THE CONTINUING EVOLUTION
OF HEALTH INFORMATION
EXCHANGE IN CALIFORNIA
Kenneth W. Kizer, MD, MPH
HIE Stakeholders Conference
Sacramento, CA
November 1, 2012
Presentation Objectives

Provide an overview of the Institute for
Population Health Improvement (IPHI)

Report on the status of the transition of the HIE
Implementation grant to IPHI-UCDHS
IPHI UCDHS

Call out some recent milestones

Highlight
Hi
hli ht some guiding
idi principles
i i l and
d strategic
t t i
priorities going forward

Preview a few upcoming developments
2
WHAT IS THE INSTITUTE FOR
POPULATION HEALTH IMPROVEMENT?
3
INSTITUTE FOR POPULATION HEALTH
IMPROVEMENT






Established as an independent operating unit in the University
of California Davis Health System in mid-2011; has since
developed
p a diverse portfolio
p
of funded activities >$75M
Population health – the intersection of public health and the
clinical sciences
New value-based health care payment models require that
population
l i
health
h l h management be
b a core competency for
f health
h lh
care systems
Serves as a resource for health care reform, health policy and
clinical quality improvement
Assists government health-related agencies in designing,
implementing and administering programs
Seeks to




Improve the effectiveness and efficiency of clinical care
Build health leadership and health care management capacity
Leverage
g data sources to develop clinical intelligence
g
Promotes understanding of the multiple determinants of health
and appreciation of health being a function of the totality of
4
one’s circumstances
IPHI REPRESENTATIVE ACTIVITIES
 Provide technical assistance in quality improvement and other support to
the state Department of Health Care Services for Medi-Cal (California’s
$50B/ Medicaid
$50B/yr
M di id program))
 Medi-Cal Quality Improvement Program
 Delivery System Reform Incentive Payments Program
 Designing the CA-specific Evaluation of Medicare-Medicaid Dual Eligible
D
Demonstration
t ti P
Program
 Manage the California Cancer Registry
 Provide technical assistance and other support for multiple state chronic
disease prevention and surveillance programs for the state Department of
Public Health, including:










California Heart Disease and Stroke Prevention
California Arthritis Partnership
Project LEAN
California Active Living Program
Breast and cervical cancer screening for underserved women
California Tobacco Control Program
Conduct a statewide assessment of surgical
g
adverse events
Investigate the feasibility of developing “Community Paramedicine”
Manage the California Health Information Exchange Development Program
Conduct various population health research programs
 Use of the OncotypeDx Genetic Assay in Medi-Cal
Medi Cal Beneficiaries with Breast Cancer
 Evaluation of Opiate Overdose Prevention Policies (in collaboration with CHPR)
 Other
STATUS OF THE HIE IMPLEMENTATION
GRANT TRANSITION TO IPHI
6
Transition of the HIE Implementation Grant
 CHHS announces intent to award HIE implementation
p
g
grant
to IPHI on May 16, 2012
 IPHI/UCDHS-CHHS Interagency Agreement fully executed
on September
p
12, 2012, and IPHI launches California
Health eQuality (CHeQ) Program
 Relocation and transfer of staff completed
 Most staff now based in Sacramento
 8 of 11 positions filled; recruitment underway for 3
 Website launched and information transfer from CeC
completed (http://www.ucdmc.ucdavis.edu/iphi/Programs/cheq/)
 Program
P
review
i
b
by B
Booz All
Allen completed
l t d
 Organizational management consultant retained to review
administrative structure and processes
 CHeQ Advisory Committee appointed
 Additional stakeholder infrastructure being developed
 Relationships
p with other university
yp
programs
g
being
g explored
p
CHeQ Advisory Committee








