WIXLIB

CHOP HIERoadmap: AChildren’s HospitalJourney to HIEBryan A. Wolf, M.D., Ph.D.Chief Information Officer and Senior Vice-Presidentfor Information Services. The Children’s Hospital ofPhiladelphiaProfessor of Pathology and Laboratory MedicinePerelman School of Medicine at the University ofPennsylvania1

CHOP Health system consisting of the main hospital and a comprehensivenetwork of care in PA and NJ Regional, national and international referral center 530 inpatient beds (203 intensive care beds) 30 primary care sites, 12 specialty care sites, affiliations with 12community hospitals, 2 urgent care centers 1.4 M outpatient visits 10,716 employees 1,900 licensed medical practitioners 450 research investigators 2B expansion plan for the next 6 years2

The CEO’s Vision (Steve Altschuler, MD) Almost a decade ago, we envisioned afuture in which the electronic healthinformation of our patients would exist on acommon platform between our caregiversto improve quality and safety We will improve the health of children usinginformation to transform pediatrichealthcare, accelerate learning and createnew scientific knowledge33

My Journey to CIO 1984: MD/PhD from the University of Paris 1984-1990: Trained in Clinical Pathology at WashingtonUniversity in St. Louis and Barnes Hospital. Research inBiochemistry 1990: Joined the University of Pennsylvania School ofMedicine 2001-2008: Chair of Pathology and Laboratory Medicineand pathologist-in-chief at CHOP 2008-present: CHOP CIO4

CHOP IS 493 FTE2 remote data centers 400 applicationsAligned with CHOP goalsEpic is our EHRFocus on AnalyticsContinuous implementation modesince 2005Teamwork, Accountability,Transparency & Patient Safety5

Epic Implementation at CHOP200120062011EpicAmbulatory atCobbs CreekEpic SpecialtyCareEpic Acute:OptTimeInpatient, Documentation,Phoenix20032007Rollout EpicAmbulatoryEpic PARC2013CHOPEHRJourney6

CHOP Annual Visits in 200115,5427

eHealth Initiatives at c ic exchange ofimmunization informationLiveMyChartPatient portalLive & expandingEpicCare LinkReferring physician portalLiveCare EverywhereEpic’s provider networkLiveSolutions for theCare NetworkExpanding support structure for On-going workIT services in Care NetworkMeaningful UseParticipation in governmentincentive programIn processTelemedicineRemote consultationsPilotingCommunityConnectHosting our Epic instance fornon-CHOP practicesIn process8

Key Drivers of CHOP Strategy Turbulence and UncertaintyRegional-National-International GrowthCustomer EngagementCompetitive AdvantageCare Delivery and Business TransformationTechnology InnovationCost Reduction9

IT Strategy1.IT infrastructure positions CHOP to be successful in aturbulent and uncertain healthcare environment2.Patient-centered, evidence-based care using theintegrated electronic health record is coordinated tosupport quality and improve patient outcomes3.Customer-focused service using state-of-the-art IT toolsresults in patient, family, and referring provider loyalty4.Innovative use of consumer technology integrateswellness behavior into patients’ daily activities5.Implementation of key IT automation results in clinical andoperational efficiency to streamline workflows and lower thecost of providing care6.Researchers have access to data and technology thatallows them to advance knowledge of pediatric medicine10

What is Health Information Exchange? Health Information Exchange (HIE) is based on two fundamental elements:1. The ability to store and maintain patient demographic and health information typically via an electronic health record (EHR).2. The ability to electronically share the information in a secure and trustedmanner with other entities according to nationally recognized standards typically through a HIE services provider. While an EHR enables information to be shared within a single organization,A HIE provides the mechanism to securely share patient information outsidethe boundaries of the single organization as patients seek medicalassistance from different providers in different locations. Health Information Organizations (HIOs) have emerged to govern,standardize, and facilitate the exchange of information among entities. Health Information Service Providers (HISP) are organizations that providesservices on the Internet to facilitate use of Direct. A HISP is a logical concept thatencompasses certain services that are required for Direct-mediated exchange,such as the management of trust between senders and receivers.11

CHOP Health Information ExchangeVision CHOP clinicians and clinicians from otherproviders who treat our patients have theability to exchange clinical information,filtered based on the specific need and incompliance with regulatory, privacy andsecurity requirements to facilitate optimalpatient care. HIE facilitates both the exchange of clinicalinformation and administrative informationwith CHOP Care Network Affiliates.12

