 800 pages long!



Try to measure whether you’re ready

for evaluation



Try to organize your federal 90-day

evaluation period

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Final Stop: Receive Federal Incentives

With the REC

Without the REC



Hopefully this:



Maybe:

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Regional Extension Center Eligibility

MD, DO, NP, PA practicing in typical primary care specialties including OB-GYN and Pediatrics, and practice size is 10 clinicians (with prescriptive privileges) or fewer

or

-Practice is a federally-qualified health center or public or critical access hospital or primarily serves medically underserved populations

You are eligible for the program even if you already have an EHR. If you do already have an EHR, the REC will assist you with post-implementation services to get your practice ready for Medicare

and Medicaid

incentive programs

If qualified, the federal government is subsidizing your participation up to $5,000 per provider

If you already have an EHR and need services to get to Meaningful Use, the standard program cost to you is

$750 for one year of participation.

If you already are going from a paper based business through to Meaningful Use, the standard program

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For more information about the Regional Extension Center (REC) visit:

www.nyecrec.org

For more information about STHL services: - Call STHL at 651-9150

- Visit www.sthlny.com

Christina Galanis, Executive Director Marc Andiel, Technical Director

Paul Almy, Project Coordinator, Technical John Hayek, Project Coordinator,

Community Outreach