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Health Information Exchange (HIE) in New Hampshire NH Hospitals Partner Symposium 2013 May 14, 2013
- 1 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Understanding the Current Environment New Hampshire Health Information Exchange (HIE) Plan New Hampshire Health Information Organization (NHHIO) HIE Architecture and Services HIE Value Propositions NHHIO Participants and Implementation Timeline NHHIO Participant Information Contact Information
- 2 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Many Current Practice Models Isolate Information Provider PatientHITFamiliesPayer
- 3 - New Hampshire Health Information Organization © NHHIO. All rights reserved. American Recovery and Reinvestment Act (ARRA)
- 4 - New Hampshire Health Information Organization © NHHIO. All rights reserved. HITECH: Catalyst for Transformation Pre A system plagued by inefficiencies EHR Incentive Program and 62 Regional Extension Centers Widespread adoption & meaningful use of EHRs Three-Part Aim: Better Healthcare Better Health Reduced Costs Paper Records HITECH ActEHRs & HIE ARRA Changed the Playing Field
- 5 - New Hampshire Health Information Organization © NHHIO. All rights reserved. New Care Team Model Extends the Reach and Need for Data Patient & Families PCP Home Health / LTC eHealth Portals Mobile Technology Diagnostic Testing Specialty Care Acute Care ACOPQRSeRXCQM
- 6 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Medicare and Medicaid Incentives and Penalties Improved Individual & Population Health Outcomes Increased Transparency & Efficiency Improved Ability to Study & Improve Care Delivery ADOPTION EXCHANGE State Grants for Health Information Exchange Standards & Certification Framework Privacy & Security Framework Regional Extension Centers Workforce Training MEANINGFUL USE 6 Health Information Technology for Economic and Clinical Health (HITECH) - Framework
- 7 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Estimated ARRA funding for Health Information Technology $30B Direct payments to individual providers $28B $1.2B $1.1B Medicaid 90/10 funds $211M $11.8M $223M $1.1M US total New Hampshire Health information exchanges Regional health IT extension centers Health Information Technology for Economic and Clinical Health (HITECH) $13,781,320 EP $13,098,698 EH Paid to NH
- 8 - New Hampshire Health Information Organization © NHHIO. All rights reserved. New Hampshire Health Information Exchange (HIE) Plan June 2010 created multi-stakeholder groups The plan is the result of collaborative planning among over 80 stakeholders 380 stakeholder comments were addressed in the current version Approved by ONC September 2010 The plan will continue to evolve as we refine the strategy, obtain broader stakeholder input, and add more detail Current strategic plan is posted at
- 9 - New Hampshire Health Information Organization © NHHIO. All rights reserved. HB #489 (July 2011) created the New Hampshire Health Information Organization (NHHIO) NHHIO Governed by a broad community based governance structure with accountability to a multi-stakeholder, public-private Board of Directors. 501(c)(3) Public Charity organization, NHHHIO complies with RSA 91-A, New Hampshire’s Right to Know law to ensure the public’s right of access to meetings and to records to “ensure the greatest possible public access to the actions, discussions and records of all public bodies, and their accountability to the people.”RSA 91-A Establishing Governance
