Factors for Creating a
Successful RHIO / HIE
498DL
Winter 2011
Beena Joy
Paul Kuo
MariJo Rugh
David Sumner
Examining Goals for RHIOs / HIEs
• 3 State review
• Technical and non-technical
concerns
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Structure and Governance
Data Security and Standards
Consent Management
Adoption
Provider Participation
• Motivators
– Compliance with mandates (eg,
e-prescribing)
– e-Billing mandates
– Pay-for-performance incentives
– Improved coding and direct links
to payers
– Time savings from direct
electronic reporting
– Increased payment if quality
goals are met
– Cost savings to public and private
health plans
– Altruistic goal to improve public
health
– Quality of care and patient safety
– Increased operational and
clinical efficiencies
• Barriers
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Lack of interoperability
Lack of vision and goals
Security and privacy concerns
Cost
Creating a successful business
model
– Limited technical support
Business Models
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Membership/subscription
Transaction fees
Sales/revenue
Affiliate/revenue
Advertising revenue
• Greatest potential
– Hybrid membership/subscription and
transaction model
Overview
Center for Health Transformation. (2010)
http://www.grrhio.org/about/~/media/HIE_For_A_New_Generation.ashx
Illinois HIE
Illinois Office of Health Information Technology, 2010
http://www.hie.illinois.gov/assets/hiesop.pdf
Illinois HIE
• General Architecture- De-centralized,
federated, 3-layer
• Financial Model- ARRA plus public-private
partnership; mechanism ??
Illinois HIE
• Clinical Messaging Future
• Clinical Summary Exchange for Care Coordination (CCD/CCR
Standards) Future
• Delivery of Structured Lab Results Operational (61%)
• Electronic Order Entry Future
• ePrescribing and Refill Requests Operational (89%)
• Quality Reporting Future
• Patient Portal Future
• Repository Services Future
• Eligibility and Claims Operational (44%)
Illinois HIE
• Connectivity to NHIN
– 2012 – 2014 ?
Illinois HIE
Illinois Office of Health Information Technology, 2010
http://www.hie.illinois.gov/assets/hiesop.pdf
Indiana HIE
• Five existing independent, private-sector,
regionally-based HIOs
• Each of which has been operational and
sustainable for at least five years
• Accounts for more than 12 million patient
records and 12,000 physicians
Indiana HIE Mission/Vision
VanZee, 2010
www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf
Indiana HIE Services
• Clinical Messaging and Electronic Results Delivery (HL7
Standard)
• Clinical Summary Exchange for Care Coordination
(CCD/CCR Standards)
• Electronic Order Entry
• ePrescribing and Refill Requests
• Quality Reporting
• Patient Engagement (Patient Portal)
• Repository Services
• Interoperability / Shared Provider Directories / Master
Patient Indexes
• Eligibility and Claims
Indiana HIE Standards
Terminology Standards
ICD, CPT, NDC, LOINC©, RxNorm, and SNOMED, and
HITSP constructs such as C32, C37
Data Transport and
Protocol Standards
Web Services, LLP, HTTPS, Standard Object Access
Protocol (SOAP), HTTPS,
SSH, SFTP, SQL, ODBC, IHE, electronic business
Extensible Mark-up Language (ebXML),
Secure Socket Layer (SSL), and Transport Layer
Security (TLS).
ePrescribing standards
NCPDP, NCPDP SCRIPT v8.1, NCPDP
Formulary and Benefit v1.0, NCPDP SCRIPT v8.1
RXHREQ, RXHRES
Image Transfer standards
DICOM
EHR standards
CCHIT certified
Indiana HIE – Moving Forward
• Connectivity to NHIN – existing HIOs have
established connectivity
Indiana Infrastructure
VanZee, 2010
www.e-healthcaremarketing.com/wp.../09/Indiana-SHIECAP-O-SPlan.pdf
Wisconsin HIE
• Mission
• Overview of the WI
• Demographics
• 4 Operational HIEs
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WHIE
OCHIN, Inc
CHIC
UNIVERSATA, Inc
• State-Level HIE Planning and Design
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Phase 1
Phase 2
Wisconsin HIE
• Clinical Summary Exchange for Care Coordination (CCD/CCR
Standards) Operational (Epic)
• Delivery of Structured Lab Results Operational
• Electronic Order Entry Operational
• ePrescribing and Refill Requests Operational
• Public Health Reporting Operational
• Electronic Lab Reporting of notifiable conditions
• Syndromic Surveillance
• Immunization Data
• Eligibility and Claims Operational
HIE Strategic & Operational Plan Profile
Governance
Security
Standards and Architecture
Wisconsin HIE Architecture
Wired for Health Board, 2010
http://wiredboard.wisconsin.gov/SOP01.25.11Posted.pdf
State Contrasts
• IL, IN Federated – WI Hybrid models
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IN, WI Clinical Messaging - Operational
IN, WI Electronic Order Entry – Operational
IN, WI Quality Reporting - Operational
IN Patient Portal – Operational
• Technical standards - Essentially matching
HIE Functionality Required for
Meaningful Use
2011
• Electronically capture health information in a coded format
• Use that information to track key clinical conditions
• Communicate that information for care coordination purposes
2013
• Encourage the use of HIT for continuous quality improvement at the point
of care
• Exchange HIT information in the most structured format possible.
2015
• Promote improvements in quality, safety and efficiency
• Focus decision support for national high priority conditions
• Enable patient access to self management tools
• Access to comprehensive patient data
• Improving population health
Recommendations for new RHIOs
• Commitment to the RHIO is a
process
• Don’t give away services
• Vendor-neutral architecture
• Understand requirements
• Encourage adoption
• Plan for consent management
• Base the solution on HIT and IT
standards
Conclusion: On Our Way to
Sustainable HIE
• Early failures and successes have laid the road
bed for the future
• State strategies further the construction
• Advancements in technologies and standards
are removing the barriers
• Additional opportunities/gaps to be
addressed
Feedback Welcomed!
• Questions?