Direct Project Implementations Take Flight

2011 has started off with a frenzy over EHR Adoption and Meaningful Use.  Serendipity Health and I owe my followers an update on many items, but today's topic will highlight a "New Way" being led by the Office of the National Coordinator.  There is a live update is being given by Dr. David Blumenthal as I type this today to leaders in Washington, DC. 
 

I am proud to have been part of this process with countless industry leaders that has led to these achievements.  Please read more about the success of open and transparent government facilitated standards development that has resulted in the Direct Project.  With permission, I am providing this write up by two of my colleagues who are on the Communications committee with me for this project.  These implementations will be shown in a live interactive demonstration at the HIMSS 2011 Annual Conference as part of the the Interoperability Showcase in Orlando, FL later this month.  I hope to see many of you there.  Stay tuned for more blog posts to come.

Direct Project Implementations Take Flight

By Rich Elmore and Paul Tuten

The Direct Project has taken off, with the first-in-the-nation production use of the Direct Project for secure direct clinical messaging.
Arien Malec, ONC’s Direct Project Coordinator, announced today that pilots in Minnesota and Rhode Island are now live with the Direct Project:

• VisionShare has enabled Hennepin County Medical Center to send immunization information to the Minnesota Department of Health.  Testing of immunization (or syndromic surveillance) communication to a public health agency is a requirement for Meaningful Use incentives.  
• Rhode Island Quality Institute has implemented provider-to-provider health information exchange supporting Meaningful Use objectives with Dr. Al Puerini and members of the Rhode Island Primary Care Physicians Corporation.

And innovative and high-value pilot projects in New York, Tennessee and California are scheduled to go live later this month.  
Also announced:

• 29 Health IT Vendors now plan to connect using the Direct Project.
• A consensus-approved Direct Project Security Overview  and Direct Project Overview Presentation have been published.
• A new look and logo for the Direct Project website
• A Direct Project briefing by Dr. David Blumenthal (National Coordinator for Health IT), Aneesh Chopra (U.S. Chief Technology Officer), and a team of federal and industry stakeholders will take place at 12 noon ET Wednesday February 2.  Live twitter feed of the event will be posted at #DirectProject.

Hennepin County Medical Center (HCMC), Minnesota’s premier Level 1 Adult and Pediatric Trauma Center, has been successfully sending immunization records to the Minnesota Department of Health (MDH). "This first-in-the-nation Direct Project for clinical exchange is an important milestone for Minnesota and a key step toward the seamless electronic movement of information to improve care and public health," said James Golden PhD, Minnesota’s State Government HIT Coordinator. Recognizing Minnesota's leadership in delivering high-quality, cost-effective healthcare, U.S. Senator Amy Klobuchar said that “this is the type of innovation that can help strengthen our health care system by reducing waste and improving quality. We need to continue to improve our health care system by continuing to integrate information technology to better serve patients and providers.”  VisionShare, a company headquartered in Minneapolis, serves as the health information services provider (HISP) connecting HCMC to the Minnesota Department of Health. In its role as a HISP, VisionShare will expand this pilot project to additional providers and other states, including the Oklahoma State Department of Health, which has already committed to participation in the program.

The Rhode Island Quality Institute (RIQI), the only organization in the nation to be awarded the Health Information Exchange, Regional Extension Center, and Beacon Community grants has delivered a Direct Project pilot project with two primary goals:

1. To demonstrate simple, direct provider-to-provider data exchange between PCPs and specialists as a key component of Stage 1 Meaningful Use.
2. To leverage Direct Project messaging as a means to seamlessly feed clinical information from practice-based EHRs to the state-wide HIE, currentcare, integrating patient data across provider settings and during transitions of care

“This recognition shows that Rhode Island continues to be a nationwide leader in improving health care with better information technology," said Senator Sheldon Whitehouse. "Health care providers communicating with each other in a secure and cost-efficient way helps patients get better sooner with less hassle and confusion.”

