Member Spotlight

Q and A with David A. Minch

David A. Minch is presently the HIPAA/HIE Project Manager at John Muir Health, a small IDN in Northern California, and has been involved in healthcare computing and strategic planning for over 30 years. Through his work as president of Coast Micro Inc., he has also gained a national reputation for his knowledge in electronic data interchange. Mr. Minch is an active member of HIMSS, and serves on several task forces, work groups and committees. He is co-chair of the Security Committee of the California Privacy and Security Advisory Board and is one of the founders of the California e-Health Collaborative. He presently divides his time between statewide Health IT & HIE planning activities and his responsibilities for technical direction of the John Muir Health Clinical Integration and HIE projects.

1. As one of the members of HIMSS’ initial HIE Steering Committee, how has the role of the HIE evolved since then? How has HIMSS’ role in the HIE community evolved?

HIE has evolved over the last three years in ways we couldn’t have imagined. While the national agenda pushed through two successive pilots of the NHIN, many healthcare provider organizations and communities at the same time were beginning to understand the value of collaboration, and were forming RHIOs: local ones, provider-based ones, and even statewide ones. In 2005, California had four RHIOs, two of them start-ups, one operational doing results distribution and one nearly operational. Today, two of the four RHIOs from 2005 are defunct, but there are now 13 in various stages of development; nine of those are operational. What is more impressive is that the data sets we see being exchanged today are significantly more complex and complete than what we saw in 2005.

One of the more interesting bits of history was the evolution and split of the term RHIO into HIE (the verb) and HIO (the organization that does HIE). I believe, however, that the fundamental role of HIE has never really changed—it has always been all about getting the right clinical information to the point of care when it is needed in a form that is easily understood and acted upon. I think the national emphasis on HIE and shift into the spotlight was fully accomplished with ARRA/HITECH, and the inclusion of HIE into Meaningful Use.

HIMSS, through the HIE Steering Committee, the IHE efforts, and other advocacy efforts, has continued to produce educational materials and reference information to bolster awareness of the benefits of clinical data exchange. One of the more valuable efforts has been the annual HIE Symposium, now in its fourth year, and the evolution of a separate HIE education track, at the Annual HIMSS Conference. The members of the Steering Committee continue to make presentations at seminars and professional meetings and are generally ambassadors for HIE.

2. What impact has ARRA had on the HIE landscape in California, including the California e-Health Collaborative (CAeHC)?

As I noted previously, California has seen many HIE efforts in the last few years. Until early this year, there had not been any significant effort to establish collaboration between the various HIOs. The CAeHC was formed in late January, and had its initial home page available on Feb. 5. We started the Collaborative because as the ARRA legislation was making its way through Congress, we saw that the states would have an unprecedented opportunity to forward their HIE efforts through funding that could come from the HITECH provisions. Equally important, however, was the knowledge that as each of us has struggled with our own HIEs, we have made the same mistakes and had to learn the same hard lessons, prepare the same presentations, and generally blaze nearly identical parallel paths to make our HIEs operational. Amongst the CAeHC group, we have an accumulation of expertise in starting and operating HIOs that is certainly on a par with any other in the country, and our organization’s original mission was to support the needs of organizations committed to mobilizing data at the point of care.

California’s governor started the Privacy and Security Advisory Board (CalPSAB) back in December 2007 to advise the Secretary of California’s HHS on matters of privacy and security in the exchange of clinical data. This effort was actually an outgrowth of the HISPC process which California participated in. Unfortunately, the CalPSAB charter was not more broadly defined, and so the HIE planning efforts that many states already had underway had not taken place here. CAeHC undertook, on its own, the collaborative planning process to assist the state in preparing to submit a request for the HITECH HIE funding. It became clear to us that no single entity in California had the ability to become the “State Designated Entity” (SDE) as described in HITECH, and consequently, at the urging of many of our constituents, CAeHC created a formal organization in August, and has submitted a proposal to become the SDE. Whether or not CAeHC is ultimately so-designated by the state, we have committed to continuing our participation in the state’s HIE activities as we strive to create a “connected California.”

3. What role do open source technologies play within HIE implementations?

Open source software has long been an interest of mine, and I believe HIE technology can benefit immensely from open source solutions. Probably one of the most significant contributions is the Federal Health Architecture multi-agency effort, which resulted in the CONNECT services package, placed into the public domain and fully available to anyone who wants to download it. CONNECT essentially provides code for all of the service layers that are necessary to interoperate with other HIEs connected to the NHIN. CAeHC performed a demonstration on July 10 where five HIEs in the state used either CONNECT or their proprietary NHIN gateway software to exchange records, and those that used CONNECT were able to incorporate that open source software into their technical environment and establish connectivity within six weeks of acquiring the software—a phenomenal accomplishment.

