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Current Health IT Environment Overview and What’s Next
Presented By LeRoy Jones – Chief ExecutiveJanuary, 2011
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Introduction to Presenter…
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GSI’s Primary Area of FocusGSI Health is a healthcare solution provider
and system integrator, focused on healthcare information technology (HIT)Enabling provider-to-provider data exchange
and deliveryEnabling public-health reporting by provider
entitiesFacilitating analytic reporting on healthcare
dataDelivering composite solutions from
complementary vendor application offering
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About GSI/Core CompetenciesHealthcare Information Exchange (HIE)National healthcare IT standards development
leadershipSystem Integration of heterogeneous partner
solutionsSoftware Architecture & DevelopmentFocused on Interoperability Standards-based
SolutionsData-Driven Quality Assurance ExpertsFederal, State, Regional, and Private Clientele
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GSI’s Approach to the HIE MarketGSI Health has a multi-pronged approach to the HIE market based on enablement, operation, and meta-knowledge.
Products – We have HIE infrastructure components that we are able to layer into other pre-existing solutions, or use as a self-contained platform for data exchange.
Services – We are a full-service consulting company that assists organizations, and the industry at large, effectively implement health information exchange. We have an emphasis on standards-based systems integration.
Partnering – We have been very successful in transitioning our clients into partners, and finding synergies among even competing organizations that lead to strong solutions.
Partnering
Products
Services
TrueInteroperabili
ty is Multi-Pronged
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Meaningful Frenzy…
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What is Meaningful Use?The Department of
Health & Human Services defined a multi-stage, expanding definition of what constitutes a “meaningful user” of electronic health record (EHR) technology
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What is Meaningful Use?Stage 1 The Stage 1 criteria for meaningful use
focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.
For Stage 1, which begins in 2011, there will be 25 objectives / measures for Eligible Providers and 24 objectives/measures for eligible hospitals.
In 2011, EPs, eligible hospitals and CAHs seeking to demonstrate Meaningful Use are required to submit aggregate clinical quality measure numerator, denominator, and exclusion data to CMS or the States by attestation.
Stage 2 Stage 2 would expand upon the Stage
1 criteria in the areas of disease management, clinical decision support, medication management support for patient access to their health information, transitions in care, quality measurement and research, and bi-directional communication with public health agencies. These changes will be reflected by a larger number of core objective requirements for Stage 2.
What is Meaningful Use?Stage 3
Stage 3 would focus on achieving improvements in quality, safety and efficiency, focusing on decision support for national high priority conditions, patient access to self management tools, access to comprehensive patient data, and improving population health outcomes. Determination for these criteria are still TBD, based on progress of previous stages.
Meaningful Use Core SetEligible Providers – 15 Core Objectives Computerized physician order entry (CPOE) E-Prescribing (eRx) Report ambulatory clinical quality
measures to CMS/States Implement one clinical decision support
rule Provide patients with an electronic copy of
their health information, upon request Provide clinical summaries for patients for
each office visit Drug-drug and drug-allergy interaction
checks Record demographics
Maintain an up-to-date problem list of current and active diagnoses
Maintain active medication list Maintain active medication allergy list Record and chart changes in vital signs Record smoking status for patients 13 years
or older Capability to exchange key clinical
information among providers of care and patient-authorized entities electronically
Protect electronic health information
Meaningful Use Core SetEligible Hospitals –14 Core Objectives CPOE Drug-drug and drug-allergy
interaction checks Record demographics Implement one clinical decision
support rule Maintain up-to-date problem list
of current and active diagnoses Maintain active medication list Maintain active medication
allergy list
Record and chart changes in vital signs Record smoking status for patients 13
years or older Report hospital clinical quality
measures to CMS or States Provide patients with an electronic
copy of their health information, upon request
Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request
Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
Protect electronic health information
Standards for Interoperability Meaningful use regulations stipulate a raft of standards and corresponding
