Utah Health Information Network

1
Utah Health Information Network

• Jan Root, Ph.D.
• Assistant Executive Director
• June 2005, AHRQ Annual Meeting

2
UHIN CHIN to RHIO

• In operation since 1993 (CHIN)
• Community-based inclusive
• Providers, payers, govt
• Statewide network
• Not-for-profit
• Self-sustaining
• Began with what members thought would bring the
  most value claims

3
UHIN Does

• Make e-exchange of healthcare data possible
• Neutral trusted third party
• Develop the IT Governance infrastructure
• Develop Standards
• Reduce the cost of health care

4
UHIN Doesnt

• Go inside office
• No EMR
• No quality of care improvement
• No patient safety
• No centralized data base
• Utah DOH holds this function
• UHIN is the pipeline

5
Current UHIN Coverage

• 50 million transactions/year
• Gateway is redundant and mirrored

• 3rd Party Payors Claims (450 payers)
• Medicaid and Medicare
• Hospitals (100)
• Physicians/Clinics (85-90)

• Laboratories (100)
• Local Health Department (100)
• Mental health centers (100)
• Chiropractics (90)

6
UHINs Success

• Community decision-making
• Pursue the value, non-profit business model
• Use standards from the beginning
• Make available to all

7
1. Community, Community, Community

• Consensus building process
• Every organization has ONE vote as an equal
  player
• Value-based operation brings partners together
• If we work together, everyone will be rewarded

8
2. Value Business Model

• Where is the money? Example
• Claim transaction cost to a payer to bring in a
  claim
• Paper claim 8
• Electronic claim lt 1
• UHIN charges 20
• Payer saves 6.80/e-claim
• Community savings
• As a Not-for-Profit RHIO, transaction volume goes
  up, average cost per transaction goes down for
  all stakeholders.

9
3. Standards, Standards, Standards

• Use standards from the beginning
• UHIN Standards Committee has been the key IT
  designing body
• Community has donated 1 million hours towards
  creating standards
• Open standards-setting process for Utah standards
• Actively participated in HIPAA standards
  development

10
4. Adoption for ALL

• Goal Bring value to everyone
• Get everyone on board (low cost)
• Everyone can play the same game (use standards)
• Approach low-tech and simple
• Technical requirements are minimal
• Baseline software offered to providers
• Free product
• Simple send/receive reports

11
Moving into Clinical

• UHIN vision always included clinical exchanges
• From the RHIOs perspective

Health data is health data is health data

• Goal Bring value driven, non-profit business
  model to clinical exchanges

12
RHIOs

• What should a RHIO be?
• Only clinical exchanges?
• Following slides are UHINs vision of a RHIO

13
RHIO Clinical X
Hospital Hospital
RHIO
Clinicians
Clinics
NHIO
RHIO
Clinics
Integrated health care system
Payers
Providers
Clinicians
Provider
Billing Services
Payers
Clearinghouse
Payers
Clearinghouse
RHIO
PBM
Pharmacies
Other orgs
RxHub
Pharm Hub
Laboratories
PBM
Pharmacies
DOH
Banks
14
RHIO Clinical X
Hospital PBM
RHIO
Clinicians
Clinics
NHIO
RHIO
Clinics
Payers
Providers
Clinicians
Provider
Billing Services
Payers
Clearinghouse
Clearinghouse
RHIO
Pharmacies
Other orgs
Pharm Hub
Laboratories
Pharmacies
DOH
Banks
15
RHIO Clinical X
E-Prescribing
RHIO
NHIO
RHIO
Payers
Providers
Provider
Billing Services
Payers
Clearinghouse
Payers
Clearinghouse
PBM
RHIO
Other orgs
RxHub
Laboratories
DOH
PBM
Banks
16
RHIO
Public Health Reporting
RHIO
Integrated health care system
Payers
Providers
Provider
Billing Services
Payers
Clearinghouse
Payers
Clearinghouse
PBM
RHIO
Other orgs
RxHub
PBM
Banks
17

UHIN
Administrative Exchanges
RHIO
NHIO
RHIO
Integrated health care system
Clearinghouse
Clearinghouse
PBM
UHINet
Pharmacies
Other orgs
RxHub
Pharm Hub
Laboratories
PBM
Pharmacies
Banks
18
RHIO (UHINet)
19
Physician to Hospital Medical necessity
Admissions pre-natal reports current drugs CCR
Hospital to Physician Results Discharge notes
lab results, ED admissions ED labs and
prescriptions transcription dictation CCR
Doing It All
Health Care Providers to Payers Claims,
eligibility inquiries claim status lab results
CCR
Public Health Reportable diseases Real-time
reduce public health burden notice of disease
outbreaks
Pharmacy/PBMs E-Prescriptions Formularies
20
UHIN and DOH

• Goal Create a single pipeline for health care
  entities to move many kinds of data including
  public health data to ease burden of reporting.

21
Major Challenges

• Public perception of loss of privacy / control
• Physician concerns about privacy
• Building a business case
• No killer app for clinical
• Must build a collection of messages
• Need uniform privacy law across the nation

22
Major Challenges

• Competition
• Community doesnt compete on exchanging
  information
• Compete on core services
• Standards
• RHIOs adopt community message and connectivity
  standards
• Builds trust
• RHIOs participate in national message and
  connectivity standards setting process