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IHE Conference June 11, 2007

IHE Conference June 11, 2007. Who are we?. 1,200 Physicians Many Rural and Smaller Practices No dominant payor 25% Medicare, 20% Medicaid 18% uninsured 2-20% Other Few Large Employers Eastman Chemical – (7,000) is the largest Government and healthcare entities next largest.

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IHE Conference June 11, 2007

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  1. IHE ConferenceJune 11, 2007

  2. Who are we? • 1,200 Physicians • Many Rural and Smaller Practices • No dominant payor • 25% Medicare, • 20% Medicaid • 18% uninsured • 2-20% Other • Few Large Employers • Eastman Chemical – (7,000) is the largest • Government and healthcare entities next largest • Multi-State Region • 750,000 Patients • (2/3 in TN, 1/3 in VA) • 18 Hospitals • 2 Large Community-Based Health Systems

  3. Innovative Regional Cooperation To Improve Health • Active, representative membership, including • Employers: Eastman Chemical Company, CGI • Payors: Blue Cross Blue Shield, John Deere Health, Cariten PHP • Hospitals: Mountain States Health Alliance, Wellmont Health System, • Frontier Health, Johnston Memorial Hospital, • Quillen V.A. Medical Center, Laughlin Memorial • Physicians: Holston Medical Group, Highlands Wellmont • Health Network, Health Alliance PHO, Cardiovascular • Associates, ETSU University Physicians, Clinch River • Health Services, Rural Health Services Consortium • Education: East TN State University School of Medicine, • College of Nursing, College of Public and Allied Health • Public Health: Regional Health Departments: Sullivan and Northeast • Regional in TN, Cumberland Plateau and Lenowisco in VA • Community: Kingsport Tomorrow, United Way of Kingsport, Rotary • Club of Kingsport • Patient Advocates: American Cancer Society, Minority Health Coalition • Technology: Intellithought, LucentGlow, eTechSecurityPro, Holston • Technology, the CreativeTrust, ntara, OnePartner

  4. CareSpark Mission • To improve the health of people in Northeast Tennessee and Southwest Virginia through the collaborativeuse of health information CareSpark region has $2,400 higher per capita patient care coststhan other regions of the country Regional Population Has High Disparities of: • Diabetes • Cardiovascular Disease • Hypertension • Lung Disease • Cancer

  5. Goals & Priorities – Parallel Pathways • Interoperable EHR Adoption – Encourage and supportincreased use of EHRs(with e-prescribing and decision support tools) among providers • Regional HIE Platform – Implement infrastructure and connectivity for sharing of information among providers, payors, public health • Align with AHIC national standards and Nationwide Health Information Network infrastructure to connect with other networks • Align with statewide initiatives in Tennessee and Virginia • Public Health Improvement – Increased biosurveillance, community-wide aggregation and study, improved disease reporting, prevention services and chronic disease identification, management and outcomes • Financial Incentives – Implement financial incentives for payor and provider participation

  6. CareSpark’s Core Values • Cooperation • Privacy • Integrity • Inclusiveness • Community Accountability • Continuous Improvement Process • Stakeholder Parity

  7. CareSpark RHIO Consortium • National / International: Local / Regional: • ActiveHealth the Creative Trust AllScripts eTechSecurityPro • CGI Holston Technology • Cisco Intellithought • Covisint LucentGlow • Dell OnePartner • GE Healthcare • Initiate State: • Intel Tennessee • McKesson Virginia • Misys • Oracle • Quovadx • Siemens • SureScripts

  8. Phase 1.2 Inputs and Outputs Decision Support Provider ListMember List Payors ActiveHealthCare Engine Care Considerations messages HL7 Clinical Data Health Information Exchange HL7 Clinical/Demographic/CC Data ProviderEMR HL7 DemographicsDischarge SummariesRx Orders, Results RHIO MasterPatient Index PhysicianPortal Providers Portal/EMR-Lite Physicians HL7 Orders Pharmacy Portal Platform RHIO RecordLocation Service PatientPortal Portal Interface Engine Terminology/Normalization Patients HL7 Results Labs Care Considerations ActiveHealth RHIO ClinicalData Repository BusinessIntelligence/Reports Reports PublicHealth HL7 DemographicsDischarge SummariesRx Orders, Results Reports PerfMeasures Reports Helpdesk P4P Pilot Hardware and Software Infrastructure Access Requests UserManagement Security (C/I/A) Infrastructure PhysicianAdoption Physicians Application Use EMR 1 EMR 2 EMR 3 Application Use Physicians Helpdesk HL7 Rx Orders Hardware and Software Infrastructure Pharmacy Security (C/I/A) Infrastructure