“The Direct Project is a giant step forward in improving communication between primary care providers, specialists, hospitals, laboratories and health information exchanges”, according to Dr. Albert Puerini Jr., President and CEO at Polaris Medical Management and Rhode Island Primary Care Physicians.   “The Direct Project’s ability to seamlessly transmit relevant healthcare information greatly enhances the quality of care that is delivered, while also creating much needed efficiencies within our healthcare system.”

Discussing RIQI’s collaborative approach to health IT, Laura Adams, President and CEO of RIQI said “Direct allows the Quality Institute to be on the cutting edge – providing health information exchange via currentcare, delivering the efficient rollout of technology through the Regional Extension Center, and enabling and measuring real patient outcome improvements in our Beacon Community.” Throughout the Pilot, RIQI has worked with a number of key partners, including Arcadia Solutions (program manager and systems integrator), Inpriva’s Health Information Service Provider  solution that supports the security, trust, and Rhode Island-specific consent laws, InterSystems, and Polaris Medical Management’s EpiChart.

Federal Government Perspective

Aneesh Chopra at the Roundtable on Federal Government Engagement in Standards on January 25, 2011 said "I am pleased to report today... the very first Direct specification email message occurred between a county public hospital in Minnesota called Hennepin County and the state Health Department on the issue of a patients immunization record, which is a requirement as part of our meaningful use framework, supported by a commercial vendor called VisionShare".  Speaking of the collaborative nature of the unique public/private collaboration of the Direct Project, he said "This voluntary process has turned this around and in fourteen months [from the time a physician first raised the need to the HIT Standards Committee] the idea is real. And dozens and dozens of vendors will have this service widely deployed across 2011."

On the Runway

Several other Direct Project implementations are scheduled for take-off later this month.  New York, Tennessee and California are among the states where Direct Project will be enabling directed health information exchange among a wide variety of participants.  And later this year, look for Connecticut and Texas to join their ranks.  

New York

MedAllies, a Health Information Service Provider (HISP), will launch a Direct Project pilot to demonstrate the delivery of critical clinical information across transition of care settings in a “push” fashion that supports existing clinical workflows in the Hudson Valley of New York. MedAllies will implement the full Direct Project infrastructure, including both the required SMTP backbone, as well as support for the XDR elective protocol. MedAllies is working with many stakeholders, including EHR vendors Allscripts, eClinicalWorks, Epic, Greenway, NextGen and Siemens, and clinicians in both ambulatory and hospital settings.
The three initial use cases include:
· Primary care provider refers patient to specialist including summary care record
· Specialist sends summary care information back to referring provider
· Hospital sends discharge information to primary care provider
Technical integration with leading EHR and Hospital Information System vendors is underway with pilot exchange alpha sites beginning to go live in Q1 2011.

Tennessee

In this project, CareSpark, a non-profit regional health information exchange supported by the Tennessee State HIE, and the U.S. Department of Veterans Affairs (VA) seek to demonstrate Direct Project-based health information exchange between a federal agency and providers in a private-sector HIE. The main focus will be on facilitating an improved process for exchanging referrals and consultation reports between VA providers and private-sector providers in east Tennessee and southwest Virginia. It will demonstrate two Direct Project user stories: Primary care referral to specialist and Specialist sends summary care information back to referring provider. Text-based mammography interpretation reports will be exchanged utilizing source code made available from the Direct Project workgroups. The project scope will also demonstrate the routing of mammography referrals from the VA to the private sector provider. It is also the intent of the participants that this project once fully vetted could be expanded to additional VA sites. The pilot will exchange information between two different Health Information Service Providers (HISPs) - the VA and CareSpark, respectively.

California

Redwood MedNet provides health information exchange services in rural Northern California. The Redwood MedNet Direct Project pilot has one goal: to deploy directed secure messaging for production data delivery in support of meaningful use measures. Three meaningful use messaging patterns are in development.

