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The KHIE Connection: Partnering to Improve Patient Health Outcomes

The KHIE Connection: Partnering to Improve Patient Health Outcomes. Key Points. EMR vs EHR Health I.T. (HIT) Kentucky eHealth initiative ‘The Journey’ ARRA/HITECH ACT (Funding $$) Health Information Exchange Kentucky Health Information Exchange. EMR vs EHR. EMR:

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The KHIE Connection: Partnering to Improve Patient Health Outcomes

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  1. The KHIE Connection: Partnering to Improve Patient Health Outcomes

  2. Key Points • EMR vs EHR • Health I.T. (HIT) • Kentucky eHealth initiative • ‘The Journey’ • ARRA/HITECH ACT (Funding $$) • Health Information Exchange • Kentucky Health Information Exchange

  3. EMR vs EHR • EMR: • The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

  4. EMR vs EHR • EHR: • The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care. • By these definitions, an EHR is an EMR with interoperability

  5. Health Information Technology (HIT) Optimizing operations using information technology to drive significant safety, quality and financial improvements

  6. 1935

  7. 2010

  8. 1935

  9. 2010

  10. 1935

  11. 2011

  12. Healthcare Today A Disconnected System • Disconnected islands of data • Poor coordination • Fragmented processes • Limited connectivity • Patients and clinicians often left without tools and data required Imaging Center IDN/Hospital Tightly Aligned Physician Offices Owned Practices Clinics Reference Lab Community Pharmacy Non-Affiliated Practices Patient Loosely Affiliated Physician Offices

  13. Kentucky e-HealthHistorical Overview • March 8, 2005 • Legislation (Senate Bill 2) to create a secure interoperable statewide electronic health network • Kentucky eHealth Network Board (KeHN) • Health care Infrastructure Authority • University of Kentucky • University of Louisville • Supported by the Cabinet for Health & Family Services • Appointment of several committees • Health Information Exchange

  14. Kentucky Health Information ExchangeThe Beginning 2007 Medicaid Transformation Grant ($4.9M) Utilized for development of core functionality of KHIE 6 Pilot Hospitals and 1 Clinic signed the KHIE Participation Agreement

  15. The Sun, Stars & Moon Align 2009 - American Recovery & Reinvestment Act (ARRA) ‘HITECH Act’ to provide State Grants to Promote Health Information Technology to improve the quality and efficiency of health care and expand the secure, electronic movement and use of health information among organizations according to nationally recognized standards

  16. GOEHI Governor’s Office of Electronic Health Information In August 2009, Governor Steve Beshear named the Cabinet for Health and Family Services as the state entity responsible for the administration of Kentucky’s Health Information Exchange (KHIE) and issued an Executive Order to create GOEHI Charged with providing leadership for statewide health information technology

  17. ARRA Funding • State HIE Cooperative Agreement • Strategic & Operational Plan submitted August 27, 2010 • ONC– APPROVED February 25/2011 • Kentucky award $9.75M – Statewide Health Information Exchange

  18. HIE Defined • Health Information Exchange: • The electronic movement of health-related data and information among organizations according to agreed standards, protocols, and other criteria (ONC)

  19. KHIE and REC Coordination 2 Regional Extension Centers For Provider EMR Adoption, Implementation, And Connectivity KY REC (University of Kentucky) and Tri-States (HB & NeKYRhio)

  20. Kentucky Regional Extension Center

  21. Structure/Start-Up • Engagement of Seven Pilot Organizations • Six Hospitals/One Clinic • Pikeville, ARH, UK, UL, Baptist, St. Joseph’s • Trover Clinic • Engagement of State-Wide Stakeholders • KHIE Coordinating Council • Working Committees

  22. KHIE – The Stakeholders 23 Members on the Council 6 Committees reporting to the Council (Six to ten members serve on each committee) Accountability & Transparency Business Development & Finance Interoperability & Standards Development Provider Adoption & Meaningful Use Privacy & Security Population Health CHFS Administrative Order in February 2010

