1.
Best Practices for Enabling HIE and
Incorporating Capabilities into EHR workflows
2018 Minnesota e-Health Summit

2.
Agenda
• Why is HIE needed?
• Value Based Care
• Consumerization of Healthcare
• What should you expect from HIE?
• HIE Capabilities
• How do you do it?
• Sharing Data
• Leveraging Insights
• SHIEC
• What is SHIEC and what role does it play?
• What PCDH is and how it works
• Where is PCDH working and future
expansion
• Why is PCDH important?

3.
Health Information Exchange is now Table Stakes
Why should you care?
Payers are seeking opportunities to reduce low value care by transferring risk to
Providers with System-wide, Total Cost of Care Capitated.
Payers are selecting systems as strategic partners based on the value of the
physician enterprise as a leading indicator of the system’s ability to maximize
outcomes per dollar spent for populations.
Managing inpatient efficiency is not enough to be successful in value-based
arrangements. The decisions that impact inpatient activities starts much earlier,
often with the patient’s first visit with a physician. Managing risk starts with a visit.

4.
High Performing Networks and Low Value Care
Why should you care?
Reducing that 30% of unnecessary, low-value care will directly impact
healthcare spend without an impact on outcome or quality of care delivered.
Offering patients the proper direction toward high value physicians within the
system will ensure that only necessary care is provided at the right cost to the
plan, employer and patient.
By utilizing RowdMap’s Risk-Readiness® benchmarks, your system can
express to payers and employers the benefits, both financial and quality
outcomes, that companies, payers and patients can receive by choosing a
high value partner.

5.
The average person sees more than 18 providers in their lifetime

6.
And each provider has their own EHR(s) and other clinical data sources

7.
Patients believe that their physicians have access to all their health data

8.
But we all know the reality: Health data information is still very siloed

9.
Community
Hospital
IDN
Pharmacy
Lab
Post-Acute
Specialist
PCP
Clinic
• In this example alone, 28 distinct
point-to-point interfaces
• Organizations are forced to create
contract-by-contract interoperability
between local IT systems
• Regional “networks” achieve only
regional results
Current interoperability approaches simply don’t scale

10.
Care Coordination is too dependent on patients and on archaic technology

11.
Health Information Exchange Solves a Hard Problem

12.
To Create a Patient-Centered Network
Community
Hospital
IDN
Pharmacy
Lab
Post-Acute
Specialist
PCP
Clinic Community
Hospital
Pharmacy
Post-Acute
Specialist
PCP
Clinic

13.
Study by researchers at University of Notre Dame, as reported by EHR Intelligence: https://ehrintelligence.com/news/effective-hie-use-federal-incentives-may-save-medicare-billions
Accessing Patient Data Through HIE
Studies have shown that accessing and using data through HIE can:
Reduce
Medicare costs
by more than
$3B per year
(average savings of $139
per Medicare beneficiary a
year – a 1.4% decrease in
spending per individual)
Lead to many
other financial
and patient care
benefits
Reduce
radiology exams
by 26%
Reduce lab tests
by 25%

14.
HIE Value Proposition: Provider Perspectives & Links to Initiatives
• Enhance decision-making cycle time / effectiveness / TOC
• Coordinated care, streamlined referral processes / PCMH
• Quality Improvement Programs (i.e. avoid errors, ADEs)
• Reduce readmissions, unnecessary procedures
• Enhance patient engagement – for outcomes and loyalty
• MU, PQRS, MACRA/MIPS, Immunization, RAC, Malpractice, HIMSS7
• Ops Excellence to reduce cost of supply chain, labor, overhead
• Reduce unnecessary procedures and hospitalizations
• Increase referrals, outreach,
• New service lines or become COE
• Improve rates with payers, enhance charge capture
• RCM: Coding / Billing / CDI / Denials Management
• Save time providers spend looking for / sending data
• Productivity tools to enable PCMH
• Deployment of telehealth
• Risk-sharing contracts with upside and minimal revenue loss
• Clinical integration network and workflow that aligns key partners
• Programs to identify, stratify, engage, and manage high risk patients
• Care / Disease / Case management views and tools
• Enhance satisfaction of providers, staff, and patients
• Mergers and Acquisitions – and Integration
• Affiliation and Alliances
Quality &
Compliance
Financial
Strategic
• Improve Outcomes
• Compliance
• Cost Reduction
• Increase Revenue
• CashAcceleration
• Increase Effective
Capacity
• ACO / P4P
• Population Health
• Provider / Patient
User Experience
• Scale
Overall
Benefits
-
TCO
=
Value $$

