# Presentation: 780912

## HIE Organizations and Accountability

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

## RHIO Accreditation Research Project

## 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 and 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.

- Success of SHIN-NY depends upon RHIOs’ ability to:
- ensure consistency with state privacy and 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.

**Project Overview **Assumptions and Hypotheses

## Analytic FrameworkRHIO – Core Components

**Analytic Framework**RHIO – Core Components

**Nature of participants**

**Purpose of exchange/mission**

**Type of information exchanged**

**How information is exchanged**

**Multi-stakeholder and all consumers**

**Improve quality, safety, **
**efficiency of care**

**Clinical data**

**Protocols, standards and services via SHIN-NY**

**Scope of services**

**Security, authentication, authorization, access, and auditing policies**

**Governance**

**Transparent policy framework,**
**inclusive decision making process**

**Consumer access**

**Provisions for ensuring consumer access to and control of data**

## 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. 

- 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.

**Project Overview **Goals

**Notes:**
Not limiting this to accreditation, we are exploring how to establish and measure RHIO performance.

## 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

- 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

**Participants **National and Local

## 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 1⁄2 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

|  | Feb |  | March |  | April |  | May |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Conduct research on accreditation models |  |  |  |  |  |  |  |  |
| Convene advisory committee to discuss the 
(1) analytic framework and (2) the interview approach |  |  |  |  |  |  |  |  |
| Conduct interviews with accreditation bodies |  |  |  |  |  |  |  |  |
| Convene advisory committee to review findings |  |  |  |  |  |  |  |  |
| Finalize White Paper |  |  |  |  |  |  |  |  |

**Project Overview **Timeline

**Notes:**
Very quick turn around time
Focused on collecting and parsing information to inform the policy discussion. 

## 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 Florida Health Information Network

**ahca.myflorida.com/dhit**

**Notes:**
Map of FHIN Grants Program recipients, 2006-2007

## FHIN Grants Program Funding RHIO Startup

**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.

**Notes:**
FHIN Grants Program Provides Funding to Local Health Information Exchange Initiatives
The FHIN Grants Program was developed in 2005 to help local health information network initiatives “get off the ground”
The Governor’s Advisory Board oversees grant evaluations and recommends grant awards to the Secretary of the Agency for Health Care Administration
All grants funds are matched dollar for dollar at the local level, indicative of a tremendous level of local volunteerism
FHIN Grants Project Categories
Planning Grants: Support engaging appropriate health care stakeholders to develop a strategic plan for health information exchange in their communities. 
Implementation Grants: Support projects that demonstrate health information exchange among two or more competing provider organizations.
Training Grants: Support practitioner training designed to increase physician and dentist use of electronic health record systems. 
FHIN Grants Program Is only Intended for Health Information Exchange Startup 
The FHIN Grants Program has been successful in providing startup funding for RHIOs across Florida but is not intended as a long term solution to funding
Implementation grantees are expected to develop a sustainable model for ongoing activity
The Florida Center is also working on sustainable models of health information exchange

## Funding the FHIN Grants Program 

**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.

**Notes:**

FHIN Grants Program, 2005-2006
The Agency for Health Care Administration started the FHIN grants program with a $1.5 million appropriation from the Legislature
The Governor’s Advisory Board recommended nine grants for FY 2005-06:
Five Planning Grants
Three Implementation Grants
One Training Grant
FHIN Grants Program, 2006-2007
The Legislature appropriated $2 million to the FHIN Grants Program in 2006
A total of 18 proposals were received, amounting to $6 million in requested funds
The Governor’s Advisory Board evaluated all of the proposals and recommended six implementation grants for FY 2006-07
The Legislature again appropriated $2 million to the FHIN Grants Program in 2007
AHCA Legislative Goal: Fund the FHIN Grants Program for $6.8 million in 2008-2009 to leverage ongoing RHIO development.  

## FHIN Grants Program Funding, 2007-2008

**Notes:**
FHIN Grants Funding by RHIO, 2007-2008.

The RHIOs provide a secure, real-time exchange of medical records that guarantees the efficient delivery of patient data to the authorized physician. 
The following examples will demonstrate how three Florida RHIOs are implementing health information exchange 

## 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 |

**Notes:**
Proposed  health information exchange activity of Florida RHIOs, 2007-2008.

## 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 |  | 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 |

**Notes:**
Proposed  health information exchange activity of Florida RHIOs, 2007-2008.

## Vision for the Florida Health Information Network

**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.

**Notes:**
Vision of the Florida Health Information Network.

## Christopher B. Sullivan, Ph.D.

**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](mailto:rawlinsl@ahca.myflorida.com)__[ ](mailto:rawlinsl@ahca.myflorida.com)_

**Notes:**
Contact Information – Christopher B. Sullivan, Ph.D.
Tel: 850-414-5421