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ConnectVirginia:
Cybersecurity and Health Information Exchange
Presented To:
Health and Human Resources Sub-Panel,Governor’s Secure Commonwealth Initiative
December 16, 2013
MICHAEL MATTHEWS
Hospital EHR Adoption by State
Physician EHR Adoption by State
EHR Adoption Trendlines
HIE: Where we are….
HIE: What we believe….
• Many respondents agree that having patient information at or before the point of care will improve care coordination (96%), provide a more complete (95%) and accurate patient medical history (94%), improve test/procedure coordination (94%) and identify discrepancies in patient information (94%).
• Respondents are slightly less likely to agree that having medical information at or before the point of care will improve the quality of care (88%), streamline patient communication (88%), allow for more timely health maintenance screening (87%) and allow for easier public health reporting (84%).
• Respondents are least likely to agree that having medical information at or before the point of care will reduce health care costs (59%), create additional work tasks (54%), decrease face time with patients (43%) and generate information that is not valuable(40%).
• There seems to be a gap in awareness of electronic health information exchange participation: 77% of provider respondents say they exchange health information electronically and only 26% of consumer respondents say their provider has asked them to participate in electronic health information exchange.
• Providers are more likely to agree than consumers that electronic health information exchange will improve care coordination, provide a more accurate medical history and that patient information will be used responsibly.
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eHealth Exchange
eHealth Exchange Participants • Alabama One Health Record
• Centers for Medicare and Medicaid Services (CMS)
• Childrens’ Hospital of Dallas
• Community Health Information Collaborative (CHIC)
• Conemaugh Health System
• Department of Defense (DOD)
• Department of Veterans Affairs
• Dignity Health
• Douglas County Individual Practice Association (DCIPA)
• Eastern Tennessee Health Information Network (etHIN)
• EHR Doctors
▫ Hawaii Pacific Health
• Geisinger Health
• HealthBridge
▫ HealtheConnections RHIO Central New York
• HEALTHeLINK (Western New York)
• Idaho Health Data Exchange
• Indiana Health Information Exchange (IHIE)
• Inland Northwest Health Services (INHS)
• Kaiser Permanente
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• Lancaster General Health
• Marshfield Clinic
• Medical University of South Carolina (MUSC)
• MedVirginia
• MultiCare Health System
• National Renal Administrators Association (NRAA)
• New Mexico Health Information Collaborative (NMHIC)
• North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA)
• OCHIN
• Quality Health Network
• San Diego Beacon
• Social Security Administration (SSA)
• South Carolina Health Information Exchange (SCHIEx)
• South East Michigan Health Information Exchange (SEMHIE)
• Strategic Health Intelligence
• University of California, Davis
• Utah Health Information Network (UHIN)
• Walgreens
• Wright State University
eHealth Exchange Growth
Wounded Warriors
70
DoD VADoD-VA Continuum of Care
PrivateSector Care
60% 40%
Veterans receive approximately
40% of their care outside of VA
treatment facilities.
Up to 60% of service member’s
healthcare is provided outside
of the Military Health System.
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Developed by TS in collaboration with NeHC, funding provided by ONC
NHIN Work Group has recommended this framework to the HIT Policy Committee
Requirements/ Expectations
Identity and Authenticati
on
Transparent Oversight
Accountability and
Enforcement
Technical Requirements
Universal Components of Trust
TRUST IS A REASONABLE CHOICE
•Permitted Purposes•Permitted Users•Consent and Authorization
•Privacy and Security•Secondary or Future Use•Minimum Participation Requirements
•Local Autonomy
AGREED UPON BUSINESS, POLICY AND LEGAL REQUIREMENTS/ EXPECTATIONS
•Validation of exchange partners•Potential validation mechanisms
IDENTITY AND AUTHENTICATION
•General oversight and governance
•Breach management
•Dispute resolution
TRANSPARENT OVERSIGHT
•Suspension and termination•Allocation of risk•Liability limitations
ACCOUNTABILITY AND ENFORCEMENT
•Define specifications•Architecture of exchange
•Differing specifications for different stakeholders
•Interoperability and base system operation
IDENTIFICATION OF MINIMUM TECHNICAL REQUIREMENTS
Requirements/
Expectations
Identity and
Authentication
Transparent
Oversight
Accountability and Enforce
ment
Technical Requirements
HIEs and Emergency Preparedness
1. Understand the State’s disaster response policies and align with the State agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs.
2. Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across State lines before a disaster occurs.
3. Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act (HIPAA) rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement (DURSA) in order to address and/or expedite patient privacy, security, and health data-sharing concerns.
4. Assess the State’s availability of public and private health information sources and the ability to electronically share the data using HIE(s) and other health data-sharing entities.
5. Consider a phased approach to establishing interstate electronic health information-sharing capabilities.
Sustainability Update – Health Systems
18
Signed MOUs: Augusta UVA Centra Mary Washington Bon Secours (MedVirginia) VCU (MedVirginia) Sentara Inova
MOUs in Legal/Process: Valley Health VHC Carilion HCA LifePoint Riverside
83% = $960, 075 Target = $1,200,975
54%
29%
17%
Staffed Beds Committed
Signed In Legal Unknown
19
Governance Framework
Phase IJanuary 20,
2012– February 7, 2014
Phase IIFebruary 8,
2014 – July 31, 2016
Phase IIIJuly 31, 2016 –
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Current Model
Phase IJanuary 20,
2012– February 7, 2014
Phase IIFebruary 8,
2014 – July 31, 2016
Phase IIIJuly 31, 2016 –
ConnectVirginia is NOT a legal entity, it is a contract activity
Governing Body of 22 members
Multi-stakeholder
Heavy policy engagement
21
Recommended Model
Phase IJanuary 20,
2012– February 7, 2014
Phase IIFebruary 8,
2014 – July 31, 2016
Phase IIIJuly 31, 2016 –
Virginia non-stock, non-member corporation
It will apply for federal tax exemption per 501(c)(3)
Governed by a self-perpetuating Board of Directors (11 members)
Secretary of HHR and Health Commissioner will remain members of the Board
Standing committees with Board and non-Board members in order to retain stakeholder engagement
Health IT and Health Information Exchange:
Pillars of Innovation
Presented To:Health and Human Resources
Transition Work Group
December 13, 2013
MICHAEL MATTHEWS