2011 CMIO Summit | David Cochran
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This document provides an overview of health information exchange (HIE) in Vermont. It discusses VITL, a non-profit organization that operates the statewide HIE, connecting hospitals, practices, and other providers. It describes how HIE is integrated into Vermont's health reform efforts like the Blueprint for Health, which uses clinical data to support practices' transformation to the patient-centered medical home model and provide population health management. The document also notes some learnings around vendor challenges, interoperability issues, and ensuring HIE sustainability beyond public funding as payment models evolve.
2011 CMIO Summit | David Cochran
- 1. HIE: The Vermont Version David Cochran, MD President and CEO Vermont Information Technology Leaders, Inc.
- 2. Topics • VITL Overview • Vermont Health Reform • Blueprint for Health • Health Information Exchange
- 3. Snapshot of Vermont 637,000 population 9615 square miles 13 Health Service Areas Few large employers (IBM, State Government, University of Vermont) Little industry Dairy and Tourism
- 4. VITL Background • Started as a project within the Vermont Association of Hospitals and Health Systems • Spun off as independent entity in July 2005 • Received 501(c)(3) non-profit status in March 2009 • A public-private partnership with participation from health care providers, government, employers, consumers, and health plans • Shared public investment supporting IT requirements of Vermont’s health care reform efforts 4
- 5. VITL Programs Vermont REC Statewide HIE Blueprint Support ePrescribing 5
- 6. Support Based on Practice’s Technology Maturity Meaningful Advanced Paper EHR Labs Blueprint HIE Use Paper EHR Lab Patient Clinical, Clinical (clinical) installed results demo- structured data practice Standard update graphics data sharing May have workflows EHR and captured with a PMS Data May also clinical Quality consent entry is have summary measures manual immun- sent to are ization Registry automatic 6
- 7. Vermont Health Care Reform 60+ Discrete, Active Initiatives which combine to… Improve Quality • Provider Access, Transparency Increase Coverage • Promote Wellness / Prevention • New Coverage Options • Blueprint for Health • Premium Assistance integrated Medical Home & • H202 – Roadmap to Single Payer Community Health Team • Health Information Technology • Accountable Care Organizations Contain Cost Growth All of Above PLUS • Cost Transparency • Statewide Health Resource Planning and Review • Prescription Drug Cost Containment • Administrative Simplification 7
- 8. HIT & HIE Fully Integrated in Health Care Reform from start • In 2005, VT authorized and funded a single statewide Health Information Exchange • VITL (Vermont Information Technology Leaders), a 501(c)3 public/private partnership, developed standards based architecture for statewide HIE and began operations. • Investment in EHR adoption and deployment included in HCR legislation, starting with a primary care EHR pilot, expanded through creation of HIT Fund (fee of 0.199 of 1% on each health care claim) in 2008 8
- 9. Blueprint for Health Advanced Primary Care Practices Community Health Teams Payment Reforms Health Information Infrastructure Expansion & Quality Improvement Program (EQuIP)
- 10. Advanced Primary Care Practice Doc Site Centralized Registry Community Health Team Medical Home
- 11. NCQA Score & Payment $3.00 $2.50 $ PPPM per provider $2.00 $1.50 $1.00 $0.50 $0.00 0 10 20 30 40 50 60 70 80 90 100 NCQA PCMH Score
- 12. Continuum of Health Services - General Specialized & Targeted Services Higher Community Health • Specialty Care Acuity & Teams • Advanced Assessments Complexity • Advanced Treatments • Support Patients & Families • Advanced Case Management • Support Practices • Social Services Level of Need Advanced Primary • Coordinate Care • Economic Services • Coordinate Services • Community Programs Care Practice • Referrals & Transitions • Self Management Support • Health Maintenance • Case Management • Public Health Programs o DVHA Care Coordinators • Prevention o SASH Coordinators • Access • Self Management Support • Communication • Counseling • Self Management Support • Population Management • Guideline Based Care Lower • Coordinate Referrals Acuity & • Coordinate Assessments Complexity • Panel Management 6/15/2011 12 Level of Service & Support
- 13. Blueprint for Health: Practice Transformation Engine Blueprint for Health’s integrated platform: – web-based registry, – clinical data repository, – population-based management tool Populated through the HIE for bi-directional feeds from practice and hospital EHR systems, labs, public health registries, other sources to support: – clinical messaging, – care coordination, – patient and panel management functions 13
- 14. Hospitals Medical Self-Help Recovery Home Communities Medical Social, Economic, & Community Health Team Home Community Services Nurse Coordinator Social Workers Nutrition Specialists SASH Coordinator Medical Mental Health & MCAID Care Coordinators Home Substance Abuse Programs Medical Home Long Term Care Public Health Programs & Services Health IT Framework Evaluation Framework 6/15/2011 14
- 15. Federal HIT/HIE Policy, Oversight, & Standards - Office of the National Coordinator (ONC) State HIT/HIE Policy, Oversight, & Standards – OVHA/HCR State Government & Public Health Vermont Health Care Providers & Institutions NHIN Connectivity Public Health surveillance, Tertiary and Community Hospitals registries, & other public health functions Primary Care & Specialty Providers Health Information Medicaid health programs case management Exchange “Cloud” Federally Qualified Health Centers & Rural Health Clinics functionality and connectivity for secure, privacy protected interchange of health records, Free Clinics Other Medicaid & AHS case management functionality demographic data, image files, Mental Health/BH/SA Providers and connectivity clinical messaging, & other digitized health information Long Term Care Providers Other state agency & dept. Statewide HIE Operated by VITL case management Home Health & Hospice Providers functionality and connectivity Community Human Service Law Enforcement, Agencies (Family Centers, Area Corrections, & Court System Individual Vermonters: connectivity to EHR Agencies on Aging, etc.) Portals, Personal Health Records (PHR), Health 2.0 applications and Ix Services 15
