AAFP Southeast Family Medicine Forum Lessons Learned About

AAFP Southeast Family Medicine Forum Lessons Learned About Health Information Exchange Michele Grinberg Flaherty Sensabaugh & Bonasso PLLC

Technology -Not to Create Problems-

Technology -To Solve Problems-

Problems • WV’s Personal Health Issues • WV’s Health Care System Issues • WV’s Technology Issues • WV’s Geography Answers • State-of-the-art communication among all providers and patients • Viable, affordable technology that meets all providers at any stage • Lack of Access to Care

West Virginia’s Health Problems – The 2 nd oldest population – with all the comorbidity problems of aging – Chronic disease management – Patient compliance – Medication and drug management – High ER usage – All-age obesity – Low birth weight babies

West Virginia’s Health Care Systems Problems • Continuity and Coordination of Patient Care • Lack of complete patient data at the time and place of care delivery: accepting this as an inevitable part of the system • Extensive patient histories; multiple providers • Limited Private Payers

West Virginia’s Tech Problems – Limited broadband connections – 17 percent adoption of EMR systems - multiple EMR brands - varying levels of satisfaction - slow uptake among all providers - High costs – Multiple portals – More than one interface – “Wait and See” philosophy

-Technology – The Easy Part

-Technology Solutions • Limited broadband connections WV Telehealth Alliance FCC grant • Low and Slow EMR Adoption Top HIN vendor companies offer lower cost, less complex entry point systems. Can connect almost all EMR systems • High Costs WVHIN = 1 portal 1 interface 1 format

O -T - C!

Health Information Network in a Box

HIN in a Box Health. Bridge Delaware Health Information Network

Delaware Health Information Network (DHIN) • Public/Private Partnership • First Statewide Health Information Network. DHIN went live Spring 2007 • Secure network for distributing clinical results and reports from the hospital, lab or radiology center to the treating physician • Data is managed by those who order and perform the tests • Supported by Medicity

Health. Bridge ØCited extensively in the health information literature as a sustainable, replicable and successful HIN

Health. Bridge – Since 1997 • Serves 2. 2 million patients • Connects 4, 400 physicians • More than 1. 7 million clinical messages per month • Connects 17 Health Departments • Quest, Labcorp, Proscan Imaging, KY Diagnostic • St. Elizabeth’s; St. Luke’s; The Health Alliance; Tri. Health; Mercy Health Partners; Children’s; Deaconess; Mc. Cullough Hyde; Christ Hospital and Adams County

Health. Bridge Ø Working with independent exchanges including Øe. Health Collaborative, Bloomington, Indiana ØClark and Campaign County HIE, Springfield, Ohio Ø Built on pushing out clinical results ØUpcoming additions to include disease registry and biosurveillance

-Touch – The Hard Part

Touch Issues • Scorched Earth reactions to HIT • Change - work habits work flow staffing patterns and job descriptions • Fear of the New • Wait and See Philosophy • Cost • ROI

Touch Issues • Enabling a new paradigm of patient care where complete, timely and accurate information can be expected by both providers and consumers at the time and place where care is delivered via a private and secure electronic network.

How?

Meeting the Challenges Through WVHIN • Creating a community of a sufficient mass of data users and senders who can “converse” with each other electronically • Provide the most viable technology solutions for our state and for all providers • Maintain technology to optimize ease of entry, use and minimize costs • Coordinate with related projects

Technology • RFI and RFP Process • Staggered Roll-out of Services • Substantial Input from Users • Lessons Learned from NHIN Projects

NHIN Lessons • National NHIN Care. Spark, TN Delaware HIN Indiana University Long Beach Network for Health, CA Lovelace Clinic, NY Med. Virginia New York e. Health Collaborative NC Healthcare Information & Communications Alliance WVHIN • WVHIN Providers Cabin Creek Health Systems Appal. Regional Healthcare, Beckley and Summers County Amer. Medical Facilities Management WVU Physicians of Charleston Area Medical Center

NHIN 2 - Lessons • Varying state practices & laws • Varying HIE/RHIO governance • Varying development stages • ALL PARTICIPANTS COMMITTED

LEGAL ISSUES • Consent/authorization laws vary from state to state, and state vs. HIPAA – What governs when data sent across state lines? • Liability & Insurance – States cannot indemnify others while private corps can. • Dispute resolution – States cannot agree to binding alternatives while private corps can.

NHIN 2 -WVHIN Lessons • Demonstration accomplished between June 15 -- July 30! • Privacy and Security Policies confirmed • Legal agreements in place • Incident procedures in place • Opt-out Consent process used with success BUT…. . – Registration process critical (The Touch)

WVHIN’s Financial Benefits • • 1 portal, 1 interface to maintain 1 call for support Low-cost or no-cost entry Reasonable subscriber fees for those benefiting from the Network • Inclusion of all providers with respect to ability to pay • ROI evaluation statements

Reduce the Paper Chase • • Paper Storage Paper Cost Paper Retrieval Paper Organization Paper Handlers Paper Reading Paper Damage Paper Lost Forever

1 day 1 doctor 115 faxes A Day in the Life of One 10 ads Doctor’s Fax Machine 55 lab results 30 consult reports 19 pharmacy renewals 1 stat abnormal mammogram that needs immediate attention

Touch • Extensive Community Outreach • Hand holding Installation and support • Vendor must demonstrate current ability to connect all but the most obscure EMR systems • Scheduled, staggered roll-out of services • Serving as a “hook-up” to link providers for informal help

Phase 1 Messaging Phase 2 Coordinated Care Phases 3+ Quality and Value Task Get everyone connected; achieve critical mass Enable inquiry of data from multiple sources Longitudinal analysis of data from multiple sources; patient engagement; quality performance Big Win Efficiency; reduce costs by replacing paper Reduce duplicate tests; improve coordination; save lives Huge for all – right info at the right place at the right time Major Winners Providers Public health Health Plans, Providers; ED; Public Health Plans, Providers, Public Health/Population Health, Researchers, Patients

“WVHINs” for Practices • HIE diminishes the hassle of patient handoff • One interface! One portal! • Low cost ease of entry via an electronic inbox with workflow tools • Can meet practices at any stage of electronic readiness • Less paper!

Easier Patient Handoff • Electronic Messages for – Referrals, ED Visits, Hospital Discharges – Accompanied by Labs / Meds / Allergies – Prior Authorizations – Insurance Information

Physician Benefits • Phase I – – – Real-Time Access to Information Better Organization of Information Order, Result, and Referral Tracking Improved Communication Office Efficiencies – Low Cost Entry Point – BETTER, MORE EFFICIENT PATIENT CARE

Staff Benefits • • • Far fewer games of telephone tag Appropriate routing of routine requests Audit trails Less handwriting to decipher Tailor to each provider’s work habits Less paper!

Community Benefits • Phase II – Disease Registries – Automated Public Health Reporting – Quality Indicator Measurements Easier – Sharing Clinical Data is Easier and Controlled by Physicians – Reduce duplication in all areas – payers benefit

www. wvhin. org