Click to insert picture Pamela Clarke, Senior Director, HSXDaniel Wilt, Senior Director, HSX

NJ DVHIMSS October 29, 2015

SEPA Health Information Exchange:

How to Get Services Deployed

Transforming Healthcare and Improving Patient Care in the Greater

Philadelphia Region

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Who are we?

• A Non Profit 501(c)(3) Member Owned Entity. • Corporation formed in May 2012.• Board and Governance formed in January 2013.• Staff of 8 FTEs, technology vendors, consultants, several

college interns and incredible volunteerism from our members.

• Geography Focus City of Philadelphia and surrounding counties: Bucks, Montgomery, Chester, Delaware and Philadelphia counties.

• Plans to expand coverage as current members become connected.

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What is HealthShare Exchange of Southeastern Pennsylvania?

HSX is a non-profit health information exchange (HIE) organization serving the greater Philadelphia Region.

• The HSX Mission is to provide secure access to health information that enables preventive and cost effective care; improves the quality of care; and facilitates the transitions of care.

• The HSX Vision is to build a trusted community of healthcare stakeholders collaborating to deliver better healthcare to patients.

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HSX Current Membership

Health Systems• 37 Acute Care Hospitals• 93%+ Emergency Department

(ED) visits in the region

Independent Behavioral Health Facilities• Eagleville Hospital• Elwyn

Specialty Hospitals• Physicians Care Surgical

Hospital

Accountable Care Organizations• Delaware Valley ACO• Noble Health Alliance

Health Plans• AmeriHealth Caritas• Health Partners Plans• Independence Blue

Cross• 62%+ of the covered

lives in the region

Independent Ambulatory Practices and FQHCs• 42 New Signed Up

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New Member Candidates 2015 2016Entities Interested in Joining HSX• Behavioral Health Facilities

• Behavioral Health MCOs

• Birthing Centers

• Large Private Practices

• Long-Term Care Organizations

• National Health Plans

• Other Hospital/Health Systems

• Regional-Focused Health Plan

• Retail Pharmacy

• Urgent Care Centers

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Enabling Exchange within a Layered Ecosystem

Hospital/ Health System EMR/IDN

Region/Member Connections/Exchange

Neighboring HIO-HIO Connectivity

State Exchange

National Exchange – Sequoia Project and Global Exchange

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Solving Critical Health Problems in the Region

Uncoordinated Discharge ProcessThe hand-off to the next provider is not well coordinated.

Unknown Primary Care Provider (PCP) or Care TeamThe discharging facility does not know the name of the patient’s PCP or Care Team or how to contact them.

Incomplete and Delayed InformationEven if information is transmitted, it is usually incomplete, not timely and sent by handwritten hard-copy or fax.

Results in Failed SystemLeads to medication mix-ups and errors, absence or delay in follow-up care and increased emergency room utilization.

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HSX Services Roadmap

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Keys to Success for Deployment and Adoption

• Social Work Ideal: Begin where the client is.• Field of Dreams: If you build it, he/they will

come.• Problem Solving Approach: What is the

problem you want to address?• Be Hands On: Engagement and Adoption

Works!

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Provider Directory

Jun-2014

Jul-2014

Aug -2014

Sept-2014

Oct-2014

Nov-2014

Dec-2014

Jan-2015

Feb-2015

Mar-2015

Apr-2015

May-2015

Jun-2015

Jul-2015

Aug-2015

Sep-2015

0

1000

2000

3000

4000

5000

6000

7000

Independent Practices

Prime Healthcare - Lower Bucks Hospital

Doylestown Hospital

Grand View Health

Aria Health

Main Line Health

Einstein Healthcare Network

Crozer

Jefferson Health - Abington Health Physicians

St.Chris

Temple Health

Hahnemann

Penn Medicine

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Challenges with Direct Secure Messaging Solutions that Work

• Duplicate Direct Addresses: HSX’s primary Direct address solution!• Principle #1 : Don’t let the perfect get in the way

of the good!• Interoperability Challenges: Exchange Partner

Testing• Principle #2: If at first you don’t succeed, try, try

again!• Clinical Naysayers: The “What Ifs Club”• Principle #2: “Progress always involves risks. You

can’t steal second base and keep your foot on first.” Frederick B. Wilcox

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Direct Secure Messages Sent and Received by HSX HISP Users

Jun-2014

Jul-2014

Aug-2014

Sep-2014

Oct-2014

Nov-2014

Dec-2014

Jan-2015

Feb-2015

Mar-2

015

Apr-2015

May-2

015

Jun-2015

Jul-2015

Aug-2015

Sep-2015

-

5,000

10,000

15,000

20,000

25,000

174 286

2,557

4,785

2,500 2,576 3,850

4,881 5,923

7,094 7,852 8,027

19,474 19,814 18,514

22,525

Messages Sent and Received*Note: Message count shown is for those entities using HSX as their HISP, meaning it is a subset of all message volume that exists within the HSX member/participant community. January 2015 message count is an estimate based on January 14th – January 31st data.