As the industry moves more fully to adopting a Web-services model for providing health IT, in general, and EHR and HIE services, in particular, many more open source solutions are becoming available. There are now some companies of significant size that are contributing open source solutions, many of which are using SOA as the basis for interoperation of service components. HIE sustainability remains a significant issue for most of us. We have sponsored and participated in HIE because it is the right thing to do for our patients and members, not because it is financially attractive. Open source solutions, if you have a competent development staff and a good support vendor relationship, can be very attractive to HIEs because of the low start-up cost, and reasonable support costs. I should also point out that the HIE Steering Committee has an on-going task force that I continue to participate in. The task force is dedicated to open source; its charter for this year is to produce its third white paper, one devoted to open source solutions in the HIE space.

4. What can attendees look forward to hearing and learning about during the HIE Symposium to be held in conjunction with HIMSS10?  What are some of the “hot topics” that will be explored during the symposium?

The HIE Symposium this year titled “Meaningful HIE” will again feature an outstanding lineup of speakers examining HIE from different perspectives. As HIEs become more abundant, many of the more mature HIEs are presenting their “stories” during the Annual HIMSS Conference. As a result, the HIE Symposium is starting to become more introspective into the functions, strategies, challenges, opportunities and technologies of HIE as perceived by those who are operating HIEs or are counting on them to achieve “meaningful use.” By request from previous attendees, we have provided three separate breakout opportunities for attendees to chat in small groups about significant challenges and issues within HIE. We will also, once again, feature an update from ONC, and this year will have a panel of state officials offering their perspectives on HIE and the implications to their states.

I will be particularly interested in hearing from a panel of speakers representing operational HIOs who will explore the topic of outcomes and performance measurement—another first for HIMSS. There will be a session on HIE in rural and underserved communities exploring the benefits of connecting the safety net community to its tertiary care anchor facilities. Finally, a technology session will examine emerging technologies and their expected impact on future HIE connectivity. This session should be particularly interesting as the speaker will explore the relatively new field of grid computing; this field has already had a significant impact on cancer research (the Cancer Biomedical Informatics Grid or caBIG project) and shows promise in many other informatics areas and HIE.

5. Shifting gears a bit, can you tell us a bit about one of your favorite activities—skiing? How did you get involved in this sport?  Do you have favorite spots for skiing in the winter and summer?

I enjoy snow skiing during the winter and water skiing during the summer. I mostly perform both activities in the Sierras – Tahoe for snow skiing (I’m particularly partial to Squaw Valley), and water skiing on Lake Tahoe and other lakes in the area and in the foothills. Every couple of years, I tag along with a group of Squaw Valley Ski Patrollers and go to Europe for a change of venue. This year, we are going to the Italian Dolomites to run the Sella Ronda, a circuit from town to town in an area 30 miles by 50 miles that contains over 450 lifts. A few years back, a friend and I performed my version of the perfect triathlon (after a late snowfall at Squaw): snow skiing in the morning, nine holes of golf in the early afternoon and waterskiing at sunset.

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HIE NEWS

Save the Date: HIMSS10 HIE Symposium

“Meaningful HIE”

Sunday, February 28, 2010

8:00 am – 1:00 pm

There are more HIEs and HIOs (Health Information Organizations) throughout the country than ever before; but, where do they fall in relation to ARRA and Meaningful Use? The HIE Symposium, to be held in conjunction with the 2010 Annual HIMSS Conference and Exhibition in Atlanta, will explore issues and challenges facing today's HIEs and share success stories. The opening keynote session will examine the HIE national landscape, followed by an update from ONC on interoperability and the Healthcare Information Technology Regional Extension Center program. Other sessions will include opportunities for hearing practical “how to’s” from experts in the field and sharing success stories with colleagues from other operating HIOs.

For more details on the HIE Symposium, see the Member Spotlight in this issue of HIELights.

Save $100 on Registration
Save $100 when you register for the full conference and any symposium. This special discount applies to full paid conference registration (Sunday-Thursday) only and is not available for students. The discount will be applied automatically during the registration process. 

Registration, Travel and Housing
Early-bird registration rates for HIMSS10 are available now through Dec. 15. HIMSS10 registration includes entrance to all education sessions and the exhibit hall, the Sunday Night Welcome/Opening Reception on Sunday, Feb. 28, and registration tote bag (while supplies last). The HIMSS10 Web site features details on all registration categories, registration for optional events such as the symposia, and discounted rates for a One-Day Pass and Wednesday Exhibit Hall Only Pass.

