Nov 2011Lyman Dennis

Organizer & Facilitator

What is Health Information Exchange?Exchange of clinical (and administrative)

information among unaffiliated providersPush data point-to-point called “clinical

messaging”Starter approach; will always work but more

complex as add more participating providersOptions

1.Direct provider-to-provider exchange2.Provider-to-central HIE; HIE to relevant

providers

Hospital

Hospital Hospital

Doctors Office

Doctors Office

Doctors Office

Dental OfficeDental Office Dental Office

Urgent Care

Urgent Care

Urgent Care

Speciality Surgery

Speciality Surgery

Insurance

Pharmacy Pharmacy

HIE

HIE PlayersCal eConnect – State-designated entityActive HIEs (e.g.s)

Standalone HIEs Santa Cruz HIE Western Health Information Network Redwood MedNet Orange County Partnership… (OCPRHIO)

Vertical HIEs Kaiser VA John Muir Sutter Health CHW Partnership HealthPlan of California

Startups

Meaningful Use for IncentivesStage 1

EHRBasic exchangeLimited number of clinical measures

Stage 2, Stage 3Use of EHR features for more patients (to 50% to 90%)Menu items become core itemsElectronic medication administration Chemotherapy automationRecord patient communication preferencesJudge clinician performance based on patient adoption

of PHRsLongitudinal care planningPublic health enhancements

Cal eConnect – Current PlanFocus on what is important to the

stakeholdersFocus on what is needed to sustain

the grant funding from ONC and the State:Provide an ability for ePrescribingReceipt of structured lab resultsSharing patient care summaries

Enabling data sharing through Direct and emphasizing importance of and reliance on local HIEs

Cal eConnect Strategic & Operational Framework

Gov

erna

nce

¹

Technical Assistance²

¹ Policy, Leadership, & Barrier Removal² Expert support to select or develop solutions to problems³ Conserving scarce resources and making big impacts

Coordination³

ONC & CHHS PrioritiesEstablish Trust EnvironmentRobust Support for Ancillary Services

Public HealthCommunity PharmaciesCommunity Diagnostic

LaboratoriesCoordinate, Monitor,& Report on HIE Landscape

Sustainable HIE in California

InteroperabilityStates’ Vendors’ EHR/HIE Interoperability

Project– Increase the value of the individual EHR systems

by assuring integration with HIE providers– Create a set of interoperable implementation

specifications not unlike what IHE has developed for the Interoperability showcase

– Leverage the power of a consortium of states to influence vendors to adopt the reference implementations (1/3 to ½ of the US population)

– Encourage vendors to provide these standard interfaces “out-of-the-box” for all installs

– Encourage other states and vendors to adopt the reference implementations

Multi State/Vendor Collaborative

• Allscripts• eClinicalWorks• eMDs• Greenway• McKesson• NextGen• Sage• Siemens

States• California• New York• Maryland• Massachusetts• New Jersey• Ohio• Oregon• Delaware• Colorado

EHR Vendors

HIE Vendors• Medicity• Axolotl• InterSystems • • Cerner

New States• Arizona• Florida• Virginia • Maine• Texas

New HIE Vendors

AccomplishmentsAugust: Data and Metadata Workgroup completed

work on the C32 specifications to create a fully defined and constrained implementation specification.

September: Push Workgroup completed work on a robust specification for implementation of NwHIN Direct using SMTP s/MIME or SOAP/HPD+ with Directory Services.

September: C32 specification fully aligned with Beacons and ONC S&I efforts.

October: Pull Workgroup completed a constrained implementation specification for NwHIN Connect using XCPD and an optional state-wide MPI.

In Process: Alignment of the States’ Interop work with ONC – ONC statement of support imminent. Pilots being sought.

Privacy & SecurityPrivacy & Security Advisory Board and CalOHII

have led the State in development of guidelines. PSAB Eliminated by Gov Brown Exec Order.

Regulations now in their second draft out for public comment and input:http://www.ohi.ca.gov/calohi/

Committees:Privacy Committee: Focused on consent and use of

datahttp://www.ohi.ca.gov/calohi/eHealthPolicy/PrivacySteeringTeam.aspx

Security Committee: Focused on securing the datahttp://www.ohi.ca.gov/calohi/eHealthPolicy/SecuritySteeringTeam.aspx

Privacy & SecurityCal eConnect Committees:

Policy Advisory Group: Focused on policies governing the use of Cal eConnect funded services. The goal is to build and leverage HIE policy based on evidence and supported by consensus.

http://www.caleconnect.org/?page_id=525Technology Advisory Group: Provides a

neutral forum for adoption and/or establishment of standards-based approaches to technical operations for those organizations that wish to participate in Cal eConnect services.

http://www.caleconnect.org/?page_id=527