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Susan Forbes,, DrPHCurrent PresidentPresident & CEO,CEOHawaii Health Information Corporation
Steve HurlbutRHIO LiaisonAccount ExecutiveExecutive, Phoenix Health SystemsSystems, IncInc.CIO, ISI Health Enhancement Services
Steve RobertsonMemberSenior Vice President of Revenue Management &CIO, Hawaii Pacific Health
Employee Schedules, flatfile XFR Once per day.OneStaffOnce per month, G/Lpersonnel dial up anddownload flat files of “paidor cleared” checks fromBOH and First Hawaiian.Users reformat the files inExcel and move to the GLserverserver.Bi-weekly 7-9 flat filescontaining payroll data byindividual are transferred.This provides input forproductivity reports.Flat File TransferChecks IssuedDataControlTSIDaily SMS Flat FileExtracts viaVSDM & PA/PMSegment HandlersWeekly APR-DRG,Birth weights, flatfile transfer from Monthly file transferCascadeof Rev 3 Report data.3MAPR-DRGDOH BCDataElectronic xfrTSI,APR/DRGsKMC/PMAll RxOrdersTubedADT ExtractDaily FileDownloadSMSRTFGENIE HL7thru CloverleafDaily ChargeManual File CopyVia OperatorsVia 48 RecordsDaily ChargeFTP UploadVia 48 Recordsthru S results into KareLinkADT, HL7VPNADTDaily and HourlyTranstat & MedquistLab, Radiology,Dietary Ordersentered inKareLinkKareLink.Orders enteredmanually into SMSby unit secretaries.ADT& OrdersCustom HL7ProcedureStatus(work list)ProcedureStatus(work list)RecordingDictationDual Entry ofSMS ADTORs generate a materialsusage list of SPD items(inventory depletion based on“sticker” bar code system).OR send this list daily to SPD.SPD manually enters MRNCatalog and account # into ESI.DownloadOR clerk manually enters(ESI Items)non-SPD charges (services)Daily,into SMS from ORSOSBatch File(future: create 48 Recordsand batch this via FTP,TBD)ORSOSADT, MPIKMCWC/KMCPMUpdates SMS ORSOS Work list (RTIF display) when a patientis scheduled. Registration uses this to register the patient.DataControlLab Results, HMSA:1500 Claims sentEDI ddailyil viaiModem (separatefromclearinghouse)Payer Billing:1500 Claims sentEDI ddailyil ttoClearinghouse (viaModem) MedicKMS (KCC) CBOMicrotechn.Blood-GasData ManagerBLIP, RTIFLab Results, HL7LanierSystemTHE PROBLEMSunQuestClinical LabsRes. Sched.TIF,CustomHL7ADTs, Lab Results, non-HL7PrintedRx Order(Tubed)ClinicompKareLinkIRS(Materials Management)Issues by Department, report file. Once per month.PatientManagementHHIC/NPICBirth Data &DemographicsSMS ReportsDistributionPatient Refunds, flat file, bi-weeklyHMSAMag Filer(A/P)Daily upload (flat file export)export). Converted to 48/49records by custom code for posting to PA.CORDOH BirthCertificateVPN1099sESI/TitanRx OrdersHCS MedicsPharmacyReal-time, ADT, TIF,GENIE HL7Cascade(MR Encoder)Flat file ofPA Chargessentmonthly Daily ExtractMJK001BillingInformationOrdersADT and ProceduresDaily FileDownloadCleared Checks, flat file, once per month(Mainframe Custom Code)Custom CodeThis file used forreconciliation.Daily Birth DateUpdatesUploaded to SMSVia OThis is just 1 hospital’sInformation flow.Web ServerReconciliation Report:Openp Check reportpESI Paid Check reportUpload “paid orcleared” check fileto MainframePyxisyMeds DispensersBudget ExtractFlat file xfrFax ServerAccounts PayableEnd-of-month flat fileGEACGLMonthly Flat File TransferUser TransmittedVoice DialerFlat File TransferChecks Issued?Flat FileTransfer(MS Access)TempusEncompassTime &AttendanceEmployeeDemographics, flags, updateauthorities Flat file, daily XRFCeridianEnsembleCash ReceiptsTSISTACSActual Hours worked. Not built,but ready to be worked.EmployeeHours WorkedFlat File XFROrders &Results,Custom HL7SMS Lab OrdersADT, Custom HL7Pt JacketPremisiERATelepathTelephoneClaims via ModemDCL FaxMachine(Young Street)Aloha CareProvides tape ofremittancesPayer Billing:UB92 Claims sent daily at5am (Paper prints out on24th floor). 