Regional Health Information Organizations: Where Are We Now

1
Regional Health Information Organizations
Where Are We Now?
Harris County Public Health Task
Force Information Technology Subcommittee Status
Report April 28, 2005

• April 19, 2005

2
Agenda

• Overview of IT subcommittee charter and
  membership
• Results of clinician interviews
• Regional Health Information Organizations (RHIO)
  overview
• Go forward action plan

3
Charter

• Provide recommendations to the Harris County
  Public Healthcare Council on how our Community
  can better use technology to improve public
  health care service delivery. The scope of this
  group would be to
• Develop an electronic network to support a more
  integrated flow of information between our
  communities emergency rooms and public / private
  clinics
• Review technology offerings that may solve this
  problem and be used to build a community
  infrastructure
• Determine the value proposition to the potential
  end users
• Identify governance, funding, and operations
  models to support the effort

4
Membership

• David Bradshaw Memorial Hermann
• Charles Bacarisse Harris County
• Bill Burge HealthLink
• Ron Cookston HCPH
• Janet Donath Good Neighbor Healthcare Center
• David Fenn Texas Childrens Hospital
• Elena Marks City of Houston
• Robert Murphy, MD Memorial Hermann
• Kathleen Randall Greater Houston Partnership
• Linda Ricca HealthLink
• Beverly Shelton Memorial Hermann
• Tom Shirley CHRISTUS St. Joseph Hospital
• Manfred Sternberg Bluegate
• Tim Tindle Harris County Hospital District

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From the Front Lines
Providers Speak on the Need for Regional
Information Sharing
Robert Murphy, MD Presentation to the Harris
County Public Health Council April 28, 2005
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A system in crisis

• Growing number of uninsured
• ED overcrowding and diversion
• Rising costs of medical care well-described
  waste

7
Caregivers on the front-lines can speak to
problems-and solutions
8
Interviews

• David Buck, M.D., President CMO Houston
  Healthcare for the Homeless
• Guy Clifton, M.D., Neurosurgeon, Memorial Hermann
• Stacie Cokinos, CFRE, San Jose Clinic
• Ron Cookston, Ed.D, Director Gateway to Care
• Janet Donath, Executive Director - Good Neighbor
  Healthcare Clinic
• Karin Dunn, Navigation Supervisor, Gateway to
  Care
• Jeremy Finkelstein. M.D., Medical Director ER
  Methodist
• Tom Flanagan, AVP Emergency Services, Memorial
  Hermann
• Thomas Granchi, M.D., Medical Director ER - Ben
  Taub
• Brent King, M.D., ER Chief Hermann, University
  of Texas
• Carol Paret, VP Clinical Effectiveness, Memorial
  Hermann Vice Chair, Gateway to Care
• Frank Redmond, M.D., Medical Director ER - St.
  Lukes
• John Riggs, M.D., Medical Director, Harris County
  Hospital District
• Miriam Serrano, Care Navigator, Good Neighbor
  Health Clinic
• Joan Shook, M.D., Medical Director ER - Texas
  Childrens
• Jorge Trujillo, M.D., Medical Director ER - St.
  Josephs

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1. Eligibility determination is costly to
administer and a barrier to care
10
2. Duplication of care is expensive, inefficient,
and a risk for patients
11
Abnormal EKGnew or old?
Even when testing is appropriate, without
comparison ? ADMIT
12
Many duplicate procedures have risks
13
Cardiac catheterization may result in a serious
complication
14
3. Barriers to information sharing cause poor
coordination of care
15
HIPAA and release of information rules have
hindered access
16
I shuffle way too much paperthat is time I
would rather be caring for patients--emergency
physician
17
We can never get ER records. We often ask
patients to drive to the clinic just to sign
paperwork. clinic director
18
I had a patient with a red leg and possibly a
blood clot. With follow-up, we could have
discharged her home on medication but instead
we admitted her for observation --ED physician
19
Currently no access to clinic schedules after
hours
20
Go to the ER becomes the defaultthat is
where the specialists are. I cant blame
them.ED physician
21
4. Poorly managed chronic conditions are the most
serious problem
22
The cliché I see is that people think that the
ED is overrun with inappropriate patients. I
dont see that to be the case. These
non-urgent cases are easy. 5 minutes and they
are out. --emergency physician
23
Its not the non-urgent care thats killing us
it the serious complications of chronic
conditions.emergency physician
24
Patients needing acute care (flu, sore throats,
etc) are not the issue The issue is lack of
disease management for chronic conditions. The
chronic conditions are more of a drain on the ED
system because patients continue to present to
ED due to lack of management of these
conditionspublic health leader
25
Patients with (seizure disorder, asthma,
diabetes, high blood pressure) unable to get
meds.
26
Is there a role for a care facilitator or care
navigator?
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• Better eligibility determination
• Less duplication of expensive care
• Improved coordination of care
• Improved management of chronic conditions

