HealthInfoNet

1. Leveraging the HIE and Regional Extension Center in Maine for Behavioral Health Integration, Support and Technical AssistanceSAMHSA 2011 Regional Forum

2. HealthInfoNet • HealthInfoNet operates Maine’s designated statewide health information exchange, a secure, standardized electronic system where providers can share patient health information for treatment purposes. • The Statewide Regional Extension Center • Supporting 1,000 and primary care providers and 22 Rural and Critical Access Hospitals statewide in: • Accelerating EHR adoption • Education • Participation in HIE and other Statewide HIT activities • Key partner in the Bangor Beacon Community • HIE support for care transitions, coordination, and population health 2

3. HealthInfoNet’s Mission • Mission: Develop, promote and sustain an integrated, secure and reliable regional information network dedicated to delivering authorized, rapid access to person-specific healthcare data across points of care that will support: • Improved patient safety • Enhanced quality of clinical care • Increased clinical and administrative efficiency • Reduced duplication of services • Enhanced identification of threats to public health • Expanded consumers access to their own personal health care information 3

4. About HealthInfoNet • Maine-based: The Board of Directors are active and prominent in the Maine medical community and represent a variety of organizations and interests. • Independent:HealthInfoNet is independent and is not owned by insurance companies, health care organizations, associations, employers or government. • Nonprofit: HealthInfoNet is a private nonprofit organization. It is funded by many sources including charitable foundations, Maine health care providers, and the state and federal government. • Multi-stakeholder: Involves Consumers, Providers, Payers, Business and Government. 4

5. HealthInfoNet Principles of Operation • Information privacy and security is the highest priority • Information is organized and presented to promote effective clinical decision making and patient safety • Access to individually identified health information is based on the formal consent of the individual • Access to individually identified health information for the purpose of promoting public health and safety is based on established State and Federal law • Participation in the system is open to and affordable for all individual health providers involved in the care of a patient • Participation in the system is voluntary and includes the right of any individual or organization to withdraw from participation 5

6. Brief History of HealthInfoNet • 2005 - Health stakeholders convened “We will no longer compete on data!” • 2006 – 2008 HealthInfoNet’s Beginning • Designed the core infrastructure requirements • Centralized model based on experience of the All-Payer Claims database • Portal solution until EHRs capable of taking in and un-packaging HIE data • Data to be gathered from the source where possible • Established HIN as a 501(c)3 • RFP released, prime vendor chosen • 2008: “Go Live” on Demonstration Project • 2010: Demonstration Ends Statewide Roll-out Begins • Re procured vendors – HealthInfoNet = Prime Vendor • Reduced cost / increase scalability • Began Regional Extension Center • Initiate Beacon Community Activities 6

7. Clinical Data Exchanged by HIN Participants • Patient Identifier and Demographics • Encounter History • Diagnosis/Conditions/Problems • Laboratory Results • Microbiology Results • Radiology Reports • Adverse Reactions/Allergies • Medication History (Commercial and Medicaid) • Dictated/Transcribed Documents (HIN does not currently collect Mental Health, Substance Abuse or HIV diagnoses and related procedures – Beginning in 2012) 7

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9. HealthInfoNet’s HIE Current Status • Over 965,000 individuals have a HealthInfoNet record • 66,000 individuals have primary addresses outside of Maine • 18% of individuals have visited two or more participating providers • 5,900 individuals, less than 1%, have opted out • 2,106 Maine clinicians can access the system • Impact of provider organizations participating • 65% of annual statewide inpatient discharges • 60% of annual statewide Emergency Department visits • 45% of annual statewide ambulatory visits • Support provider disease reporting requirements to Maine CDC • Reporting 28 of 72 mandated diseases 9

10. Value for providers • Reduced Time To Access of Clinical Information at the Time/Point of Care • Access to information not previously seen • Improved continuity of care • Repeat testing avoided 10

11. Value for providers – Insights from the Field • “ED Patient with multiple respiratory complaints with possible pulmonary embolism - able to avoid unnecessary CT angiogram after checking HIN and determined patient had recent CT and alternative respiratory diagnosis.” • “I was able to access lab data from Franklin Memorial that allowed me to trend a patient's platelet count over the course of the past year. As a result, I was able to see a pattern that helped to form a differential diagnosis and pushed our decision making.” • “One avoided repeat CT of Abdomen and one case confirming a bizarre story of patient care moving from Augusta to Bangor to Augusta and back in less than 7 days. The second case, accessing data allowed me to trust the story being presented.” 11

12. Maine Regional Extension Center • In April 2010, HealthInfoNet awarded $6.1 million to serve as the Regional Extension Center for Maine (MEREC). • Goal is to accelerate the adoption and use of electronic medical records (EMR) and HIE by 1,000 PCPs and 22 Critical Access and rural hospitals by: • Driving down the cost of interoperable EMRs, • Providing educational and technical assistance • Delivering interoperability between individual EMR and the HIE • Current Participation: • 934 Providers Enrolled • 18 Rural and Critical Access Hospitals Enrolled • Anticipated over 400 go-live on EHR by September 2011 12

