Health Information Exchange 2014:
Connecting via Regional, State, and
National Efforts
The Children’s Hospital of Philadelphia’s Seventh Annual Mid-Atlantic
Healthcare Informatics Symposium on Friday, April 25, 2014
The Southeastern Pennsylvania
Story
HealthShare Exchange of Southeastern PA, Inc (HSX)
Martin Lupinetti, MBA
Jonathan Sternlieb, MD
Disclosure
• I, Martin Lupinetti,disclose that neither I
nor my partner have relevant financial
relationships with commercial interests.
• I, Jonathan Sternlieb, disclose that neither I
nor my partner have relevant financial
relationships with commercial interests.
Learning Objectives
• At the conclusion of this activity, the learner
should be better able to:
1. Understand HealthShare Exchange’s history and
unique model
2. Understand HSX present state
3. Understand HSX challenges and future goals
2013 – An Exciting First Year of HSX!!
• Governance, Board and HIO in Place!
• Secured Four-year Commitments by
37 Hospital Systems and Three Health
Plans Members!
• Three-time Grant Recipient!
HealthShare Exchange
Connectivity in 2013!
HSX Context:
Geography
The five-county region
represents the largest and
most densely populated
healthcare marketplace in
the Commonwealth:
•
32% of all consumers live
in the region
•
36% of all hospital
discharges in the State (PA
DOH FY2010 Hospital reports, all
hospital discharges (acute, specialty
and federal hospitals))
•
39% of Pennsylvanian’s
births occur in the region (PA
DoH report 2009)
•
42% of all Medicaid
admissions in the State (PHC4
County Utilization Reports for CY
2010)
“Enhanced” Direct
Use Case #1 - Discharge Information – Q3 ‘14
Enhanced by Payers Routing Intelligence.
Health Plan
IDs PCP/Care Team,
Routes to Care
Manager
Hospital
Provider
(eg PCPs, specialists,
home health)
Sends inpatient and ED
discharge information
Receives info via EHR,
email or via health plan
portal
Use Case #2 – Claims History – Q4’14
Enhanced by Payers Delivering Claims Data.
2. Provider requests
eligibility and clinical history
from Health Plan
1. Patient visits Provider
(hospital or practice)
5. Provider receives data
via EHR or secure email in
support of medication
reconciliation and treatment
3. Eligibility Request
triggers plan to request
medication history and
claims data
4. Information returned
via PDF or CCD which
can be consumed by
EHR
Health Plan
Claims Data
HSX and CDA
•
Primary currency for health information exchange
• Important for scalability at regional, state, national and international level
• Based on Extensible Markup Language (XML) - HL7 Version 3
• Leverages controlled terminologies
•
SNOMED-CT, Logical Observation Identifier Names and Codes (LOINC), RxNorm,
etc..
•
Facilitates Incremental Interoperability
• can begin with a simple CDA, can add structured data elements over time
• Level 1 (most simple) to Level 3 (completely machine readable)
•
Enables re-use of CDA templates & document types in multiple applications
• Supports re-use of clinical data for reporting (public health, quality measures,
registries)
• Healthcare Associated Infections (NHSN/CDC),
• Quality Data Reporting Architecture (QRDA)
• Cancer Reporting, etc…
•
Allows use of validation tools to test conformance [NIST]
http://xreg2.nist.gov/cda-validation/validation.html
HSX CCD Elements –
Discharge Info Use Case
Start Simple and Build Upon Approach
Crawl, Walk, Run…



DIRECT Messaging via HISP
Introduction of Query Based Exchange (HIE)
(Years 1 - 2)
(Years 3-4)
Introduction of DIRECT secure
messaging

Enablement of 2 use cases:

Discharge Information

Medication / Clinical History
Continued onboarding of HISP
services to HSX stakeholders

3-4 large health systems

8-10 community hospitals

Additional health plans

Introduction of robust HIE

Introduction of new HSX use cases
Onboarding of HSX stakeholders

4 large health systems

9 community hospitals

2-3 health plans
Identification of new healthcare stakeholders for participation in HSX
HSX State Alignment
HSX Technology Architecture – Direct Operations
HSX Core Services
PA Patient & Provider Network (P3N)*
Enhanced
DIRECT
Services
• Certificate Authority
• Health Entity Directory(Entity
and Provider Directory)
• State Direct Gateway Services
HSX Services Platform
HSX ENHANCED FEATURES
• Automated PCP Finder
• Automated Clinical Activity
History
Routing intelligence and claims
data to care team
CONNECTIVITY OPTIONS
Hospitals
FQHC
LTC
Behavioral
Health
Providers
Physician
Offices
Private HISP
Payers
IDNs
• WebMail
• Internal EHR inbox
• HISP to HISP
*RELEVANT P3N SERVICES
Long-term member opportunities
City Clinics
HSX Members
* Note: Members and external data sources are intended to representative and for illustrative purposes only.
They may not be inclusive of all HSX member types and external data partners.
• Statewide Provider Directory
• DIRECT-enabled State
Registries
HSX and State Alignment(continued)
HSXs role with the PA eHealth Partnership
Authority:
• Part of PA HIT Plan
• Represented on Authority Board
• Supports State Committees
• Supports P3N(PA Patient & Provider
Network)Services
IMPROVING YOUR CARE THROUGH THE
EXCHANGE OF HEALTH INFORMATION
Multi-State Exchange:
• PA and HSX Hosted a Multi-State Exchange Forum.
• NJ, PA, MD, DE, DC HIT Coordinator Offices and HIEs gathered to discuss
synergies.
• Future sessions planned in 2014/15.
Lessons Learned on Vendors’ Readiness**
•
•
•
•
EHR Certification and MU Stage 2 Readiness
Direct Enabled (XD, SMTP)
CCD and CDA Exchange Capability
Provider Directory Capability:
– HSX intends to provide a Federated PD Model (HPD+)
– Market Limitations and Inability of Vendors to Support HPD+, Results in HSX
Developing Interim Approach to Manage Directories.
**Only 13% of office-based physicians reported an intention to participate in the
EHR incentive program and had a system meeting 14 of the 17 Stage 2 core
objectives, according to a report released this week from the CDC's National
Center for Health Statistics (NCHS). The Gupta Guide, January 17th, 2014.
Key Challenges and points for
discussion….
• Aligning commitment and harmonization of
systems
• Standing up a unified and accurate healthcare
provider directory
• Integrate workflows and disparate systems
• How best to implement query along with Direct
• Use Case development governance
Thank You!
Contact Information:
Jonathan Sternlieb, M.D., F.A.C.G.
Chief Medical Information Officer
Holy Redeemer Health System
1602 Huntingdon Pike, 2nd Floor
Meadowbrook, PA 19046
Mobile 267-278-3239
jsternlieb@holyredeemer.com
Martin Lupinetti
Executive Director
HealthShare Exchange of Southeastern Pennsylvania, Inc.
1801 Market Street, Suite 750
Philadelphia, PA 19103
martin.lupinetti@hsxsepa.org
609.792.3896
www.hsxsepa.org