New Care Paradigms Require Health Information Exchange

1. New Care Paradigms Require Health Information Exchange Combining IHE interoperability profiles to enable interoperability between care providers

2. Presentation Topics • New Paradigms in Healthcare • Patient-centered medical homes • Accountable care organizations • EMR Interoperability prior to IHE • IHE profiles & HITSP National Standards • XDS Cross-enterprise Document Sharing (HITSP TP17) • XDS-MS Clinical Summary Document (HITSP C48)

3. Hospital to Physician Alignment Changing “Breakthrough integration” • Hospital & physician align on strategy • Medical home & accountable care orgs. Physician as principal in partnership • Better alignment of incentives • Control vs. autonomy issues Physician as hospital employee Physician as affiliated provider • Physician sees hospital as income source • Hospital seeks “affiliated” physicians Physician as hospital customer • Physician sees hospital as workshop provider • Hospital sees physician as source of income Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009 “Doing the deal”

4. Patient-Centered Medical Home "It's a model where the center that serves as your medical home might help you keep track of your prescriptions or get the referrals you need or work with you to develop a plan of care that ensures your providers are working together to keep you healthy," Source: National Academy for Health State Policy Medicaid & SCHIP State Efforts to Advance Medical Homes 2009 www.nashp.org/med-home-map Source: President Obama Press Conference on Approval of PCMH Demonstration Project, December 9, 2009

5. Rethinking Care Delivery: Medical Home Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009

6. Patient-Centered Medical Home Benefits • Patient-centered medical home is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. • Care is facilitated by: • Registries • Information technology • Health information exchange • Other means to assure that patients get the indicated care when and where they need and want it

7. Accountable Care Organization Definition A set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population Source: Medicare Payment Advisory Committee www.medpac.gov/chapters/Jun09_Ch02.pdf

8. Will ARRA Focus Practice Attention More on HIT and Less on Transformation? Health Information Technology Clinical Transformation PCMH Standards Requirements exceed meaningful use criteria Understand what is required by ARRA-and what is needed to make this really “work” in their practices (PCMH) Meaningful Use • Certified EHR technology which shall include the use of electronic prescribing • Connects in such a manner that provides…exchange of information … to improve the quality of care, such are promoting care coordination • Submits information…on clinical quality measures and such other measures as selected by the Secretary

9. Health Information Exchange is Critical to Patient-Centered Medical Home Patient Portal PHR PCP MD’s MD’s HIE ACO Financial Hospital/Clinic Quality Specialist EHR Reporting Public Health

10. EMR to EMR Interoperability without IHE Bi-directional synchronization of problems, meds, allergies Interface/ Integration Engine Web Service Eclipsys Sunrise Acute Care™ HL7 PIX SAML Allscripts Ambulatory EHR User Identification: Authentication Person Identification: Index & Cross-map Terminology Service: Vocabulary Cross-map • Challenges • User Authentication, Trust • Patient Identification Mapping, Resolution • Mapping of Meds & Allergies Vocabularies • Responsible Party(s)? • Operation • All patients in both systems • Updates in one system automatically populate the other system • User may be notified of change (inbox) but does not control the exchange

11. IHE-XDS (HITSP TP17) Interoperability Bi-directional exchange of problems, meds, allergies, results… HITSP - IHE XDS Infrastructure Security & Audit (IHE-ATNA) Identity (IHE-PIX/PDQ) Registry (IHE-XDS) Repository (IHE-XDS) Eclipsys Sunrise Acute Care Allscripts Ambulatory EHR • Operation • Patients only exist if there is a visit • User searches IHE infrastructure for outside records • Users control the import/export of documents and data • Enterprise / lifetime record is federated between multiple systems • Challenges • IHE Infrastructure costs • CCHIT certified versions of EMR system software required • Not all use cases are currently supported by CCHIT (referrals)

12. The CCD is generated by the user to “publish” required data set based on selected data from the EHR system

13. Continuity of Care Document generated from the Structured Note

14. Underlying level 3 CCD “discreet data” XML containing codified data

15. Hospital Admission Workflow using IHE-XDS

16. Acute Discharge to Ambulatory Workflow

17. Using IHE-XDS to Connect the Community State/Regional HIE gateway IHE-XCS SBHCS Out Patient Centers & Extended Care SBHCS Hospitals (x6) Affiliated Physicians Community Health Information Exchange IHE-XDS & HL7 Quality & Outcomes Reporting 17

18. Summary • New care paradigms (PCMH & ACOs) require Health Information Exchange • Using IHE-XDS to exchange CCD/HITSP C32 is just the starting point for a robust community solution • Focus on the high value workflows in a community: admission-discharge, outreach services • New care paradigms require robust quality and outcomes reporting as well as data exchange

19. Thank You