# Presentation: 139328

## AHRQ Annual  Meeting June 9, 2005

**3 U’s of Rhode Island’s Health Information Exchange: Useful, Usable and Used**

- Presented by
- Amy Zimmerman, MPH
- Rhode Island Department of Health
- RI HIT Project Manager

## Health Care Landscape in RI

- 2 State Agencies with major health responsibilities   (Health, Human Services)
- No local or county  health departments
- 3 major health insurers
- 2 major hospital systems
- 15 Hospitals (7 are independent)
- 3 very large group practices
- 1 Quality Improvement Organization (QIO)
- 1 Medical school & Public Health program
- 1 Quality Institute

- 10/19/2004

##  Rhode Island Quality Institute (RIQI)

- RIQI’s Mission:
- A collaboration among hospitals, health care providers, insurers, consumers, business, academe and government for  the purpose of improving health care quality, safety and value in Rhode Island.

- 10/19/2004

## The Quality Institute’s Strategic Agenda

***The Quality Institute’s Strategic Agenda***

***Statewide Electronic Prescribing***

* *
***Technology Infrastructure****       ****Safety in Care Delivery       Evidence Based Medicine***

***Statewide Coordination and Collaboration of Health Information Technology (HIT)***

## Goals of Rhode Island HIT Project

- Create, implement and evaluate a Master Patient Index as a core component of an interconnected information system putting the right information into the hands of clinicians and their patients when and where it is needed.
- Progressive design and implementation to encourage broad acceptance, adoption and use of the HIT system by authorized users.

- 10/19/2004

## Initial MPI Data Sharing Partners

- RI  Department of Health’s KIDSNET (already sharing data with providers)
- RI Department of  Health’s Clinical laboratory system (beginning to share data with Lifespan)
- Lifespan’s Lifelinks (Clinical Lifetime Record)
- SureScripts -** **electronic prescribing pipeline;
- Rhode Island Health Center Association’s patient registry/data warehouse  (administrative/encounter)
- East Side Clinical Laboratory’s web-based reporting system
- Medicaid ’s Third party Liability , TPL  (evaluation only)

- 10/19/2004

## 5 Components of MPI Project

- Technical Assistance and Coordination and  with other Health Information Technology  (HIT) efforts within the state  (RIQI)
- Technical design and development of the MPI (TBD);
- Health care provider engagement,  training and participation (QPRI);
- Consumer education and engagement (Subcontractor TBD);
- Well-defined and rigorous evaluation (Brown University)

- 10/19/2004

## Stakeholder Input: Initial Activity: 

- Fall Stakeholder Meetings: To identify needs for a system that will be **useful, usable and used**
- Informational meeting
- Needs Identification Workshop (2 meetings: mixed group, and care givers)
- Discussion re models for IT principals and architecture

- 10/19/2004

## Feedback received: 

**Ease of  Use:**
- input , viewing, training,
- standards based,
-  adaptable to workflow,
-  accessible
**Security/Privacy/confidentiality:**
- authentication and access,
- multiple mechanisms for access access with different users in mind,
- proxy issues,
- accountability for accuracy

- 10/19/2004

## Feedback received: 

**Data related needs: **
- accurate, consistent, reliable,
- uniform data definitions,
- consistent/standardized  presentation and reports but user specific (by medical specialty),
- standardized test reports,
- very close to real time availability,
- robust unique identifier,
- provide added value:  labs, pharmacy, ER discharge summary and referral,   other  treating physicians (specialists),
- ability to self populate
- identify who submitted data, audit trails

- 10/19/2004

## Feedback received: 

**System accessibility and reliability:**
- variety of access modes,
- Flexibility: integrate with existing systems
- leverage web,
- neutral platform & technology,
-  minimum access & response time,
- access if system goes down,
- able to customize defaults etc,
- certification of data sources,
-  ? Patient direct access

- 10/19/2004

## Feedback received: 

- Organizational/Practice infrastructure:
- not duplicate data entry,
- links to billing/administrative systems,
- primary care focused,
- build on existing workflow and technical systems requirements,
- still support legacy systems,
- need to access information for print including previous information,
- technical support,
- affordable,
- incentives to use

- 10/19/2004

## Revised Project Approach 

| 
Phase 1
(18 mos.) |  Establish project structure and roles
 Engage subcontractors and data partners 
 Identify HIT system requirements; 
Design, build and test operating prototype/1st     release |
| --- | --- |
| 
Phase 2
(+18 mos.) |  Build/Enhance Community buy-in
 Refine prototype functionality and features
 Establish evaluation baseline
 Iterative deployment of the HIT system  |
| 
Phase 3
(+24 mos.) |  Continue progressive system enhancements
 Continue active user outreach; build support
 Perform rigorous evaluation
 Implement a plan to sustain infrastructure |

- 10/19/2004

## Initial Proposed Approach 

- Phase 1- MPI created and could serve as single portal to provide access to each data sharing partner’s data
- Phase 2- Common interface developed  so patient information presented in a unified,logical manner, add other data sharing partners
- Phase 3- include decision support , add other data sharing partners,  develop warehouse for population health analysis

- 10/19/2004

## Established a Governance Structure

- Governing Council: RIQI Board of Directors
- Steering Committee: Administered by the RIQI
- Management Committee- HEALTH and subcontractors
- Working groups (technical, legal and policy, users, communication,education and outreach, data sharing partners, evaluation)
- Consumer Advisory Committee of RIQI

- 10/19/2004

##  Project Governance & Structure

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## Stakeholder Themes :  

- Make system standards based
- Design system to be flexible/adaptable to different workflow environments
- Value- fast & reliable data
- Integrate existing systems with what is in place  (includes administrative)
- Carefully address authentication, authorization, security and access
- Need for uniform data definitions

- 10/19/2004

## Stakeholder Themes cont. 

- Consistent data presentation with some ability to customize (specialty areas)
- Need for immediate and tangible results
- Most important principals:  cost effectiveness, security and confidentiality, accuracy and ease of use, visible benefits and standards
- Architecture- combination of information broker and warehouse- seemed initially to be the theme
- Governance-Need to clearly recognize partners expertise and roles and play to those strengths – takes Negotiation

- 10/19/2004

## Some Critical Challenges:  

- Working through State Systems – impact on timing
- Technical solution that meet’s local needs, in line with national efforts
- So..many efforts underway, determining what how to decide what to align with
- Managing stakeholders agendas
- Identity management
- Sustainability and business  models
- Tight time frames- resulting in parallel workgroups
- Defining the scope

- 10/19/2004

## More Critical Challanges

- Legal: HIPAA, Fraud & Abuse, Anti-Trust, Liability/Malpractice
- Physician Adoption
- Few EMRs
- Connect to what?
- Unique Patient Identifiers

- 10/19/2004

## Contact Information

- Amy Zimmerman, MPH
- Rhode Island Department of Health
- 401-222-5942
- amyz@doh.state.ri.us

- 10/19/2004

## Developing Data Prioritization Plan  

- Convened data sharing partners group
- Developed consensus based criteria to evaluate feasibility of data sharing
- Data sharing partners ranked their data elements according to criteria (weighted values)
- Analyzed feasibility Data: \
- Labs
- Prescriptions
- Reports (discharge, procedure, operative)
-  Need to Take to Provider Advisory Panel
-  Need Approval by Steering Committee  I

- 10/19/2004

## Developing Technical Solution:  

- Convened Technical Solution Workgroup
- Conducting gap analysis  of data sharing partners
- Assessing existing infrastructures within state could leverage
- Initiated discussion re overall vision, defining scope of this project
- Initiated  discussion re architecture

- 10/19/2004