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The KHIE Connection: Partnering to Improve Patient Health Outcomes

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1 The KHIE Connection: Partnering to Improve Patient Health Outcomes

2 Kentucky eHealth initiative ARRA/HITECH ACT (Funding $$)
Key Points EMR vs EHR Health I.T. (HIT) Kentucky eHealth initiative ‘The Journey’ ARRA/HITECH ACT (Funding $$) Health Information Exchange Kentucky Health Information Exchange

3 EMR vs EHR EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual’s health and care.

4 By these definitions, an EHR is an EMR with interoperability
EMR vs EHR EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual’s health and care. By these definitions, an EHR is an EMR with interoperability

5 Health Information Technology (HIT)
Optimizing operations using information technology to drive significant safety, quality and financial improvements

6 1935

7 2010

8 1935

9 2010

10 1935

11 2011

12 Healthcare Today A Disconnected System Disconnected islands of data
Poor coordination Fragmented processes Limited connectivity Patients and clinicians often left without tools and data required Imaging Center IDN/Hospital Tightly Aligned Physician Offices Owned Practices Clinics Reference Lab Community Pharmacy Non-Affiliated Practices Patient Loosely Affiliated Physician Offices

13 Kentucky e-Health Historical Overview
March 8, 2005 Legislation (Senate Bill 2) to create a secure interoperable statewide electronic health network Kentucky eHealth Network Board (KeHN) Health care Infrastructure Authority University of Kentucky University of Louisville Supported by the Cabinet for Health & Family Services Appointment of several committees Health Information Exchange

14 Kentucky Health Information Exchange The Beginning
2007 Medicaid Transformation Grant ($4.9M) Utilized for development of core functionality of KHIE 6 Pilot Hospitals and 1 Clinic signed the KHIE Participation Agreement

15 The Sun, Stars & Moon Align
American Recovery & Reinvestment Act (ARRA) ‘HITECH Act’ to provide State Grants to Promote Health Information Technology to improve the quality and efficiency of health care and expand the secure, electronic movement and use of health information among organizations according to nationally recognized standards

16 In August 2009, Governor Steve Beshear
GOEHI Governor’s Office of Electronic Health Information In August 2009, Governor Steve Beshear named the Cabinet for Health and Family Services as the state entity responsible for the administration of Kentucky’s Health Information Exchange (KHIE) and issued an Executive Order to create GOEHI Charged with providing leadership for statewide health information technology

17 ARRA Funding State HIE Cooperative Agreement Strategic & Operational Plan submitted August 27, 2010 ONC– APPROVED February 25/2011 Kentucky award $9.75M – Statewide Health Information Exchange

18 Health Information Exchange:
HIE Defined Health Information Exchange: The electronic movement of health-related data and information among organizations according to agreed standards, protocols, and other criteria (ONC)

19 KHIE and REC Coordination
2 Regional Extension Centers For Provider EMR Adoption, Implementation, And Connectivity KY REC (University of Kentucky) and Tri-States (HB & NeKYRhio)

20 Kentucky Regional Extension Center

21 Engagement of Seven Pilot Organizations
Structure/Start-Up Engagement of Seven Pilot Organizations Six Hospitals/One Clinic Pikeville, ARH, UK, UL, Baptist, St. Joseph’s Trover Clinic Engagement of State-Wide Stakeholders KHIE Coordinating Council Working Committees

22 KHIE – The Stakeholders
CHFS Administrative Order in February 2010 23 Members on the Council 6 Committees reporting to the Council (Six to ten members serve on each committee) Accountability & Transparency Business Development & Finance Interoperability & Standards Development Provider Adoption & Meaningful Use Privacy & Security Population Health

23 The Participation Agreement
Structure & Development Pilots Legal Input KHIE Coordinating Council Privacy & Security Committee HIPAA Compliance Business Associates Agreement How the data will be shared and NOT be shared

