Write a formal, in-depth SWO(no C) analysis for powerpoint due Aug 11, 2018 9:00am EST
King Wave
DRAFTCompletehealthcaredatasharingpresentation.pptxNationwide Electronic Patient Healthcare Data Sharing
by XXX
Clinical/Technical Integration Project Manager
Speaking notes: Mention five year experience with healthcare data sharing and exchange. Experience includes healthcare data sharing on the community, state, and national level.
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Why share healthcare data?
The more information your healthcare provider has, the better and safer your care will be.
Speaking notes:
Discuss vacations or times when away from home when your local provider who knows you is not available and the healthcare facility you are at does not have access to your healthcare data.
The physician/ provider not knowing what medications the patient is on, their current medical condition(s), and allergies could be fatal. For example, if the provider gave the patient a medication they did not know the patient had an allergy to. Maybe the patient just forgot to tell the provider/ nurse or the patient was incapacitated and could not communicate this information.
Being able to share patient data will lead to improvements in healthcare quality and patient clinical outcomes because easier access to your medical information will lead to better care.
Note: Reminder- three second delay after first click before the three images launch
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To review the state of electronic healthcare data sharing in the United States.
Purpose
Speakers Note:
This will include a review of where we are now with electronic healthcare data sharing and the not so distant future state
Also note there are barriers in reaching the optimal not do distant state state.
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we will be reviewing
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we will be reviewing
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Interoperability
What is interoperability?
Speakers Note: Interoperability is two things for this discussion:
The ability for multiple healthcare systems and organizations to share healthcare data with each other.
To offer a seamless process for physicians and clinicians to access this shared data efficiently in their everyday workflow. A physician or clinician should not have to access multiple disparate systems to fine this shared patient data.
Interoperability is the technical component of electronic healthcare data sharing.
With the pictures in this slide representing interoperability, each of these gears can operate alone and turn, but when they all come together, they create a powerful unit.
Over the past decade, the federal government has awarded grants to states to create health information exchanges (HIE). An HIE is a large database that stores patient healthcare data from healthcare facilities. Most states mandate that all hospitals send patient data to the HIE. Every state, except for Wyoming, has an active HIE and they are working on it.
However, data sharing stops at the state line with state based HIE’s. Few states have agreements with other states to share healthcare data across states.
To get to real interoperability, we need EHR’s vendors, state Health Information Exchanges (HIE), and other patient data owners to work together to create systems that break down data and geographic silos to allow data to be accessible by physicians and clinicians to take care of patients.
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Interoperability Examples
Speakers Note: Here is an example of healthcare data sharing and interoperability with a state HIE. In this example, all of the hospitals in the state are sending patient data to the state HIE.
Example one- No interoperability, no data sharing.
Dr. Smith sits down at his office computer
Dr. Smith logs into his hospital Electronic Health Record System
Dr. Smith is able to look at Ms. Jones healthcare record only for services provided at his hospital
Example two- No interoperability, data sharing through a state HIE
Dr. Smith sits down at his office computer
Dr. Smith logs into his hospital Electronic Health Record System
Dr. Smith is able to look at Ms. Jones healthcare record only for services provided at his hospital
If Dr. Smith wants to check the record in the state HIE, he will need to access different software and use a different login/ password. Also, Dr. Smith will need to search for the patient in the state HIE to find the healthcare records he needs. Also, difficult to go from the patient record in the EMR to the patient record in the HIE to compare information, such as lab result values.
This is not an efficient workflow
Example three- Data sharing and interoperability with state HIE
Dr. Smith sits down at his office computer
Dr. Smith logs into his hospital Electronic Health Record System
Dr. Smith is able to look at Ms. Jones healthcare record for services provided at his hospital and all records in the state HIE from the hospital EHR.
This is an efficient and seamless workflow. This workflow keeps Dr. Smith in a single health record system.
We will next look at the legal and patient side.
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we will be reviewing
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Patient Consent
Speakers Note:
With patient consent to allow the sharing of their healthcare data, there are two patient consent models, opt-in or opt-out.
Opt-in consent
Does not allow data sharing and data access with other healthcare providers (besides what the Health Insurance Portability and Accountability Act (HIPAA) allows), state HIE’s, and other data exchanges unless the patient signs a consent form and “opts-in”, allowing data sharing with others. In opt-in states, few patients sign consent to share their data. In Vermont, 35% of patients have a signed consent to share their data.
Opt-out consent
Allow automatic data sharing with other healthcare providers, state HIE’s, and other data exchanges, unless the patient signs a document to “opt-out” of data sharing. In these states, most patients share their data because they are automatically set up to do so and few patients opt-out of data sharing.
