Improving Patient Care With
Health Information Exchange
Shannon Vogel
Texas Medical Association
Director, Health Information Technology
Tiffany Champagne
Director of Business Development
Greater Houston HealthConnect
Jim Langabeer, PhD
CEO
Greater Houston HealthConnect
CME
The TMA designates this educational activity for a
maximum of 1 AMA PRA Category 1 creditTM.
Physicians should only claim credit commensurate
with the extent of their participation in this activity.
This activity has been designated as 1 hour of ethics
and/or professional responsibility education.
CME
Please fill out your CME form!
White copy – TMA
Yellow copy – Keep for your records
Please fill out evaluation form – anonymously!
CME Disclosure
Policies and standards of the Texas Medical Association, the
Accreditation Council for Continuing Medical Education, and the
American Medical Association require that speakers and planners for
continuing medical education activities disclose any relevant
financial relationship they may have with commercial entities whose
products, devices or services may be discussed in the content of the
CME activity.
The content of this material does not relate to any product of a
commercial interest; therefore, there are no relevant financial
relationships to disclose.
Objectives
1. Define a health information exchange (HIE);
2. Describe ways a health information exchange can
enhance quality of care; and
3. Determine if a health information exchange meets
criteria to increase patient safety.
HITECH Act
The Health Information Technology for Economic
and Clinical Health (HITECH) Act has HIT
provisions.
HITECH Act – Texas Funding
• $38 million – regional extension centers
• $28.8 million – health information exchange
• $15 million – SHARP grant (Strategic Health IT
Advanced Research Projects)
• $5.4 million – HIT workforce education
• $4.5 million – Medicaid health IT planning
$91.7 million total
Texas in Context
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254 counties
268,581 square miles
773 miles east to west; 790 miles north to south
221x the size of Rhode Island (1.5 million residents)
25.7 million residents
25 metropolitan areas more than 100,000 residents;
four more than a million
• 40,000 direct patient care physicians
• 630 hospitals
What is an HIE?
HIE Defined
The secure electronic movement of health information
among treating physicians and other health care
providers and related organizations according to
national and state laws and nationally recognized
standards.
Benefits of HIE
• HIEs improve care coordination.
• Silos of information are broken.
• Authorized physicians and other providers have
access to patient information quickly and securely.
• It’s about having the right information at the right
time to enhance clinical decision making.
Benefits of HIE
• Information about your patient may include:
• Recent labs
• Current medications
• Radiology images
• Recent hospitalizations
Helps reduce duplicate
testing!
This is not always complete. The amount of information
available is as good as the number of health organizations
participating within the community.
Private Versus Public HIEs
• Private HIEs typically operate under the governance
of a single health care system.
• Public HIEs are usually community-based and
receive grant funding from sources such as the Office
of the National Coordinator.
Private Versus Public HIEs
• Twelve Texas public HIEs; the Texas Health and
Human Services Commission (HHSC) funds them
with support from the Texas Health Services
Authority (THSA)
• Multiple private HIEs through hospital systems
Public HIEs
• Texas public HIEs are in various stages
throughout the state.
• Texas received $28 million from the Office of
the National Coordinator for HIE infrastructure.
• HHSC and THSA oversees grants to regional
HIEs in Texas.
• Details about Texas HIEs available at
http://hietexas.org/.
Public HIEs in Texas www.hietexas.org
HIE Participation
Ideally physicians should use an electronic health record
(EHR), but physicians do not have to have an EHR to
participate in an HIE.
Internet access is necessary!
HIE Models
• Centralized — Patient information is stored in a
centralized database.
• Federated (decentralized) — Patient information is
gathered from sources upon a query but not stored
anywhere centrally.
• Hybrid — Some data is stored, and some is not.
Protecting the Patient
• Four consent models exist for patient information:
• Opt-in: Every patient is out of the HIE unless the patient
indicates wanting in — affirmative authorization needed.
• Opt-in with restrictions: allows patients to agree to make all
or some data available.
• Opt-out (no-consent): A predetermined set of data is
automatically included in the HIE, but any patient may opt
out of participation.
• Opt-out with exceptions: allows protected health information
(PHI) to be included but may exclude some data. This is
sometimes referred to as data segmentation.
Protecting the Patient
• HIPAA does authorize a physician to share
information directly for purposes of:
• Treatment
• Payment
• Health care operations
• If the HIE model is at any time to monetize the data
or use it for any other reason than stated above,
patient consent (authorization) is required!
Secondary Use of PHI
• Secondary use of PHI may include:
• Medical research
• Public health surveillance
• Compilation for registry use
• Marketing
Protecting the Patient
• There is a delicate balance between the physician
having all information, and the patient’s right to
determine what information is shared.
• Notice the source of the information.
• Information received from the HIE should be verified
with the patient.
HIE Governance
• Important for physicians to be involved in HIE
governance
• Public HIEs are required to have multi-stakeholder
boards. Find out who the physician representatives
are and become involved!
• Attend meetings if possible. Ask questions!
• Private HIEs may not have multi-stakeholder boards.
HIE Sustainability
• There are various models for HIE sustainability.
• Grants (limited)
• Taxpayer (not likely in Texas)
• Subscription fees
• Transaction fees
• Payer participation
• Many times determined by who directly benefits
from HIE information
HIE Sustainability
• There may also be start-up fees.
• Physicians should inquire about HIE sustainability
plans.
• What happens to patient data if the HIE closes?
Information Sharing
• It is important to know what information will be
shared from your EHR and how it will be shared.
• When receiving the information from the HIE, will it
go directly into the EHR? Is it a PDF? This may
depend on the EHR specifically.
• Know which hospitals and labs are participating.
White Space
• Counties where HIEs do
not exist are considered
white space.
• THSA qualified five
health information
service providers to
provide basic
connectivity.
White space
• Direct email, which is secure, encrypted, and
HIPAA-compliant, is used to directly connect
physicians.
• Computer with Internet access required
• No long-term contracts
• Allows physicians to achieve meaningful use
White Space
• Physicians practicing in white space counties are
eligible to participate in a voucher program that covers
initial connection fees.
• More information about white space and the voucher
program is available at www.hietexas.org/white-space.
Intelligence is the ability to increase efficiency;
Wisdom is the ability to increase effectiveness.
— R.L. Ackoff
HIEs in Texas
Country road or
super highway?
Thank you!
CONTACT INFORMATION
Shannon Vogel
Director, Health Information Technology
401 West 15th Street
Austin, Texas 78701-1680
(800) 880-1300, ext. 1411
shannon.vogel@texmed.org
www.texmed.org
Jefferson County Medical Society
Jim Langabeer, PhD
CEO
Tiffany Champagne, PhD ABD
Director of Business Development
August 21, 2013
What is an HIE?
A health information exchange moves patient information
electronically among physician offices, hospitals and other health
professionals directly involved in a patient's care, such as
pharmacies and labs.
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Our Geographic Reach
 Southeast Texas region represents nearly 25% of the entire
Texas population
 6.9 million population
 14,000 physicians
 1,402 pharmacies
 133 hospitals of all types
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Southeast Texas Trading Partners
• Harris County (Ben Taub)
• Texas Children’s Hospital
• Methodist Hospital
• MD Anderson CC
• CHRISTUS
• Kelsey-Seybold
• Houston Fire/EMS
• Baptist Hospital
• Beaumont Family Eye
• CHRISTUS (St. Elizabeth,
St. Mary, Jasper Memorial)
• Legacy Health
• SETMA
• Med Center of SE TX
• SE TX ENT
• Advanced
Cardiovascular
• UTMB
• Galveston County
Health District
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Go-Live Timeline
CHRISTUS Health:
-St. Mary
-St. John
-St. Catherine
-Jasper Memorial
-St. Elizabeth
2013
April
Legacy
Community
Health Services
SETMA
SE Texas ENT
SW OBGYN
Beaumont Family
Eye
UTMB Galveston
MHMRA – Houston
The Methodist
Texas Children’s Hospital Hospital System
Quest Labs
Houston
Medical
Imaging
June
August
October
Baptist
Hospital
System
December
2014
Kelsey – Seybold Clinic
Spring Branch CHC
Good Neighbor HC
Harris Health
Galveston Co. EMS
Houston Fire Department
February
Technical Model
A secure “pipeline” between providers that allows certain
patient information to be securely accessed electronically by
authorized physicians and providers.
 Opt-In Model: Every patient is out of the HIE until they
express affirmative authorization.
 Federated (decentralized): Patient information is gathered
from source areas upon a query but not stored centrally.
 Access limited to purposes of treatment, payment, and
operations (TPO).
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Board Members