24 KHIE and CHFS Cabinet Resources:
The Advantage KHIE is the resource for Cabinet data 3 years of Medicaid Claims Data currently available in production with nightly data load updates State Laboratory Results Microbiology Results - LIVE Newborn Screenings – FALL 2011 All other legally available state lab tests available Immunization Registry LIVE interface to KHIE! Public Health Reportable Diseases – FALL 2011 Syndromic Surveillance Reporting 8/19/2011 24

25 Other Connectivity State Lab Microbiology and Newborn Screening Data
State Immunization Registry Interface State Public Health Reportable Diseases Interface Private Lab Data Cancer Registry RHIOs (via Direct) Medicaid Claims Data

26 Participation Agreements Signed
Total 68 – represents 105 provider organizations Healthcare Systems/Hospitals Representing 52 hospitals Physicians/Clinics/Health Departments 42 Physicians/Clinics 1 Health Department Laboratories LabCorp Cumberland Medical Lab Kentucky Division of Laboratories Immunization Registry Kentucky Cancer Registry

27 LIVE Connections Pikeville Medical Center Central Baptist Hospital
University of Kentucky Medical Center Murray-Calloway Hospital University of Louisville Medical Center Kings Daughter Medical Center (Ashland) Twin Lakes Medical Center Bowling Green Medical Center Scottsville CAH Franklin CAH Ephraim McDowell Fort Logan CAH Big Sandy Healthcare Harrison Memorial Lourdes/Marcum & Wallace Appalachian Regional Healthcare, Inc (9 hospitals)

28 KHIE Outreach Coordinators
Campbell Boone Region 1 – Laura Shonk Region 2 – Teresa Poff Region 3 – Ann O’Hara Region 4 – Dawn Gasser Region 5 – Pat Robinson Kenton Gallatin Carroll Pendleton Bracken Trimble Grant Mason Owen Robertson Lewis Greenup Henry Harrison Oldham Nicholas Fleming Carter Scott Boyd Shelby Franklin Jefferson Bourbon Rowan Bath Elliott Spencer Woodford Lawrence Bullitt Anderson Fayette Montgomery Clark Menifee Meade Hancock Mercer Jessamine Powell Morgan Johnson Henderson Breckinridge Nelson Martin Union Washington Estill Wolfe Daviess Hardin Garrard Madison Magoffin Boyle Lee Larue Marion Floyd Webster McLean Lincoln Breathitt Pike Ohio Grayson Jackson Owsley Crittenden Taylor Rockcastle Hart Casey Knott Hopkins Muhlenberg Butler Edmonson Green Perry Livingston Caldwell Clay Ballard Adair Pulaski Laurel Leslie Letcher McCracken Lyon Metcalfe Russell Warren Barren Carlisle Marshall Christian Todd Logan Knox Trigg Cumberland Harlan Graves Wayne Whitley Hickman Simpson Allen Monroe Clinton McCreary Bell Fulton Calloway

29 The Role of the KHIE Outreach Coordinator
‘Boots on the Ground’ Extension of the Governor’s Office for Electronic Health Information Local assistance/hand-holding Coordination with RECs to target physician offices and CAH’s

30 On-Boarding: The Process
Welcome! Intake SIGNED Participation Agreement Technical Implementation Completion of technical forms W/w the EMR vendors Data flow Data validation

31 How the Exchange ‘Works’
ADT’s/Demographics Populate the Community/Master Patient Index Record Locator Service Locates all the patient encounters Consolidates patient information for presentation to the provider Access KHIE Community Portal/Virtual Health Record Provider EHR Portal/Dashboard

32 Continuity of Care Document (CCD)
The Technology Continuity of Care Document (CCD) Built using HL7 Clinical Document Architecture (CDA) elements and contains data that is defined by the ASTM Continuity of Care Record (CCR). It is used to share summary information about the patient within the broader context of the health record Standard technology but relatively new Many EHRs/vendors not ready

