Achieving Interoperability

John W. Loonsk MD FACMI

June 2013

Achieving Interoperability

• The health IT interoperability milieu

• Interoperability is…

• Breadth and depth

• The inducing process

• Status going forward

Health IT interoperability milieu

• Health IT interoperability - notoriously bad

• “Standards impede innovation” - CTO

• ONC defunds HITSP - begins S & I framework

• MU prioritizes adoption then exchange

• Republican chairs question HIT interoperability progress before election

• There is a Stage II?

• “Reboot HITECH” report

• Growing diversity in “networks” – HealtheWay, CCC, EHR:HIE Working Group, CommonWell, DIRECT

Interoperability is…

1. Data content exchange• Intra and inter-organizational• Foundational, structural, semantic

2. EHR and other system data portability

Interoperability also is…

3. Supporting infrastructure for exchange• Transactions, security architecture, metadata,

provider & patient directories, indices, electronic consent

• Sharing the burden of support

4. Increasing functions that can span applications• eRx, PH, CDS, research, analytics, case

management etc.

5. Co-managed information and more…• Care plans, problem and medication lists etc.

Interoperability also is…

6. Non-technical

• Policy interoperability

• Laws, rules and practices

• Incentives and disincentive

• Commercial alignment

Interoperability - Breadth

ACO

Interoperability - Depth

• Coded value• Value set• Terminology• Message• Technical transaction • Security• Network

Inducing Interoperability - Process Incentives

• Commercial benefits, funding, regulation, network effects

Documentation of “business needs”• Use cases, requirements

Identify standards• Data, technical and policy

Develop detailed implementation guidance• And manage

Prototype implementations• Feedback and refinement

Access to support• Guidance, standards and testing tools

Third party testing and certification• All parties and all transactions

Where are we?

A lot left to do…• Breadth and depth• What is and anticipating what healthcare

is to be

Meaningful Use Stage II has more• Leverage diminishing• “Outcomes” and “deeming” for Stage III?• Penalty phase?

Hope for better aligned incentives in health reform?

Achieving Interoperability

John W. Loonsk MD FACMI

June 2013

Interoperability and Health Information Exchange

June 6, 2013

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Ascension Health, part of Ascension Health Alliance, is the largest Catholic health system, the largest private nonprofit system and the third largest system (based on revenues) in the United States, operating in 23 states and the District of Columbia.

Our System

Daughters of Charity Health System isan affiliate of Ascension Health

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Strategic Directions in Connected Healthcare

Community Interoperability• Public and private HIE to share patient-specific

community data• Referrals, e-prescribing, plan of care• Surveillance, epidemiology and economics

Point of Care (POC) Workflow: Information to Drive the Next Decision - Foundational to all integration

• Transactional systems (i.e. Lab, Rx, Rad)• Patient-specific, real-time alerts and decision

support• Provider collaborative view of critical patient

events• Clinical operational reporting capabilities• Private HIE to normalize internal and affiliate

disparate data views

Population Health Management• Coordinate care delivery across a population to

improve financial and clinical outcomes• Chronic condition management• Care delivery innovation

Business Intelligence• Accelerated clinical outcomes improvement• Population risk management and predictive modeling• Financial risk management and predictive modeling • Clinical benchmarking and investigational research

Connected Healthcare

Data Capture—Dissemination—Integration-and-Analysis

Advancing Clinical and Financial Information Integration

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Data Composition

BI Tool Demographics Insurance Provider Facility Encounters Laboratory Medications (full) Prescription Diagnoses Allergies Problems Procedure History Observation Documents (NLP -discrete) Immunizations Vitals

HIE Demographics Provider Facility Encounters Laboratory Medications (Currently Discharge Meds) Diagnoses Allergies Problems Procedures Observation Documents (text)• History• Insurance• Prescription• Immunizations• Vitals

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What do we need to interoperate?

• Systems able to capture and store data• Systems able to send and receive data securely• Data mapping to standards• DURSA/Data Sharing Agreements• Patient participation• Participating organizations willingness to

participate in HIE interoperability

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Implementing Interoperability in large Health Systems

• Meaningful use program helped move EHR vendors forward

• Meaning use program focused vendors on implementations of EHR applications

• Multiple vendor platforms within your Health System increases the work time to reach interoperability

• Competition among vendors with HIE products

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If you interoperate, you must map

• Multiple vendor platforms – Hospital– Practice Systems– Other systems

• Free text entry fields are the enemy of standards– PCPs– Race/ethnicity– Other stories we have all heard

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Standards for interoperating

Historically, we have had multiple versions of HL-7 – 2.x for most transactions– 2.5.x for Immunizations– V3 not implemented widespread

• Soap vs Rstful• XCA vs XDS.b• CCD uses?• Direct push

– HISP to HISP connectivity now needed• Integrated Provider Master• Mapping to standards, both national and intra-organization• Remove opportunities for free text entry when a standard can be

implemented