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