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M ETROPOLITAN C HICAGO H EALTHCARE C OUNCIL

M ETROPOLITAN C HICAGO H EALTHCARE C OUNCIL. Illinois Health Information Exchange. Medical Trading Area Health Information Exchange Kick-off Meeting. Mission

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M ETROPOLITAN C HICAGO H EALTHCARE C OUNCIL

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  1. METROPOLITAN CHICAGO HEALTHCARE COUNCIL Illinois Health Information Exchange Medical Trading Area Health Information Exchange Kick-off Meeting 1

  2. Mission The Metropolitan Chicago Healthcare Council (MCHC) is a membership and service organization dedicated to helping members care for their communities through access to health care and improved delivery of services. Vision High quality, accessible healthcare for all communities. Illinois Health Information Exchange MCHC 2

  3. Illinois Health Information Exchange Goals for Today • Provide Background and HIE Briefing • Discuss the Work Ahead • Help Define Your Involvement 3

  4. Illinois Health Information Exchange Agenda • Welcome and Introductions • Overview of Health Information Exchange • Vision to Reality • Stakeholder Engagement 4

  5. Illinois Health Information Exchange To Begin… • Please Introduce Yourself / Organization • What brought you here? • What is the number 1 question on your mind? 5

  6. Overview of Illinois Health Information Exchange Illinois Health Information Exchange IL Dept of Healthcare & Family Services 6

  7. Illinois Health Information Exchange A Critical Time for Health Information Exchange (HIE) • In Illinois – On February 4, 2009, Governor Pat Quinn signed Public Act 95-1030 into law, appropriating $3 million to the Department of Healthcare and Family Services to establish a program for health information exchange planning. • Across the Country –The American Reinvestment and Recovery Act (ARRA), signed into law on February 17th, dedicates more than $20 billion nationwide in federal funding to implement electronic health records and health data exchange by 2014. 7

  8. Illinois Health Information Exchange Federal Health IT Timelines • State Health Information Exchange Cooperative Agreement Program, 2010 – 2014 • State of Illinois submitted an application to the Office of the National Coordinator (ONC) on October 16, 2009 • Application is currently under review by ONC; awaiting feedback and further direction • Illinois awarded $18,837.639.00 for the four year planning and implementation period • Regional Extension Center Program (REC) – 70 awards nationally; 3 applications from Illinois • REC programs begin in early 2010 8

  9. Illinois Health Information Exchange Federal Health IT Timelines • Rate incentives to providers through Medicare and Medicaid for Meaningful Use of EHR, beginning in 2011 • Incentives are gradually reduced with penalties beginning in 2015 • Provider incentives range from $40,000 and $65,000 over a 5 year period • Hospital incentives are based on a formula that includes a $2 million base that takes bed days and discharges into account 9

  10. Illinois Health Information Exchange Goals of Illinois HIE • Improve healthcare quality and outcomes • Reduce medical errors and redundant services • Improve patient safety • Enhance coordination of patient care among providers • Engage patients and their families by providing meaningful health care information at the point of care • Reduce health disparities; increase disease surveillance • Control the cost of health care Illinois Department of Healthcare and Family Services 10

  11. HIE Planning Grants Illinois Health Information Exchange • With funding from PA 95-1030, HFS awarded 16 grants across Illinois for HIE planning. • The goals of HIE Planning Grants are to: • establish the governance structures • promote provider collaboration • develop the social capital necessary to sustain HIE • develop a technical and operational framework • develop a financially sustainable state-level HIE • promote state-level interoperability 11

  12. Illinois Health Information Exchange 16 Medical Trading Areas f 12

  13. MTA Analysis Illinois Health Information Exchange • Captured the majority (75-85%) of medical transactions within a geographic region in order to define a Medical Trading Area (MTA) • Medical Transaction is defined as one of the following: • Hospital admissions • Outpatient ER visits • Physician office visits, consultations, specialty care referrals • Diagnostic services • OTC pharmacy prescribed by a physician 13

  14. MTA Analysis (continued) Illinois Health Information Exchange Medical transaction data will be used to identify data exchange partners Used Medicaid transactions, from State FY 2007, covering 2.5M enrollees Validated data by using data from State employee claims data 14

  15. Illinois Health Information Exchange Stakeholder Requirements Successful applicants provided a commitment to include a majority (>50%) of MTA stakeholders in their HIE planning efforts Stakeholders are representative of entire geography of the MTA including: practicing physicians, nurse practitioners, hospitals and hospital associations, corporate and independent laboratories, chain and independent pharmacies, health plans and insurers, local health departments, consumers and consumer advocacy groups, quality improvement organizations, behavioral health providers and long term care facilities 15

