IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
David L. Johnson
BioCrossroads President and CEO
CTSI Annual Meeting
April 19, 2010
www.biocrossroads.com
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
CLINICAL INFORMATION DRIVES INNOVATION
The Indiana CTSI spans and strengthens health information technology
(HIT) as a national research center and an Indiana signature strength
At the national level, the CTSI Program is premised on the importance of
electronic communication of clinical information to advance outcomes and drive
research
•
“Bioinformatics is the cornerstone of communication within the [CTSIs] and with all
collaborating organizations… To facilitate the conduct of research in health care
settings and to transfer research findings into routine care, clinical and translational
research must employ applicable standards adopted by the HHS for use in U.S. health
care and public health operations.” (U.S. Department of Health and Human Services,
RFA for Institutional Clinical and Translational Science Award, March 22, 2007, p. 8)
HIT research is inherently translational anyway
•
Constantly seeks to produce, transmit, aggregate and analyze more and higher quality
clinical data for better and higher quality health care delivery and health outcomes
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
CLINICAL INFORMATION DRIVES INNOVATION
The IUSM-led consortium won Indiana’s CTSI based, in significant
measure, on Indiana’s unique strengths in developing HIT assets and
applications
•
•
•
•
The Regenstrief Institute (and the Indiana Health Information Exchange)
The Regenstrief Center for Healthcare Engineering
The IU School of Informatics
Specific proposed HIT-driven collaborations with Eli Lilly and Company (disease
modeling/personalized medicine) and WellPoint (drug safety and health outcomes)
The CTSI is now perfectly positioned to provide and sponsor the
continuing, collaborative research components essential to advance the
“meaningful use” of HIT throughout the Indiana healthcare system and
across the United States
•
•
Tailored research on HIT standards, interoperability and quality measures
Focal point for receiving federal grant funds and coordinating significant programs in
comparative effectiveness and clinical effectiveness research (CER)
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
BioCrossroads: WE’RE REALLY IN THIS FOR THE DATA
From the beginning, BioCrossroads has promoted strong
collaborations that bring the promise of better data to healthcare
delivery – and discovery
•
BioCrossroads is Indiana’s initiative to build on our healthcare and life
sciences strengths. HIT is one of our very best Indiana assets.
•
BioCrossroads drove the structuring and formation of the Indiana Health
Information Exchange in 2004, drawing upon the research strengths of the
Regenstrief Institute to aggregate and analyze and transmit privacy
protected patient information through the development of one of the nation’s
largest and most successful regional health information networks.
•
BioCrossroads coordinated the structuring and formation of the Fairbanks
Institute for Healthy Communities in 2006, developing a multi-therapeutic
platform for longitudinal studies pairing rich clinical information with clinical
samples to achieve better health outcomes for communities like Indianapolis.
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
BioCrossroads: WE’RE REALLY IN THIS FOR THE DATA
•
BioCrosroads worked closely with the IU School of Medicine, the Regenstrief
Institute, Indiana University and Purdue University in pursuing the CTSI
award in 2008 and in promoting the specific CTSI health outcomes
collaborations with our members, Lilly and WellPoint.
•
BioCrossroads continues to work closely today with the State of Indiana, our
statewide regional health information organizations (including IHIE), IU,
Purdue, the Regenstrief Institute and the Regenstrief Center for Healthcare
Engineering and Ivy Tech in assisting with the structuring, formation and
submission of grant proposals for ARRA funding that have so far brought
over $33 million to Indiana and our HIT sector.
•
Better data will benefit all of our stakeholders (e.g., Lilly, Cook, Roche,
Clarian, Covance, Medco, WellPoint) as well as our start ups.
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Indiana is truly a national leader in HIT
State’s Robust and Advanced Network Preceded Federal Reform Efforts
• 5 Health Information Exchange Organizations (HIOs) in Indiana
– IHIE (Central), MedWeb/MIE (Northeast), MHIN (North Central),
HealthLINC (Southwest), HealthBridge (Southeast)
– Different but complementary structures, markets and models
– Together, these HIOs cover and connect 45 hospitals, 40 outreach
laboratories,12,000 physicians and 12 million patient records and
generate over 6.3 million monthly results.
