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HIE, RHIOs and EHR Interoperability
The Journey to Meaningful Use, Interoperable Health
Care Delivery and Improved Quality of Care
Christina Galanis
Executive Director, Southern Tier HealthLink
From paper to meaningful use and beyond
Topics to be covered in this session
Understanding the landscape & terms: HIE and RHIO
Southern Tier HealthLink sources & services
RHIOs & Meaningful Use
Where is all this interoperability going?
How can REC can help you?
The Need for Health Information Exchange
Hospital
Laboratories
National
Laboratories
Hospital A
Hospital
Imaging
Imaging
Centers
Hospital B
Chain
Pharmacy
Independent
Pharmacy
Cardiologist
Orthopedist
Ambulatory
Surgery
Primary Care
Physician
Home
Health Care
Support
Southern
HealthLink
Support for
for the
SouthernTier
Tier HealthLink
“The staff at the Lourdes Emergency Department is very excited to gain access to the
Southern Tier HealthLink HIE. Particularly for patients who are unconscious or have
difficulty remembering things like their medications and allergies, our ED personnel
can rapidly gain access to this critical information. This STHL tool will allow us to
provide better treatment and perhaps even save lives.”
Regina Pufky, Lourdes Hospital Emergency Department Nurse Manager
“The rapid transfer of medical information enables the Broome County Health
Department to conduct ongoing disease surveillance through the ordering, analyzing
and weighing of data to determine risk for illness and injury. This cannot be possible
…without sharing information through robust, reliable, and secure computing and
communication products. ”
Claudia Edwards, Broome County Public Health Director, NY DoH
The Alphabet Soup

EHR (Electronic Health Record): a computerized record keeping
system at your hospital or doctor’s office

HIE (Health Information Exchange): the system of sharing (exchanging)
medical information from one EMR system to another

RHIO (Regional Health Information Organization): the not-for-profit
group that manages the HIE, ensuring it works properly and securely

PHR (Personal Healthcare Record): a computerized collection of
medical information about a particular person, viewable via the internet

STHL (Southern Tier HealthLink NY): our central NY
RHIO that makes sure the HIE works like it is supposed to
5
The Alphabet Soup
STHL is
…the local RHIO
…which oversees the HIE
…which stores EHR information from different sources
…that you can see in your PHR.
6
RHIOs Are Statewide
Southern Tier HealthLink Background
 Founded as a partnership between UHS, Lourdes hospital and local physicians.
 Board of Directors represents founding stakeholders, physician practices, long-term
care, public health, rural health, and the patient community
 Has a patient centric view of clinical information informed by multiple sources
 Funded by NYDOH and as part of the SHIN-NY, STHL acts as a public/private entity
 As funded by NYDOH, STHL must comply with state policy guidance
 Uses a Central Data Repository model: patient data is deposited and sealed until the
patient consents to have records shared/accessed
 Provides a range of services to member hospitals, practices, and patients
Southern Tier HealthLink Board of Directors
Rajesh Dave, MD (President)
Christina Boyd, (Vice President)
Mark McManus (Treasurer)
Michael Rusnak (Secretary)
Keith Chadwick, Long-Term Care
Claudia Edwards, Public Health
Merwyn Jones, Consumer
John LaLiberte, Hospital
Afzal Rehman, Physician Group
Robert Taylor III, MD, Hospital
Jack Salo, Rural Health
Southern Tier HealthLink Objectives
 Higher quality patient care
 Improved coordination between ALL care providers
 Cross institutional patient centric care
 More efficient delivery of care
Value occurs across the regional health system
Patients
• Access to medical
records
• Less time
gathering records
• Reliable source
for medical history
• Easier medication
reconciliation
Health care
providers
Hospitals &
Health Centers
• More complete
clinical profiles of
patients
• Better
documentation at
point of care
• Less time
gathering results
• Improved patient
care
• More complete
clinical profiles of
patients
• Better distribution
of results
• Simplified EMR
integration
• Improved care
coordination
• Easier medication
reconciliation
Payers
Employers
• Higher member
satisfaction
• More informed
disease
management
programs
• Improved care
coordination
• Fewer duplicate
tests
• Enhanced
formulary
compliance
• Improved
employee health
• Reduced costs
through
administrative
efficiency and
fewer redundant
services
• Employees
engaged as active
participants
Southern Tier HealthLink Sources Data
UHS
Binghamton
General
Hospital
UHS
Wilson
Memorial
Hospital
UHS
Chenango
Memorial
Hospital
Lourdes
Hospital
UHS Primary
Care &
Medical
Group
Southern
Tier Imaging
Delaware
Valley
Hospital
Demographics
X
X
X
X
X
X
X
Contact Info
X
X
X
X
X
X
X
PCP Info
X
X
X
X
X
X
X
Insurance
X
X
X
X
X
X
X
Allergies
X
X
X
X
X
Medications
X
X
X
X
X
Problem List
X
X
X
X
X
Diagnosis
X
X
X
X
X
Procedures
X
X
X
X
X
Immunizations
X
Lab Results
X
X
X
X
Radiology Images
X
X
X
X
Radiology Reports
X
X
X
X
X
Hospital Discharge
Summary
X
X
X
X
X
Transcription
S
S
S
X
General CCD
X
X
X
S
X
X
S
S
X
Southern Tier HealthLink Services
Current Products/Services
 Clinical results delivery
 Patient portal and access to
tethered PHR
 Radiology image exchange
 Bi-directional connected EHR
 Physician portal
 Training and HIE adoption
 Master Patient Index
 SHIN-NY on-ramp
Emerging Interoperability Services