15.
1. Clinical results delivery (lab, radiology, etc.)
2. Medication history, summaries, alerts, etc.
3. Notification of clinical events for patients in a defined
population
4. Immunizations, syndromic surveillance and public
health data
5. Electronic prescribing and refill information
6. PHRs, patient-reported data
7. Claims transaction/electronic eligibility information
8. Data quality and research support
9. Connectivity to electronic health records
10. Alerts to providers
11. Enrollment or eligibility checking
12. Electronic referral processing
13. Clinical decision support
14. Disease or chronic care management
15. Quality improvement reporting for clinicians
16. Ambulatory order entry
17. Disease registries
18. CCR/CCD summary record exchange
19. Quality performance for purchasers or payers
20. Public health surveillance
21. Electronic prescribingand refill information
22. Alerts to providers
23. Query for documents
24. ADT notification
25. Claims processing
26. Population health management
27. Public health data
28. Research support
29. Syndromic surveillance
30. Eligibility checking
31. Ambulatory order entry
32. Patient-reported data
33. Connectivity to EHRs
Health Information Exchange is Comprised of Many Use Cases

16.
Once an organization decides to invest in HIE to support initiatives, need an
approach to define the objectives & scope including stakeholders, content &
use cases.
The lenses through which scope can be defined include:
▪ Enhancing Transitions of Care (ToCs)
▪ Which ToCs? - What Data? - What Facilities? – Workflow?
▪ Enabling Patient Engagement & Care Management
▪ Which Problems? - Functions? - What Apps? – Workflow?
▪ Supporting Analytics for Population Health & Value-Based Payment
▪ What Contracts? - Which Population? - What Measures? – What Data?
Defining the Scope of the HIE Program

17.
• Comprehensive Care Coordination, Health
Coaching and PCMH Model
• Medication Management
• Effective Hand-offs to Providers and Social
Workers
• Timely Post Discharge Follow-up
• Self-Management Care Plans with Patient
Education and Clear Follow-up
• Identify and Provide Resources for Social
Determinants of Care
• High Patient Satisfaction (correlated with
lower 30 day readmit rates)
Sources:
• Project BOOST (Better Outcomes by Optimizing Safe Transitions) – www.hospitalmedicine.org
• Care Transitions Interventions (CTI) –www.caretransitions.org
• CMS Community-Based Care Transitions Program (CCTP) – www.innovations.cms.gov/initiatives/CCTP/
Enhancing Transitions of Care
Right Information
Right Time
Right Format
• Guided Care Comprehensive Primary Care for Complex Patients – www.guidedcare.org
• Project RED (Re-Engineered Discharge) – www.bu.edu
• State Action on Avoidable Rehospitalizations (STAAR) – www.ihi.org

18.
Enabling Patient Engagement & Care Management
Patient
Portal
Outreach &
Engagement
Education
Personal Health
Record
Remote
Monitoring
Medication
Management

19.
ACOs most often analyze:
• Claims data (96%)
• Clinical data (79%)
• Administrative data (52%)
• Disease registry data (39%)
• Patient-reported data (38%)
In order to:
• Identify and close gaps in care (84%)
• Identify outliers in cost/utilization (80%)
• Compare clinician performance (77%)
• Measure/report on quality (77%)
• Proactively identify risk (68%)
Results are Used to:
• Address specific high-cost or high-utilization patient populations (84%)
• Care transitions management/care coordination programs (82%)
• Disease-management programs (73%)
• Post-discharge programs (68%)
• Development of evidence-based clinical/care guidelines (55%)
• Medication management programs (38%)
Supporting Analytics for Population Health & Value-Based Payment

20.
Determine
Risk and
Provide
Actionable
Data
Real-time
Intervention
at the
Point of
Care
Coordinated
Care:
Complete
View
of Patient
1 2 3
Opportunity
for a
Richer
Patient
Portal
4
BETTER
OUTCOMES
COST
EFFICIENCY
HIGHER
SATISFACTION
Providing Solutions, Adding Value

21.
Sources of Data

22.
22
• Demographics (Name,
Gender, DOB, Race,
Ethnicity, Language)
• Allergies
• Medications
• Medication Allergies
• Smoking Status
• Immunizations
• Encounters
• Observations
• Vital Signs (Hgt, Wgt, BP,
BMI)
• Pharmacy Fill Data
• Lab Tests, Values / Results
• Radiology Reports / Images
• Other Diagnostic Results
• Diagnoses
• Problem Lists
• Procedures
• Functional /
Cognitive Status
• Care Plans /
Team Members
• Discharge Instructions /
Clinical Summaries
• Advanced Directives
• Care Plans
• eMOLST
• EMS Run Sheets
• Medicaid Claims Data
• Social Determinants of
Health
Types of Data

23.
Core HIE Services
Patient Record Search:
Access to a more comprehensive patient profile Statewide
Delivery of Clinical Summaries:
Ability to push clinical summaries (CCD, C-CDA) and lab results
Clinical Event Notifications (CENs):
24/7 Custom alerts provide real-time updates for patients in care
Direct Messaging:
Secure HIPAA-compliant messaging
Predictive Analytics:
Assessing risk and managing patients to optimize care