33 CCD Elements Problems Procedures Family History Social History Vital Signs Functional stats Results Payers Advance Directives Alerts Medications Immunizations Medical Equipment Encounters Plan of Care

34 Standard CCD Layout Patient: Given Name Family Name , Jr. or Sr., etc... Street Address City, State, Zip Code tel: MRN: Birthdate: January 1, 1954 Sex: Male Guardian: Next of Kin: Given Name + Family Name Street Address City, State, Zip Code tel:(999) Table of Contents Purpose : Automated Medical History Summary Payers Problems Family history Social History Allergies, Adverse Reactions, Alerts Medications Immunizations Vital Signs Results Procedures Encounters

35 KHIE Community Portal (Virtual Health Record)

36 KHIE Community Portal: Patient Info Tab

37 KHIE GOAL Provide HIE Connectivity to as many providers as possible over the next two years with little or no startup cost to the providers

38 What’s Possible? With a Connected Community Better Coordination
Hospitals Imaging Center What’s Possible? With a Connected Community Tightly Aligned Physicians Owned Practices/ Clinics Better Coordination Safer Care More Cost-Effective Care Reference Lab Community Pharmacy Non-affiliated Practices Patients Loosely Affiliated Physicians

39 Benefits to KHIE Participation
Real-Time Information Detailed patient summary RX/Medication History Laboratory Results Encounters Clinical Rules that alert ‘Opportunities for Care’ Allergy and Drug to Drug Interaction Alerts Radiology Reports and Images

40 KHIE & Meaningful Use Menu Criteria: EHs and EPs must meet 5 of these, including one public health objective (i.e. may opt out of 5) Drug-formulary checks Incorporate clinical lab test results as structured data Generate lists of patients by specific conditions Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate Medication reconciliation Summary of care record for each transition of care/referrals Capability to submit electronic data to immunization registries/systems Capability to provide electronic syndromic surveillance data to public health agencies Record advanced directives for patients 65 years or older (EH only) Capability to provide electronic submission of reportable lab results to public health agencies (EHs only) Send reminders to patients per patient preference for preventative/follow-up care (EPs only) Provide patients with timely electronic access to their health information (EPs only) Public health objectives Providers may claim certain objective(s)/measure(s) is inapplicable to them if they meet CMS criteria of such an exception. Source: Kentucky Hospital Association, 2010

41 Benefits to KHIE Participation
REAL-TIME Access to Patient Information Clinical Decision Support at POC Reduce duplication Impact on Continuity, Quality & Safety of Patient Care The RAND corporation states that potential benefits of a connected, interoperable healthcare system could save an estimated $80 billion per year.

42 Quality of Diabetes Care: Patients Treated by Physicians using EHR vs
Quality of Diabetes Care: Patients Treated by Physicians using EHR vs. Paper Medical Records % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365: Retrieved from * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

43 % of Patients Obtaining Outcome Standards
Health Outcomes for Diabetes Patients: Patients treated by Physicians using EHR vs. Paper Medical Records % of Patients Obtaining Outcome Standards A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes* Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365: Retrieved from * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.005

44 Quality of Diabetes Care at Safety Net Practices: Patients Treated by Physicians using EHR vs. Paper Medical Records % of Patients Receiving Care A significantly higher proportion of patients being treated by physicians with EHRs received care that aligns with accepted treatment standards * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365: Retrieved from * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant; p<0.001

45 % of Patients Obtaining Outcome Standards
Health Outcomes for Diabetes Patients at Safety Net Practices: Patients treated by Physicians using EHR vs. Paper Medical Records % of Patients Obtaining Outcome Standards A significantly higher proportion of patients being treated by physicians with EHRs obtained better outcomes * Source: Cebul, R. D., M.D.; et al. (2011). Electronic Health Records and Quality of Diabetes Care. New England Journal of Medicine, 365: Retrieved from * Even after adjusting for patient demographic characteristics and insurance type, differences remain significant p<0.002