55% of allclaims are electronic.Some 1500’s are sent out;these are manually enteredinto Premis.CustomCodeEven iin a singleEi l hhospital,it l patientti t IInformationfti comes ffrom amultitude of electronic and paper sources. It’s a huge problemto reconcile this information into a view to support real-timeclinical decisions. Imagine 22 hospitals and 100 clinics.RadiologyRdi lTranscribers Write into RMSUB-92/ 1500Flat FilesHost FaxSMS RMS*At KMCWC, most (95%)radiology orders are placedin Invision. KMCPM placenearly 100% of all Orders inRMS. Once Order is enteredin either RMS or Invision,Barcode is Laser printed fromRMS. Charge is posted inInvision only after bar codeis swiped.Two flat files from ad hocsin SMS. One containingPA info for IVR. Theother is guarantor info forout dial system. Xmitdaily by 7:30am.Catalog DownloadHl7NEC PxPhone SystemRegistration printsSchedules(mainframe)Bar-codeReaderAloha CareFormattedRemittanceFl t filklList of claimssent outelectronically.This is used togenerate 7Mrecords(comments) in SMS.Flat file,Sent daily at6pm.Payer Remittance:HMSA and Medicare(HMSA posts on bulletin board, NDC provides Medicare remitfiles via clearing house). Flat files, HMSA is picked up onThursday, Medicare is daily.Flat file containing payment,adjustment,j, and comments. Processedin SMS. HMSA is every Friday,Medicare is daily by 5:30pm.
What are Hawaii Hospitals Doing?Most of our largest Hospitals have already installed (or nearly installed) ElectronicMedical Record systems. We are among the top 20% in the country.Even better: The hospitals in thisred box use the same kind of EMRsystem. Combined they have morethan 2 million patients in theirregistries.i tiMMuchh off ththe hhardd workk iisdone.Tripler
How can you help?Technology is the easy part, it is less than 20% of theproblem and cost.costThe hardest thing is getting everyone to agree onhow to do things. 61.Encourage and incent efforts to improve clinicalinformation exchange between clinics and hospitals.Healthcare providers can’t afford to do it on their own.2.Revise legislation and remove the barriers that impedeclinical exchange that supports patient care.
CreightongAritaMemberPresident & CEO, TeamPraxis, LLC
About TeamPraxisFounded in 1992 as a Regional Physician InformationNetwork to empowerppphysiciansyto providepthe highestgquality of patient care.Largest Physician Information Network in Hawaii, servingmore than 11,000000 providers across the state,state including 120on Electronic Health Records (EHR).Local staff of more than 140 (and growing), with 13Certified Professional Coders and 50 offshore full-timecontractors.A leader in developing innovative healthcare softwaresolutions with a focus on serving physicians.A Qualified High Technology Business under Act 221 8
Key Milestones for 2007Raised 20 million in local Act 221 fundingExported our Clinical Quality Solution software toolto Allscripts through a National Reseller AgreementPurchased an exclusive Statewide enterprise licensefor TouchWorks EHR, making this award-winningproduct available to every Hawaii physicianR h d kkey partnershipReachedthi agreementst withith HMSA,HMSAQueens, HHSC, DLS, CLH and First Hawaiian Bank 9
Our Business Model:MSO ASP Non SharingMembersHMSA/MedicareExternal EMRs(i e EPIC)(i.e.,LabsBanksInternetAncillary ServiceProvidersp, PharmacyyHospitals,Clinical Trials &ResearchFederal GrantOpportunitiesMembersMembers1000 PProvidersidPatient HealthRecordsPhysicianPhysicianPhysicianClinical DataWarehouseP4P AlgorithmsPh i iPhysicianPh i iPhysicianPh i cianPhysicianPhysicianElectronic HealthRecordsBilling Services andSupportPracticeManagementSystemsMedic, ConnxtMD,Medical ABCAdmin Efficiency: EMC, ERA, eCRTP, eRTP, EFT, Eligibility, Claim Status,Claim Editor, HIPAA Update10Clinical Transformation Agent for Physicians and Patients
Challenges Acceleratingadoption of EHR amongl l physicianslocalh Participation 11in Federal programsAlmost all require official State endorsement oracknowledgement
