Friday, April 13, 2007

More on Scott Shreve and HIE from CALRHIO

For those of you who have already read Scott's blog you will realize here is an experienced professional who has laid "the railroad tracks" for Enterprise Health Records. I recommend the article highly to others.

CALRHIO has elaborated a comprehensive plan for the state of California to plan and implement a Health Information Exchange Backbone. This structure will be built out by Medicity and Perot Systems. It will integrate both state, county and private health care providers.

For details I have extracted the information from their posting.
It follows:

HIE Utility Service at-a-Glance

To build a statewide health information exchange (HIE) utility service that will offer California health care providers and patients secure electronic access to patient medical records, where and when needed.

CalRHIO’s primary goal is to deliver critical health information services securely, reliably, and affordably to clinicians, patients, state, county, and federal health agencies, and communities throughout California.

The CalRHIO HIE Utility Service will provide a suite of services from which individual organizations and regional efforts can select to use some, all, or none. The financing model is designed so that participants are not paying for initial development and implementation of the utility service. Those who benefit pay only for the services they need and use.

The CalRHIO HIE Utility Service will provide health information exchange services that are:
available at a price that no one entity can achieve alone
flexible and adaptable to support a wide variety of legacy systems and technical environments – services adapt to existing technology
designed to permit local users to consume and pay only for those services they find valuable and are not duplicative of services provided locally
Service Oriented Architecture (SOA): SOA framework and Web services platform facilitates scalable, incremental growth and is capable of quickly deploying new services through the re-use of existing services. Because of the variability in IT system environments, as well as the diversity of business and clinical landscapes within health care communities, no one architectural model will suffice. Given the existing challenges, an architectural style of design for constructing HIE models must be flexible and adaptable to resolve variability and diversity issues. A Web services implementation of SOA can meet these complex, diverse business and technical requirements characteristic of HIE initiatives.

Phase I: Establish a state layer or “backbone” of data and services
Phase II: Create regional overlays that leverage and expand on the state layer by adding local data sources and additional services
STATE LAYER - State Network Backbone consists of data and services
· Data: state and multi-regional clinical feeds (claims history from payers, lab/pathology reports from national labs, Meds from RxHub and SureScripts)
· Applications: Master Patient Index (MPI), Record Locator Service (RLS), e-Prescribing
· Options (for regions that are ready):
o Integration Hub: translates patient-centric health information between various Electronic Medical Record (EMR) vendor applications
o EMR Gateway: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application
REGIONAL LAYER – regional overlay of state network with local data and services
· Data: Local clinical data from hospitals, local labs and imaging facilities (data to include labs, radiology reads, transcription, etc.)
· Application Services: include a MPI; RLS; Electronic Health Record (HER) & Personal Health Record (PHR); medication management (e-Prescribing & medication reconciliation); clinical messaging (referral, lab & imaging orders and results; and data warehouse for reporting and analysis
· Integration Hub Service : translates patient-centric health information between various EMR vendor applications.
· EMR Gateway Service: clinical feeds from lab/path reports from national labs, Meds from RxHub and SureScripts to the physician’s EMR application

State Layer
State of California Clinical Data Services
EMR Gateway
National Data Feeds
Statewide, Real-time
Clinical Data Access

Region A
State of California Clinical Data Services
EMR Gateway
National Data Feeds
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
· An information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated health care records
· A utility-like infrastructure that moves health care information efficiently and at a cost that is a small fraction of the money saved for payers, patients, and providers alike
· Affordable utility services that facilitate regional health information exchanges and interconnections among them


Users must be authorized and authenticated and have either obtained a patient’s consent or documented an emergency. All data sharing will be carried out pursuant to state and federal laws involving patient consent, privacy, and security. Will require all appropriate parties agree on data sharing scope and methodology.

Participation by individual organizations and communities is completely voluntary. Participation is NOT mandated by any private or public entity.

Q: Why is CalRHIO creating a technology platform of its own instead of relying entirely on local organizations to provide a technology platform that satisfies local needs?

A: Time is of the essence. On average, every business day in California more than 50,000 patients are receiving suboptimal clinical care solely because we do not have a comprehensive method for moving patient records where and when they are needed. To rely solely on local organizations to individually engage in the expensive and time consuming effort to select vendors, develop detailed requirements, and supervise a complex HIT project will materially delay the widespread sharing of important patient medical information. CalRHIO is offering an option that organizations and communities can use to meet their individual needs and help advance HIE throughout the state.

Medicity and Perot Systems Corporation were selected to build the CalRHIO utility service through a competitive bidding process. Medicity and Perot Systems were selected because their solution offers a strong, proven, and scalable technology platform that will eliminate limitations on how individual health care organizations and local communities design and implement the health information exchange services they need.

In addition to a suite of solutions that are already integrated and interoperable, Medicity and Perot Systems brought an innovative financial model to the table that will enable CalRHIO to sustain the project long term. Creating a sustainable business model is one of the biggest challenges for health information exchange efforts nationally.

· The financing model eliminates the front-loaded expenses that penalize the early adopters.
· Cost to the Point of Sustainability: Capital required to finance an implementation that is thereafter sustainable without further capital infusion will require up to $300M with financing coming in two stages: 1) initial private equity funding covering the phase one build of the state HIE backbone and 2) after backbone delivery of basic information and proof of concept, final funding with more traditional debt financing replacing private equity capital. A connected California could save $9B annually.

HIE Benefits
· More “real time” information from outside clinical setting
· Rapid access to test results and ability to track medication history
· Changes the point of clinical aggregation from physician’s desk to having aggregated clinical data accessible electronically – reportable and available anywhere, anytime
· Improves referred patient flow, eligibility determination
· Improve patient experience
· Improves administrative efficiencies and offers administrative savings
· Improves the consistency and completeness of documentation
Health Plans
· Potential to drive down administrative costs
· No capital required; only an expense-related payment, and then only after patient HIE services actually rendered
· Potential to significantly reduce expenditures for unnecessary, redundant, or ineffective services
· Pathway to improved care, quality
· Support for value driven health care and pay-for-performance by helping health care organizations track and document the efficiency and appropriateness of care patients received
· Potential to perform widespread data capture for analysis of utilization rates and quality and performance measurements, which has the potential to reduce costs and improve quality of care
· Reductions in administrative times: (Experience of Indiana HIE is 12 min. reduction in nurse and pharmacist time for each admission as a result of “delivering synthesized useful medication histories to hospitals”)
· Improves care delivery and efficiency through immediate access to information that assists clinicians in diagnosis and treatment
· Support for medication reconciliation in accordance with JCAHO requirements
· Source for patient coverage eligibility for both private and public health plans/insurance
· Improve care at the point of delivery (including reduced medical errors)
· Improve overall coordination of care
· Improve application of evidence-based medicine
· Facilitate greater patient engagement in their health care through networked personal health records
· Improve transparency on cost and quality
· Help educate consumers about value and ultimately reduce cost through increased preventive care and lower hospital admissions
· Improve quality of care and reduce preventable admissions
Public Health
· Move toward ability to aggregate surveillance data of disease and critical patient information during disasters or bioterrorist threats