1. COHIE: Colorado Health Information Exchange “The road to CORHIO” David Kaplan, MD Matt Madison Art Davidson, MD March 6, 2005 Funded in part through a contract with Agency for Health Care Research and Quality (AHRQ), and the Foundation for eHealth Initiative (FeHI) and their cooperative agreement with HRSA, Office for the Advancement for Telehealth (OAT). The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official view of AHRQ, HRSA/OAT or FeHI.

2. COHIE & the road to CORHIO  Where did we start  COHIE partners  Organizing the trip  The primary scenario  Work groups & lessons learned  Evolution of a vision

3. Where did we start?  Colorado Health Outcomes Program UCHSC Denver Health Kaiser Permanente Colorado The Children’s Hospital University of Colorado Hospital  Complementary HIT projects: Boulder County El Paso County Larimer County Mesa County Weld County

4. COHIE Initial Partners Building upon what exists  Denver Health (DH) 150,000 residents (25% of population)  Kaiser Permanente of Colorado (KPC) 3 rd largest CO HMO (350,000 members)  The Children’s Hospital (TCH) Largest pediatric specialty care provider  University of Colorado Hospital (UCH) Largest Metro area teaching hospital

5.  Shared communities and patient care: PediatricsAdults DH ⇔ TCH UCH ⇔ DH TCH ⇔ KPC KPC ⇔ (& Exempla)  UCHSC health professional training sites  Technical: advanced IS and IT at four initial partner institutions with strong health information systems vendors (e.g., Epic, Siemens) COHIE Initial Partners Building upon existing relationships

6. COHIE Initial Partners

7. Initial / Potential Partners

8. Organizing the Trip  Enthusiasm and support quickly generated questions  COHIE established Steering Committee with “Expert” Working Groups  Community Advisory Council is exploring RHIO

9. Learning from Others Study existing “maps”  Legal Group: reviewing “participation agreements” from Santa Barbara, CA, IN & MA  Technical Group: considering IN & MA models, “Connecting for Health”  Research Group: reviewing cost savings models from WA, MA, IN  Community Advisory Council: examining organizational models from UT & MA for RHIO business planning

10. The “Primary” Scenario  Clarifies the scope (common understanding)  Provides a structure to focus meetings and discussion  Creates a mechanism for logging issues and decisions

12. COHIE Process Iterative review of scenario  Steering Committee  Working Groups Technical Clinical Legal Research/evaluation Organization Financial  Community Advisory Council

14. COHIE Working Groups COMPONENTS Legal Clinical Technical Research/Evaluation

15. 1.e) Potential matches  Legal Questions: What are the implications of the clinician choosing the wrong match?  Clinical Parameter: Provide a useful, small list of potential matches  Technical Issues: What logic constitutes a real match and realistic number of matches to handle? Build, buy vs. wait? Parameter: Clinician must confirm one specific patient record to use for clinical data requests Assumptions: Clinician’s confirmation shall persist in system and shall initiate request for patient’s clinical data  Research Question: How many is too many matches to review? What is the clinician threshold to retain as useful?

16. 2.g) Audits  Legal Questions: what are minimum legal/institutional audit requirements? Assumption: A “superset” of data will be valid for all entities.  Technical Assumption: Audit data will persist in COHIE logs. Question: Can COHIE build an audit query tool?  Research Question: How often do clinician abort from the system? Will the audit tool allow us to infer reasons for leaving? How can we organize and deliver a survey for interruptions and what might identify other valuable data needed by clinicians.

17. Other potential use cases  Health care facility electronic data interchange  Adult presenting to ED with chest pain  Expanded use of decision support  Continuity of care record (CCR) and skilled nursing facility or nursing home patient  Pharmacy benefits managers, large laboratories as clinical data resources  PH: registries (IZ & reportable diseases)  Patients controlling access to their EHR

18. Going to Scale COHIE  CORHIO

19. COHIE & CORHIO An Evolving Vision  COHIE – learning laboratory Purpose: provide data exchange services Goal: build a data exchange environment that promotes patient-centric quality of care Product: generate value through data exchange  CORHIO – production environment Purpose: organize service availability/distribution Goal: sustainable, neutral (non-profit) body with balanced representation Product(s): efficient CO data flow, standards, guidance, & development/improvement opportunities

20. CORHIO Process  Colorado Health Institute  Legal support  Explore/define relationship COHIE ⇔ CORHIO  Working Group Business plan Articles of incorporation (501c3) Defining the board Education/public relations  Community Advisory Council

21. CORHIO Candidate Partners

22. COHIE Contact information: Project Manager:Matt Madison Telephone:303-724-0334 Email:matthew.madison@UCHSC.edu