What the Legislature Can Do to Help Help encourage EHR adoptionCCreateincentives and community awareness EstablishE t bli ha pointi t person tto endorsedcommunity initiatives that would allowfor participation in Federal programs12
What are the benefits of ElectronicHealth Records? Benefits to Physicians BBenefitsfit tot PatientsP ti t Facilitates improved documentation (complete, legible records)EEasyto sharehpatientiinformationi fi withi h labs,l b otherh physicians/specialistsh i i /i liReduces need for physical storage spaceImproves office efficiency (fewer chart pulls/filing)Improved documentation reduces common preventable medical errors(e.g., prescription errors)Improved information flow and access to complete patient recordsduring Emergency Room situationsBenefits to Community 13Reduced duplicateptests/services,, ppreventable medical errorsCurbs the rising costs of healthcare
Impact of EHR to Doctors? Three Phases of Adoption Substitutive Phase Efficiency Phase TaskingeLabsePrescriptionsTransformative Phase 14Replace paper chartChronic Disease Management and Preventative Health
Georgiana FujitaImmediate Past PresidentHMSA Senior Vice President
What is HMSA Doing ePrescribing50 Million Initiative for Innovation & Quality 30 Million for Hospitals 20 Million for Physicians yto Adoptp Electronic MedicalRecords (EMRs)Recognition of Telemedicine Services16
Challenges Impact on Day-to-Day OperationsConversion of Paper RecordsCommitment of Resources17
How You Can Help Encourage State DOH, DHS & HHSCParticipationSupport Development of Infrastructure ProvideP id OpportunityOt it ffor MMatchingt hi FundsF d Align Privacy/Security Requirements Require Interoperability Standards Adoption Provide Incentives i.e., Tax Credits18
Lee CastonguayAdvocacy ChairHealthcareHlthInformationI ftiSpecialist,Si li tTelecommunications and Information Policy Group
Consumer Managed Health Record 20Empower the Consumer Control who has access to what data Own their data and their identification number Choose to participate or not in researchAutomated Data Population Physicians Labs Pharmacies Hospitals Home monitoring devices Insurance companiesAdded Value Services Disease Management Resource Directories Health Savings Account
Population of PHRComes from multiple data sources21
Consumer Managed Health Records CONCEPT 22Consumer opens Personal Health Record (PHR) account (similar to a bank account)and gets routing and account numberConsumer provides their health account number to all providers, labs, pharmacies,etc.Health services electronically send pertinent data to Consumer’s health accountConsumer determines who can look at what parts of their health record, thuseliminating many privacy issuesCConsumerdeterminesd tiif ththey wantt theirth i datad t tot beb usedd as partt off researchh effortsff t(and can get remunerated for it)Consumer can not change provider data, but can add to it and control whom canview itA RHIO can provide a standard gateway for providers to access consumer healthrecords; plus other services like specialized views, a clearance house to update healthrecords, and messaging and alert services
An HIE provides the HubRecord BanksProvidersHIE System23
Consumer Privacy Issues 42 percent of Americans feel privacy risks outweigh the expected benefitsoff electronicl t i healthh lth records.d 77 percent of Americans fear that their data in electronic records will beused for purposes other than their healthcare, like marketing. (Lake Research Partners for Markle Foundation, Nov. 11-15, 2006)59 percent of healthcare consumers do not trust their health insurer. (Harris-Westin 2006)(Harris/WSJ 2004)53 percent of Americans are very concerned about health insurers gainingaccess to their electronic health records. 24(Lake Research Partners for Markle Foundation in Nov. 11-15, 2006)