Tom Williams,
T
Willi
IIntegrated
t
t dH
Health
lth A
Associates
i t
Jim Crawford, Kaiser Permanente
Mary Gatter,
Gatter Planned Parenthood
Parenthood-Los
Los Angeles
Bill Beighe, Physicians Medical Group of Santa Cruz County
Sajid
Saj
d Ahmed,
ed, LA Care
Ca e
Ellen Wu, California Pan Ethnic Health Network
Mark Savage, Consumers Union
Linette Scott (Ex Officio), California Department of Health
Care Services
 Pam Lane (Ex
(E Officio),
Officio) California Health and H
Human
man
Services Agency
 2 others TBN
SELECTED RECENT MILESTONES
9
HIE Infrastructure Awards
Initiative
HealthShare
Bay Area
Inland Empire HIE
Counties Served
Alameda, San Francisco, & Contra Costa
Riverside &
San Bernardino
OCPRHIO
Orange County
Redwood MedNet
Humboldt, Lake, Mendocino, Sonoma Napa
Sonoma, Napa, & Marin
Award
Not to Exceed
Project Focus
$490,000
Build initial infrastructure to create an amalgamated MPI which will enable exchange of electronic lab results, patient care summaries, and other transfer‐of‐care documents; connect to enterprise HIOs; make lab and immunization reporting available to respective public health agencies.
$470,000
Connect IEHIE to three enterprise HIOs through Connect; develop Connect
IEHIE to three enterprise HIOs through Connect; develop
infrastructure to enable 300 new providers to exchange lab and radiology orders and results; enable these providers to connect to public health departments for immunization reporting and syndromic surveillance.
$217,000
Provide standard interfaces to the top 5 EHRs used by physicians in the REC into the HIE and onboard the 1,200 REC‐affiliated providers in Orange County who are using one of those EHR systems. Provide lab results from LabCorp and Quest to all OCPRHIO‐participating providers.
d
Obtain
b
HealtheWay eHealth Exchange
lh
lh
h
Certification.
f
$90,000
Enable providers to receive structured lab results from two hospitals and one outpatient laboratory operated by Sutter Health and enable providers to facilitate transitions of care between a tertiary care hospital operated by St. Joseph Health and safety net primary care clinics in Sonoma County.
HIE READY Buyers Guide
 Identifies
Id tifi interoperability
i t
bilit and
d iinterface
t f
ffeatures
t
th
thatt
support healthcare data interchange
 Promotes
o otes ttransparency
a spa e cy
 Will assist healthcare providers make informed
choices about EHR and HIO capabilities to support
HIE by allowing side
side-by-side
by side comparison of features
based on commonly accepted standards
 Being
g made available November 1,, 2012,, on IPHI’s
website
 Initial participants include 6 EHR vendors and 6 HIOs
 Will b
be updated
d d on a regular
l b
basis;
i iit iis a liliving
i
document
 IPHI/HIE READY does not endorse any product or
organization
Participation in Western States Consortium
 Western
W t
States
St t Consortium
C
ti
is
i an ONC-funded
ONC f d d ((via
i RTI)
partnership of 8 states (CA, OR, NV, AZ, NM, UT, AK
and HI)
 California and Oregon have reached agreement on
policies, standards, operational procedures and
technical services that create a trusted environment for
i t t t exchange
interstate
h
off health
h lth information
i f
ti
 Actual exchange of patient data is imminent
 Will expand to additional WSC partners in next phase
 Will also benefit intrastate HIOs, public health registries
and other state systems
 First (?) state-initiated
state initiated effort for scalable interstate
exchange of health information
Immunization Gateway Service Contract
 Provides for the delivery and configuration of an
Immunization Gateway Service to support public
h lth reporting
health
ti and
d a provider
id portal
t l and
d message
validation service to establish a web service-based
gateway to enable electronic transmission of
immunization records to California’s Immunization
Information System
 6 proposals received and evaluated
 Notice of intent to award contract to Scientific
Technologies Corporation posted October 25
25, 2012
SOME GUIDING PRINCIPLES AND
STRATEGIC PRIORITIES GOING
FORWARD
14
Guiding Principles and Strategic Priorities
 The
Th technology
t h l
and
d sociology
i l
off HIT is
i rapidly
idl
changing so we must continually question past
strategies
s
a eg es a
and
d tactics
ac cs a
and
d co
consider
s de whether
e e they
ey
continue to be appropriate in light of new
circumstances
 EHRs and HIE are tools, not outcomes; the focus
f
must be on better health outcomes measured by
the improved safety
safety, effectiveness
effectiveness, timeliness
timeliness,
patient-centeredness, efficiency and equity of
care
 Need more integration of HIE with other health
care reform and public health efforts (e.g.,
Medicare-Medicaid Dual Eligibles,
Eligibles DSRIP
Program, registries)
THE WORLD OF HIT IS RAPIDLY CHANGING
A Call for a National Summit on Information Management and Healthcare Quality Kenneth W. Kizer, MD, MPH
Medscape
p General Medicine │Posted: 03/13/2001
│
/ /
Over 40 years ago, a vision was born of a computerized patient record that would integrate data from all caregivers and all care sites to provide a continuous chronology of the patient's treatment and health status and that would allow
treatment and health status and that would allow instantaneous access to clinical, administrative, and financial information….. While technological issues remain to be resolved, the primary barriers to a national health information infrastructure are political ‐ ie, the lack of standards to govern such an infrastructure, the lack of broad‐based agreement among healthcare's many stakeholders of a system concept, and legal concerns about confidentiality and privacy
concerns about confidentiality and privacy…..
Therefore, the NQF, representing a broad cross‐section of the healthcare industry, calls for a high‐level National Summit on Information Management and Health Care Quality to be held in the nation's capital no later than July 2001. '
16
Guiding Principles and Strategic Priorities
 Build broad support and increase demand for HIE
 Develop a trusted environment for HIE
 Increase public and professional awareness through strategic
communications
 Increase HIE deployment
 Support growth of regional efforts
 Identify
y opportunities
pp
for leverage,
g , synergy
y gy and convergence
g
of
HIE between and among:




Public and private initiatives
Organizations
Local state and federal government
Local,
Funding streams
 Identify and support high impact opportunities
 Selected populations (e.g., Medicare-Medicaid
Medicare Medicaid dual
eligibles, VA-Medicare dual eligibles, foster children,
incarcerated persons)
 High impact conditions (e.g., cancer, stroke, diabetes)
 Settings of care (e.g., emergency care, primary care safety
net clinics)
UPCOMING DEVELOPMENTS
18
Upcoming Developments
 Western States Consortium Phase 1 goes live
 Cancer Uniform Reporting and Exchange System
(CURES) Initiative
 Initiation of a California HIE Ecosystem to nurture
i
innovation
ti and
d creativity
ti it and
d supportt d
deployment
l
t
activities
 Additional
Additi
l funding
f di opportunities
t iti
QUESTIONS
20