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Patient Consent
Data gathered from the Milken Institute School of Public Health, 2016
Speakers Note:
Review map. Wyoming is just now setting up their HIE and has not decided on a consent method. In Kentucky, some patient data requires the patient to opt in, such as behavioral health data, while other data follows the opt-out method.
These differing consent laws create a barrier to nationwide patient healthcare data sharing because not all the data is available for physicians to access to help treat the patient.
For example, we will use a patient from Vermont that has not opted-in for data sharing. This patient spends their winters in Arizona. Arizona is a opt-out state and this patient has not opted-out in Arizona. While in Arizona, the patient gets sick and needs to go to the hospital. In a national healthcare data sharing model, the physician could locate shared patient data from this patients healthcare in Arizona because the data is shared and the patient has not opted out, however because the patient has not opted-in for data sharing in Vermont, none of the patient’s electronic healthcare record would be immediately available to the physician in Arizona to treat the patient.
For effective patient healthcare data sharing, all the applicable patient data needs to be available to achieve higher quality, more effective, and safer healthcare.
Milken Institute School of Public Health. (2016, September). State HIE Consent Policies: Opt-In or Out-Out. Retrieved August 9 2018, from https://www.healthit.gov/sites/default/files/State%20HIE%20Opt-In%20vs%20Opt-Out%20Policy%20Research_09-30-16_Final.pdf
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we will be reviewing
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Patient privacy concerns
Speakers Note:
Often patients that decide to opt-out or not opt-in typically because of concerns with the security and privacy of their data. They are right to be concerned. To be able to identify the patient with their data, many patient identifiers and data points need to be part of the healthcare data.
Some of these data point include:
Patient’s full name
Date of birth
Current and past addresses
Telephone numbers
Sometimes Social Security numbers
Full medical history
With this information, criminals can steal the patient's identity and/or sell their personal information.
Even if healthcare facilities have robust privacy and security plans in place, sharing the patient's data by sending the data to another location puts that data at risk.
To my knowledge, no one has hacked a state HIE.
However, imagine a situation where a hacker stole the healthcare and personal data for every patient in the state. It would a disaster.
A solution for a nationwide patient healthcare data sharing needs to include safeguards to protect the patient data and not create a national HIE where patient data for every patient in the country exists in one location, which could be a target by criminals.
It is safer for the patient data to only exist in one location, such as the hospital or facility where the care was provided.
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we will be reviewing
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CommonWell and CareQuality
Speakers Note:
To achieve the goal of a nationwide healthcare data sharing network, EHR vendors have formed alliances to create an interoperable framework to achieve this goal.
Separate groups of the largest EHR vendors have formed two groups for this purpose- CommonWell and CareQuality.
CommonWell and Care Quality have much in common:
Offers nationwide patient healthcare data sharing between multiple EHR vendors
Allows the physician to search for and view patient records from other healthcare facilities within the patient’s electronic medical chart without needing to access a different application
Connects EHR to EHR, so the patient data location is at each facility where the patient has been and not in a central location like a typical HIE. This keeps the data in one location, where the patient received their healthcare at, not a huge database of all patients for a state, region, or nation.
The difference is that CommonWell is lead by the Cerner corporation and Care Quality is lead by the Epic corporation. Cerner and Epic are the two largest EHR vendors.
Animation note- click to display barrier picture
This has, unfortunately, created two separate, siloed, data sharing networks. Other EHR vendors are joining one network or the other creating a nationwide data sharing barrier.
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CommonWell and CareQuality
CommonWell Health Alliance site map
CareQuality site map
Speakers Note:
Explain maps of the CommonWell and CareQuality site map of the northeast
This barrier between CommonWell and CareQuality his has been an issue for my organization in sharing data in our region.
Our EMR is from Cerner and use CommonWell. But, the two largest hospitals that we refer patients to have Epic for their EMR, and use CareQuality, so we are not able to share patient healthcare data between us.
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CommonWell and CareQuality
Speakers Note:
There is a light at the end of the tunnel.
In late 2018, CommonWell and CareQuality will begin to share data with each other creating a much larger healthcare sharing network.
There is also a trend where state HIE’s are also joining CommonWell or CareQuality, adding to the healthcare data available.
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CommonWell and CareQuality
Speakers Note:
If we look at the earlier interoperability example with Dr. Smith, how this looks with interoperability and nationwide data sharing using CommonWell or CareQuality is:
The top graphic is with Dr. Smith’s hospital having interoperability with a state HIE.
Animation note- click to display the CommonWell/CareQuality example
The bottom graphic is Dr. Smith’s hospital being part of the CommonWell or CareQuality network with access to data from multiple hospitals and multiple state HIE’s.
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Interoperability
Patient consent for sharing healthcare data
Patient privacy concerns
CommonWell and CareQuality
Topics we have reviewed
Speakers Note:
Review the topics covered.
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Questions?
Speakers Note:
Any audience questions about the presentation?
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