1. Receipt of Structured Lab Results
2. Immunization Reporting
3. Sharing Patient Care Summaries Across Unaffiliated Organizations (including both referral to a specialist and discharge summary to a patient centered medical home)

The project will establish a standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients. As an HIE in a rural area, participants in the Redwood MedNet directed messaging project will include small practices, community clinics and small hospitals, as well as the State immunization registry. The discharge summary may also incorporate use of a patient controlled health record (PCHR).

Connecticut

Medical Professional Services (MPS) is a clinically-integrated, multi-specialty IPA in Connecticut with approximately 400 physician members. Along with several partners, MPS is working to demonstrate successful exchange of laboratory results back to the ordering provider and exchange of referral information and summary care information between providers, a local hospital (Middlesex) and a multi-site FQHC (Community Health Center, Inc.). Electronic exchange of data is a challenge in this setting because of the diversity of MPS physician practices, EHRs and HIT tools in place.
The goal set for this pilot is to enable MPS physicians to receive lab results back from Middlesex Hospital and Quest Diagnostics, to exchange referrals with Middlesex Hospital, and to exchange referrals and summary care information among MPS primary care and specialty physicians. Results and referral information will be exposed through MedPlus, eClinicalWorks, Covisint, or through a secured e-mail client. In addition, physicians will have the ability to securely send lab results and care summaries to their patients via Microsoft’s portal.

Texas

A broad set of stakeholders in South Texas are planning to use Direct to improve the health status of persons in South Texas with diabetes, including gestational diabetes. Participants come from the medical community (CHRISTUS Health, the Health Information Network of South Texas, the Driscoll Children’s Health Plan, Corpus Christi Medical Center, Public Health Department, Nueces County Medical Society), community-based social service organizations, colleges, and employers (the Coastal Bend Diabetes Community Collaborative, The Salvation Army, the United Way, and others). The main goal for this project is to connect the OB-GYNs, pediatricians, hospitals, and the State of Texas’ Newborn registry so they can share information (referrals, lab results, discharge summaries) in real time with their care teams to improve patient outcomes. Additionally, the project participants hope to provide patients with better information so that they may better manage their chronic diseases. This will be accomplished using Direct by enabling the following use cases:

1. Physician to physician referral
2. Physician to hospital referral
3. Hospital to physician lab results reporting
4. Hospital or physician to state newborn registry

What is the Direct Project?

Today, direct communication of health information from a care provider to another healthcare stakeholder is most often achieved by sending paper through the mail or via fax. ONC’s Direct Project (formerly NHIN Direct) benefits providers and patients by improving the direct transport of structured and unstructured health information, making it secure, fast, inexpensive and, for some applications, interoperable.  Using Direct Project addresses, a care provider can send and receive important clinical information, connecting to other healthcare stakeholders across the country.
For more information, see the Direct Project website and keep up with the latest on Twitter at #DirectProject.  
Also, at noon (EST) on February 2, hear about the Direct Project from Dr. David Blumenthal, National Coordinator for Health IT, Aneesh Chopra – U.S. Chief Technology Officer, Mark Briggs – CEO VisionShare, Glen Tullman – CEO Allscripts, Sean Nolan – Distinguished Engineer and Chief Architect Microsoft Health Solutions Group, Dr. Al Puerini Jr. – President and CEO Polaris Medical Management and Rhode Island Primary Care Physicians, Doug Fridsma - ONC Director, Office of Interoperability and Standards and Arien Malec - ONC Direct Project Coordinator.

The Authors

Rich Elmore serves as the Direct Project Communication Workgroup leader and Vice President, Strategic Initiatives at Allscripts.  Paul Tuten participates as the Direct Project Implementation Geographies Workgroup Leader and is Vice President, Product Strategy and Management at VisionShare.

