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

PURPOSE
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.

PROFILE
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
ARCHITECTURE
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.

UTILITY SERVICES
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
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Statewide, Real-time
Clinical Data Access




Region A
State of California Clinical Data Services
MPI
RLS
EMR Gateway
Patient
Payor
Provider
Claims
History
RxHub
SureScripts
National
Labs
National Data Feeds
Region
B
Region
C
Regional Layer
Local Data
(From Labs, Hospitals, EMR)
EMR Gateway
Regional Reporting
BENEFITS FOR ALL USERS
· 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

PHASE I USERS
· EMERGENCY DEPARTMENTS
· CLINICS
· PHYSICIAN OFFICES

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

FAQ
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.

CalRHIO and ITS STRATEGIC PARTNERS
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.

COST AND FINANCING
· 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.

Stakeholder
HIE Benefits
Physicians
· 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
Hospitals
· 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
Patients
· 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
Employer
· 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

Scott Shreeve, MD: A New Dimension: Introducing the XHR

Scott Shreeve, MD: A New Dimension: Introducing the XHR

NATIONAL HEALTH INFORMATION NEWS-WATCH

Timely and current information regarding RHIOs in the United States is available at NHIN Watch, http://nhinwatch.com/performSearch.cms?channelId=1

The Office of the National Coordinator for Health Information Technology (ONCHIT) offers a listserv mail list which announces what ONCHIT is doing to advance RHIO development.
It can be found at: https://list.nih.gov/archives/health-it.html

Google announces collaboration with Practice Fusion

Practice Fusion and Google, the internet search engine have announced a collaboration whereby the EMR and RHIO solution will be offered to providers free of charge. Income will be derived from advertising banners supplied and linked by Google, which will be accessible from the EMR pages used by the provider online. Privacy issues are one of the main concerns for this business model, which however can be addressed since the advertising would not be linked to particular patient's records.

Featured in RHIO Monitor CALRHIO selects Vendors

Featured in: RHIO MonitorCalRHIO Selects Medicity and Perot Systems Corporation to Build Statewide Health Information Exchange for California
CalRHIO Selects Medicity and Perot Systems Corporation to BuildStatewide Health Information Exchange for California
SAN FRANCISCO, Calif., March13, 2007 – CalRHIO announced today that it has selected Medicity, Inc.,teamed with Perot Systems Corporation (NYSE:PER), to build a statewidehealth information exchange utility service that will offer Californiahealth care providers secure electronic access to patient medicalrecords, where and when they are needed.
“CalRHIO’s primary goal is to deliver critical health informationservices reliably and affordably to clinicians, patients, state,county, and federal health agencies, and local exchange effortsthroughout California,” said CalRHIO CEO and President DonaldHolmquest, MD, JD. “Medicity and Perot Systems were selected becausetheir solution offers a strong, proven, and scalable technologyplatform that will eliminate limitations on how individual health careorganizations and local communities design and implement the healthinformation exchange services they need.”
“In addition to a suite of solutions that are already integrated andinteroperable, Medicity and Perot Systems brought an innovativefinancial model to the table that will enable us to sustain the projectlong term,” said Molly Coye, MD, MPH, one of the founding directors ofCalRHIO’s board and CEO and president of the Health Technology Center.“Creating a sustainable business model is one of the biggest challengesfor health information exchange efforts nationally,” Coye noted, citingfindings of a federal study she chaired last year that assessed ninestatewide HIE initiatives.
Medicity and Perot Systems’ first step will be to assist in theprocurement of private seed money to fund start-up costs for theCalRHIO HIE utility service, including building the statewide backboneinfrastructure and integration, marketing and communication, andCalRHIO’s operating budget. Financing requirements for this phase areestimated at $300 million.
The health information exchange platform will make it possible forphysician offices, hospitals, and health plans that have invested inhealth information technology to use their current technology to accessdata outside their walls. While details of charges are yet to bedetermined, the savings expected as a result of having betterinformation will be many times greater than the cost, according toHolmquest.
Through its partnership with Medicity and Perot Systems, CalRHIOwill offer a suite of secure, privacy-protected services from whichorganizations can select to use all, some, or none. For example, forcommunities that want to enable all their health care providers toexchange information, CalRHIO’s HIE utility service will offer anoptional alternative to building and financing their owninfrastructure. For communities that have already initiated localhealth information exchange efforts, the services offered will becompatible and complementary.
“It is imperative that we get a technology solution up and runningas soon as possible to accommodate the needs of California doctors,hospitals, and patients,” Holmquest said. “Every day in California,50,000 or more patients are experiencing suboptimal care solely becauseimportant medical information is missing from their records. Payers andpatients are paying huge additional costs because of the fragmentedcare that result from lack of timely information.”
-