  23. The Participation Agreement • Structure & Development • Pilots Legal Input • KHIE Coordinating Council • Privacy & Security Committee • HIPAA Compliance • Business Associates Agreement • How the data will be shared and NOT be shared

  24. KHIE is the resource for Cabinet data • 3 years of Medicaid Claims Data currently available in production with nightly data load updates • State Laboratory Results • Microbiology Results - LIVE • Newborn Screenings – FALL 2011 • All other legally available state lab tests available • Immunization Registry • LIVE interface to KHIE! • Public Health • Reportable Diseases – FALL 2011 • Syndromic Surveillance Reporting KHIE and CHFS Cabinet Resources: The Advantage 24

  25. Other Connectivity • State Lab Microbiology and Newborn Screening Data • State Immunization Registry Interface • State Public Health Reportable Diseases Interface • Private Lab Data • Cancer Registry • RHIOs (via Direct) • Medicaid Claims Data

  26. Participation Agreements Signed • Total 68 – represents 105 provider organizations • Healthcare Systems/Hospitals • Representing 52 hospitals • Physicians/Clinics/Health Departments • 42 Physicians/Clinics • 1 Health Department • Laboratories • LabCorp • Cumberland Medical Lab • Kentucky Division of Laboratories • Immunization Registry • Kentucky Cancer Registry

  27. LIVE Connections • Pikeville Medical Center • Central Baptist Hospital • University of Kentucky Medical Center • Murray-Calloway Hospital • University of Louisville Medical Center • Kings Daughter Medical Center (Ashland) • Twin Lakes Medical Center • Bowling Green Medical Center • Scottsville CAH • Franklin CAH • Ephraim McDowell • Fort Logan CAH • Big Sandy Healthcare • Harrison Memorial • Lourdes/Marcum & Wallace • Appalachian Regional Healthcare, Inc (9 hospitals)

  28. KHIE Outreach Coordinators Campbell Boone Kenton Region 1 – Laura Shonk Region 2 – Teresa Poff Region 3 – Ann O’Hara Region 4 – Dawn Gasser Region 5 – Pat Robinson Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Boyd Scott Shelby Franklin Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

  29. The Role of the KHIE Outreach Coordinator • ‘Boots on the Ground’ • Extension of the Governor’s Office for Electronic Health Information • Local assistance/hand-holding • Coordination with RECs to target physician offices and CAH’s

  30. On-Boarding: The Process • Welcome! • Intake • SIGNED Participation Agreement • Technical Implementation • Completion of technical forms • W/w the EMR vendors • Data flow • Data validation

  31. How the Exchange ‘Works’ • ADT’s/Demographics • Populate the Community/Master Patient Index • Record Locator Service • Locates all the patient encounters • Consolidates patient information for presentation to the provider • Access • KHIE Community Portal/Virtual Health Record • Provider EHR Portal/Dashboard

  32. The Technology • Continuity of Care Document (CCD) • Built using HL7 Clinical Document Architecture (CDA) elements and contains data that is defined by the ASTM Continuity of Care Record (CCR). It is used to share summary information about the patient within the broader context of the health record • Standard technology but relatively new • Many EHRs/vendors not ready

  33. CCD Elements • Problems • Procedures • Family History • Social History • Vital Signs • Functional stats • Results • Payers • Advance Directives • Alerts • Medications • Immunizations • Medical Equipment • Encounters • Plan of Care

  34. Standard CCD Layout • Patient: Given Name Family Name , Jr. or Sr., etc...Street Address City, State, Zip Codetel:+19995551212 MRN: 123456789 Birthdate: January 1, 1954 Sex: Male Guardian: • Next of Kin: Given Name + Family Name Street Address City, State, Zip Codetel:(999)555-1212 • Table of Contents • Purpose : Automated Medical History Summary • Payers • Problems • Family history • Social History • Allergies, Adverse Reactions, Alerts • Medications • Immunizations • Vital Signs • Results • Procedures • Encounters