ACTF and CAH Go Live

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Average Daily Direct Secure Messages and Unique Recipients

Jun-2014

Jul-2014

Aug-2014

Sep-2014

Oct-2014

Nov-2014

Dec-2014

Jan-2015

Feb-2015

Mar-2

015

Apr-2015

May-2

015

Jun-2015

Jul-2015

Aug-2015

Sep-2015

0

100

200

300

400

500

600

700

800

900

1000

6 9

82

154

85 83124

157212 229 253 259

649 639 617

751

94 82

394

486

415 424

499

620

782

655690

617

721749 753

917

Average Messages Per Day Number of Unique Recipients

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Master Patient Index (MPI) Patient Entities

Mar-2015 Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 -

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

7,524

617,237

983,962

2,341,307

2,991,467

3,288,797 3,506,309

3,735

299,421 457,568

1,057,214

1,317,251 1,444,462 1,527,633

Gross MPI Net CDR

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ENS Subscriptions and Notifications

Apr-2015 May-2015 Jun-2015 Jul-2015 Aug-2015 Sep-2015 -

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

206,919

416,092

948,394 948,394 948,394 948,394

2,037 9,849 22,139 33,204 44,173 50,768

Patient Subscriptions Notifications

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Considerations for ENS Roll Out • What are you going to do with the data?

• Establish a subscription for data that is meaningful and is actionable.

• Who is going to access the data?

• Need to think about workflow and resource allocation.• When do you want to receive the data?

• Consider the best time frame for receiving the information.

• How do you want to receive the data?

• Consider the options for data delivery.• Review the Model

• ENS is a flexible service. Patient panels and subscriptions can be updated and changed based on need.

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Emergency Management Preparations

• After The Recent Train Incident and Ability to Location Family Members• 200+ Injured Individuals Were Admitted to 5

Different Hospitals in the Philadelphia Area

• In Preparation for the Papal Visit in September to Philadelphia• Estimated 1M+ People to be on the

Benjamin Franklin Parkway

• How Can the HIE Help Support the Region?

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HIE Emergency Management Urgent Patient Activity Liason (UPAL)

• What is UPAL? • A real time look up capability of an individual patient’s emergency

healthcare activity across the greater Philadelphia region in the event of a regional situation impacting healthcare services for a large number of citizens.

• Why is HSX Establishing UPAL?• HSX members believed that it is critical for HSX to be able to provide a

back up in the event of a crisis or emergency circumstance during the Papal visit.

• UPAL can be invoked to respond to member hospitals on behalf of inquiring family members in an effort to locate patients who have been admitted, discharged or transferred to one of the region’s hospitals.

• What UPAL is NOT?• This service is not a replacement for Knowledge Center. UPAL

could be deployed if several HSX member hospitals needed assistance responding to family member inquiries in an emergency circumstance.

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HIE Emergency Management Urgent Patient Activity Liason (UPAL)

• How UPAL works?• If HSX was notified by their members and or a

governmental agency that there was an emergency circumstance warranting the initiation of UPAL, HSX would obtain approval from the Executive Committee to begin the UPAL service.

• HSX would notify hospital members that the service was available.

• HSX Staff will provide 24/7 availability and support when this service is available.

• To make patient location requests, contact HSX Support via the phone at 855-479-7372

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HIE International Exchange

• Proof of Concept Exchange• C-CDA Exchange Between HSX and Toronto,Canada

and Rome, Italy

• Technical Foundation• Prior work from 2014 ONC exploratory project based

on EU-USA MOU for HC data exchange• Mutual support for IHE International standards for

message transport

• Business Foundation• Papal visit and other VIP events in Philadelphia• Europe & Canada considered high-frequency

vacation/business destinations for PA residents

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HIE International Exchange

• What Went Well• We were able to demonstrate use of the

IHE standard for transport easily• CDA CCDA continues to be conduit to

International Pt Summary (IPS) content for international exchanges

• Challenges• Obviously Languages and Coding Sets• Patient consent differences

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HIE Promotes Consumer Focused Care

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HealthShare Exchange of Southeastern Pennsylvania

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Thank You!

HealthShare Exchange of Southeastern Pennsylvania, Inc.1801 Market Street, Suite 750Philadelphia, PA 19103 www.hsxsepa.org

Martin Lupinetti Executive Directormartin.lupinetti@hsxsepa.org215-391-4907

Pamela ClarkeSenior Director, Member Services and Policypam.clarke@hsxsepa.org215-422-4323

Daniel WiltSenior Director, Information Technologydaniel.wilt@hsxsepa.org215-422-4321

Jennifer NataleSenior Manager, Engagement and Adoptionjennifer.natale@hsxsepa.org215-422-4322

Rakesh MathewProgram Managerrakesh.mathew@hsxsepa.org215-391-4908

Yolande GreeneProject ManagerYolande.greene@hsxsepa.org215-422-4325