Greg Bernica– CEO, Harris County
Medical Society

Ruthanne Mefford – Executive Director,
Child Advocates of Fort Bend

Marc Boom, M.D – CEO, The Methodist
Hospital System

Osama Mikhail, Ph.D. – Senior VP,
University of Texas Health Science Center

Chris Born – CEO, Texas Children's
Health Plan

Ivo Nelson – Founder and former Chair,
Encore Health Resources

George Conklin – CIO, CHRISTUS Health


Paul Frison – Exec Vice Chairman,
Houston Technology Center
Lamar Pritchard, Ph.D. – Dean,
University of Houston College of
Pharmacy

William Gilmer, M.D. – Neurologist,
private practice


Bernard Harris, Jr., M.D.- CEO, Vesalius
Ventures
Ben Raimer, M.D. – Senior VP,
University of Texas Medical Branch at
Galveston


Gilbert Herrera – CEO, Herrera Partners
Tim Tindle– Executive Vice President
and Chief Information Officer, Harris
Health System

Michael Jhin – Former CEO, St. Luke’s
Episcopal Health System

Mark Toups, M.D. – Physician executive,
CHRISTUS Health- Beaumont

Kelly B. Lobley, M.D.– Co-Managing
Physician for Clinical Information
Technology, Kelsey-Seybold Clinic

Umesh Verma– CEO, Blue Lance

Chris McKee– AVP for Business Affairs,
MD Anderson Cancer Center
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Sharing
Clinical Information
• Patient Demographics
• Encounters
• Alerts
• History and Physical
• Advanced Directives
• Problems
• Procedures
• Providers
• Medications
• Hospital Discharge Summary
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• Vitals
• Plan of Care
• Lab Result Data
• Images and Scans
Demonstration
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Thank you
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