  9. Proposed CareSpark IHE Architecture CareSpark HMG AllScripts Clinical Data Repository Portal IHE DocConsumer MSHA Siemens For Patient Care XDS PatientIdentitySource (MPI) XDS DocumentRegistry Clinical Data Repository IHE DocConsumer MSHA Phys Portal FILTER IHE DocConsumer Clinical DataRepository Wellmont McKesson For Public Health Improvement Clinical Data Repository Public HealthData Mart De-IdentifiedData Mart IHE DocConsumer Wellmont Phys Portal IHE DocConsumer Other Providers

  10. PACS EHR System CareSpark IHE-compatible Architecture Provider X CareSpark HMG AllScripts Lab IHE DocSource IHE DocConsumer CareSpark PortalIHE DocConsumer MSHA Siemens IHE PDQDemographicsServer IHE DocSource Transcription IHE Embedded Repository IHE DocConsumer Email/Paper/Rich Media IHE XDS DocumentRegistry MSHA Phys Portal Legacy App IHE DocConsumer App withoutRepository Wellmont McKesson IHE DocSource IHE DocConsumer Wellmont Phys Portal IHE DocConsumer Other Providers

  11. CareSpark commitment to IHE-compatible architecture That CareSpark Will Leverage The IHE Cross-Enterprise Document Exchange (XDS) Profile • Accommodates both federated and centralized document repositories and clinical data repositories (hybrid model) • Utilization of internet between secure nodes via encrypted, dual-authenticated links • Centralized audit management, security, and consent policies • IHE is promoted and supported by Federal standards bodies which worked to define standardized data sets and formats

  12. Compliance with US National Health Info NetworkHITSP Interoperability Specs and CCHIT Roadmap Request Formfor Data Capture Clinical and PHR Content Security Patient ID Mgmt Emergency Referrals PHR Extracts/Updates Format of the Document Content and associated coded vocabulary Basic Patients Privacy Consents Patient Demographics Query ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Establish Consents & Enable Access Control Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content and associated coded vocabulary Patient Identifier Cross-referencing Imaging Information Format of the Document Content Medical Summary (Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Map patient identifiers across independent identification domains Document Digital Signature Format of the Document Content and associated coded vocabulary Attesting “true-copy and origin Health Data Exchange Audit Trail & Node Authentication Other Cross-Enterprise Document Sharing Centralized privacy audit trail and node to node authentication to create a secured domain. Registration, distribution and access across health enterprises of clinical documents forming a patient electronic health record Notification of Document Availability Consistent Time Public Health Reporting Cross-Enterprise Document Media Interchange Coordinate time across networked systems Cross-Enterprise Document Reliable Interchange Accepted by HITSP&CCHIT in 2006 Candidates for HITSP&CCHIT in 2007

  13. Gaps for IHE and CareSpark • Patient Consent • Identity Management • Central Repository for public health improvement • Clinical Data Presentation

  14. Patient Consent –CareSpark and IHE • CareSpark Consensus: • Passive enrollment mechanism • Control consent at the patient/provider level • Providers help patients manage their consent • CareSpark never stores or transfers non-consensual data • Questions for IHE: • How do IHE solutions accommodate patient consent? • How does consent connect to EMPI and IHE network? • Is Basic Patient Privacy Consent ready for prime-time use? Are there demonstration projects?

  15. Identity Management –CareSpark and IHE • CareSpark Consensus: • Develop federated trust network across CareSpark providers • Minimize overhead of identity management at CareSpark level • Questions for IHE: • What is practicality of XUA implementation across Vendor Consortium solutions? • Are there demonstration projects we should look to as a reference?

  16. Centralized Repository – CareSpark and IHE • CareSpark Consensus: • “Easy” way to report health metrics and monitor public health • # of Patients 18-75 with ICD-9 code of 250.00-250.99 (Diabetes) and having two HgA1c values at least 91 days apart during the 12 months prior to the date of data gathering • Reporting and analysis (research, surveillance) • Questions for IHE: • What part of XDS and/or vendor solutions address this?

  17. Clinical Data Presentation – CareSpark and IHE • CareSpark Consensus: • Present RHIO data in clinician’s native systems (not a separate portal whenever possible) • Have physician-centric view of XDS clinical data within providers’ native EHR systems • Integrated with local data • Not a big list of “other HIE data” • Questions for IHE: • What are vendors doing to make document-centric XDS data usable to physicians? • Have directions been defined about document grouping for display?

  18. Why does CareSpark matter? • Voluntary commitment to interoperability (local, regional, state, national, international) • Participation in NHIN prototype demonstrations, state-level pilots • Private-sector, market-driven approach to assure sustainability • Attention to outcomes and measurable results

  19. Who are we? • CareSpark plans to be • “RHIO Done Right”

  20. Better Health for Central Appalachia • www.carespark.com • Liesa Jenkins, Executive Director • 423-963-4970 • ljenkins@carespark.com

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