• These HIOs are innovative enterprises on the frontier of HIT service and
software development
• The network is powered by Indiana’s premier research institutions
– The Regenstrief Institute is the largest and most comprehensive
medical informatics laboratory in the world
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
The Indiana landscape is conducive to
achieving necessary, early success as we move to a national
system flowing health information securely from coast to coast
•
Indianapolis-based hospital systems are already freely exchanging data
among one another (currently expanding across other communities
throughout the state)
–
•
The Indiana network has also achieved effective interstate exchange of
data.
–
•
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Indiana’s medical malpractice environment allows hospitals and physicians to securely share
data more readily than most states
HIOs in Indiana are now exchanging messages with Kentucky, Michigan and Ohio
Indiana’s privately funded collaborative model has enabled market
driven advancement toward adoption and interoperability
Regenstrief’s INPC repository holds promise for the types of data that
can be aggregated and analyzed to generate better health outcomes
–
The demographics of central Indiana’s population can provide valuable insight into therapies
for cardiovascular disease and metabolic disorders, as demonstrated by the work of
Regenstrief and the Indiana Health Study of the Fairbanks Institute for Healthy Communities
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Indiana has already built workable, regional HIE capabilities
with home-grown resources
Indiana HIE has received only 3% of federal
funding awards for HIT
$33.50
$84.30
$24.00
•
Indiana HIE was opportunistically
created, privately funded, AND IS
OPERATIONAL
•
Prior to any federal funding, Indiana’s
5 HIOs have collectively invested over
$52 million in innovation and
implementation of HIE infrastructure and
services.
$38.90
$101.20
$638.15
$42.20
Indiana
New York
Massachusetts
Illinois
California
Texas
All Others
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
IHIT Board
Governance
Advisory Committees
Indiana Health Information Technology, Inc. (IHIT)
(CEO/ State HIT Coordinator)
HHS/ONC
Implementation Funding
Philanthropy
The result is a rapidly growing – and
highly promising -- Indiana HIE
network
$
Adm & Contracting
Coordination, Contracting,
Policy, & Certification
Public Health
As needed for
meaningful use (TBD)
Policy & Standards
Committee
2. Regional HIE
interconnectivity
forming the Indiana
Health Information
Network
HIE Operations
FSSA
Medicaid
Audit, Cert., &
Licensing Committee
Loan Program
MHIN
Med Web
3. Expansion to
underserved areas
$
Hospital
IHIE
Clinical
Reporting
HealthLinc
ADT
Healthbridge
Labs
Radiology
Pharmacy
$
Claims
Patient Care
$
1. Build-out of required
HIE capabilities and
services as needed
Payers
State
Indiana
Health
Information
Network
Regional Center
Program
Tech. Assist.
Provider Desktop
Office Applications
EHR
ePrescribing
Clinical Summary (CCD)
Hospitals and Physicians
$
$
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Even before the national healthcare debate began, the Federal
Government had already secured HIT-enabled “healthcare reform”
through ARRA stimulus funding
•
•
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ARRA is funding $35 billion in new programs advancing the development, adoption and
use of health information technology to deliver better healthcare for hospitals, doctors and
patients across the United States.
The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted
as part of the ARRA, promotes the adoption and meaningful use of health information
technology to:
– Develop electronic patient records, report test results, prescribe medicines, record
doctor visits, and
– Exchange clinical information among each provider of care for every patient.