Benefits Empowers the Consumer to manage their PHRAllAllowstheh ConsumerCto controll whomhhash access to theh PHRProvides an easier Consent process between Consumers andResearchersEnsures the correct patient record is being updated anddisplayed for clinical useMedication reconciliation (checking the mix of drug with otherdrugs and allergies) can be performedHelps resolve privacy issues, both actual and perceived25
Challengesg Conformity to data standards which is a commonproblemblwithith allll datad t sharingh i solutionsl tiLeadership – if recognized as a public health issue, Federaland State leadership is requiredStartup fundsSustainable modelsPeople that don’t sign up26
Consumers Want Health ITAmericans who know about connected, interoperable health care systems recognizetheir benefits. Roughly 70% report that they would use one or more features of a PHR.63 PercentWould Look Upand Track TheirOwn TestResults63 PercentWould TrackImmunizationsSource: Connecting forHealth Collaborative.The Personal HealthWorking Group:Final Report.ReportMarkle Foundation.July 1, 2003.2765 PercentWould TransferInformation toNew Doctors69 PercentWould MonitorTheir Recordf MistakesforMi t k75 PercentSay They WouldEmail Their Doctor
Consumer Managed Health Records SUSTAINABILTYPHR BBanksk can use some screen didisplayl space forf internali tladvertising¾ PHR Banks can sell de-identified data¾ PHR Banks can sell identified data with consumer consent(can share remuneration)¾ PHR Banks can provide other online health services andcharge consumer¾ Providers can subscribe to RHIO to simplify access andreceive other benefits¾ Insurance industry can provide incentives for consumers andproviders to use PHR¾ Employers can elect to provide the service as a benefit¾28
National Legislative HIT Environment No significant action during 1st Session (2007) of110th CongressWhat to expect during 2nd Session (2008)? S. 1693 ((Wired for Health Care Qualityy Act)) H.R. 1467 ((10,000 Trained byy 2010)) Passed HouseNo Senate Action to dateS. 2408 (Medicare Electronic Medication and SafetyProtection Act) 29Has passed HELP CommitteeAwaiting full Senate Action; No House Action to dateIntroduced into both House and Senate
Topp Issues Privacy and Security Some are demanding that no healthcare legislation passeswithout patient guarantees to privacy and securityE-prescribing legislation will probably be attachedto Medicare Physician Reimbursement ReformOffice of National Coordinator for HIT andAmerican Health Information Communityy couldend in January 2009 unless both are codified intolaw.30
State LegislativegHIT Environment 2008 Session – Almost all states have introduced legislation that addresses an aspectof HIT, such as ppublic health informatics, ePrescribing,g privacy,py standards, etc. Prominent State HIT Legislation: MASSACHUSETTS Senate Bill 263- Establishes the Massachusetts eHealth Institute to develop a statewide plan forHIT (Introduced) NEW JERSEY Assembly Bill 4044- Established New Jersey Health Information Technology Commission (Signed intolaw by Governor Corzine) NEW MEXICO House Bill 522- AddressesAddtheh use off healthh l h iinformationfi thath residesid on an EHR,EHR suchh asindividuals’ rights regarding disclosure of health information and createspenalties for the unauthorized disclosure of health information (Introduced)31
Publication of a Strategic Framework:Julyy 2004Goal 1: InformGoal 3: PersonalizeCareClinical Practice Incentivize EHR Adoption Reduce Risk of EHR Investment Promote EHR Diffusion inRural and UnderservedAreasGoal 2: InterconnectClinicians Foster Regional Collaboration Develop a Nationwide HealthInformation Network (NHIN) Coordinate Federal HealthInformation Systems32 Use of Personal HealthRecords, Enhancement ofInformed Consumer Choice,and Promotion of TelehealthSystemsStrategicFrameworkGoall 4:G4 ImproveIPopulation Health Unify PH surveillancearchitectures, streamlinequality and health statusmonitoring, and accelerateresearch and dissemination ofevidence into practice
