Medical Economics Data
May 09, 1994 [draft]
Author: Carol Sansone,
Business Development Manager

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Definition
Integrated collection of computer and telecommunications capabilities that facilitates communication of clinical and financial patient information among multiple providers, payers, employers, pharmacies, and related healthcare entities
Variables
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CHIN will live within a health plan
Ownership
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Number of participants
Transaction volume
Level of integration with other systems
Range of applications
Model of CHIN
ARCHITECTURE

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Transaction switching from station to station
Universal implementation of clinical communications linking hospitals and physicians
Payer communication offering electronic data interchange and insurance eligibility information
Creation of clinical information (virtual) repositories
Utilization of outcome database
ORGANZATION

Three Phases of CHIN Automation
 Electronic Ordering – Single Institution
 Electronic Medical Record – Multiple/Single
Institutions
 Lifetime Health Record/CHIN
 Development – Multiple Encounters/Multiple
Institutions

C
CLINTON’S HEALTHCARE INITIATIVES
 Cut the cost of healthcare administration.
 Govern healthcare administration simplification through
Federal regulation.
 Expressed interest in the CHIN marketplace by large
Hospital Information Systems (HIS) vendors.
 Drive outcome measurements through CHIN users
(payers, government, research/education, providers, patients, employees, accreditation agents/regulators).
 MARKET FORCES

PATIENT BENEFITS
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Reduce redundancy in forms, exams, tests
Facilitate continuity of care
Promote knowledgeable choice
Lower cost of care
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PROVIDER BENEFITS
 Improve quality of care
Reduce isolation of rural physicians
Reduce litigation exposure
Manage total cost of therapy
Build a competitive marketplace advantage

ENVISIONED CHIN BENEFITS
(CONT’D)
 Employer Benefits
 Evaluate plan benefit characteristics
 Compare provider performance
 Reduce costs of health benefits
 Improve employer/employee satisfaction with selected healthcare service options

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All participants will pay fees for installation, systems integration, transmission, maintenance, service charges such as flat fees, eligibility fees and transactions fees.
Current systems usually omit physician fees to encourage participation.
Longer term, physicians will be charged for incremental services.
The network is largely transparent to the patient, who pays nothing.

 Data and image transmission standardization
 Data standards are evolving
(HL7/IEEE/MEDIX)
 Industry imagery transmission standards are in their infancy stage of development

UNRESOLVED CHIN ISSUES
(CONT’D)
 Data ownership once (value-added) data is on the network
 Data access role within a local network
 Data security to both code and protect lifetime health records

Community Health Information
Network (CHIN)
1) AMERITECH/WHIN/AHC
(AMERITECH HEALTH CONNECTIONS, INC.)
 Area of Service
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7 hospitals with 750 physician users targeted
5 payers targeted for claims
5 billing services
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3 labs and 4 clinics interested
MILWAUKEE AREA WITH COMMUNITY
FOCUS

Community Health Information
Network (CHIN)
1)
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AMERITECH/WHIN/AHC
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Features
Open system architecture
Host systems include IBM, Tandem, HP,
DEC, and Unisys
User interface with Windows, so all data can be presented on one screen
ARCHITECTURE DESIGNED FOR
GROWTH

Community Health Information
Network (CHIN)
1)

AMERITECH/WHIN/AHC
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Analysis
User functionality includes both payer and provider clinical communications
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Specific applications include the following:
E-Mail
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Bulletin board
Deferred results
Integrated with practice-management systems
STRENGTHS

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1)
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Community Health Information
Network (CHIN)
AMERITECH/WHIN/AHC Future Applications
Insurance enrollment
Eligibility Verification
Claim payment notifications
Radiology images
Rx notification
Pre-admit
Good financial stability
Security through a card with microchip-encoded password/ID
STRENGTHS

Community Health Information
Network (CHIN)
1)
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AMERITECH/WHIN/AHC
Analysis
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Future applications (continued)
Scheduling inquiry
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Orders
Medical library
Credit histories
Insurance change notifications
Integrated community database
STRENGTHS

Community Health Information
Network (CHIN)
1)
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AMERITECH/WHIN/AHC
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Analysis
Limited payer functionality at present
Development of clinical database in early stage of development
Not fully proven line
 WEAKNESSES

Community Health Information
Network (CHIN)
1)
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AMERITECH/WHIN/AHC
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Analysis
How and when all interfaces will be accomplished
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Time to market concept
Proving cost-justification
Development of outcomes/utilization database
CHALLENGES

Community Health Information
Network (CHIN)
2)
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CHMIS/HARTFORD FOUNDATION
Test site in Memphis
Comprehensive design created by New
York based Benton International
(consultants)
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Features
User and payers ATM-style efficiency
 Not-for-profit John A. Hartford foundation

Community Health Information
Network (CHIN)
2)
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CHMIS/HARTFORD FOUNDATION
Analysis
Combine EDI/WEDI concept of electronic processing and transactional facilitation
Meeting shared information needs through communitycontrolled database
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Focus on community/cost/quality as goals
Straight-forward design
Ride the back of existing claims structure and build on an embedded base rather than a perfect system concept
 STRENGTHS
(WEDI/Workgroup Electronic Data Interchange)

Community Health Information
Network (CHIN)
2)
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CHMIS/HARTFORD FOUNDATION
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Analysis
Unproven
Database issues of security and confidentiality because of size
Focusing on claims and insurance rather than larger vision
 WEAKNESSES

Community Health Information
Network (CHIN)
2)
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CHMIS/HARTFORD FOUNDATION
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Analysis
Community support because of size
Operational complexity
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Time to market
System integration and interface issues
 CHALLENGES