Currently fewer than 20% of physicians and fewer than 10% of hospitals employ even
basic electronic health records for their practices and patients, but this will change…
– Incentives, and ultimately penalties, have been put in place to drive adoption and
meaningful use of electronic health records (EHRs)
• Eligible professionals will receive up to $44,000 over 5 years from Medicare or up to $63,750
over 6 years from Medicaid
• Hospitals are eligible for incentive payments from both Medicare and Medicaid
• Failure to achieve meaningful use brings reimbursement penalties, starting 2015
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
HIT enabled healthcare reform will improve healthcare quality, safety and efficiency
driving toward Meaningful Use* (MU) of HIT
2009
2011
2013
2015
Meaningful Use Criteria
HIT Enabled Health Reform
HITECH
Policies
2011 MU Criteria
Electronically capture
health information in a
coded format; using that
information to track key
clinical conditions and
communicating that
information for care
coordination purposes
2013 MU Criteria
Encourage the use of
health IT for continuous
quality improvement at the
point of care and the
exchange of information in
the most structured format
possible
2015 MU Criteria
Promote improvement in
quality, safety and efficiency,
focusing on decision support for
national high priority conditions,
patient access to self
management tools, access to
comprehensive patient data
and improving population health
11
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Achieving “meaningful use” will require significant public and private resources
Current HITECH funding is the federal down payment for HIT & HIE infrastructure
Funding for Health Information Exchange
$564 million for Statewide HIE Development
•
States receive between $4 and $40 million
•
Indiana received $10.3 million on 3/15/10
$220 million for Beacon Community Program
•
15 HIEs to receive between $10 and $20 million
•
IHIE and Memorial Hospital (MHIN) each applied
from Indiana
•
300 applications were submitted nationwide
•
IHIE awaiting announcement
Incentives for Adoption
New Medicare & Medicaid payment incentives
for HIT adoption
•
$23 billion in expected payments from
Medicare
to hospitals & practitioners thru 2016
•
$21 billion in expected payments from
Medicaid
through 2021
•
~$44 billion expected outlays
Community Health Centers
Funding for Health Information Technology
$1.2 billion for loans, grants & technical assistance for:
•
Regional Extension Centers ($640M)
•
Purdue awarded $12M
•
Workforce Training ($80M)
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Ivy Tech awarded $5M (HIT training)
•
IPIC awarded $4.8M (Healthcare training)
•
University Based Workforce Training Programs
•
Indiana University awarded $1.4M
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Research
•
Regenstrief awaiting announcement
•
HER State Loan Fund (pending)
$1.5 billion in grants through HRSA for
construction, renovation and equipment,
including acquisition of HIT systems
Broadband and Telehealth
$4.3 billion for broadband & $2.5 billion
For distance learning / telehealth grants
12
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Indiana’s HIT strengths give us a head start in achieving meaningful use
U.S. HIT Implementation Readiness: Landscape as of December 2008
Source: www.slhie.org
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Indiana’s opening advantages in competing for federal funds
Indiana has:
• meaningful data exchange across health provider networks with minimal investment (e.g.
IHIE and HealthBridge)
• a medical malpractice environment (tort reform) that is physician-favorable and allows
hospitals to share data
• a cooperative environment among exchanges working collaboratively to meet meaningful use
• invested millions of private and philanthropic dollars toward a workable, revenue sustained
system already utilized by providers and physicians
VS. Other National Models
California has:
• multiple parties competing to lead the state’s program to implement federal grant funding
• not achieved meaningful data exchange across networks
• invested billions of dollars in systems that are not self-sustaining
Massachusetts (and Boston) have:
• robust electronic health records in siloed systems that to date have been neither
interoperable nor accessible among hospital systems
• competition for patients and substantial privacy concerns that have inhibited data sharing
between hospital systems
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Indiana’s HITECH Funding for HIT and HIE Efforts
to date = $33.5 million
Funding for Health Information Exchange
State Health Information Exchange Cooperative Agreement Program
•
•
Indiana Health Information Technology Inc. has been established by the Governor to
serve as a governance and contracting structure for extending health information
technology exchange capabilities to every corner of the state
Indiana Health Information Technology Inc. awarded $10.3 million on March 15.
Funding for Health Information Technology
Beacon Community Program
•
Indiana Health Information Exchange (IHIE) awaiting award
Regional extension center for health information technology
•
$12 million awarded to Purdue
Job training and educational/university grants
•
•
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$5 million awarded to Ivy Tech
$4.8 million awarded to Indianapolis Private Industry Council
$1.4 million awarded to Indiana University
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Expansion projects have been identified and coordinated among Indiana’s
stakeholders to further interoperability and meaningful use
1.
2.
3.
4.
5.
6.
7.