CAN be achieved!
28
Information technology wont solve all the
problems.
29
Providers are willing to work towards integrated
solutions
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Information Challenges

• Identification of patients from multiple
  providers
• Aggregation of patient specific clinical data
• Notification system for important events
• Data protection - security and confidentiality
• Interoperability between existing systems
• Value identification and quantification
• Operations
• Funding and governance

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Framework for Strategic Action

• Four goals, 12 strategies (http//www.hhs.gov/heal
  thit/ )
• Inform clinical practice
• Interconnect clinicians
• Personalize care
• Improve population health
• Consolidates and coordinates many initiatives
  currently underway
• Makes the case for why now to adopt HIT
• Avoid medical errors
• Improve use of resources
• Accelerate diffusion of knowledge
• Reduce variability of care
• Advance consumer role
• Strengthen privacy and data protection
• Promote public health and preparedness

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Current RHIO Activity

• Over 140 RHIO efforts underway nationwide
• Typically formed by providers, business
  coalitions, physicians, health plans, or
  government-related entities
• 42 states have at least one RHIO organized or
  planned
• 24 states have introduced and/or passed
  legislation supporting RHIOs or other e-health
  initiatives
• Congress is considering bills in both Houses

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RHIO Examples

• Santa Barbara County Data Exchange California
• Massachusetts Technology Collaborative (MA-SHARE)
• Rhode Island Health Improvement Initiative
• Taconic Healthcare Community Information Network
  (Fishkill, NY)
• Indiana Health Information Exchange
• Maryland/DC e-Health Initiative
• Delaware Health Information Network
• MedVirginia Richmond, VA
• Maine Health Information Center
• North Carolina Healthcare Information and
  Communications Alliance

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Whats Working

• Oversight provided by broad-based collaborative
  group representing the local healthcare market
  (e.g., providers, payers, hospital association,
  medical society, QIOs, DOH)
• Collaborative group independent of a specific
  government agency or a single private entity
• Focus is on community benefits, approach is
  patient-centric
• Benefits are driving technology decisions, not
  the other way around
• Business model based on subscriptions
• Start up funding needed, sources are varied

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Common Challenges

• Need for interoperability standards
• Money
• Start-up funds
• Sustainable funding model
• Payers will not pick up the full tab
• Blueprint for a technology architecture
• Distributed versus centralized data structure
• Low technology user interface
• Politics
• Finding a Switzerland
• Competitive differences
• Lack of trust among parties
• Fear of lost advantage
• Pride of ownership

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Findings - Governance

• Most are creating a corporate structure
• Some, but not many, are defined by state statute
• Independent
• LLC incorporation used frequently, some are
  pursuing 501(c)(3) status
• Boards are broadly representative of the local
  healthcare market
• Typically have working committees to establish
  policies (e.g., mission, governance, financing,
  technology, privacy security, legal,
  communication marketing)

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Go Forward Action Plan

• Complete impact analysis to size the dollar value
  of solving this problem
• Hire acting Executive Director from consulting
  firm to provide day to day leadership for the
  subcommittee
• Establish 3 Work Groups
• End user
• Technical
• Governance
• Develop solution model (time, scope, and money)
• Develop proposed governance models
• Report back to the Council in 90 to 120 days from
  project kickoff