  16. Goals of HIE Planning Efforts Illinois Health Information Exchange To determine the level of EHR adoption and barriers to adoption through a state-wide survey To leverage federal incentives for EHR adoption and Meaningful Use (MU) as outlined in ARRA and the HITECH Act Plan for ability to share protected health information from disparate information systems and service providers within their MTA 16

  17. Illinois Health Information Exchange HIE Advisory Committee • Membership reflects broad-based stakeholder involvement • Governance Work Group formed to develop recommendations for structure of public-private entity; to be established by legislation in early 2010 • Sustainability Work Group formed to identify long-term funding options, including private sector and philanthropic contributions • To increase e-prescribing throughout Illinois • To connect to a health information exchange 17

  18. Illinois Health Information Exchange HIE Advisory Committee • Privacy and Security Work Group is integrating Health Information Security and Privacy Collaboration (HISPC) efforts into HIE planning • Consumer Education Work Group formed to research and develop HIE communication messages and strategies • Technical and Business Operations Work Group is addressing the functions necessary for a successful HIE 18

  19. Illinois Health Information Exchange Coordination with Medicaid Program • Current Medicaid Management Information System (MMIS) and Medicaid Medical Data Warehouse will provide significant foundation • Strategic and Operational Plans will be consistent with the State Medicaid Health IT Plan • Utilize Medicaid data to target high volume providers eligible for MU incentives 19

  20. Collaborative Efforts Illinois Health Information Exchange Working closely with the IL Department of Public Health and all local public health departments Coordinating efforts with the IL Department of Commerce and Economic Opportunity on health care workforce development strategies Coordinating HIE planning efforts with the IL Broadband Development Council Will work closely with the Regional Extension Centers that will be designated to provide technical assistance 20

  21. Illinois HIE Website Illinois Health Information Exchange http://hie.illinois.gov All MTA maps, details about counties, hospitals, and FQHC contained in each MTA Planning Grant resources, toolkits, wiki Educational webinars Best practices lessons learned from HIE projects and initiatives in Illinois and other states 21

  22. Illinois Health Information Exchange Questions? 22

  23. Illinois Health Information Exchange • AHQR Demonstration Projects • eHealth Initiative: 2009 Study on HIE • MCHC HIE From Vision to Reality 23

  24. Illinois Health Information Exchange AHRQ Demonstration ProjectsBefore ONC, HITECH, Meaningful Use, ePrescribing… • Agency for Healthcare Research and Quality: Five year project to support state-wide data sharing/interoperability aimed at improving quality, safety, efficiency and effectiveness of health care for patients and populations • In 2004, awarded 5 year contracts to Colorado, Indiana, Rhode Island, Tennessee, Utah and later, Delaware • Developed a variety of approaches with different technical, business and governance • Clinical Messaging, Medications, Problem Lists, Results, Quality • Handout for additional details or go to www.healthit.ahrq.gov 24

  25. Illinois Health Information Exchange AHRQ Demonstration Projects(continued) Some Thoughts from Demonstration Sites Leaders: • Level of alliance; memo of understanding before signed contracts • Must operate HIE with consensus building • Drive value; reduce cost per transaction • Money and deadlines are huge incentives to get things done • “Exchange is both a verb and a noun” 25

  26. Illinois Health Information Exchange State of HIEeHealth Initiative 2009 survey • 193 HIE initiatives are pursuing exchange efforts; 150 responded to the survey • Number of initiatives involved in health information exchange is growing; 67 new organizations have arisen since 2008 • All 50 states, Puerto Rico and District of Columbia • Most commonly reported as a Multi-County coverage area (47), although there are also HIEs that cover an Entire State (39); Multi-State area (12); Metropolitan area (7) and National level (6) • Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” * 26

  27. Illinois Health Information Exchange Staging of Initiatives *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 27

  28. Illinois Health Information Exchange Status of HIEs • Where is the US at with regard to HIE Staging? • 57 operational (Stages 5, 6, 7) • 79 implementation (Stages 2, 3, 4) • 9 early planning (Stage 1) • 5 unknown • We are Stage 2 Moving to Stage 3 in 2010 *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 28

  29. Illinois Health Information Exchange Key Findings The Services most offered are: • Results delivery (e.g. laboratory or diagnostic study results) (44 initiatives). • Connectivity to electronic health records (38). • Clinical documentation (34). • Alerts to providers (31). • Electronic prescribing (26). *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 29

  30. Illinois Health Information Exchange Key Findings More health information initiatives are exchanging data, with increases in the type of data exchanged nearly across the board. • The number of initiatives currently exchanging data: • Laboratory data increased to 49 initiatives, up from 26 in 2008. • Medication data (including outpatient prescriptions) 48 initiatives are currently exchanging. • Outpatient laboratory increased to 45, up from 25 in 2008. • Outpatient episodes increased to 43, up from 23 in 2008. • Radiology results increased to 39, up from 23 in 2008. • Emergency Department episodes increased to 36, up from 27 in 2008. rce: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 30