Medicaid Medications
EMS Connectivity
Advanced EHR interoperability
Referrals (CCD exchange)
CCD Query
RHIO-to-RHIO exchange
Provider Registry
Public Health reporting
Interoperability Footprint
 EHR Connections established with DOH
funding through HEAL
Cerner Millennium
Emageon – PACS
Fugi – PACS
HMS
ITL – PACS
McKesson – PACS
Medent
Meditech
MedSeries 4
Microsoft HealthVault
NextGen
Siemans Invision
Siemans Signature
Softlabs
 Conversations with:
Multiple EHR vendors
eHealth Global Technologies (eHGT) –PACS

Six-county service area
Broome, Chenango, Delaware, Cortland,
Otsego and Tioga
Cortland
Otsego
Chenango
Tioga
Delaware
Broome
Southern Tier Healthlink Program Status
Receiving patient information from



5 area hospitals
37 area medical practices
1 independent radiology practice
Accessing patient information (Connected EHR/Web Portal)


3 area Emergency Departments
40 area medical practices
~ 200 physicians or other providers
~ 800 clinical staff (nurses, etc.)
Have collected patient consent forms from


40,000 patients—only about 3% choose not to participate
Via 60 collection sites
Southern Tier HealthLink’s Privacy and Security
Technical safeguards exceed industry standards:
 Access is “need to know” based on user’s role
 Level 2 Assurance on user authorization and
authentication
 Health information transactions are encrypted
 Access is subject to HIPAA and HITECH regulations
STHL actively monitors HIE utilization:


Periodic audits, in partnership with Participants
Access reports available at patient request
EHR Interoperability Variability
 EHR interoperability can vary by HIE or RHIO & EHR
Results/Reports delivery
Patient summary exchange with CCD
Referrals
Ordering
Care alerts or subscription
 Results delivery can vary too by Practice
Selecting data to receive/filter
(for example preliminary and/or inpatient result)
Assist with turning off paper/faxes process at various data providers
 Results delivery can surface issues that may have been addressed differently in the paper
world
Getting results from patients that are no longer yours
Not getting results as a primary care physician that you used to get by paper/fax
Combining results to one report
Results/Reports volumes
Other Support issues
Overview of Meaningful Use
 The American Recovery and Reinvestment Act (ARRA)
authorizes the Centers for Medicare & Medicaid Services (CMS) to
offer a financial incentive to physician and hospital providers who
demonstrate the “meaningful use” of an EHR.
 According to the CMS, a provider uses an EHR “meaningfully”
when he or she:
1.
2.
3.
4.
5.
Improves quality, safety, efficiency, and reduce health disparities
Engages patients and families
Improves care coordination
Improves population and public health
Ensures adequate privacy and security protections for personal health
information
Where Is All This Interoperability Heading?

