Engaging Florida’s Regional Health Information Organizations with the County Health Departments

1. Engaging Florida’s Regional Health Information Organizations with the County Health Departments Florida Association of County Health Officers Annual Meeting ~ February 21, 2008 Christopher B. Sullivan, Ph.D. Florida Center for Health Information and Policy Analysis Agency for Health Care Administration

2. Florida’s Strategies for Empowering Regional Health Information Organizations This talk addresses three areas in the development of health information exchange in Florida: • A historical summary of the Florida Health Information Network (FHIN) initiative and Florida’s Regional Health Information Organizations (RHIOs). • The current context of the Florida RHIOs in 2008 and their integration into the Florida Association of RHIOs. • Florida’s ongoing strategies for developing the FHIN and its pursuit of initiatives to support RHIO sustainability. 2

3. The nature of modern health care requires involvement of multiple medical providers to diagnose and treat many medical conditions • Effective coordination of care is dependent on communication of information about a patient’s medical condition. • The exchange of patient data currently depends on telephone calls, mail, the transmission of fax copies of records or photocopies carried by the patient. • A more timely, accurate, comprehensive and secure method of exchanging patient records is electronically through an electronic health record system that includes the health information exchange. Greater Need for Coordination of Care

4. Need for Better Information Exchange Coordination of Specialty Referrals • “Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion.”1 Communication Breakdown in the Outpatient Referral Process • “68% of specialists report that they received no information from the primary care physician prior to specific referral • “Four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists.”2 1. Christopher B. Forrest, MD, PhD, et al. (2000) Coordination of Specialty Referrals and Physician Satisfaction With Referral Care. Archives of Pediatric Adolescent Medicine. 2. Tejal K. Gandhi, et.al. (2000). Communication Breakdown in the Outpatient Referral Process. Journal of General Internal Medicine, Volume 15, Number 9, September.

5. One Answer: Connectivity Through a Regional Health Information Network • Utilizing a health information exchange can improve coordination of health care among treating physicians. • Florida’s Regional Health Information Organizations (RHIOs) offer a means for the secure exchange and efficient delivery of patient records to authorized physicians. • It is in the best interest of Florida’s RHIOs to work with the county health departments to integrate the exchange of medical records.

6. Vision for the Florida Health Information Network (FHIN) The vision for the Florida Health Information Network proposes integrating Florida’s community-based activity in clinical health information exchange through a statewide network, the FHIN. • The FHIN will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients.

7. The FHIN Begins at the Local Level The FHIN is a collaboration of Regional Health Information Networks (RHIOs) funded by the FHIN Grants Program and by local in-kind support. Each RHIO is responsible for working with local providers to initiate the exchange of medical records through the RHIO portal. The Florida Health Information Network is being built from the local community up.

8. What is a Regional Health Information Organization?

9. Building Local Health Information Exchange Through FHIN Grants • AHCA’s strategic plan for promoting health information exchange is to empower local stakeholder collaborations focused on creating local health information networks. • The driver of this plan is the FHIN Grants Program for RHIOs. • Legislative Support: The Florida Legislature has allocated over $5 million in grant funds for the FHIN Grants Program since 2005.

10. FHIN Grants Project Categories • Planning Grants: Support appropriate health care stakeholders to develop a strategic plan for health information exchange in their communities. • Implementation Grants: Support projects that demonstrate health information exchange among two or more competing provider organizations. • Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems.

11. FHIN Grants Program, 2007-2008

12. Northeast Florida Health Information Consortium

13. NEFHIC Technical Capacity ASP Model – Safety net data repository server hosted in Cerner’s secure data center with redundant hardware and power. Records for 90,000 clients loaded with feeds from 7 participants, including hospitals and clinics. System operational and accessible via the Internet using 128-bit secured communications. Pilot testing of user access and data retrieval is complete.

14. Partners Public Funders Free Clinics Private Funders Health Dept. Social Services Hospitals PBC Community Health Alliance (An Alliance of Funders and Providers Serving Health Care Consumers) Collaborative Projects Care Expansion Language Access Project Access Shared EHR Common Eligibility Palm Beach County Community Health Alliance

15. Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project The Glades Community • 28% uninsured rate • Glades General Hospital is only Acute Care facility • 17,753 ER visits; 1,900 Medicaid discharges in 2002 • Prevent duplication between hospital and clinics

16. PBCCHA All-Care Shared Health Record Real-time electronic interface to existing data systems used by hospitals, clinics, and other safety net providers. Shared summary records created for all uninsured/ Medicaid/other patients. No duplicate data entry. Free clinics, Federally Qualified Health Centers, PBCMS Project Access and key competitor safety net hospitals are participating. Viewable via the Web - after patients have signed authorizations.