  35. KHIE Community Portal (Virtual Health Record)

  36. KHIE Community Portal: Patient Info Tab

  37. KHIE GOAL Provide HIE Connectivity to as many providers as possible over the next two years with little or no startup cost to the providers

  38. Hospitals Imaging Center What’s Possible? With a Connected Community Tightly Aligned Physicians Owned Practices/ Clinics Better Coordination Safer Care More Cost-Effective Care Reference Lab Community Pharmacy Non-affiliated Practices Patients Loosely Affiliated Physicians

  39. Benefits to KHIE Participation • Real-Time Information • Detailed patient summary • RX/Medication History • Laboratory Results • Encounters • Clinical Rules that alert ‘Opportunities for Care’ • Allergy and Drug to Drug Interaction Alerts • Radiology Reports and Images

  40. KHIE & Meaningful Use Public health objectives Providers may claim certain objective(s)/measure(s) is inapplicable to them if they meet CMS criteria of such an exception. Source: Kentucky Hospital Association, 2010

  41. Benefits to KHIE Participation • REAL-TIME Access to Patient Information • Clinical Decision Support at POC • Reduce duplication • Impact on Continuity, Quality & Safety of Patient Care • The RAND corporation states that potential benefits of a connected, interoperable healthcare system could save an estimated $80 billion per year.

  42. Quality of Diabetes Care: Patients Treated by Physicians using EHR vs. Paper Medical Records % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

  43. Health Outcomes for Diabetes Patients: Patients treated by Physicians using EHR vs. Paper Medical Records % of Patients Obtaining Outcome Standards A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes* Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.005

  44. Quality of Diabetes Care at Safety Net Practices: Patients Treated by Physicians using EHR vs. Paper Medical Records % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

  45. Health Outcomes for Diabetes Patients at Safety Net Practices: Patients treated by Physicians using EHR vs. Paper Medical Records % of Patients Obtaining Outcome Standards A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365:825-833. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMsa1102519#t=article * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant p<0.002

  46. “We frequently talk about health IT with an emphasis on the technology. But at the heart of the transformation of our health system, it’s really all about people. • Above all, it’s about improving care for all Americans.” • Dr. Charles Friedman • Office of the National Coordinator for • Health Information Technology

  47. Register for EHR Incentive Program

  48. eHR Incentive Payment Hospitals Payments by County As of September 22, 2011 Campbell Total Hospital Incentive Payments to date $42,395,577.26 Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Franklin Boyd Scott Shelby Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Livingston Perry Hopkins Edmonson Green Butler Muhlenberg Clay Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

  49. eHR Incentive Payment Physician Payments by County As of September 22, 2011 Campbell Total Provider Incentive Payments to date $9,328,750.00 Boone Kenton Gallatin Bracken Pendleton Carroll Grant Mason Trimble Owen Greenup Robertson Lewis Henry Harrison Oldham Fleming Nicholas Carter Boyd Scott Shelby Franklin Rowan Bourbon Jefferson Bath Elliott Woodford Lawrence Spencer Fayette Bullitt Montgomery Anderson Menifee Clark Meade Morgan Hancock Jessamine Powell Johnson Mercer Henderson Martin Nelson Breckinridge Washington Wolfe Estill Union Daviess Madison Magoffin Hardin Garrard Boyle Lee Larue Marion Floyd Breathitt Webster McLean Pike Lincoln Ohio Jackson Owsley Grayson Rockcastle Crittenden Taylor Knott Hart Casey Perry Hopkins Edmonson Green Butler Muhlenberg Clay Livingston Caldwell Pulaski Leslie Laurel Letcher Adair Ballard McCracken Metcalfe Russell Lyon Warren Barren Carlisle Marshall Christian Knox Logan Todd Cumberland Harlan Trigg Wayne Whitley Graves Simpson Allen Hickman Clinton McCreary Monroe Bell Calloway Fulton

  50. More information on the KHIE can be found on the Governor’s Office of Electronic Health Information website at http://khie.ky.gov

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