Cerner Statement

I missed last week’s deadline for RHIO MONITOR and Health Train Express due to some interviews and other related projects on EMR. I myself am in the midst of examining and implementing an EMR for my practice. In the process I have had the advantage of my research and study of RHIO as coordinator of a RHIO. In my evaluation it has become apparent that having an EMR which is certified by CCHIT is the ticket of admission, for any serious vendor. All that hard work of the past two years is paying off and demonstrates the process will take time and much patience. Of course I am speaking to the choir, but it emphasizes that we need to do a lot more educating of our fellow physicians. The scope and depth of understanding varies tremendously amongst physicians about EMRs, and RHIOs. There continues to be a divide between vendors and providers. According to my sources they have a difficult time and spend much of it explaining IT to providers. Providers’ eyes glaze over when given a new set of vocabulary and how these systems operate. The differences are also generational. Younger MDs have a set of material from their education which now exposes almost all school children to the basics and more of computers. Microsoft Windows is now the W of the three Rs.
One publication I have access to is a resource is “Functional Matrix” of a number of EMR solutions as prepared by the American Academy of Ophthalmology. While focused on ophthalmology it organizes in a readable manner the items all provider should look at when examining EMRs.
This resource can be found at: http://www.aao.org/aaoesite/promo/business/EMR3.cfm
A profound statement by the CEO of Cerner was quoted in iHealthbeat, published by the California Health Foundation.
“
Cerner CEO: Revamp Health Care Reimbursement SystemMarch 01, 2007
The U.S. health care reimbursement system is "grossly inefficient" and "needs to be changed," Cerner Chair and CEO Neal Patterson said Tuesday at the Healthcare Information and Management Systems Society conference in New Orleans, the Kansas City Star reports.Patterson cited the Healthe Mid-America program, run by Cerner, as an example of how the system could be improved. The independent, not-for-profit program manages the employee health records of Cerner and about 20 other Kansas City-area businesses. Program participants can use an electronic debit and information card to pay for a physician visit and to access computerized personal health records with a PIN, the Star reports. Patterson cited a study that found that 31% of U.S. health care spending is on administrative costs and said that one of Cerner's "goals is to eliminate insurance companies as they exist today." The Healthe Mid-America program is being tested in the Kansas City area, and Cerner hopes eventually to expand the program nationwide, the Star reports (Karash, Kansas City Star, 2/28).

End quote: The Kansas City Star link expands on this brief .

Information from HIMMS Summit Meeting

HIMSS Chair Kicks Off Conference by Touting Necessity of Health ITFebruary 26, 2007
The health IT industry should stop debating the value of electronic health records and accept the technology's importance in the future of health care, Buddy Hickman, chair of the Healthcare Information Management Systems Society board, said on Monday in his opening remarks at the annual HIMSS conference in New Orleans, Healthcare IT News reports."Placing the focus on quality, patient safety and necessary clinical process improvements is consistent with HIMSS' mission and with the reasons why adoption of [health IT] was strongly recommended by the Institute of Medicine's Crossing the Quality Chasm report," Hickman said.Hickman also encouraged the industry to have a unified voice on goals, policies and messages, including a broader view on health IT from the federal and state levels. "In this way, [health IT] becomes part of a necessary solution to critical challenges rather than being viewed as a lesser priority competing for funds," he said."Through smart public policy, alliances and the right incentives, we can create the right kind of national health information network -- one that contributes to quality, safety and better outcomes for all," Hickman said, adding, "If we don't do this now, we only create a greater challenge to fix later" (Enrado, Healthcare IT News, 2/26).


Microsoft last year acquired medical database developer Azyxxi and currently has more than 600 employees focused on health care projects, according to Microsoft Vice President Peter Neupert. Health care "is a huge sector of our economy," yet it still is relatively low tech, he said. As the country's aging baby boomers require more medical attention, the need for health care technology will become clearer, Neupert said. Microsoft CEO Steve Ballmer on Monday will speak at the Healthcare Information Management Systems Society's annual conference in New Orleans. IBM General Manager Dan Pelino said that better computer systems could improve the accuracy of data, prevent duplication and reduce errors. More than 4,000 IBM employees are working on health care products, USA Today reports. IBM also is developing a nationwide patient database with HHS that would store patient information regardless of which hospital or physician a patient visited. Intel and Motion Computing this month unveiled a laptop for physicians and nurses that includes a digital camera to take pictures of patients.