The Direct Project - Where We Are Today

This article originally appeared in The Health Care Blog and O'Reilly Radar. by Brian Ahier, Rich Elmore and David C. Kibbe The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of... read the rest.

I have copied highlights below, but please note that CareSpark will be piloting the standards used by the Direct project to demonstrate our ability to be a Health Information Service Provider (HISP) communicating to the Veterans Administration.  Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans.  This is of particular interest to me as my father and mother-in-law locally receive health care benefits from the VA. In addition, I have multiple family members across TN and the state of Tennessee has over 500,000 veterans with over 1 million dependents who will eventually benefit when the pilots move into production in the future.  

The Direct Project announced today the completion of its open-source connectivity-enabling software and the start of a series of pilots that will be demonstrating directed secure messaging for healthcare stakeholders over the internet. The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

Also announced:

• A new name - The Direct Project was previously known as NHIN Direct 
• An NHIN University course(The Direct Project - Where We Are Today), to be presented  by Arien Malec, November 29 at 1PM ET, sponsored by the National eHealth Collaborative
• An extensive list of HIt vendors (20+) that have announced plans to leverage the Direct Project for message transport in connection with their solutions and services.  
• Presentations at the HIT Standards Committee on Tuesday, November 30 where three or more vendors will be announcing their support for the Direct Project. 
• A thorough documentation library including a Direct Project Overview 
• Best practice guidance for directed messaging based on the policy work of the Privacy and Security Tiger team
• A new website at DirectProject.org
• A new hashtag #directproject for following the Direct Project on twitter.

What is The Direct Project?

Today, communication of health information among providers and patients is most often achieved by sending paper through the mail or via fax. The Direct Project seeks to benefit patients and providers by improving the transport of health information, making it faster, more secure, and less expensive. The Direct Project will facilitate “direct” communication patterns with an eye toward approaching more advanced levels of interoperability than simple paper can provide.

The Direct Project provides for universal boundaryless addressing to other Direct Project participants using a health internet “email-like” address.

The Direct Project focuses on the technical standards and services necessary to securely transport content from point A to point B and does not specify the actual content exchanged.  When The Direct Project is used by providers to transport and share qualifying clinical content, the combination of content and The Direct Project-specified transport standards may satisfy some Stage 1 Meaningful Use requirements. For example, a primary care physician who is referring a patient to a specialist can use The Direct Project to send a clinical summary of that patient to the specialist and to receive a summary of the consultation.

How might the Direct Project be Used?
2009-10 Congress and agencies of the federal government have created regulations that require physicians and hospitals participating in the ARRA/HITECH incentives awarded for meaningful use of EHR technology to:

• send messages and data to each other for referral and care coordination purposes;
• send alerts and reminders for preventive care to their patients;
• send patients clinical summaries of their visit and of their health information
• receive lab results from labs
• send immunization and syndromic surveillance data to public health agencies
• integrate with HIT vendor systems

There are already organizations that have announced the establishment of national clinical exchange networks, including integration with the Direct Project. States and HIO’s will need to decide how best to provide Direct Project services to their constituents, whether by partnering with existing exchange networks or incorporating direct messaging into the services they provide.
 

The Direct Project Implementation
The Direct Project is organizing real-world pilots to demonstrate health information exchange using The Direct Project standards and services. Six pilots are ramping up including:

Rhode Island Quality Institute, Redwood MedNet and MedAllies will be sending Continuity of Care
Documents to other providers for referrals and transitions of care. Visionshare will be linking to
immunization registries. Carespark (Tennesee) will be linking the VA with private clinics providing health services to veterans. And Connecticut’s Medical Professional Services, an IPA, will be
linking Middlesex Hospital with primary care providers.

The HISP
Connectivity among providers is facilitated by Health Information Service Providers (HISP). HISP describes both a function (the management of security and transport for directed exchange) and an organizational model (an organization that performs HISP functions on behalf of the sending or receiving organization or individual).
 