sources for implementation guidance, which is likely to dominate all discussions of standards for some time to come
The standards expressed generally coverContent (HL7 CDA R2 CCD, ASTM CCR, NCPDP Script v8.1, HL7
2.5.1 [PH Labs], HL7 2.3.1/2.5.1 [PH Surveillance/Immunizations], CMS PQRI XML)
Vocabulary (ICD9-CM, CPT4, SNOMED CT 2009, LOINC v2.27, RxNORM, HL7 CVX – Vaccines Administered, OMB Race/Ethnicity codes)
Privacy / Security (NIST FIPS Pub 140-2 for encryption, FIPS Pub 180-3 hashing SHA-1, audit trail items)
Transport standards (SOAP, REST) were expunged in Final Rule
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MU Sucked the Air Out of the Room
…Phase 2 will, hopefully, be more controlled
Phase 1 created frenzy…Providers rushed to learn
how they could get their share of the Federal $$
Vendors rushed to pledge MU allegiance so they could get their share of the providers’ $$
Vendors rushed to release the MU versions of their software
HIEs bolted it on as an organizing principle
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Meaningful Use
Stakeholder Interplay
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Meaningful Use
Federal Government Activities
Federal Governmen
t
Primarily through the efforts of CMS and the Office of the National
Coordinator, regulation and programs launched
to spur both industry and government to adopt
standards for interoperability, to define
functionality floors for EHRs, and to deploy
functional connected clinical systems
The Direct Project vs. NHIN Exchange
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Certification Programs
HHS has released rules for both temporary and permanent product certification, detailing how
organizations may become certifiers or certifiers of certifiers
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NIST Testing InfrastructureNIST has a
number of test profiles published to demonstrate compliance with MU standards
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Many Tangential Gov’t Initiatives Launched…
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Meaningful Use
State Government Activities
Many States have already explored statewide
information exchanges, either through support of
regional projects, or supplying centralized
infrastructure for connecting clinical
systems, though financial sustainability is elusive, but now have embraced the ONC State HIE efforts
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Statewide HIEAccomplish State
HIEs in five easy steps:
1. Write and submit State Strategic and Operational Plans for HIE
2. Release RFI/RFP for technology partner selection
3. Convene governance and oversight groups for rollout
4. Design Statewide system
5. Build out and rollout
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Meaningful Use
Vendor Activities Vendors had been participating in the
various programs from ONC as demonstrations,
but now have gotten serious about
incorporating the tenets of meaningful use into
released products
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Where Do I Fit in the Health Information Exchange Ecosystem?
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Provider / HIE
Directory
Message
Routing
RLS / MPI
Consent Mgmt.
Centralized Shared Service Provider
EventNotify
Portal
Regionally-Sponsored Services
Lab Order & Result
transactions
eRx transactio
nsID
Mgmt. / Auth.
ID Mgmt. / Auth.
Lab Order & Result
transactions
eRx transactio
ns
Point of care solution(e.g. – EHR, HIS)
Point of care solution(e.g. – EHR, HIS)
• Multi-Transport (SOAP, SMTP, etc.)
• Bi-Directional Initiation (Push, Pull)
• Secure transport over public internet (e.g. TLS)
• Multi-Transport (SOAP, SMTP, etc.)
• Bi-Directional Initiation (Push, Pull)
• Secure transport over public internet (e.g. TLS)
Leverage of established national networked services (e.g. – connection with national labs)
Leverage of established national networked services (e.g. – connection with SureScripts)
Other National or
Regional Services
Federated Core Service
MedMgmt
PHReporting
Centralized Core Services
Value-Added Services
Federated Core Service
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Meaningful Use
Provider Activities
Providers as a group have largely been recipients of
the current wave of industry changes, and
now are evaluating technology adoption as the critical players in the clinical transformation
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Meaningful Use
Payer ActivitiesPayers have not been
strongly at the interoperability table
with the meaningful use government activities,
except in various payment reform
initiatives, such as pay for performance pilots, and patient centered medical
homes. CMS as the largest payer serves as a
model for the private payers, and will be the
vehicle for EHR incentive payments
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My Conclusion…Because of the work of the previous
administration, this administration has been able to move more quickly toward realizing production interoperability
There is still some “wait and see” sentiment in the vendor community which should dissipate as the standards and certification picture gets clearer
2011 can be a breakout year if we see vendor product releases that support widespread interoperability