Foundational Projects
Statewide Provider Directory
Nomenclature Normalization
Clinical Message Routing
Electronic Results Delivery
Computerized Order Entry
Patient Health Record Integration
Data Source Connectivity
Infrastructure Proj. & Use Cases
1. Central Repository
2. Quality Reporting
3. Public Health Reporting
4. Clinical Summary Capability
5. Providing a Medicine List
6. Patient Identity Matching
7. ePrescribing Application Provision
8. Results Discovery/Query
9. ePrescribing Transaction Hub
16
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
THE OPPORTUNITY
Models achieving early success will be positioned to attract
significant additional resources
•
ARRA and the healthcare reform act have demonstrated the federal
government’s resolve for rapid implementation of systematic change
– The prior market driven models of opportunistic (and occasional) HIT and HIE
development have been surmounted by the ARRA mandate to create a national
health information framework that must be deeply adopted, widely interoperable,
and eventually self-sustained
•
Initial funding has been directed broadly to develop “a level playing field” for
HIT and HIE capabilities over 50 state “laboratories”
•
But state and regional models that are replicable and scalable will be
rewarded with increased opportunity and funding
•
Ultimately, widespread adoption, interoperability and meaningful use will
likely be achieved by the selective scaling and deployment of the best and
most successful models in multiple markets
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
THE VISION FOR OUR MODEL
Indiana’s Proposed HIE Network Service Structure
Electronic HIE Services
• Clinical Summary Exchange for Care
Coordination & Patient Engagement
• Discrete Data Provision for CDS & PM
• Clinical Lab Ordering/Results Delivery
• ePrescribing and Refill Requests
• Rx Fill Status/Medication Fill History
• Eligibility and Claims Transactions
• Quality Reporting
• Public Health Reporting
Data Services Users
Health Care Providers
Health Information
Exchange Organizations
Central
Repository*
Future?
HealthBridge
Others
Pharma
Physicians
Community
Health
Centers
Message/
Data Routing
MHIN
CROs
Provider
Directory
HealthLINC
Patient
Directory
Patient
Directory
Clinical
Laboratories
Health PlansCase
Management
Med Web
Others
Patients
Hospitals
Payers
Pharmacy
IHIE
Radiology
Medicare
GovernmentPublic Health
*For:
CDS- Clinical Decision Support
PM- Population Management
MedicaidCase Management
CTSI – Research
Universities
GovernmentQuality Reporting
18
Secure Health
Information
“Pipeline”
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
THE CHALLENGES
Our opportunities to succeed and remain a leader in HIT are
tremendous, but challenges remain
Historic challenge:
•
Although we have a group of the nation’s largest and longest-running HIOs,
optimal connections among the HIOs have been limited and exchanges were
not progressing toward interoperability until recently
Over the past year, Indiana’s collaborative
efforts have identified solutions to solve this
problem, but adoption and implementation
challenges remain on the horizon…
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Adoption and Implementation Challenges
•
Physician resistance to adoption
–
Real and perceived costs of implementation may not outweigh the incentives for
adoption
•
Questions abound on the credibility of threatened reductions in Medicare
reimbursement rates
•
Privacy concerns may inhibit access to repository data that will unlock the
true potential of better information for reducing costs and increasing quality of
healthcare
•
Are personal EHRs the future of healthcare or a distraction?
–
Data ownership at the patient level or system level could enable -- or inhibit -- true meaningful
use of data
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
Despite challenges, recent business developments show
the early promise of HIT application in new settings
Drug-safety monitoring
•
Pfizer’s recently announced Aster (adverse drug event spontaneous triggered event
reporting) project aimed at making reporting easier and obtaining better data more
likely
Product registries
•
The Kaiser Permanente National Total Joint Replacement Registry (TJRR) is a national
level database designed as a post-market surveillance system for elective total hip and
knee replacement. It has resulted in a successful identification, monitoring, and
notification of a hip implant recall as well as identification of patient risk factors for
postoperative complications and hospital readmissions, leading to significant changes
in surgical indications and preoperative care
Public Health Alerts
•
The Indiana Public Health Emergency Surveillance System now pushes electronic
public health alerts to providers in its network during health crises such as H1N1
IndianaCTSI
ACCELERATING CLINICAL AND
TRANSLATIONAL RESEARCH
Indiana Clinical and Translational Sciences Institute
www.indianactsi.org
BETTER HEALTH INFORMATION = BETTER LIFE SCIENCES
Success for Indiana HIT and HIE can put all of Indiana’s life
science stakeholders at a competitive advantage
• A centralized repository to study health outcomes
and collect post-market data holds tremendous
potential to:
– Increase the efficiency of clinical development
– Increase the safety of products reaching patients
– Track clinical outcomes
– Conduct post-market evaluation of new therapies
– Provide quality reporting to payers and providers
– Enhance translational research capabilities
– Reward innovation