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RHIO Case Study

RHIO Case Study. J. Marc Overhage, MD, PhD, FACP, FACMI President and CEO, Indiana Health Information Exchange Senior Investigator, Regenstrief Institute, Inc. Associate Professor, Indiana University School of Medicine. Statewide E-Health Strategy Vision and Mission. Vision

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RHIO Case Study

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  1. RHIO Case Study J. Marc Overhage, MD, PhD, FACP, FACMI President and CEO, Indiana Health Information Exchange Senior Investigator, Regenstrief Institute, Inc. Associate Professor, Indiana University School of Medicine

  2. Statewide E-Health StrategyVision and Mission • Vision • Extend Indiana as a leader in the exchange of health care information that enables improved quality and efficiency of health care and reduced growth rate of its costs. • Mission • Improve overall quality, safety and efficiency of health care across the state through system interoperability and standardization of health care data. • Within medical referral regions. • Across medical referral regions throughout the state.

  3. State-wide E-Health Strategic PlanGuiding Principles • The intent is to develop patient centric information systems • The strategy should enable referral networks not influence them

  4. Statewide E-Health StrategyStrategy and Tactics • Develop a self-sustaining business model that aligns the providers and other stakeholders and clearly define the value proposition for startup funding. • Tactics…

  5. Statewide E-Health StrategyStrategy and Tactics • Enhance the ability of communities and other stakeholders to become more electronic. • Assist in educating health care leaders from different communities. • Support local efforts to adopt community-based health information networks. • Develop a communication mechanism for addressing local and state-wide health care data issues.

  6. State-wide E-Health StrategyStrategy & Tactic • Implement specific applications • Consider developing a state-wide directory • Identify a few projects with actionable data (e.g., public health, pharmacy data) that benefit all communities and do it!

  7. Statewide E-Health StrategyStrategy and Tactics • Monitor and evaluate results and revise plans accordingly. • Develop a consistent system to measure improvements and share with constituencies.

  8. Immunizations Newborn screening ED encounters Morgan County Hospital

  9. Barriers to AddressTechnology • How do we optimize interoperability within medical referral regions? • Northwest IN/IL, FW, SB, Muncie/Anderson, Indianapolis, Kokomo, Terre Haute, Bloomington, Columbus, Evansville/KY, Southeast IN/Cincy/KY? • How do we optimize interoperability across medical referral regions? • FW/SB, Lafayette/Indy, Bloomington/Indy, South Bend/Niles, MI? • Exactly what are the data needs? • Physician to physician, hospital to hospital, Physician to hospital • What is the volume and value of needed transactions?

  10. Barriers to AddressTechnology (Cont.) • How do we address state-wide issues to improve access to data? • Public health, bio-terrorism, clinical trials, academic research • What do we have to do to standardize across the state? • How do we minimize expensive data feeds across the state to reduce cost and complexity? • How can we more effectively exchange data with national and state-wide data senders?

  11. Barriers to AddressPolitical • Why should Community Health Information Networks participate in a state-wide strategy? • What is the value proposition for them? • What are the areas for collaboration vs. competition (Coopetition) among stakeholders? • How do we build trust?

  12. Barriers to AddressOrganizational • How do we address the scale issue organizationally? • Need to be able to do large scale projects that cut across medical referral regions. • Has to work at each level • Medical referral region • Multi-referral region • State-wide • National

  13. Barriers to AddressOrganizational • What are the roles and relations of various parties at the local, regional, and state-wide levels? • Areas include: Governance, grants, funding, usage of data, allocation of resources, interface with feds, etc. • Entities include, among others: • Community health information networks • State Health Department • Regenstrief Institute and other researchers • Federal and state initiatives – Medicare, Medicaid, QIOs • Economic development • Vendors • What is IHIE’s role – state-wide grantee, community health information network, vendor?

  14. Barriers to AddressFinancial • How do we fund projects through out the state when federal funding is not a reliable source? • Few people will want to pay for a state-wide interface engine. How do you get it paid for? • How do we access large $ on behalf of the entire state?

  15. Scenario 1 – Centralized Interface ModelState-wide Messaging MHIN MIE Organized Health Information Network IHIE No formal community structure BEHC Overseer & coordinator of regional IE and RS Others

  16. Scenario 1 – Centralized Interface ModelFlow of State-wide Messages Out of Region Hospital Com. HIN If Any Requesting Doc Out of Region Lab Interface Engine & Record Search (Central) Public Health Data Non-Local data

  17. Scenario 2 – Regional Interface ModelState-wide Messaging MHIN MIE Organized Health Information Network No formal community structure IHIE Messages sent via Reg. Utility Coordination between Reg. & Coordinator Regional interface engine and record search BEHC Overseer & coordinator of regional IE and RS Others

  18. Scenario 2 – Regional Interface ModelFlow of State-wide Messages Out of Region Hospital Com. HIN If Any Requesting Doc Out of Region Lab Interface Engine & Record Search (Regional) Public Health Data Non-Local data

  19. Referral Region:Preferred Modes of Exchange of Data Single Hosp. System Multiple Hosp. Systems Relatively High % Internal Referrals • High need • Hospital integrated EHR • Rural – Integration with referral hospital or messaging • Low need • Cross-com. Messaging • High need • Com. Health Info. Network • Rural – Part of HIN or messaging with referral hospitals • Low need • Cross-com. messaging • High need • Hospital integrated EHR • Cross-com. Messaging • Rural – Integration with referral hospital or messaging • Low need • Com. HIN • High need • Com. HIN • Cross-com. messaging • Rural – Part of HIN or messaging with referral hospitals Relatively High % External Referrals

  20. State-wide Data UsersRequired Information Flows • Public health • Continuous specific data for a patient’s condition • Provider referrals • Specific data for a patient • Need to fill in this chart!

  21. Typical Statewide Data Feeds • Those with high value/high volume • Lab • Radiology reports • Prescription data • ADT • Transcription • Other?

  22. Strategy QuestionsTechnology – Interface Models • What is the appropriate interface model based on the following factors? • Cost/benefit • Overall costs • Funding opportunities • Sustained business model • Data scrubbing and data mapping requirements • Ability of Regenstrief to license the engine to the local Health Information Networks • Value of aggregated data to all communities • State-wide role vs. local role • Impact on local control

  23. Strategy QuestionsClinical and Patient/Consumer • Increasing provider electronic usage is done at the community level. • How do we catalyze culture change in the communities to increase utilization? • Who are the people in each community we need to be working with? • How do we involve community reps in this planning process?

  24. Strategy QuestionsOrganizational, Legal, Financial • Given the required data flows and the technical, business and political issues: • What are the guiding principles for organizational relations? • What are organization options? • What are the role relations of key parties?

  25. So the question is… • How can multiple local efforts (LHIIs) be integrated to create a coherent statewide strategy?

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