HIE Recommended RoadmapEstablish electronic exchange capability between CHOP, its affiliates, nonGoal: affiliated providers and healthcare industry at largePhase 1Phase 2Pilots with SelectedAffiliates and Non-affiliatesRollout to All Affiliates andSelected Non-affiliatesPhase 3Extend Capability and ReachKey Outcomes Implement Epic’s CareEverywhere to exchange healthinformation with all participatingEpic providers. Start in ED andexpand institution wide. Pilot programs for one nonEpic affiliate and one nonaffiliate provider to validate HIEapproach Define future detailed HIErequirements Select an initial HISP and pilotDirect message exchange Rollout standard CHOP HIEcapability available across allaffiliates Include standard CHOP HIEcapability available toselected non-affiliateproviders Implement a Master PatientIndex (MPI) to support clinicalexchange services foraffiliates Build a Provider directoryfor clinical referral processesEngaged Entities CHOP/other Epic providersOne CHOP/Affiliate - non EpicOne CHOP/Non-Affiliate non EpicHISP CHOP Affiliates (Epic/ non Epicproviders) Selected Non-Affiliates Implement Fully functional HIEservices to all providers (affiliatesand non-affiliates) desiringinformation exchange with CHOP Extend clinical exchange to local,regional, state and nationwideexchanges Make Full query capabilityavailable across CHOP networkproviders for collection of all desiredand available patient clinical data Create ability to aggregate clinicaldata for use by CHOP physiciansfrom the entire healthcare continuumfor CHOP and affiliate patients CHOP AffiliatesNon-AffiliatesRegional, State and Federal HIEsInternational Entities/Providers

HIE - Key Strategic Outcomes to CHOPThe key benefits below, identified during stakeholder interviews, support the desired outcomes of CHOP HIEservices and achievement of Meaningful Use objectives.Improved Patient CareImproved CHOP Image Sharing information across locations regardless of specialty gives clinicians thebest opportunity to provide the highest quality of care regardless of location ofservice CHOP becomes “partner of choice” because of ability to provide information toreferring physicians and patients Reduction in rework and duplication CHOP will be viewed as an active participant in state and regional HIE efforts Enables CHOP to maintain leadership position in community Faster decision making – quicker access to clinical data Fewer delays in treatment Aggregation of data over patient life provides continuity of careIncreased Volume Drives current affiliate network volume via ease of interactionEnhanced Patient/Family Experience Fewer delays in treatment due to information accessibility Reduces need for patients and families to transport personal records or binders More complete patient information available to provide better treatmentReduced Operating Expense Reduces manual effort to exchange clinical and financial data across CHOP andamong affiliates Workflow /time savings in bill creation and distribution Reduction in treatment delays improves utilization of services Better eligibility/authorizations – reduces risk of reimbursement denials Incents non-affiliate providers to work with CHOP Enables CHOP to increase participation with community and regional physiciansand drive new referrals Enables growth outside normal service area (such as International) due to ease ofaccess and completeness of clinical informationBetter Data Analytics in Support ofQuality Metrics and Research Enhances clinical quality metrics for trending and analysis Ability to look at the type and quality of care of referring physicians in support ofCHOP’s treatment protocols Enables access to data required for participation in ACO or other advanced modelsof care Enables access to other provider sources for clinical information in support ofresearch activities14

Requirements for CHOP HIE Solution Health Record Repository Security / trust services Support for the DIRECT projectfor document / informationexchange Record locator service / Ability toquery another system for patientdata Master Patient Index and rulesengine for patient identityreconciliation Provider Registry Robust clinician viewer Consent Management Clinical Message Delivery Ability to connect to otherHIEs at the region, state andnational levels Referral facilitation Connectivity to reportingregistries (i.e. immunization) Analytics Customization capabilities tohandle non-standardscenarios15

CHOP HIE team evaluated offerings frommultiple vendors and concluded thatEpic’s Care Everywhere module supportsall of these requirements.Replace text box with chapter logo16

EpicEHRCare EverywhereHIE ArchitectureEpicEntitiesCareEpicQuery andResponseCareElsewhereDirectMessagingNon EpicEntities – ,State andNational HIEs17

Care Everywhere Deployment May 2013: Pilot in ED - September 2013: Big bang Deployment18

Care Everywhere last 3 monthsRow LabelsCount of Source OrgBon Secours Health System1Catholic Health Partners1Children's Hospital & Medical Center of Omaha2Children's Hospital of Wisconsin1Cincinnati Children's Hospital and Medical Center3Cleveland Clinic5Edward Hospital & DuPage Medical Group1Froedtert & Community Hospital3Johns Hopkins Medicine1Lancaster General Health34Legacy Health2Meriter Hospital, Meriter Medical Group, and Community Connect Partners2Nationwide Children's Hospital1Nemours253Novant Health1Oregon Health & Science University1Park Nicollet Health Services1Premier Health Partners2Sentara Healthcare1Sisters of Charity of Leavenworth Health Systems / Exempla Healthcare1Swedish Medical CenterThe Children's Hospital of PhiladelphiaUC HealthUniversity of Pennsylvania Health Systems1242273University of Rochester Medical Center6UW Health - Wisconsin3Grand TotalAbout 220 organizations live on Care Everywhere64419

HealthShare Exchange of Southeastern PA Initiative of the Delaware Valley Health Care Council (DVHCC)About 40 health care organizations including3 Health PlansCHOP: Is using HealthShare Exchange as our HISP Completed successful testing of DirectMessaging Meeting the Meaningful Use requirement tosend a percentage of transitions of caredocuments electronically Use case: send summary of care documentsand discharge to PCP and Referring MD viaDirect (currently using Fax) Very much interested in query capability ofHealthShare ExchangeAttend Closing Keynote by Marty Lupinetti,Executive Director of HealthShare Exchange20