17. Big Bend RHIO

18. pMAN Connectivity – Dedicated fiber-based Private Medical Area Network & VPN gateway VPN Small organizations can connect either directly to the RHIN or through a VPN gateway Organizations can connect bi-directly to feed their data and receive data directly into their EMR In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available ASAP Big Bend RHIO RHIN Architecture

19. Big Bend RHIO RHIN Services Data Sharing – Patient demographic and clinical data feeds from major providers. RHIN Web Portal – Secure web interface for clinicians. User Access & Audit Control – Detailed audit logs across the entire system. Disaster Recovery & Business Continuity. Patient Portal – Web interface for electronic patient registration form and Personal Health Record (PHR).

20. Florida’s Health Information Networks – January 2008

21. DOH Health Maintenance System FHIN Connection

22. RHIOs and County Health Departments County health departments and the RHIOscan work together to provide integrated, longitudinal health care records for patients in the community. • Become familiar with the RHIO operating in your local community. • Build trust relationships through Business Associate Agreements. • Explore data exchange for the benefit of patients who need coordination of care.

23. Opportunities for Mutual Engagement Between RHIOs and County Health Departments • Data exchange between the Health Maintenance System and the RHIO. • Accessing Medicaid data through Gold Standard and EDS data streams. • Become involved in the rural broadband pilot project in the Florida Panhandle. • Support the development of new RHIOs.

24. Data Exchange Between the Health Maintenance System and the RHIO Secure Internet Access RHIN Web Portal patient search

25. Data Exchange: Big Bend RHIO Applications e-Prescribing and Medication History Clinical data display including: labs, radiology reports, allergies, problems, providers, and medication history

26. Accessing Medicaid Data through Gold Standard and EDS Data Streams • Florida Medicaid Gold Standard eMPOWERx e-prescribing software is available to all Medicaid physicians at no cost. • Florida DOH is currently assessing eMPOWERxfor use by county health departments. • AHCA is working with Gold Standard and Medicaid to make eMPOWERxmedication history available to Medicaid physicians through RHIO portals.

27. eMPOWERx provides 100 days of a patient’s prescription drug history available to Medicaid physicians. Provides clinical benefits through clinical pharmacology report tools that alert the provider to potential drug-drug and drug-allergy interactions. Providers can “write” prescriptions from a desktop computer to any pharmacy for dispensing. eMPOWERx Utilities

28. Medicaid Claims-Based Electronic Health Record System Ported Through RHIOs Working with the new Medicaid fiscal agent, EDS, on a pilot project to roll out a claims-based EHR for Medicaid physicians. Medicaid pilot to work with Big Bend RHIO to integrate the claims data feed for display on the Big Bend portal. Plan to roll out the Medicaid EHR through RHIO portals in spring 2008.

29. Medicaid Claims-Based Electronic Health Record System Pilot Medicaid-EDS Web Application Home Local RHIO or Direct Medicaid Portal Access Office Hospital

30. The goal of the broadband project is to improve the health information infrastructure of rural counties in the Florida Panhandle in coordination with the FHIN initiative.One of the objectives of the FHIN is to offer cost effective information technology services to primary care physicians, rural health care providers, and community clinics serving indigent patients. FCC Rural Broadband Pilot Program

31. FCC Rural Broadband Pilot Program In November 2007 the Federal Communication Commission awarded $9.6 million to the Big Bend RHIO and AHCA to build a gigabit fiber network to nine rural hospitals and surrounding clinics in the Florida Panhandle. • This contract will allow the Big Bend RHIO to connect these hospitals with gigabit fiber and extend its RHIN services to them. • Providing broadband optical fiber connections to rural hospitals brings them into the Florida Health Information Network.

32. Connecting Rural Hospitals in the Florida Panhandle The FCC pilot project will provide 1 Gigabit connectivity to nine rural hospitals.

33. Broadband Rural Network Will Benefit from Big Bend RHIO Services • Once the nine rural hospitals are connected with gigabit fiber, they will receive the data exchange services of the Big Bend RHIO. • Each hospital will be able to send digital image files (X-rays, Cat Scans, MRIs) downstream for diagnosis by specialists. • County health departments are encouraged to connect to the broadband network.

34. Working Together to Improve the Quality of Health Care for All Patients • As the RHIOs establish their health information exchanges, a key to their success will be working with the county health departments. • The Duval County Health Department has already stepped in to broker the Northeast Florida Health Information Collaborative. • AHCA looks forward to engaging in an ongoing relationship between RHIOs and county health departments for the benefit of health care in Florida.

35. Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32308