Best Practices
The Direct Project is bound by a set of policies that have been recommended to the HIT Policy Committee (HITPC) or are being examined by the HITPC’s Privacy and Security Tiger Team for directed messaging. Within this context, the Direct Project has developed best practice guidance for secure communication of health data among health care participants who already know and trust each other. The Direct Project assumes that the Sender is responsible for several minimum requirements before sending data, including the collection of patient consent. These requirements may or may not be handled in an electronic health record, but they are handled nonetheless, even when sharing information today via paper or fax. For example, a sender may call to ask whether a fax was sent to the correct fax number and was received by the intended provider. The following best practices provide context for the Direct Project standards and services:

• The Sender has obtained the patient’s consent to send the information to the Receiver.
• The Sender and Receiver ensure that the patient’s privacy preferences are being honored.
• The Sender of a Direct Project transmission has determined that it is clinically and legally appropriate to send the information to the Receiver.
• The Sender has determined that the Receiver’s address is correct.
• The Sender has communicated to the receiver, perhaps out-of-band, the purpose for  exchanging the information.
• The Sender and Receiver do not require common or pre-negotiated patient identifiers. Similar to the exchange of fax or paper documents, there is no expectation that a received message will be automatically matched to a patient or automatically filed in an EHR.
• The communication will be performed in a secure, encrypted, and reliable way, as described in the detailed The Direct Project technical specifications.
• When the HISP is a separate entity from the sending or receiving organization, best practice guidance for the HISP has been developed for privacy, security and transparency.

The demonstrations will likely take place early next year at the HIMSS Annual Conference in Orlando. 

What is a Unicorn?

When I was much younger and extending into my early 20’s, I loved the concept of and collected Unicorns. While I still love the concept of Unicorns, I no longer collect them, so you can imagine my surprise to hear from one of the CareSpark stakeholders that I was leading and helping to build the region’s Unicorn. 

During the last CareSpark Board meeting, a CIO from one of the hospital systems in the region mentioned that he could share his vision of a Unicorn to support the needs of his providers for Health information exchange (HIE). He went onto mention that an HIE is like a Unicorn…we all know what we think one should look like, but who’s to say my unicorn looks like your unicorn. What does your Unicorn look like?  

 

I would like to think my Unicorn would be golden and sparkly…something like this…  

“Now I will believe that there are unicorns…” William Shakespeare – The Tempest

As the common fare of little girls' fantasies, the origin in histories becomes quite ironic. In thinking about this blog topic, I thought it was interesting to correlate that the Unicorn is known for the healing power in it’s horn.  A fabulous beast born of man’s imagination, the unicorn form and function are as variable as the minds and religions of mankind;  but whatever its shape – and it has been described as an ox, ram, goat, bull, antelope, wild ass, horse,  rhinoceros, serpent or fish, - a one-horned beast was always a symbol of supreme power.

In the west, the unicorn was first mentioned in 398 BC by Ctesias, a Greek physician and historian of Persia and India.  He traveled to the Persian court and remained there working as a physician for 17 years under two rulers.  

Why did they go away, do you think? "Who knows? Times change –especially in health care today. Would you call this age a good one for unicorns?"  

For those of you who may not be aware yet, I stepped in as Interim CEO for CareSpark on September 30, 2010. One of my deliverables during my tenure will be to develop a sustainable business plan and I have spent the past several weeks helping to shepherd and lead CareSpark toward the evolution necessary to sustain them into the future and reduce the dependency on federal funding. 

Out of the 234 HIEs surveyed by the eHealth Initiative for 2010 only 18 are operational, not dependent on federal funding, and have broken even through operational revenue only. To date, CareSpark has been dependent on federal funding business plan will begin to wean them from the dependencies over the next several years with the support of the community and state.

In addition to the Carespark business plan, I have the pleasure of working with the State of TN and the state designated entity (HIP TN) to develop their sustainability plan and roll out the backbone connecting the various HIEs across the state beginning in 2011. 
 

