Interoperability:

What Will it Take to Achieve a Connected Future

Our Interoperability Panel

• Kenneth Kleinberg - Managing Director, the Advisory Board Company (Moderator)

• Brian Ahier – Director of Standards & Government Affairs, Medicity, an Aetna Business

• Anuj Desai – Vice President of Market Development, New York eHealth Collaborative

• Jacob Reider, MD – Deputy National Coordinator, Office of the National Coordinator for Health Information Technology

• Mariann Yeager, MBA, CEO, Healtheway

So Much To Considerfor Interoperability!

Standards

Consent

Identity

Certification

Network of Networks

Source: The Advisory Board Company Research and Analysis

Health Information

Exchange

Interfaced Vs. Integration

Cost

Open Vs. Closed

APIs

Push Vs. Pull Public Vs. Private

Regulation

Incentives Vs. Penalties

At What Level isHealth Information Exchanged?

Hospital

Region

State

Nationwide

Integrated Delivery Systems

Physician Practice

Source: The Advisory Board Company Research and Analysis

Five W’s (and the Big H)of Interoperability

Description Tools/Approaches Issues/Challenges

Who

Who should be at the table: providers, payers, government, patients, employers, vendors

• RHIO• HIEs• EDI• Portals• Clearinghouses

• Clinically integrated networks• Data sharing networks

• Trust• Competition• Privacy• Governance• Data ownership

• Public vs. private• Federated, centralized, hybrid• Payment contribution

Wha

t What do we need to exchange: clinical, financial, demographic data

• Documents• Messages

• Transactions• Database updates

• Completeness • Granularity• Context• Volume

• Accuracy• Source• Consent

Whe

n

When does information need to be exchanged: push vs. pull/search, transitions of care

• Care coordination tools• Decision support

• Registries• Surveillance• Reporting• Analytics

• Real-time vs. periodicreporting periods

• Opt-in vs. opt-out

Whe

re

Where does information need to flow: care continuum - acute, ambulatory, extended care

• Local• Regional• State

• National• International

• Varying regulation• Geographic vs. political

boundaries

• IT readiness

Why

Why should we exchange: care coordination, quality, cost reduction, regulation, market forces

• Pay for performance • Readmission penalties• Bundled payments

• Meaningful use (MU)• Accountable care (ACOs)

• Varying incentives• Quality measurement

challenges

• Patient compliance

How

How will we accomplish interoperability: standards, testing, certification

• HL7, IHE, FHIR, Direct• Controlled Medical

Vocabularies,• DURSA

• “Rules of the road” • EMPI, record locator services, • Provider directories

• Open vs. closed• Proprietary vs. standardized• Point-to-point vs. hub• Terminology

• Content vs. transport• Patient matching• Jason task force

recommendations

Source: The Advisory Board Company Research and Analysis

Interoperability Levelsfrom Core to External

Data Integration

IHE2 XDS / XCA

Syntactic Interoperability (HL7

V2)

Semantic Interoperability

(HL7 v3)

DocumentExchange

InterfacedAmbulatory and Extended Care

Further from Center Based on Low Common Denominator Standards

Core Organization

Owned / Closely Affiliated

Affiliated / External

Integrated Ambulatory and Extended Care

Private HIEPublic HIE

CDA1 and Transactions

ProcessInteroperability

Enterprise Architecture

Single Database

1) Clinical Document Architecture.2) Integrating the Healthcare Enterprise Cross Document Sharing.

Source: The Advisory Board Company Research and Analysis

Interoperability / HIE StandardsStill Evolving

Complementary, Competitive, or Confusing?

The EHR | HIE Interoperability Workgroup (IWG) is led by the New York e-Health Collaborative (NYeC); supported by 19 states, 20 EHR vendors, and 22 HIE vendors

The CommonWell Health Alliance is an effort led by a number of EHR vendors to take an industry lead in addressing interoperability issues, including patient matching and consent

The Care Connectivity Consortium, founded by provider organizations, is working with the eHealth Exchange and aimed at pioneering health information exchange in the US

Carequality, with over three dozen organizations pledging commitment, is a public/private collaborative taking a broader (non-services) approach to building consensus to enable networks to interconnect

The Workgroup for Electronic Data Interchange (WEDI) recently released a 20-year update to its 1993 report, with ten recommendations for “next-generation” HIE grouped in four “megatrend” areas

Healtheway is a non-profit, public-private collaborative that provides support to the eHealth Exchange (a nationwide network of exchange partners with a trust agreement and implementation guides) and Carequality

HSPC, the Healthcare Services Platform Consortium, a group of providers, IT vendors, system integrators and venture-led firms dedicated to solving the industry-wide interoperability problem using SMART on FHIR (Fast Healthcare Interoperability Resources)

DirectTrust, a non-profit governance organization working under a Cooperative Agreement with the ONC that creates policy and business processes/practices for Direct exchange – it works with the Electronic Healthcare Network Accreditation Commission (EHNAC)

Source: The Advisory Board Company Research and Analysis

Panel Q&A

• Kenneth Kleinberg - Managing Director, the Advisory Board Company (Moderator)

• Brian Ahier – Director of Standards & Government Affairs, Medicity, an Aetna Business

• Anuj Desai – Vice President of Market Development, New York eHealth Collaborative

• Jacob Reider, MD – Deputy National Coordinator, Office of the National Coordinator for Health Information Technology

• Mariann Yeager, MBA, CEO, Healtheway

That’s a Wrap

Thanks to our panelists, the NYeC, and your participation!