HIE Organizations and Accountability

NHIN-HISPC-SLHIE Joint Conference

Rachel Block - Lammot du Pont
Christopher Sullivan
Lynn Dierker

Agenda

Background
- Context for considering HIE organizational accountability
Research
- Studying models and options
Issues in defining organizational accountabilities
- Readiness, timelines
- Incentives – "market demand"
- Roles and effective models for constituents e.g., government, HIEs
- Linking national and state-level strategies e.g., legislation, NHIN requirements, AHIC
State-level activities

Background

Steering Committee deliberations
Rationale for more formal definition of organizational accountabilities
- Clarifying stakeholder expectations (roles and functions)
- Preparing for broad connectivity (NHIN)

"Governance" vs Government

State-level HIE "governance"
- Convene diverse statewide stakeholders
- Lead and coordinate consensus-based efforts
  - The statewide roadmap for interoperability (strategies, relationships, timelines for the particular characteristics of a statewide landscape)
  - The policies, procedures and practices related to data use, access, and control; privacy and security.

State-level HIE governance entity
- Sits between state government and the health care sector
  - Any configuration of HIE networks or RHIOs, agencies, and relevant medical trading areas
- Mission to facilitate compliance across diverse interests and organizations
  - Prevailing laws and regulations and sound data management practices
- Neutral and skilled resource serving all stakeholders

Accountability Framework

New York

The following slides are from "New York e-Health Collaborative, RHIO Accreditation Research Project."

RHIO Accreditation Research Project

Project Overview

Assumptions and Hypotheses

NYSDOH has committed over $150 million to develop a statewide health information network (SHIN-NY).

Success of SHIN-NY depends upon RHIOs' ability to:
- ensure consistency with State privacy & security policies
- provide set of core services
- conform with data exchange standards

For RHIOs to become trusted stewards, stakeholders need assurance that RHIOs have the necessary characteristics and capabilities to perform required services.

Analytic Framework

RHIO – Core Components

Graphic consists of a series of rectangular boxes on the left that appear in a vertical column; each box is connected with an oval containing text to its right. Text in the first box reads Nature of participants. Text in the oval to the right reads Multi-stakeholder & all consumers. Text in the second box reads Governance. Text in the oval to the right reads Transparent policy framework, inclusive decision making process. Text in the third box reads Purpose of exchange/Mission. Text in the oval to the right reads Improve quality, safety, efficiency of care. Text in the fourth box reads Type of information exchanged. Text in the oval to the right reads Clinical data. Text in the fifth box reads How information is exchanged. Text in the oval to the right reads Protocols, standards and services via SHIN-NY. Text in the sixth box reads Scope of services. Text in the oval to the right reads Security, authentication, authorization, access, and auditing policies. Text in the last box reads Consumer access. Text in the oval to the right reads Provisions for ensuring consumer access to and control of data

Project Overview

Goals

Examine the applicability and feasibility of developing a process to evaluate regional health information organizations (RHIOs) in New York State.

Assess whether and how accreditation would help to establish RHIO performance measures.

Evaluate the timing of implementing an accreditation process and its potential impact on the evolution of the marketplace for RHIOs and health information exchange.

Participants

National and Local

Advisory Committee...National Experts
- Laura Adams, Rhode Island Quality Institute
- Kelly Cronin, HHS-Office of the National Coordinator for Health IT
- John Glaser, Partners Healthcare
- Linda Kloss, AHIMA
- Janet Marchibroda, eHealth Initiative
- Deven McGraw, National Partnership for Women & Families

Advisory Committee...New York Participants
- Rachel Block and Alex Low, NYeC
- Lori Evans, Keegan Bailey, New York State Department of Health
- Martin Hickey, Excellus BlueCross BlueShield
- Irene Koch, Brooklyn Health Information Exchange (BHIX)
- Ted Kremer, Greater Rochester RHIO (gRrhio)
- Art Levin, Center for Medical Consumers
- Barbara Radin, Bronx RHIO
- Carol Raphael, VNA-NY
- James Tallon, United Hospital Fund of New York

Project Overview

Data Gathering and Report Preparation

Phase 1: Background Research
Study applicable accreditation models and develop interview instruments to gather in-depth information

Phase 2: Field Research
Conduct ½ day interviews with four accreditation entities

Phase 3: White Paper
Develop report that defines prevailing accreditation models, addresses key considerations, identifies drawbacks and advantages and implications of various implementation approaches.

Project Overview

Timeline

Analytic Framework

Accreditation in Health Care

Health Care Accreditation Entities

Joint Commission…accredits hospitals
NCQA…accredits health plans
URAC…accredits utilization review organizations
EHNAC…accredits claims clearinghouses

Data Collected

Background…Origins, purpose, types of entities accredited

Market…Nature and size of market, who uses results of accreditation

Implementation…What are their processes, criteria, duration, and frequency

Funding Model…Who pays, how much, and when

Accountability Framework

Florida

The following slides are from "Florida Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis."