At the beginning of this week, after the Thanksgiving holidays, I have much to give thanks for reflecting back over the past two years of business after starting Serendipity Health. I am doing what I set out to do and am working full time to help improve the quality of health care in my region and across the state. CareSpark has always had a place in my heart having followed the standards based approach for building the HIE which now has 33 signed data sharing agreements from providers in the region. Over the coming years, I look forward to working with health care provides to deploy connected health care, thus providing actionable information at the point of care.As the cartoon below depicts, I am pleading for all providers to give generously! 

Call for Participation - 2010 Summit of the Southeast

 

As a TN HIMSS Board Member and HIE Liaison, I feel it is my duty to fulfill the mission and vision of the TN HIMSS Chapter and ask all those that follow me to consider attending the next conference event. Join the AL, AR, KY, SC and TN Chapters in the largest HIMSS Combined Chapter Conference.There is still time to register for the early bird rates for the 2010 HIMSS Summit of the Southeast.  The Summit offers attendees the chance to join one of the most unique Chapter conferences in the country.  

This meeting is designed to offer attendees access to and hear from the leading healthcare providers and healthcare technology companies in the Southeast.  By attending this conference, you will get a chance to hear national and local leaders on these key agenda items:

• Clinical Informatics (A Credit Session)
• Hospital CEO Discussion
• Keynote – Meaningful Use and Meaningful Change
• State of HIMSS
• Keynote – State of our Nation: A National Road Map
• HIT/HIE Short-term Benefits and Long-term Investment – Panel Discussion
• Evolving Role of the CIO/CMIO/CMO – Panel Discussion
• Keynote – Safety and Quality
• Hospital Point of Care Impact:  Clinicians Sound Off
• Ambulatory Point of Care Impact:  Clinicians Sound Off

This year, the Summit is two days, October 11th and 12th. As such, we have two different options for registration. If you would like to attend the Special Session on October 11th ONLY, please choose that option. If you wish to attend the ENTIRE Summit on October 11th and 12th, please choose the Entire Summit option. I will be attending both days and look forward to seeing many of you there. Make sure to register now to get your early bird rates while they still apply! Safe travels!

Tennessee's Department of Economic & Community Development...Invest in Tennessee

The 57th Annual/2010 Governor's Conference will be held September 16 - 17, 2010 in Nashville, TN.   I won't be able to attend as I will be on vacation, but a variety of informative sessions will be delivered. As a proud Tennessean, I can say, Tennessee is good for business, offering a beneficial labor environment, productive and educated work force, wonderful quality of life and wealth of technology resources. These factors combine to create a business climate that gives companies a winning edge in their long-term growth and profitability.

Since my blog is centered on Healthcare IT, I wanted to tie together this conference with the Nashville Medical Trade Center.  I blogged about this new center back in April.  I understand that since the initial announcement in April, there has been significant activities.  I wanted to share this video that highlighted some of these activities.



I am so happy to see the continued success of the interactive interoperability showcase that I helped create in 2004 and launch internationally in Europe and Asia. I was blessed to meet and introduce our Governor to the showcase for the first time in 2005. It is wonderful to see this key feature for HIMSS now have a permanent and flexible home at the Nashville Medical Trade Center.  I look forward to seeing the vision and passion continue to grow while creating many wonderful opportunities for the citizens in our great state.  I hope that I as founder and President of Serendipity Health can continue collaborating with stakeholders across the state of Tennessee to find ways to deploy connected healthcare to help improve the quality of care for us all.   

Temporary Certification Announced and Tennessee excels toward HIE

In my first blog post dated January 5, 2010, I mentioned that our nation is at the forefront of aligning the stars with monetary incentives to stimulate the adoption and meaningful use of the Electronic Health Record (EHR). Some have dubbed this as the perfect storm of Healthcare reform. Earlier this month, the Office of the National Coordinator for Health IT (ONC) issued a final rule to establish a temporary certification program for EHR technology. This program will establish processes that organizations will need to follow in order to be authorized by ONC to test and certify EHR technology. Use of "certified EHR technology" is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid EHR Incentive Program. 