New Hampshire Health Information Organization © NHHIO. All rights reserved. NHHIO Board of Directors Board MemberRepresentationBoard MemberRepresentation Denise Purington CIO Elliot Hospital NHHIO Chair, Board Member at Large Hospitals David Briden, CIO Exeter Hospital NH Hospital Association, Large Hospitals Mary Beth Eldredge IT Director Dartmouth Hitchcock NHHIO Vice Chair, Board Member at Large Lorraine Nichols IT Director Alice Peck Day Hospital NH Hospital Association, Critical Access Hospitals Kirsten Platte CHAN NHHIO Secretary, Bi-State Primary Care Association Dr. Richard Lafleur, Anthem BC/BS Board Member at Large, Health Plans Carol LaCross CFO - Retired NHHIO Treasurer, Volunteer & Consultant Michael Lehrman, Catholic Charities Board Member at Large, Skilled Nursing Providers and NH Health Care Assoc. Deb Mullen Concord VNA Home Care Association of NHVacantBoard Member at Large Dr. Daniel Waszkowski Derry Medical Center NH Medical SocietyDavid Querusio, Harvard Pilgrim Healthcare Board Member at Large, Health Plans William Baggeroer NH DHHS Office of the Commissioner Board Member at Large, NH DHHS, Office of the Commissioner Dr. Christine Rosenwasser Dartmouth Hitchcock Pediatrics Board Member at Large, Physicians Victor St. Pierre Consumer Advocate Board Member at Large, Consumers Jay Couture, Seacoast Mental Health Center NH Community Behavioral Health Association VacantPharmacy Board
New Hampshire Health Information Organization © NHHIO. All rights reserved. NH HIE Facts: (RSA 332-I:2) A health care provider or business associate may disclose an individual's PHI and information about the location of an individual's medical records to a HIE – allows for Electronic Master Person Index (EMPI) (Phase 2) Individual must be given an opportunity to opt out of sharing his/her name, address, and PHI through a HIE – information not sent to HIE (Phase 1) Only a health care provider, for purposes of treatment, may access PHI in a HIE – does not include patients or payors A HIE must maintain an audit log of health care providers who access PHI – central site will maintain transmission logs When federal certification standards are established, a HIE must be certified to be in compliance with nationally accepted interoperability standards and practices – NHHIO is using Direct standards for message transport SB288 – Required reporting to Department of Health and Human Services (DHHS) – AHEDD, Cancer Registry, Immunization Registry, Electronic Lab Reporting
New Hampshire Health Information Organization © NHHIO. All rights reserved. Legislative Committee Goal: Allow PHI to be accessed by other participants to include patients and payors, and used for additional purposes outside of treatment. Allow for greater expansion of Care Coordination efforts Enhance patient engagement as part of Meaningful Use requirements Allow for potential data aggregation and reporting of CQMs Support ACO models Support pay-for-performance and other quality based contracts Meaningful Use reporting for CMS EHR Incentives, Patient Centered Medical Home, and Million Hearts campaign
New Hampshire Health Information Organization © NHHIO. All rights reserved. NHHIO Architecture and Services NH Statewide Network – “Backbone” CHAN Provider Practices Hospital Public Health (DHHS) Security Node addressing Provider addressing Audit MD EMPI Record Locator Service Long-term care SNFs Phase I: Direct Secure Messaging among participants, DHHS, and HIE partners Interstate gateway Phase II: Electronic Master Person Index (EMPI) Record Locator Service for information queries Payers Health Centers Behavioral Health Diagnostic testing Patients NH Hospital VNA / Homecare MD ASCC
New Hampshire Health Information Organization © NHHIO. All rights reserved. Electronic Health Record (EHR) Integration Provider directory Certificate repository DIRECT gateway Web portal mailbox HIE ServicesUser types 3 methods of accessing HIE services EHR connects directly Browser access to webmail inbox Physician practice Hospital Long-term care Other providers Public health Health plans EHR connects through LAND Appliance
New Hampshire Health Information Organization © NHHIO. All rights reserved. Value Propositions “Broad but shallow” network in providing secure and auditable transactions Can send “anything to anyone” – replaces traditional point-to-point communications (unsecure fax, mail, etc.) with electronic directed exchange streamlining workflow in the practice setting (including inter-state communications) – HIPAA compliant Provides Public Health reporting mechanism and peer connectivity to comply with Meaningful Use requirements and possible future DHHS reporting requirements Uses approved Direct standards being incorporated by EHR vendors for compliance with Meaningful Use and increases Coordination of Care with structured data sharing Annual subscription fee for all transactions providing a “one to many” gateway with fixed budget projections to eliminate creation and management of multiple point-to- point connections (VPN tunnels, routers, TCP/IP and SSL connections)