HISPC National Meeting, Dallas, TX - April 30 - May 2, 2008.

The Florida Health Information Network

A map of Florida is shown with 8 boxes that correspond to a legend with numbers 1-8 on the left. Lines from all the boxes go to a larger box containing the words FHIN Public Private Partnership with an icon of a computer. The legend contains the following text: 1. Big Bend Regional Healthcare Information Organization. 2. Central Florida Regional Healthcare Information Organization. 3. Community Health Informatics Organization. 4. North West Florida Regional Healthcare Information Organization. 5. Northeast Florida Health Information Consortium. 6. Palm Beach County Community Health Alliance. 7. South Florida Health Information Initiative. 8. Tampa Bay Regional Healthcare Information Organization. The 8 boxes are placed on the area of the state that corresponds to their location (e.g., number 7, South Florida, has a box labeled 7. Under the legend the following URL appears: ahca.myflorida.com/dhit. At the bottom of the screen, the following words appear: HISPC National Meeting, Dallas, TX - April 30 - May 2, 2008

FHIN Grants Program Funding RHIO Startup

The FHIN Grants Program began in 2005 to empower local stakeholder collaborations focused on health information exchange.
All grants funds are matched dollar for dollar at the local level, indicative of a tremendous level of local passion and volunteerism.
The FHIN Grants program funded Planning Grants, Operations Grants and Training Grants.

Funding the FHIN Grants Program

The Florida Legislature has funded RHIOs through the FHIN Grants Program since 2005:

$1.5 million in 2005
$2.0 million in 2006
$2.0 million in 2007
AHCA has requested $6.8 million for the FHIN Grants Program in 2008-2009 to leverage ongoing RHIO development.

FHIN Grants Program Funding, 2007-2008

Organization	Matching Funds	Grant Funding	Total Funding Impact
Department of Veterans' Affairs	$70,614	$70,614	$141,228
Big Bend Regional Healthcare Information Organization	$651,000	$249,750	$900,750
Duval County Health Department	$927,362	$406,944	$1,334,306
Florida Healthcare Coalition/Central Florida Regional Health Information Organization	$468,809	$200,000	$668,809
North West Florida Regional Health Information Organization	$420,000	$296,250	$716,250
Palm Beach County Community Health Alliance	$540,168	$200,000	$740,168
South Florida Health Information Initiative	$496,262	$284,924	$781,186
Tampa Bay Regional Research and Educational Foundation	$1,095,224	$246,618	$1,341,842
Palm Beach County Community Health Alliance - Florida Alliance of RHIOs	$50,927	$44,900	$95,827
	$4,720,366	$2,000,000	$6,720,365

Projected 2007-2008 RHIO Operational Metrics

No	Metrics Description	Actual 4Q 2007	Target 1Q 2008	Target 2Q 2008	TOTAL Targeted
1	Number of facilities authorized	48	27	54	97
2	Number facilities sharing data within the network	38	27	59	96
3a	Number of physician offices authorized	1,527	432	610	1,154
3b	Number of clinicians authorized	1,672	595	916	1,731
4	Number of patients participating	167,280	95,364	172,714	341,800
5	Number of queries to the network	13,079	32,250	50,848	95,348
6	Number of queries returning results	10,654	6,550	19,761	29,561

Projected 2007-2008 RHIO Operational Metrics

SUMMARY		Original Projected Target Metrics Totals From Proposal	October - December 2007 Due Date: January 10, 2008		January - March 2008 Due Date: April 10, 2008		April - June 2008 Due Date: July 10, 2008		FINAL CONTRACT TOTALS
No.	Metrics Description	Original Projected Target Metrics Totals From Proposal	Target	Actual	Target	Actual	Target	Actual	Target	Actual
1	Number of hospitals, clinics, or other facilities authorized to use the network (attach list)	128	16	48	39	54	68		123	102
2	Number of hospitals, clinics, or other facilities sharing data within the network (attach list)	81	10	104	36	20	70		116	124
3a	Number of physician offices authorized to use the network (attach list)	1,149	612	1,527	232	1,822	310		1,154	3,349
3b	Number of clinicians authorized to use network	1,735	720	1,672	1,095	2,001	816		2,631	3,673
4	Number of patients participating in the network	364,872	73,722	253,278	108,522	138,558	178,714		360,958	391,836
5	Number of queries to the network from facilities or physician offices	93,375	12,250	440,398	37,250	478,125	61,348		110,848	918,523
6	Number of queries from facilities or physician offices returning results	9,688	3,250	10,654	8,050	45,671	22,561		33,861	56,325

Vision for the Florida Health Information Network

The Florida Health Information Network vision proposes to integrate clinical health information exchange in Florida through a RHIO network architecture that will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients.

Christopher B. Sullivan, Ph.D.

Agency for Health Care Administration
Florida Center for Health Information
and Policy Analysis
2727 Mahan Drive
Tallahassee, FL 32308
sullivac@ahca.myflorida.com

NHIN-HISPC-SLHIE Joint Conference/May 1, 2008