Certification will be used to provide "assurance and confidence" that a product or service will work as expected. By purchasing certified EHR technology, hospitals and eligible providers will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of EHRs to qualify for the payment incentives and begin to use EHRs in a way that will improve quality and efficiency in our health care system. Systems will include the capabilities a hospital or provider envisioned when they purchased the EHR. The certification will also ensure the capabilities are available to achieve meaningful use incentives.

Exchanging health information among disparate systems quickly and in usable formats, might be the vision for improving healthcare, but getting information beyond point-to-point transactions is a challenge for even the most engaged, forward thinking organizations. As the drive for information exchange standards continues, some healthcare systems as well as Tennessee are gearing up to purchase tools to harness, index, route, and harmonize patient data to make it available at the right place and at the right time to enable the clinical caregiver to improve the patient care process.

Tennessee has been making incremental strides towards improving the patient care process and was recently recognized as one of the top five most improved states in routing prescriptions electronically. Surescripts, a health information network that operates the country's largest electronic prescribing network, announced that Tennessee ranked second behind Vermont and just ahead of Kansas, Illinois and Missouri on the top five list. Tennessee Gov. Phil Bredesen co-hosted the fourth annual Safe-Rx Awards event as part of the recent State Alliance for e-Health meeting. Bredesen has long supported improving the process and co-chairs the alliance with Vermont Gov. Jim Douglas. Surescripts created the Safe-Rx Awards to raise awareness of e-prescribing as a way to improve patient safety by providing a secure, accurate and informed prescribing process. This is the first of many steps our state will have to make to truly improve the quality of patient care.

Tennessee's department of eHealth, in conjunction with nine other states, is conducting market research regarding enterprise medication management technologies and services. An RFI was published June 17, 2010 and is due July 12, 2010. The responses to this RFI will assist the nine states in understanding the current state of the marketplace, including commercial/government best practices, industry capabilities, innovative delivery approaches, commercial market service levels, and performance strategies and measures. Information gained through this RFI will greatly assist TN in determining how best to advance innovative medication management services.

In addition to the above RFI, the Health Information Partnership for Tennessee (HIP TN) also released an RFP on June 25, 2010. Responses are due July 13, 2010. HIP TN is the state designated entity charged with coordinating activities for the Regional Extension Center (tnREC) as well as the Health Information Exchange (HIE) strategy for Tennessee. HIP TN, a non-profit organization, works to improve access to health information through a statewide collaborative process by providing services and infrastructure for the secure electronic exchange and use of health information between state-wide agencies and local or Regional Health Information Organizations (RHIO). This RFP is soliciting proposals to provide a statewide HIE infrastructure platform for Core Services and other functions to be accessed by physicians, hospitals, other health care organizations, and consumers.

HIP TN has defined Core Services to include:

• Service Access Layer
• Patient Matching Service
• Master Clinician Index
• Master Facilities Index
• Trust Broker
• NHIN Gateway

In addition, the RFP will describe hosting services and operational expertise in support of the Core Services that will be administered on behalf of HIP TN by the Solution Provider. I currently volunteer on the Technology work group who has been leading the RFP process. While the remainder of the year ahead is full of deadlines and deliverables, I look forward to assisting with one of the biggest challenges, to keep various stakeholders in HIP TN, across my state, and various other states abreast of all the technology and standards that are out there.

Tennessee’s State of the Union for Health Information Exchange (HIE) Collaboration

Tennessee’s State of the Union for Health Information Exchange (HIE)

With each passing decade, health care has consumed a larger share of gross domestic product (GDP) and Federal budgets. The Centers for Medicare and Medicaid Services (CMS) is estimating that the healthcare sector’s share of GDP made its biggest one-year jump ever, going to 17.3 % in 2009 from 16.2 in 2008. The financial burden of the ever increasing ratio of total out-of-pocket spending for health care services and premiums to total family income—continues to increase nationally. As a result of this trend, more people have been exposed to high costs and lack essential services.