New Hampshire Health Information Organization © NHHIO. All rights reserved. 39 Letters of Intent (LOI), ~1000 PPCPs* Dartmouth Hitchcock Medical Center Exeter Hospital - 43 Cheshire Medical Center - 25 Concord Hospital - 87 Elliot Hospital - 42 Southern New Hampshire Medical Center - 85 Wentworth Douglas Hospital - 43 Lakes Region General Hospital - 40 Frisbie Memorial Hospital - 51 Catholic Medical Center - 36 Franklin Regional Hospital (CAH) - 15 Valley Regional Hospital (CAH) - 12 Alice Peck Day Memorial Hospital (CAH) - 22 Monadnock Community Hospital (CAH) - 25 Speare Memorial Hospital (CAH) - 6 Cottage Hospital (CAH) - 9 Memorial Hospital (CAH) - 21 Androscoggin Valley Hospital (CAH) - 3 Huggins Hospital (CAH) - 21 (Pilot Only) Department of Public Health Seacoast Mental Health Center Greater Nashua Mental Health Center The MHC of Greater Manchester West Central Behavioral Health Northern Human Services Monadnock Family Services Concord Visiting Nurses Association Franklin VNA & Hospice Rochester District VNA Home Health & Hospice Care Pemi-Baker Community Health Central New Hampshire VNA & Hospice Visiting Nurse Home Care and Hospice of Carroll County Derry Medical Center - 25 Community Health Access Network - 65 COOS County Health Services - 21 Mid-State Health Center - 12 Access Sports Medicine Southern NH Internal Medicine - 8 * RECNH enrolled PPCPs
New Hampshire Health Information Organization © NHHIO. All rights reserved. On-Boarding Target Timeline DRAFT
New Hampshire Health Information Organization © NHHIO. All rights reserved. Active Discussions NH Healthcare Association Genesis Healthcare Quest Diagnostics Anthem BC/CS, Harvard Pilgrim Regional Extension Center of New Hampshire New Hampshire Medical Society Surescripts Network Interstate – MeHI, VITL, HealthinfoNet New Hampshire Hospital, Glencliff Home Expanded NH DHHS Reporting
New Hampshire Health Information Organization © NHHIO. All rights reserved. Implementation Information
New Hampshire Health Information Organization © NHHIO. All rights reserved. On-Boarding Documentation NHHIO On-Boarding Document (~5 week on-boarding project plan) Appendix A – Readiness Questionnaire (updated to identify multiple systems) Appendix B - LAND Form (technical contacts and integration method(s)) Appendix C – Provider Directory Upload File Format (.CSV file to be updated) Appendix D – LAND Appliance Documentation (specifications and integration) NHHIO Solution Diagram (description of technical infrastructure and communications) Available at
New Hampshire Health Information Organization © NHHIO. All rights reserved. Participation Agreement Components NHHIO Exchange Participation Agreement Participation Agreement Fee Schedule Exhibit 1 (blank until revenue verified) First and second year discounts (60%, 25%) based on three year participation ADDENDUM 1 - HIE SERVICE ADDENDUM (used to select connection method) HIE Services Addendum Exhibit 1 Support ADDENDUM 2 - POLICIES AND PROCEDURES (“rules of the road”) ADDENDUM 3 - DELEGATED ADMINISTRATION AGREEMENT (for Large sites only) ATTACHMENT 1 TO DELEGATED ADMINISTRATION AGREEMENT ADDENDUM 4 - ACCESS ADMINISTRATOR AGREEMENT (agreement for administrator) ADDENDUM 5 - BUSINESS ASSOCIATE AGREEMENT (NHHIO may also sign internal BAAs) New Hampshire Health Information Exchange Technology Grants (as applicable) 125%-150% of annual dues based on eligibility and need
New Hampshire Health Information Organization © NHHIO. All rights reserved. NHHIO contact information NHHIO offices located within the New Hampshire Hospital Association 125 Airport Road, Concord, New Hampshire, Office. (603) Fax. (603) Jeff Loughlin, Executive Director c: o:
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