New Care Paradigms Require

Health Information ExchangeCombining IHE interoperability profiles to

enable interoperability between care providers

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Presentation Topics

• New Paradigms in Healthcare– Patient-centered medical homes

– Accountable care organizations

• EMR Interoperability prior to IHE

• IHE profiles & HITSP National Standards– XDS Cross-enterprise Document Sharing (HITSP

TP17)

– XDS-MS Clinical Summary Document (HITSP C48)

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Hospital to Physician Alignment Changing

Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009

Physician ashospital customer

Physician asprincipal in partnership

Physician ashospital employee

Physician asaffiliated provider

• Physician sees hospital as workshop provider• Hospital sees physician as source of income

• Physician sees hospital as income source• Hospital seeks “affiliated” physicians

• Better alignment of incentives• Control vs. autonomy issues

• Hospital & physician align on strategy• Medical home & accountable care orgs.

“Breakthrough integration”

“Doing the deal”

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Patient-Centered Medical Home

Source: President Obama Press Conference on Approval of PCMH Demonstration Project, December 9, 2009

Source: National Academy for Health State Policy Medicaid & SCHIP State Efforts to Advance Medical Homes 2009 www.nashp.org/med-home-map

"It's a model where the center that serves as your medical home medical home might

help you keep track of your track of your prescriptions prescriptions or get the referralsreferrals

you need or work with you to develop a plan of care plan of care that ensures your

providers are working providers are working together to keep you healthy,"

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Rethinking Care Delivery: Medical Home

Source: Advisory Board, Advancing Toward Breakthrough Integration, Dec 2009

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Patient-Centered Medical Home Benefits• Patient-centered medical home is a healthcare

setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.

• Care is facilitated by:

– Registries

– Information technology

– Health information exchange

– Other means to assure that patients get the indicated care when and where they need and want it

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Accountable Care Organization Definition

A set of providers associated with a defined population of patients, accountable for the quality and cost of care delivered to that population

Source: Medicare Payment Advisory Committeewww.medpac.gov/chapters/Jun09_Ch02.pdf

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Health Information Technology

Meaningful Use• Certified EHR technology which shall

include the use of electronic prescribing

• Connects in such a manner that provides…exchange of information … to improve the quality of care, such are promoting care coordination

• Submits information…on clinical quality measures and such other measures as selected by the Secretary

Clinical Transformation

Will ARRA Focus Practice Attention More on HIT and Less on Transformation?

PCMH Standards• Requirements exceed

meaningful use criteria• Understand what is

required by ARRA-and what is needed to make this really “work” in their practices (PCMH)

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ACOACOFinanciaFinanciall

ReportinReportingg

QualitQualityy

SpecialiSpecialistst

MD’sMD’sMD’sMD’s

PCPPCP

Health Information Exchange is Critical to Patient-Centered Medical Home

EHREHR

Hospital/Hospital/ClinicClinic

PHRPHRPatient PortalPatient Portal

HIEHIE

Public HealthPublic Health

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EMR to EMR Interoperability without IHEBi-directional synchronization of problems, meds, allergies

Interface/ Integration EngineInterface/ Integration Engine

Person Identification:

Index & Cross-map

TerminologyService:

VocabularyCross-map

User Identification:Authentication

SA

ML

HL7

PIX

Web

Ser

vice

EclipsysSunrise Acute Care™

AllscriptsAmbulatory EHR

Challenges• User Authentication, Trust• Patient Identification Mapping,

Resolution• Mapping of Meds & Allergies

Vocabularies• Responsible Party(s)?

Operation• All patients in both systems• Updates in one system

automatically populate the other system

• User may be notified of change (inbox) but does not control the exchange

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IHE-XDS (HITSP TP17) Interoperability

Bi-directional exchange of problems, meds, allergies, results…

EclipsysSunrise Acute Care

Allscripts Ambulatory EHR

Challenges• IHE Infrastructure costs• CCHIT certified versions of EMR system

software required • Not all use cases are currently

supported by CCHIT (referrals)

Operation• Patients only exist if there is a visit• User searches IHE infrastructure for

outside records • Users control the import/export of

documents and data• Enterprise / lifetime record is federated

between multiple systems

Identity(IHE-PIX/PDQ)

Registry(IHE-XDS)

Repository(IHE-XDS)

Security & Audit(IHE-ATNA)

HITSP - IHE XDS Infrastructure

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The CCD is generated by the user to “publish” required data set based on selected data from the EHR systemThe CCD is generated by the user to “publish” required data set based on selected data from the EHR system

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Continuity of Care Document generated from the Structured NoteContinuity of Care Document generated from the Structured Note

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Underlying level 3 CCD “discreet data” XML containing codified dataUnderlying level 3 CCD “discreet data” XML containing codified data

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Hospital Admission Workflow using IHE-XDS

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Acute Discharge to Ambulatory Workflow

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Using IHE-XDS to Connect the Community

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Community Health Information Exchange

IHE-XDS & HL7

Affiliated Physicians

SBHCS Out Patient

Centers & Extended Care

SBHCS Hospitals (x6)

State/Regional HIE

gatewayIHE-XCS

Quality & Outcomes Reporting

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Summary

• New care paradigms (PCMH & ACOs) require Health Information Exchange

• Using IHE-XDS to exchange CCD/HITSP C32 is just the starting point for a robust community solution

• Focus on the high value workflows in a community: admission-discharge, outreach services

• New care paradigms require robust quality and outcomes reporting as well as data exchange

Thank You