Community Health Information
Network (CHIN)
3)
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INTEGRATED MEDICAL SYSTEMS, INC. (IMS)
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Area of Service
Approximately 22 networks are growing reaching more than 40 percent of Colorado hospitals.
First alpha site at St. Anthony, Denver
 EXPANSION THROUGH ACQUISITION
STRATEGY FOR NATIONAL COVERAGE

Community Health Information
Network (CHIN)
•
3) INTEGRATED MEDICAL SYSTEMS, INC. (IMS)
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Features
For-profit corporate venture
Batch system in the works for approximately 3 years
•
Mature clinical messaging capability
Transmits voice, data and image
Store and forward technology to send messages
ARCHITECTURE

Community Health Information
Network (CHIN)
•
3) INTEGRATED MEDICAL SYSTEMS, INC.
(IMS)
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Analysis
Proven capability
Simplicity of use
Low costs with batch interfaces means less worry about data loss
 STRENGTHS

Community Health Information
Network (CHIN)
•
3) INTEGRATED MEDICAL SYSTEMS, INC.
(IMS)
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Analysis
Limited payer capacity
Batch architectural design
Limited system integration
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Costs can be high depending on service and transaction volume
WEAKNESSES

Community Health Information
Network (CHIN)
•
3) INTEGRATED MEDICAL SYSTEMS, INC.
(IMS)
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Analysis
Transaction switch in development stage
Company growing rapidly so resources may be stretched
Clinical and outcomes databases planned for the future
CHALLENGES

Community Health Information
Network (CHIN)
•
4) SMS/HDX
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Area of Service
Community focus and open to all participants
Total view is national in scope
 CURRENTLY DIFFERENT STAGES OF
DEVELOPMENT IN OHIO, NEW
HAMPSHIRE, NEW YORK, AND
CALIFORNIA

Community Health Information
Network (CHIN)
•
4) SMS/HDX
•
Features
For-profit effort by subsidiary of major HIS system vendor with extensive client list nationwide
 ARCHITECTURE

Community Health Information
Network (CHIN)
•
4) SMS/HDX
•
Analysis
Extensive design with proven capability in payer-clinical communications
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Transaction switch scope to be expanded over 4 to 6 years
Includes new captive membership, utilization monitoring, payment settlement, and eventually, managed-care functionality
STRENGTHS

Community Health Information
Network (CHIN)
•
4) SMS/HDX
•
Analysis
Data processed from national center in
Malvern, PA, rather than regionally
•
• Not fully proven in concept
Database ownership issues exist for proprietary vendor
 WEAKNESSES

Community Health Information
Network (CHIN)
•
4) SMS/HDX
•
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Analysis
Developing clinical/outcomes database
Physicians want a range of functions
How proprietary vendors will interface to foreign systems
 CHALLENGES

Community Health Information
Network (CHIN)
•
5) UNITED HEALTHCARE
•
Area of Service
Minnesota is test site
 REGIONAL GEOGRAPHY

Community Health Information
Network (CHIN)
•
5) UNITED HEALTHCARE
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•
Features
Payer-focus called Providerlink
Sponsored by Minnesota-based managedcare company for EDI claims
 ARCHITECTURE

Community Health Information
Network (CHIN)
•
5) UNITED HEALTHCARE
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Analysis
Proven system processing more than 40 million claims from United’s 18 plans and more than 500 hospitals with 2 million vendors ?
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Architectural design is good for growth and flexibility
Users have flexibility in hardware and workstation devices
Substantial savings have been shown (more than $1 per claim)
STRENGTHS

Community Health Information
Network (CHIN)
•
5) UNITED HEALTHCARE
•
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Analysis
Limited clinical capability
Payer owned, so participation by others may be guarded
 WEAKNESSES

Community Health Information
Network (CHIN)
•
5) UNITED HEALTHCARE
•
Analysis
Not currently a database repository for clinical data
•
• Data ownership issues
Plan lab and results reporting
 CHALLENGES

Community Health Information
Network – Other Emerging Chins
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Inova Health Systems of Falls Church, VA
San Antonio Healthcare Partnership
NO/HIN in New Orleans
Henry Ford Health Alliance Plan in Southeastern Michigan
Metropolitan Chicago Healthcare Council
Praxis, based in Nashville
6 states now receive funding from the Hartford Foundation, with another 9 states applying in the coming months.
POPULATION SAMPLING OF CHIN(S) NATIONWIDE

Community Health Information
Network (CHIN)
 Topology Models
 STRATEGIC ALLIANCES
 INTEGRATION
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(demonstrate access points)
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(demonstrate linkages)

Community Health Information
Network (CHIN)
 B2B Linkages
 Banker,
 Hospital,
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Physician’s Office or
 Community Health Center
 Other Chins

Community Healthcare Information
Network (CHIN)
 B2B Applications
 Computerized Patient Record
 Case Management Results Reporting
Physician Direct Order Entry
 Alerts
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Nursing Documentation
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Physician Documentation

Community Health Information
Network (CHIN)
 B2B Applications (cont’d)
 Scheduling
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Patient Accounting
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Radiology
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Laboratory
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Cardiology
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Anesthesia
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Pharmacy
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Medical Records Abstracts

Community Health Information
Network (CHIN)
 B2B Applications (cont’d)
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Corporate Financials
Network
ADT
Interface Engine
E-mail/EDI
Imaging
Forms Automation
Master Patient Index

Community Health Information
Network (CHIN)
 What next!