In pilot programs across the US, it has been demonstrated that the use of electronic health records (EHRs) can significantly reduce the cost of health care while improving the quality. The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes CMS to provide reimbursement incentives for eligible professionals and hospitals who are successful in adopting and becoming “meaningful users” of certified EHR technology. CMS’ goal is for the definition of meaningful use to be consistent with applicable provisions of Medicare and Medicaid law while continually advancing the stages for contributions certified EHR technology can make to improving health care quality, efficiency, and patient safety. For stage 1, which begins in 2011, CMS proposes objectives for physicians and hospitals to meet to be deemed meaningful EHR users. Stages 2 and 3 will expand the list in 2013 and 2015. Hospitals and physicians failing to adopt EHRs and meet the objectives by 2015 will face penalties.

One future requirement to achieve meaning use is to participate in an HIE. The Knoxville region has operated an HIE infrastructure since June 2004 among the area hospitals known as Innovation Valley Health Information Network (IVHIN). In June 2009 the board of IVHIN approved a collaborative initiative with CareSpark, another HIE based in the Tri-cities for health improvement for East Tennessee. Progress to date for the collaborative community known as CareSpark – Knoxville region includes the following:

• Achieved the goal of full commitment of area hospitals and certain large physician practices to improve internal infrastructures and adopt systems to collectively connect to a secure utility for health information exchange.
• CareSpark hired Leigh Sterling as the Knoxville region coordinator for its 17 counties.
• Outreach has begun regarding the available CareSpark offering for HIE between hospitals, physician practices, health plans and public health departments. CareSpark currently serves almost 400,000 patients and 250 clinicians in the Tri-Cities region. IVHin and CareSpark are now aligning efforts and collaborating to share infrastructure for technical services, governance and policy, and business operations to enable HIE.

In addition, the state of Tennessee formed the Health Information Partnership for Tennessee (HIP TN) as a non-profit organization in the summer of 2009 with the purpose of “improving the health of people served in Tennessee using a public-private framework to coordinate and empower the sharing of appropriate health information through local and regional HIEs, as well as in areas not yet covered by exchange thereby improving quality, coordination of care, cost efficiency and public health. HIP TN is responsible for selecting and managing the infrastructure and services to support statewide HIE." The HIP-TN organization in partnership with the state of TN’s office of eHealth are working together to determine incentive program deployment strategies. HIP TN brings together Tennessee’s local, regional and state electronic health information initiatives and resources to form a collaborative partnership and framework.

With dozens of different vendors to choose from and the fast paced requirements beginning in 2011 for meaningful use, providers will need assistance with getting connected to an HIE, acquiring and implementing EHRs and other associated information systems. These systems often can't easily talk to each other; therefore, the use of qualified intermediaries will be required to support providers through the deployment of EHR technology in a meaningful way to qualify for incentives. These intermediaries will coordinate with the Regional Extension Center (REC) activities underway within TN and will increase successful adoption of EHRs by providing community-wide technical assistance and facilitating group purchasing. This coupled with the coordinated HIE efforts of HIP TN will ensure the requirements and capabilities for meaningful use can be consistently met as funding will be coordinated between programs to ensure consistency in application of rules and to maximize impact.

Serendipity Health, LLC will act as one of the intermediaries working with CareSpark, IVHIN, HIP-TN and others at the TN state office of eHealth to help area providers and hospitals understand and qualify for federal EHR incentive money while improving the health care in East TN. If your organization is interested in finding out more about deploying connected health care, please contact us at info@serendipityhealth.net to learn more about how your organization can qualify for incentives and help optimize health care for all.