24.
24
Patient History Patient Risk of Event or Outcome
Risk Model Development Population Risk Models
1000s of Patient Features
• Age
• Gender
• Geography
• Income
• Education
• Race
• Diagnoses
• Procedures
• Chronic conditions
• Visit and admission history
• Outpatient medications
• Vital signs
• Lab orders and results
• Radiology orders
• Social characteristics
• Behavioral characteristics
Multivariate Statistical Modeling –
Decision Tree Analysis Machine Learning
(predicts future 12 months)
• Predicted future cost
• Risk of inpatient admission
• Risk of emergency department (ED) visit
• Risk of acute myocardial infarction (AMI)
• Risk of asthma
• Risk of cerebrovascular accident (CVA)
• Risk of congestive heart failure (CHF)
• Risk of COPD
• Risk of diabetes
• Risk of hypertension
• Risk of mortality
Event Based Risk Models
(predicts future 30 days)
• Risk of 30 day readmission
• Risk of 30 day ED re-visit
Predictive Risk Scores

25.
25
Quality Reporting

26.
ReportingCapacity
Activity & Usage Reporting Data Audit Reporting Analytics for proactive care management
HIE
Capability
Exchange Hospital & Clinic
Data
EMR Connections CCD, Lab Results, Exchange
Event
Notification
& Patient
Portal
Care Plan
Coordination
Health Information Exchange Enablement
Data Exchange Information Exchange

27.
Source
Organization
Specific
Source
System
Type of Clinical
Data
Date first live in
production
Volume Estimates (e.g.,
# of unique patients)
Clinical Data Format
(include terminology
used, if any)
Location or
region
XYZ Health
System
(hospital)
ADT (GE) Admissions data,
discharge
summaries
Since Jan 2009 2,000,000 HL7 v2.5.1 Tallahassee
ABC Hospital Lab
(Cerner)
Lab results Since Feb 2010 1,000,000 HL7 v2.5.1, LOINC coded Jacksonville
St. Sam’s
Hospital
Transcripti
on (XYZ
vendor)
Transcribed
reports: surgical
notes, radiology
reports
Since June 2010 1,000,000 HL7 v2.6 Lakeland
Participant On-Boarding Readiness

28.
Prepare Data Feeds – Conformance Testing

29.
• Many EMRs have extensibility frameworks to
expose information from the HIE
• Tasking & Alerting can be leveraged
• Contextual Single-Sign-On from EMR to HIE
• CCD Export/Import
• Standard HL7 Integration
Integrating HIE Capabilities to the Point-of-Care

30.
• Method of Subscription
• Subscription file
• All patients
• Rule-based
• Trigger
• IP admission/discharge
• ED admission/discharge
• SNF admission/discharge
• Patient expiration (death)
• Frequent ED notifications at time of
encounter
• Detect receipt of clinical notes and
notify PCP
• Detect duplicate CT scans real-time
• Detect when prescription is
filled or not
• Method of Notification
• Clinical Message Center (Portal)
• HL7 v2 MDM interface
Integrating HIE Capabilities to the Point-of-Care: Clinical Event Notification

31.
Contextual Single Sign-On

32.
FLAG Green Yellow Red
Consent YES NOT GIVEN N/A
Data YES YES NO
New Data YES N/A N/A
Consent Status: Yes External
Data: Yes
New Data: : Yes
Message on
Mouse Over
Integrating HIE Capabilities to the Point-of-Care: EHR Flags

33.
Clinical Event Notifications

34.
Continuity of Care Document Reconciliation

35.
What is the Strategic HIE Collaborative (SHIEC)?
www.strategicHIE.com
… The National Trade Association for Health
Information Exchange Organizations
And SHIEC has a nation-wide HIE interoperability
initiative called …
Patient-Centered Data HomeTM
What is the Strategic HIE Collaborative (SHIEC)?
www.strategicHIE.com
… The National Trade Association for Health
Information Exchange Organizations
And SHIEC has a nation-wide HIE interoperability
initiative called …
Patient-Centered Data HomeTM
Strategic HIE Collaborative

36.
Patient Centered Data Home

37.
Patient Centered Data Home

38.
Relevant History
National association of more than 40 statewide, regional,
and community HIEs
How this IA aims to connect
the whole country?
Patch together a “quilt” of HIEs to cover the whole country
Who’s in Charge
SHIEC. SHIEC’s board is elected from among HIE
members.
Legal Document Evolving approaches (could be DURSA)
Geographic Span Nationwide, but limited by who’s a member and who’s not
Most Common Transaction
ADT notification from one HIE to another and clinical data at
point of care in response
Less Common Transaction Clinical data back to the HIE in the patient’s home state
Other Information
Current focus is on sharing clinical data (a) at point of care,
(b) to maintain longitudinal record in patient’s home state
Patient-Centered Data Home

39.
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