Indiana Health Information Exchange 12/16/041 RHIO Case Study J. Marc Overhage, MD, PhD, FACP, FACMI President and CEO, Indiana Health Information Exchange Senior Investigator, Regenstrief Institute, Inc. Associate Professor, Indiana University School of Medicine

Indiana Health Information Exchange 12/16/042 Statewide E-Health Strategy Vision and Mission Vision –Extend Indiana as a leader in the exchange of health care information that enables improved quality and efficiency of health care and reduced growth rate of its costs. Mission –Improve overall quality, safety and efficiency of health care across the state through system interoperability and standardization of health care data. Within medical referral regions. Across medical referral regions throughout the state.

Indiana Health Information Exchange 12/16/043 State-wide E-Health Strategic Plan Guiding Principles 1.The intent is to develop patient centric information systems 2.The strategy should enable referral networks not influence them

Indiana Health Information Exchange 12/16/044 Statewide E-Health Strategy Strategy and Tactics Develop a self-sustaining business model that aligns the providers and other stakeholders and clearly define the value proposition for startup funding. –Tactics…

Indiana Health Information Exchange 12/16/045 Statewide E-Health Strategy Strategy and Tactics Enhance the ability of communities and other stakeholders to become more electronic. –Assist in educating health care leaders from different communities. –Support local efforts to adopt community-based health information networks. –Develop a communication mechanism for addressing local and state-wide health care data issues.

Indiana Health Information Exchange 12/16/046 State-wide E-Health Strategy Strategy & Tactic Implement specific applications –Consider developing a state-wide directory –Identify a few projects with actionable data (e.g., public health, pharmacy data) that benefit all communities and do it!

Indiana Health Information Exchange 12/16/047 Statewide E-Health Strategy Strategy and Tactics Monitor and evaluate results and revise plans accordingly. –Develop a consistent system to measure improvements and share with constituencies.

Indiana Health Information Exchange 12/16/048

Indiana Health Information Exchange 12/16/049 Morgan County Hospital Immunizations Newborn screening ED encounters

Indiana Health Information Exchange 12/16/0410 Barriers to Address Technology How do we optimize interoperability within medical referral regions? –Northwest IN/IL, FW, SB, Muncie/Anderson, Indianapolis, Kokomo, Terre Haute, Bloomington, Columbus, Evansville/KY, Southeast IN/Cincy/KY? How do we optimize interoperability across medical referral regions? –FW/SB, Lafayette/Indy, Bloomington/Indy, South Bend/Niles, MI? Exactly what are the data needs? –Physician to physician, hospital to hospital, Physician to hospital What is the volume and value of needed transactions?

Indiana Health Information Exchange 12/16/0411 Barriers to Address Technology (Cont.) How do we address state-wide issues to improve access to data? –Public health, bio-terrorism, clinical trials, academic research What do we have to do to standardize across the state? How do we minimize expensive data feeds across the state to reduce cost and complexity? How can we more effectively exchange data with national and state-wide data senders?

Indiana Health Information Exchange 12/16/0412 Barriers to Address Political Why should Community Health Information Networks participate in a state-wide strategy? –What is the value proposition for them? What are the areas for collaboration vs. competition (Coopetition) among stakeholders? How do we build trust?

Indiana Health Information Exchange 12/16/0413 Barriers to Address Organizational How do we address the scale issue organizationally? –Need to be able to do large scale projects that cut across medical referral regions. –Has to work at each level Medical referral region Multi-referral region State-wide National

Indiana Health Information Exchange 12/16/0414 Barriers to Address Organizational What are the roles and relations of various parties at the local, regional, and state-wide levels? –Areas include: Governance, grants, funding, usage of data, allocation of resources, interface with feds, etc. –Entities include, among others: Community health information networks State Health Department Regenstrief Institute and other researchers Federal and state initiatives – Medicare, Medicaid, QIOs Economic development Vendors What is IHIE’s role – state-wide grantee, community health information network, vendor?

Indiana Health Information Exchange 12/16/0415 Barriers to Address Financial How do we fund projects through out the state when federal funding is not a reliable source? Few people will want to pay for a state- wide interface engine. How do you get it paid for? How do we access large $ on behalf of the entire state?

Indiana Health Information Exchange 12/16/0416 Scenario 1 – Centralized Interface Model State-wide Messaging Organized Health Information Network No formal community structure IHIE BEHC MHIN MIE Overseer & coordinator of regional IE and RS Others

Indiana Health Information Exchange 12/16/0417 Scenario 1 – Centralized Interface Model Flow of State-wide Messages Out of Region Hospital Out of Region Lab Com. HIN If Any Interface Engine & Record Search (Central) Public Health Data Requesting Doc Non-Local data

Indiana Health Information Exchange 12/16/0418 Scenario 2 – Regional Interface Model State-wide Messaging Organized Health Information Network No formal community structure IHIE BEHC MHIN MIE Regional interface engine and record search Overseer & coordinator of regional IE and RS Others Messages sent via Reg. Utility Coordination between Reg. & Coordinator

Indiana Health Information Exchange 12/16/0419 Scenario 2 – Regional Interface Model Flow of State-wide Messages Out of Region Hospital Out of Region Lab Com. HIN If Any Interface Engine & Record Search (Regional) Public Health Data Requesting Doc Non-Local data

Indiana Health Information Exchange 12/16/0420 Referral Region: Preferred Modes of Exchange of Data Single Hosp. SystemMultiple Hosp. Systems Relatively High % Internal Referrals Relatively High % External Referrals High need Com. Health Info. Network Rural – Part of HIN or messaging with referral hospitals Low need Cross-com. messaging High need Hospital integrated EHR Cross-com. Messaging Rural – Integration with referral hospital or messaging Low need Com. HIN High need Hospital integrated EHR Rural – Integration with referral hospital or messaging Low need Cross-com. Messaging High need Com. HIN Cross-com. messaging Rural – Part of HIN or messaging with referral hospitals

Indiana Health Information Exchange 12/16/0421 State-wide Data Users Required Information Flows Public health –Continuous specific data for a patient’s condition Provider referrals –Specific data for a patient Need to fill in this chart!

Indiana Health Information Exchange 12/16/0422 Typical Statewide Data Feeds Those with high value/high volume –Lab –Radiology reports –Prescription data –ADT –Transcription –Other?

Indiana Health Information Exchange 12/16/0423 Strategy Questions Technology – Interface Models What is the appropriate interface model based on the following factors? –Cost/benefit –Overall costs –Funding opportunities –Sustained business model –Data scrubbing and data mapping requirements –Ability of Regenstrief to license the engine to the local Health Information Networks –Value of aggregated data to all communities –State-wide role vs. local role –Impact on local control

Indiana Health Information Exchange 12/16/0424 Strategy Questions Clinical and Patient/Consumer Increasing provider electronic usage is done at the community level. –How do we catalyze culture change in the communities to increase utilization? –Who are the people in each community we need to be working with? –How do we involve community reps in this planning process?

Indiana Health Information Exchange 12/16/0425 Strategy Questions Organizational, Legal, Financial Given the required data flows and the technical, business and political issues: –What are the guiding principles for organizational relations? –What are organization options? –What are the role relations of key parties?

Indiana Health Information Exchange 12/16/0426 So the question is… How can multiple local efforts (LHIIs) be integrated to create a coherent statewide strategy?