- 16. Blueprint Integrated Pilots Health Information Infrastructure Medical Home • Visit planners for individual patients • Reporting for panel management & outreach (Medical Homes, CHTs) Medical Hospital data warehouse • Clinical information for care coordination (CHTs, OVHA CCs) Home (hosted EMR) • Tracking for public health services (e.g. cessation counselors) • Reporting for public health planning • Reporting & comparative benchmarks to support program evaluation Medical Core data elements Home Medical VITL Home HIE Core data elements Core data elements Central Medical FQHC Home (hosted EMR) Registry Medical Home Medical Home EMR Core data Medical elements Home EMR Access Medical Community Access Web Web Home Health Team No EMR
- 17. Blueprint Integrated Pilots Health Information Infrastructure Medical Home • Visit planners for individual patients • Reporting for panel management & outreach (PCMHs, CHTs) Medical Hospital data warehouse • Clinical information for care coordination (CHTs, OVHA CCs) Home (hosted EMR) • Tracking for public health services (e.g. cessation counselors) • Reporting for public health planning • Reporting & comparative benchmarks to support program evaluation Medical Home Medical VITL Home HIE Medical FQHC Central Home (hosted EMR) Registry Medical Home Medical Home EMR Medical Home EMR Access Community Access Web Web Medical Health Team Home
- 18. Blueprint Integrated Pilots Evidence Based Quality Improvement Data Data Data Data Source Processing & Storage Analysis Reports & Uses EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient Individual Patient transformation Reporting Tool or Process Care & Support Care VITL / GE Analyst Measures Services DocSite used for DocSite Database DocSite Health Population Individual Patient Reporting Status Management Care Tool Measures Contracted Healthcare Quality Quality Analysis Measures & Standards Improvement Services Medical Claims from BISCHA BISCHA Healthcare Provider Payment Commercial Insurers Multipayer Reports Patterns & Resource for Quality & Medicaid Database Utilization VCHIP VCHIP VCHIP Healthcare Program Chart Review & Databases Analysis & Report Expenditures & Evaluation & NCQA Scoring Generation Financial Impact Sustainability Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community & Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention Databases Database Risk Factors Planning
- 19. Blueprint Integrated Pilots Evidence Based Quality Improvement Data Data Data Data Source Processing & Storage Analysis Reports & Uses EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient Individual Patient transformation Reporting Tool or Process Care & Support Care VITL / GE Analyst Measures Services DocSite used for DocSite Database DocSite Health Population Individual Patient Reporting Status Management Care Tool Measures Contracted Healthcare Quality Quality Analysis Measures & Standards Improvement Services Medical Claims from BISCHA BISCHA Healthcare Provider Payment Commercial Insurers Multipayer Reports Patterns & Resource for Quality & Medicaid Database Utilization VCHIP VCHIP VCHIP Healthcare Program Chart Review & Databases Analysis & Report Expenditures & Evaluation & NCQA Scoring Generation Financial Impact Sustainability Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community & Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention Databases Database Risk Factors Planning
- 20. Blueprint Integrated Pilots Evidence Based Quality Improvement Data Data Data Data Source Processing & Storage Analysis Reports & Uses EMRs used for EMR Databases Data transmission & EMR Clinical Individual Patient Individual Patient transformation Reporting Tool or Process Care & Support Care VITL / GE Analyst Measures Services DocSite used for DocSite Database DocSite Health Population Individual Patient Reporting Status Management Care Tool Measures UVM CCTS Healthcare Quality Quality Health Informatics Measures & Standards Improvement Platform Medical Claims from BISCHA BISCHA Healthcare Provider Payment Commercial Insurers Multipayer Reports Patterns & Resource for Quality & Medicaid Database Utilization VCHIP VCHIP VCHIP Healthcare Program Chart Review & Databases Analysis & Report Expenditures & Evaluation & NCQA Scoring Generation Financial Impact Sustainability Public Health Surveys Public Health VDH Health VDH Health Population Indicators Community & Data Collection Registries & Surveillance Analytic Surveillance Analyst & Prevention Databases Database Risk Factors Planning
- 21. Intermittent Academic Analyses •Outcomes & Effectiveness Reporting & Studies •Guide Health Reform Policies & Programs Advanced analysis New analytic models Routine Analytic data sets Supportive reporting HIPAA Compliant DocSite Environment Clinical Data Analytic models Central Multipayor Repository High Performance Claims Data Computing Center De- Storage Identified Public Health Normalization Data Processing Data De-identification Re-identification Query for experiments Analytics (Routine) Other Data Analytics (Exploratory) Sources Workbench Reporting Data Sources UVM CCTS Health Informatics Platform
- 22. HIE Current State • Infrastructure • Connectivity – Nine hospitals – 54 practices – 1 commercial lab • Blueprint -- 34 practices • Meaningful Use
- 23. Learnings and Issues • Vendor Challenges – Capabilities – Business model – Focus • “Interoperability” – State of the standards • Sustainability – Beyond the public utility model – Preparing for reimbursement reform
- 24. Questions? David Cochran, MD Vermont Information Technology Leaders, Inc. (VITL) dcochran@vitl.net 802.839.1935