Christine SakudaMemberInformation OfficerOfficer, HPCAPresident, HHIE
What is the HPCA? Dedicated to fostering primary health care to all ofHawai i’sHawaii s residentsRepresents health organizations and providersfocused on primary care for medically underservedpeopleCore membershipp of nonprofitpmulti-serviceCommunity Health Centers and Native HawaiianHealth Care Systems seeing nearly 100,000 patientsannually on five islands.34
Why is HPCA involved in HIE? To support growing health information system needsof CHCs: 35Practice management systemsElectronic medical recordsDisease registriesTelemedicine outreachMembership communications through videoteleconferencingQuality improvement initiativesBandwidth to support multiple clinic sites and informationexchangeContinuity of care with other healthcare providers
What is the Holomua Project?A partnership between community health centers(CHCs) and hospitals that is committed toimproving health care for vulnerable patientpopulationsl itransitioningi i i betweenbfacilitiesf ili i bybdeveloping and implementing a Master VisitRegistry (HMVR) (i.e., a patient record locatorsystem).36
Who is involved? Community Health Centers Hospitals Kalihi Palama HCKokua Kalihi Valley HCHawai i Pacific HealthThe Queen’s Medical CenterPatientat e t CoCommunityu tyGrantee-Hawai i PrimaryCare Association37
What kind of HIE is being developed? Master Visit Registry 38A connection broker between disparate sourcesA record locator service listing a patients history of visitsId tifi thIdentifiesthe ttypes off servicei andd whoh providedid d serviceiPatient information remains at host institution
What is the HMVR?The HMVR allows the treating provider to review a list of thepatient’s visit history, identify which visit is pertinent tohis/her case and contact the host PartnerPartner, via phone orelectronically to request the patient’s medical record.Th HMVR includes:Thei l d391.a Master Patient Index (MPI), which identifies what types of servicesthe patient has had in the past, who provided it, and where it wasprovided usingg a matchingg patientppalgorithm;g; and2.a Master Physician Index (MMDI), which is a list of all physicians in thePartnership who enter data into their organization’s respectivere istr each withregistry,ith a uniqueni e identificationidentificati n number.n mber
What are the benefits of this HIE? Increase interoperability between health care facilities’ healthinformation systems.AddAddressfundamentalf dl transitionali i l patienticare iissues suchh aspatients inadequately prepared for next care settings,conflicting advice for illness management, and inability to reachthe right practitioner.practitionerDecrease adverse medical management/drug events afterdischarge.Decrease errorserr rs related tto discdiscontinuity:ntin it : medicatimedicationncontinuity, test result follow-up, and work-ups.Increase accuracy of discharge/transfer information conveyedto next setting.settingIncrease patient awareness about health informationtechnology and the impact it has on their transitional care.40
Hawai i Health Information Exchange
What is the HHIE? A group of healthcare leaders committed to improvinghealthcare in HawaiHawai ii through the electronic exchange ofhealth information technology42
Who are members of the HHIE? 43LaboratoriesCommunity OrganizationsIndustry ExpertsHealth Care InsurersHospitalsA illAncillaryServiceSiProvidersPhysician Organizations
HHIE Board of Directors (11/07) Kevin Roberts - Castle MedicalCenterWilliam Watkins - Clinical LabsRaymond Yeung - DLS LabsGary Allen - Hawaii Business HealthCouncilSusan Forbes - Hawaii HealthInformation Cor
Mar 07, 2008 · Cloverleaf Interface Engine SMS Lab Orders ADT, Custom HL7 Clinicomp KareLink Orders & ADT & Orders ADT, HL7 VPN ADT Daily and Hourly Transtat & Medquist ADT Extract Daily File Download 3M APR-DRG PCP/Discharge Daily Extract MJK001 Uploaded Printedto SMS Via Screen Scraper SMS R