New York is ahead of the curve in
building patient centric HIE services
through RHIOs

At the federal level, efforts such as
the NHIN direct are seeking to
provide interoperability for those that
don’t have any local HIE or RHIO
services

It is a very dynamic environment but
interoperability will continue to expand
and get more sophisticated

Workflows will improve, new data
sources will be added

Quality improvement efforts will advance
with more complete patient information
and improved analytics
We have solutions today that work today &
are here to support your interoperability needs in the future
The Vision for Meaningful Use
Each stage gets progressively harder to
drive toward the ultimate goal
3 Stages of Meaningful Use
Improved
quality of care
Stage 3
Stage 2
Stage 1
The New York eHealth Collaborative
Regional Extension Center (REC)
 Is the federally designated entity to help providers adopt EHRs
and qualify for incentives by achieving Meaningful Use
 Partners with local health groups in your community to get you
the support you need
 Negotiates on your behalf with EHR vendors and IT suppliers
 Will be with you every step of the way
NYeC REC is the Sum of Many Parts
 NYeC works with a statewide
network of highly qualified
organizations
 Our collective mission: Provide
the training and support services
providers needed for doctors
and other providers to adopt and
meaningfully use of EHR
systems
 Southern Tier HealthLink will
connect you to the REC
program.
There are 9 Stops on the Full Journey
For Those Who Have Already Adopted, The Journey
Starts Further Down the Line
Select an
EHR
Join the
REC
Purchase
Achieve
Implement Meaningful
Use
Assess
Design
& Plan Infrastructure Prepare
For Launch
Use
Receive
Federal
Incentives!
Stop Eight: Achieve Meaningful Use
With the REC
Without the REC
 The REC is the federally-designated
Meaningful Use expert for New York
 The federal definition is
over 800 pages long!
 We’ll walk you through what your
practice needs to do
 We’ll help you measure your readiness
so you’re prepared for your 90-day
Meaningful Use evaluation period
Page 23
 Try to measure whether you’re ready
for evaluation
 Try to organize your federal 90-day
evaluation period
Final Stop: Receive Federal Incentives
With the REC
Without the REC
 Hopefully this:
 Maybe:
Page 24
Regional Extension Center Eligibility
MD, DO, NP, PA practicing in typical primary care specialties including OB-GYN and
Pediatrics, and practice size is 10 clinicians (with prescriptive privileges) or fewer
- or Practice is a federally-qualified health center or public or critical access hospital or primarily
serves medically underserved populations
You are eligible for the program even if you already have an
EHR. If you do already have an EHR, the REC will assist you
with post-implementation services to get your practice ready
for Medicare and Medicaid incentive
programs
If qualified, the federal government is subsidizing your participation up to $5,000 per provider
If you already have an EHR and need services to get to Meaningful Use, the standard program cost
to you is $750 for one year of participation.
If you already are going from a paper based business through to Meaningful Use, the standard
program cost to you is $1,500 for 2 years of participation.
For more information about STHL services:
- Call STHL at 651-9150
- Visit www.sthlny.com
For more information about the Regional
Extension Center (REC) visit:
www.nyecrec.org
Christina Galanis, Executive Director
Marc Andiel, Technical Director
Paul Almy, Project Coordinator, Technical
John Hayek, Project Coordinator,
Community Outreach
Emily Pape, Project Coordinator, Privacy
and Research