46 Above all, it’s about improving care for all Americans.”
“We frequently talk about health IT with an emphasis on the technology. But at the heart of the transformation of our health system, it’s really all about people. Above all, it’s about improving care for all Americans.” Dr. Charles Friedman Office of the National Coordinator for Health Information Technology Dr. Charles Friedman recently posted this discussion on the Health IT Buzz Blog. Dr. Friedman re-emphasizes the need for health IT; but qualifies that statement with the bottom line. Healthcare, at its simplest, is about caring for Americans. It is this focus, care of the patient, that drives the healthcare industry today. How can we take care of patients better, and how can we improve treatment plans and encourage compliance in chronic diseases? Technology developed without that focus will not yield the results the healthcare industry needs. As the evolution of healthcare moves forward and technology provides opportunities to improve processes, there is no doubt that maintaining information integrity is a key indicator of how well it has succeeded. Without the right information, at the right time, on the right patient, information cannot be considered to be trustworthy. Employing technology that encourages trust is the first step in ensuring information integrity in the electronic healthcare industry to come.

47 Register for EHR Incentive Program
CMS will establish on-line provider registration as early as January 2011 Eligible hospitals and physicians and other professionals should register even before they are meaningful users. Electronic registration

48 Hospitals Payments by County
eHR Incentive Payment Hospitals Payments by County As of September 22, 2011 Total Hospital Incentive Payments to date $42,395,577.26 Campbell Boone Kenton Gallatin Pendleton Bracken Carroll Trimble Grant Mason Owen Robertson Lewis Greenup Henry Harrison Oldham Franklin Nicholas Fleming Carter Boyd Shelby Scott Jefferson Bourbon Rowan Bath Elliott Spencer Woodford Lawrence Bullitt Anderson Fayette Montgomery Clark Menifee Meade Hancock Mercer Jessamine Powell Morgan Johnson Henderson Breckinridge Nelson Martin Union Washington Estill Wolfe Daviess Hardin Garrard Madison Magoffin Boyle Lee Larue Marion Webster McLean Lincoln Breathitt Floyd Pike Ohio Grayson Jackson Owsley Crittenden Taylor Rockcastle Livingston Hart Casey Knott Hopkins Muhlenberg Butler Edmonson Green Perry Caldwell Clay Ballard Adair Pulaski Laurel Leslie Letcher McCracken Lyon Metcalfe Russell Warren Barren Carlisle Marshall Christian Todd Logan Knox Trigg Cumberland Harlan Graves Wayne Whitley Hickman Simpson Allen Monroe Clinton McCreary Bell Fulton Calloway

49 Physician Payments by County
eHR Incentive Payment Physician Payments by County As of September 22, 2011 Total Provider Incentive Payments to date $9,328,750.00 Campbell Boone Kenton Gallatin Pendleton Bracken Carroll Trimble Grant Mason Owen Robertson Lewis Greenup Henry Harrison Oldham Nicholas Fleming Carter Boyd Shelby Franklin Scott Jefferson Bourbon Rowan Bath Elliott Spencer Woodford Lawrence Bullitt Anderson Fayette Montgomery Clark Menifee Meade Hancock Morgan Henderson Mercer Jessamine Powell Johnson Breckinridge Nelson Martin Union Washington Estill Wolfe Daviess Hardin Garrard Madison Magoffin Boyle Lee Larue Marion Floyd Webster McLean Lincoln Breathitt Pike Ohio Grayson Jackson Owsley Crittenden Taylor Rockcastle Hart Casey Knott Hopkins Muhlenberg Butler Edmonson Green Perry Livingston Caldwell Clay Ballard Adair Pulaski Laurel Leslie Letcher McCracken Lyon Metcalfe Russell Warren Barren Carlisle Marshall Christian Todd Logan Knox Trigg Cumberland Harlan Graves Wayne Whitley Hickman Simpson Allen Monroe Clinton McCreary Bell Fulton Calloway

50 More information on the KHIE can be found on the Governor’s Office of Electronic Health Information website at

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