  31. Illinois Health Information Exchange Key Findings Positive Impact on Physicians • Health information exchange has had a positive impact on physician practices allowing them to become more efficient without disrupting care. Operational initiatives report the following impacts: • Improved access to test results and resultant efficiencies on practice (28 operational initiatives). • Improved quality of practice life (i.e., less hassles looking for information, getting home sooner at the end of the day, etc) (24). • Reduced staff time spent on handling lab and radiology results (23). • Reduced staff time spent on clerical administration and filing (22). *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 31

  32. Illinois Health Information Exchange Key Findings Positive Physician Impact: Quality and Efficiency (continued) • Reduction of duplicate tests (14); • Improved compliance with chronic care and prevention guidelines (12): • Reduce time spent on handling prescriptions (12); • Improve care outcomes (11); • Fewer prescription errors (10); • Reduced med errors (10). *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 32

  33. Illinois Health Information Exchange Key Findings HIEs can help Reduce Costs • In 2009, operational initiatives most often reported ROI from hospitals (21) and physician practices (19) could see the greatest return on investment (ROI). • Operational health information exchange initiatives are helping cut health care costs in a number of areas. • Primary reported areas of cost-cutting include: • Reduced staff time spent on handling lab and radiology results (26 operational initiatives). • Reduced staff time spent on clerical administration and filing (24). • Decreased dollars spent on redundant tests (17). • Decreased cost of care for chronic care patients (11). • Reduced medication errors (10). *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 33

  34. Illinois Health Information Exchange Key Findings:Other HIE Services • Implementation Support: • Tech Assistance for Implementation • Workflow Guidance • Advice on Purchasing Decision • Dissemination Best Practices • Coordinating Financial Incentives • Supporting Quality Improvement / Performance Reporting • Liaison between Public and Private Health IT efforts • Administrative • Services that reduce interfaces from EMR vendors • Distribution services (e.g., Reports to Physicians) • Data load services • Hosting Electronic Medical Records (EMRs) • Charges for Database Access • Routing Personal Health Records (PHRs) *Source: eHealth Initiative’s 2009 Sixth Annual HIE survey “Migrating toward Meaningful Use: The State of Health Information Exchange” 34

  35. Illinois Health Information Exchange Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act) 35

  36. Illinois Health Information Exchange One Consortium – A Unified Plan • MTA 7: Southern Suburbs • MTA 8: Northern Suburbs • MTA 12: Central Cook • MTA 13: Northern Cook • MTA 16: DuPage Regional and State-wide Collaboration 36

  37. Illinois Health Information Exchange DRAFT – For Discussion 37

  38. Illinois Health Information Exchange Planning Factors • Vision for the HIE • Collaboration • Trust and Commitment • Stakeholder Benefits • Privacy/Security issues • Clinical and Public Health priorities • HIE Clinical and Financial expectations • HIE cost and value • Sustainability • Technical Infrastructure • Technological capabilities • Implementation Plan 38

  39. Illinois Health Information Exchange Current HIE Initiatives • Hosting Webinars to learn from other states (AHA, Wisconsin, Indiana) • Convening stakeholders by provider type (FQHC’s, PCP’s, etc) • Chicago Community Trust FQHC/CBHO Summit • Convening MTA’s on a local level (beginning the week of November 9th) • Develop & populate regional organization structure • Plan for the future HIE Implementation 39

  40. Illinois Health Information Exchange HIE Planning Building Blocks June 30, 2010 40

  41. Illinois Health Information Exchange Questions? 41

  42. Illinois Health Information Exchange Stakeholder Involvement 42

  43. Illinois Health Information Exchange MCHC HIE PLANNING STRUCTURE MTA Stakeholders will Populate Committees Committees collaborate on a unified plan across MTA’s 43

  44. Illinois Health Information Exchange 44

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  49. Illinois Health Information Exchange Meaningful Use Objectives Requiring Health Information Exchange HIE-related requirements rise significantly by 2013 Lab results delivery ePrescribing Claims and Eligibility checking Quality and immunization reporting 2011 • Increasing volume • Lab Provider; • Provider Pharmacy • Provider to Lab • Pharmacy to Provider • Office Hospital • Office to Office • Hospital / Office Public Health Hospital / Office Reporting Entities • Office Patient Registry reporting and reporting to public health Electronic ordering Health summaries for continuity of care Public Health Alerts Home Monitoring Populate PHRs 2013 Routing availability of relatively rich exchange transactions “Anyone to Anyone” Patient to Reporting Entities Accessible comprehensive data for all available sources Experience of care reporting Medical device interoperability 2015 Source: C. Delany regarding ONC HIT, Policy August 14, 2009 49

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