1. New Care Paradigms Require Health Information Exchange Combining IHE interoperability profiles to enable interoperability between care providers

2. 2 Presentation Topics New Paradigms in Healthcare –Patient-centered medical homes –Accountable care organizations EMR Interoperability prior to IHE IHE profiles & HITSP National Standards –XDS Cross-enterprise Document Sharing (HITSP TP17) –XDS-MS Clinical Summary Document (HITSP C48)

3. 3 Hospital to Physician Alignment Changing Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009 Physician as hospital customer Physician as hospital customer Physician as principal in partnership Physician as principal in partnership Physician as hospital employee Physician as hospital employee Physician as affiliated provider Physician as affiliated provider Physician sees hospital as workshop provider Hospital sees physician as source of income Physician sees hospital as income source Hospital seeks affiliated physicians Better alignment of incentives Control vs. autonomy issues Hospital & physician align on strategy Medical home & accountable care orgs. Breakthrough integration Doing the deal

4. 4 Patient-Centered Medical Home Source: President Obama Press Conference on Approval of PCMH Demonstration Project, December 9, 2009 Source: National Academy for Health State Policy Medicaid & SCHIP State Efforts to Advance Medical Homes 2009 www.nashp.org/med-home-map medical home track of your prescriptions referrals plan of care providers are working "It's a model where the center that serves as your medical home might help you keep track of your prescriptions or get the referrals you need or work with you to develop a plan of care that ensures your providers are working together to keep you healthy,"

5. 5 Rethinking Care Delivery: Medical Home Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009

6. 6 Patient-Centered Medical Home Benefits Patient-centered medical home is a healthcare setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patients family. Care is facilitated by: –Registries –Information technology –Health information exchange –Other means to assure that patients get the indicated care when and where they need and want it

7. 7 Accountable Care Organization Definition A set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population Source: Medicare Payment Advisory Committee www.medpac.gov/chapters/Jun09_Ch02.pdf Specialists Hospital (1 minimum) Primary care physicians

8. 8 Health Information Technology Meaningful Use Certified EHR technology which shall include the use of electronic prescribing Connects in such a manner that provides…exchange of information … to improve the quality of care, such are promoting care coordination Submits information…on clinical quality measures and such other measures as selected by the Secretary Clinical Transformation Will ARRA Focus Practice Attention More on HIT and Less on Transformation? PCMH Standards Requirements exceed meaningful use criteria Understand what is required by ARRA-and what is needed to make this really work in their practices (PCMH)

9. 9 ACO Financial Reporting QualityQualitySpecialistSpecialist MDsMDsMDsMDs PCPPCP Health Information Exchange is Critical to Patient-Centered Medical Home EHR Hospital/Clinic PHR Patient Portal HIE Public Health

10. 10 EMR to EMR Interoperability without IHE Bi-directional synchronization of problems, meds, allergies Interface/ Integration Engine Person Identification: Index & Cross-map Terminology Service: Vocabulary Cross-map User Identification: Authentication SAML HL7 PIX Web Service Eclipsys Sunrise Acute Care Allscripts Ambulatory EHR Challenges User Authentication, Trust Patient Identification Mapping, Resolution Mapping of Meds & Allergies Vocabularies Responsible Party(s)? Operation All patients in both systems Updates in one system automatically populate the other system User may be notified of change (inbox) but does not control the exchange

11. 11 IHE-XDS (HITSP TP17) Interoperability Bi-directional exchange of problems, meds, allergies, results… Eclipsys Sunrise Acute Care Allscripts Ambulatory EHR Challenges IHE Infrastructure costs CCHIT certified versions of EMR system software required Not all use cases are currently supported by CCHIT (referrals) Operation Patients only exist if there is a visit User searches IHE infrastructure for outside records Users control the import/export of documents and data Enterprise / lifetime record is federated between multiple systems Identity (IHE- PIX/PDQ) Registry (IHE-XDS) Repository (IHE-XDS) Security & Audit (IHE-ATNA) HITSP - IHE XDS Infrastructure

12. 12 The CCD is generated by the user to publish required data set based on selected data from the EHR system

13. 13 Continuity of Care Document generated from the Structured Note

14. 14 Underlying level 3 CCD discreet data XML containing codified data

15. 15 Hospital Admission Workflow using IHE-XDS Patient presents in clinic Patient documentation occurs within Ambulatory EMR AEMR user sends Patient CCD, H&P, Order Req. to HIE & Hold Queues Patient admits to hospital hosp. EMR adds a flag to the Patient List Hospital provider logs on to EMR and selects flag from default patient list Hosp EMR user reviews Community tab from HIE and retrieves H&P and CCD documents User tells EMR to save /or not the displayed H&P and CCD Admission orders signed and reviewed 15

16. 16 Acute Discharge to Ambulatory Workflow Patient presents in the hospital Patient record is documented/updated within Hospital EMR EMR user creates & signs Discharge Summary which is sent to AEMR Sunrise Clinical Manager user creates and publishes CCD document to HIE HIE sends NAV notification to AEMR AEMR user reviews Discharge Summary and saves to record AEMR user reviews CCD and imports/saves discrete Dx, Rx, Alx 16

17. 17 Using IHE-XDS to Connect the Community 17 Community Health Information Exchange IHE-XDS & HL7 Affiliated Physicians SBHCS Out Patient Centers & Extended Care SBHCS Hospitals (x6) State/Regional HIE gateway IHE-XCS Quality & Outcomes Reporting

18. 18 Summary New care paradigms (PCMH & ACOs) require Health Information Exchange Using IHE-XDS to exchange CCD/HITSP C32 is just the starting point for a robust community solution Focus on the high value workflows in a community: admission-discharge, outreach services New care paradigms require robust quality and outcomes reporting as well as data exchange

19. Thank You