1. TAG Health
Opportunities in HITECH and Next Steps
for the National HIT Infrastructure
John W. Loonsk, MD FACMI
Chief Medical Officer
_experience the commitment TM
2. Opportunities in Health Information Technology
Clinical Care Payment
/ Public Health / Claims
Electronic Health
Health Insurance
Records Reform
3. Network Effects and IT Adoption
• Critical mass of participation
• Common platform
• Secondary, sometimes
unintended, value
HTTP://
PC Cards
Email
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5. Mature Data and IT Environments Can Support Value
Environment Attributes: Need:
• Stable and coherent
• Sustainable infrastructure
policies for data access
• Software and services and management
market
• Business alignment
• Well defined software
• Shared standards/
environment
transaction specifications
• Multiple products working for transacting and storing
together
• Data and services
• Many participants – value architecture
in others
• Value in data exchange
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6. Information Sharing in Health – Market Driven Chaos
Type Attributes
Community Hospitals
Academic medical centers
Affiliated physicians
Independent physician practices
Integrated Delivery Systems
Payers
Preferred Provider Organizations
Health plans that provide care Best alignment?
Labs, pharmacies and other ancillary health
organizations
Public health and government (state, local and federal) Differences between states
New permutations
EMR companies EMR “Hub”, organizational, community
Personal Health Records Personally controlled and views on EMRs, claims
Health Information Organizations / Exchanges Opt-in and opt-out, federated and centralized and hybrid
7. Some Desirable Health Data and IT Environments
1. Inside of hospitals
2. Around regional health transactions
3. Population health data stores
4. Around a “managed”, longitudinal patient record
• Community record, medical home, PHR
5. The collective - network of networks
• RHIOS / HIEs, IDNs, government, ancillary
networks, etc.
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8. Architecting Data and Technical Solutions in a
Market Driven Health System
• Increase value of participation
• Payment reform
• Pay for some services
• Clinical information management
• Summary record
• Reconciled medication list
• Health information exchange
• Infrastructure
• Directories, Identity proofing, etc.
• Public health
• Incent data exchange
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9. HITECH
• Federal
• EMR adoption through Medicare
• Meaningful use, standards, certification
• Nationwide Health Information Network
• National Institute for Standards and Technology
• State-level
• EMR adoption through Medicaid
• Health Information Exchange
• Regional
• Extension centers
• Beacon communities
• Workforce development
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10. Health Insurance Reform
• Quality reporting
• Enrolment standards
• From HIT standards and policy committees
• Care coordination
• Demonstration projects
• Data Collection in Federal Programs
• Race, ethnicity, sex, primary language, etc
• Administrative simplification
• Determination of individual’s eligibility and financial responsibility
• Community-Based Collaborative Care Network Program
• “Comprehensive coordinated and integrated health care services”
grants to support low-income populations
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11. Its not about the technology?
• Computerize what is
• Example: Implement EMR
• Technology building blocks
• Example: Network look-up and routing
• Example: Implementation guides for
network transactions
• Example: Rigorous test harnesses and
one to many testing
• Electronic process outcomes
• Example: Computerized Patient Order Entry
• Example: Maintain active problem list
• IT Enabled health outcomes
• Patient and population
• Example: Improve quality of care
• Example: Reduce costs
• Example: Prevent spread of disease
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12. It’s Also About the Data...
The data are central to technology considerations,
outcomes and value, but many issues:
• Business value of not sharing data
• Confidentially concerns for inappropriate data access
• Challenge of having well recorded data
• Challenges of transacting data between systems
• Ambiguities and complexities of selective data access
• Confusing “ownership” and “stewardship”
• Concerns about commercialization of data
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13. Architecting Data and Technical Solutions
in a Market Driven Health System
• Standards and interoperability
Harmonize
• Harmonize down
• Complex information space
• Many standards and SDOs
• Specify up
• Specified transactions
Engineer
• Detailed implementation guidance
• Test harnesses
• Many to many testing
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14. Some Further Needs - Interoperability and Standards
• HITECH Helps
• Advances for structured recording of data inside
organizations
• Still optionality
• Need for engineered transactional specifications
• Incentives for use
• Strategic, but detailed and rigorous
• HIPAA provides for claims
• Nationwide Health Information Network specifications
• Required transaction testing
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15. Some Further Needs - Interoperability and Standards
• Process for parallel work in ancillary areas
• Public Health, behavioral health, long term care etc.
• Include shared services
• Operate on date environment for external
customer
• Standard versions and “legislative lock”
• One to many testing
• Testing infrastructure
• Test Harnesses
• Data sets
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16. Tools for Trusted Mobilization of Data
• Legislation
• HIPAA, HITEC, state
• Certification of software
• Standards and capabilities
• Accreditation of organizations?
• Assurance of on site policies and procedures
• DURSA
• A common operating agreement
• Governance
• Both dynamic and legislated roles
• Consumer preferences
17. Some Further Needs - Policy Environment
HITECH helps
• Raises HIPAA floor
• State HIPAA variability documented
Enable secure, “network sharing” of health data
• Past point to point data use agreements
• Governance
Clarify data stewardship / management roles
• Managed longitudinal record
• Population health data reporting
Further ensure exchange of data
• Incentives and penalties to providers for EMR use – not
always in their control
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18. Into the States
• Medicaid HIT plans
• HIE
• Intraand inter – state
• State responsibility / no authority
• NHIN - organizational vs. direct
• Public health
• Outbreak / case management
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