13. The MEREC Services • EMR selection and discounted pricing for pre-screened vendors • Athena Health, Ingenix, EMDs, Soon More • Implementation Support • Wholesale Providers – Direct Contracting • Concordant – Implementation Optimization Organization • Connection to HealthInfoNet’s HIE – Part of ALL REC Contracts • Low-interest loans • Quality improvement and coaching support – Minimum of 8 hours available per provider • HIT & HIE Privacy and security best practices • Education – Bi-monthly webinars – Annual Forums – Partnership with Community Colleges 13

14. Maine REC Services Structure HealthInfoNet (Prime Contractor) • Brokerage for REC Direct Services • Vendor Neutral Contracting (RFP) • EMR • Implementation Support • Vendors • Wholesale Providers • Core Services (HIN and Partners) • Vendor Selection and Group Purchase • Education and Outreach • National Learning Consortium • Functional Interoperability HIE • Privacy and Security Best Practices • Quality & Reporting • Local Workforce Development through Partnership with OSC Maine Regional Extension Center REC Contracts • Direct Services • EMR Implementation • eRx Implementation Support • Meaningful Use Compliance • Quality Improvement Services • Wholesale • (Affiliated Practices) • Eastern Maine • MaineGeneral • Central Maine • Maine Health • Maine PCA • Nova Health • Franklin Memorial • Maine Coast • Martin’s Point • Mercy • St. Joseph’s • Western ME PHO • Retail • (Unaffiliated Practices) • Private Practices • Small-Med Groups • Independent Clinics / Hospitals 14 14

15. Maine REC Technical Assistance Program 15

16. Mental Health and HIV Information Exchange • 2011: The State (OSC) convened a Legal Workgroup including stakeholders from MH/SA, ACLU, Health Systems, State Govt., and HIN • The group made recommendations to amend state law to allow for MH/BH/HIV information to be included in the HIE. • Allow information to flow from provider to HIE • Require the HIE to manage an “opt-in” process for patients wishing to include their information in the exchange • Shield sensitive information if there is no consent • Bill became law in June 2011 • Patients will have meaningful choice to share ALL health information for treatment purposes • Those with a mental health or HIV diagnosis or treatment were being denied the means to have this health care • Supports efforts to integrate care across primary care and specialty • Providers will have quick access to sensitive health information in emergency situations • Patients will have access to their own health information (through patient portal) to manage ALL of their health and personal information 16

17. Maine Accelerating Behavioral Health Information Project • Begun in 2010 and Organized by the Hanley Center for Health Leadership • Foundation funding support • Key partners: • Office of the State Coordinator for Health IT • Maine Health Access Foundation • HealthInfoNet • Maine Association of Mental Health Services • Maine Association of Substance Abuse Programs • Co-Occurring Collaborative Serving Maine • MaineHealth Information Management Association • Maine Primary Care Association • Maine Provider Network for Children and Families • Quality Counts 17

18. Maine Accelerating Behavioral Health Information Project Cont. • Goals: • Significantly increase awareness of the value of electronic information sharing and identify the most significant barriers to be overcome in behavioral health; • Plan and begin to implement activities to remove barriers; • Develop knowledgeable and effective constituency for continuing to accelerate information sharing • Finalize a report by December 2011with specific recommendations that: “will lay the groundwork for appropriately accelerating the sharing of information among behavioral health providers and with primary care providers” • Four Workgroups Created: • Health Information Sharing, Design, & Data Integration • Staff Education, Adaptation, & Technical Expertise • Consumer Engagement & Buy-In • Legal, Policy, and Financial Barriers and Incentives 18

19. HIN 2011 – 2012 Activities to Support Integrated HIT Services in Maine • Continue statewide expansion and MU supports • Connecting to 29 of Maine’s 39 hospitals by end of 2011 • Connecting primary care and ambulatory practices (REC/Beacon) • Connecting behavioral health providers – initially view only • Continued participation in BH convening activities • Roll-out REC support and education services to All providers Exploring technical supports for Behavioral Health • Shared service EMRs • Continuing discussions with the State on options to leverage HIE for Medicaid and Prescription Monitoring • Implementing Secure point-to-point communications (NwHIN Direct) project statewide • Personal health record (PHR) in 2012 • Sponsor and support statewide education on HIT integration 19

20. Questions/Comments? • Shaun T. Alfreds, COO, HealthInfoNet • salfreds@hinfonet.org • HealthInfoNet Website: http://www.hinfonet.org • Hanley Center for Health Leadership : http://www.hanleytrust.org/leadership 20