Air travel and hotel information are also available online. Hotels are expected to fill up quickly, so attendees are encouraged to make hotel reservations early through Ambassadors, HIMSS’ official housing and travel bureau. In addition to making reservations online, attendees can contact Ambassadors at 877-517-3038

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Get Strategies for Achieving Meaningful Use and HIE On Demand
This week’s HIMSS Virtual Conference & Expo answered healthcare professionals’ most pressing American Recovery and Reinvestment Act and meaningful use questions. Although the live segment of HIMSS Virtual Conference on Nov. 3-4 is over, the event’s educational sessions and expo remain available to registrants through Dec. 4. The following sessions provide guidance to the HIE community:

ARRA, HITECH and Health Information Exchange: Opportunities and Pitfalls
John Kansky, MS, MBA, vice president, business development, Indiana Health Information Exchange, kicked off the event by sharing key success factors for using states’ HITECH dollars to build and advance the nation’s health information exchange infrastructure.

CareSpark: Collaboration, Sustainability and Commitment, a Real-World HIE Example
CareSpark, a unique multi-stakeholder collaborative of healthcare providers, purchasers, technology companies and policy-makers, is a financially sustainable RHIO. CareSpark Executive Director Liesa Jenkins explained how it delivers value to the community.

Using an Enterprise-Wide EMPI to Achieve Interoperability and Meaningful Use: The Catholic Healthcare West Approach
While there is much discussion around electronic health records, EHR alone does not deliver interoperability. Scott Whyte, senior director, physician and ambulatory IT strategy, showed how Catholic Healthcare West is rolling out across its network of hospitals an EHR Alliance program with an enterprise-wide EMPI as part of the infrastructure to achieve interoperability and meaningful use.

HIMSS Virtual Conference is free to qualified registrants. Non-qualified individuals may attend for a nominal fee ($99 for HIMSS Members/$119 for non-members). Learn more and register at online.

The call for proposals for the next HIMSS Virtual Conference & Expo on June 9-10, 2010 opens Jan. 18; the deadline for proposal submissions is Feb. 22. Details on proposal submissions will be available in the coming months.

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NHIN, FHA, and CONNECTing the Dots
By Anthony Stever, CPHIMS, and Darren D. Clark

NHIN, FHA, and CONNECT are all topics that have had a lot of recent attention and some confusion between them. This article is intended to demystify and disambiguate the three. One is an entity, another is a software utility and the third is a mostly virtual construct with some presence in the physical world.  Which is which? Our intent is to provide high level descriptions of each and to point you toward resources to learn more.

NHIN
The Nationwide Health Information Network (NHIN) was conceived to provide a standards-based, secure network over which health information can be shared between providers, consumers, and others involved in supporting health and healthcare.  A crucial element of the NHIN is the sets of standards selected for connectivity, transmission, and security of the data which travel across it. The public Internet is the primary physical medium for NHIN and there are servers/systems in operation now to enable users’ systems to locate and securely connect to one another.

FHA
When 26 federal agencies collectively collaborate about the needs for standards and ways to seamlessly exchange health data, the outcome is the Federal Health Architecture (FHA). Realizing they share many of the same needs, expertise and resources, the FHA was formed as an E-Government Line of Business to achieve greater levels of efficiency and effectiveness. Given that charge, the FHA has developed and disseminated 20 standards for health IT, HIE processes, input to health IT standards, and released the CONNECT utility for the NHIN.

CONNECT
CONNECT is a product developed by the FHA and its partners enabling federal agencies to exchange health care information with each other and regional hospital networks securely through the NHIN. Connect is an open source software product that uses the protocols, agreements and core services that make up the NHIN.

Anthony Stever, CPHIMS, has been an IT consultant since 1992 and has worked on information technology projects since 1984 for various organizations. In 1997, he began working for healthcare organizations including government agencies and private, not-for-profits in various capacities, including CIO and project manager. Darren D. Clark has served in his current role as an infrastructure architect for Iowa Health System since 2003. In this role, he provides consultative services to the business, researches technologies and applications for achieving business objectives. Darren has nearly 20 years of experience supporting, implementing and designing solutions for strategic use by the business.

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STANDARDS

The Role of Standards in Successful HIE

By Noam H. Arzt. PhD, FHIMSS

Welcome to a new monthly column in HIELights focused on standards and HIE. We thought it was important to raise the visibility of standards in the HIE discussion. Standards are the primary enabler of successful, cost-effective system interoperability. They allow disparate organizations to exchange electronic information without necessarily using the same products or specific technologies. In a 2007 white paper, the HL7 Electronic Health Record Interoperability Workgroup identified over 100 definitions of interoperability from more than sixty organizations.¹ Ultimately, the workgroup defined interoperability as “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.” The workgroup then identified three primary components:

• Technical interoperability: Relates to the structure and syntax of data flowing between systems, including reliable and secure communications.
• Semantic interoperability: Relates to preserving the meaning of data from sender to receiver, usually by enforcing agreed-upon code sets and meaning.
• Process interoperability: Relates to how data is used to support the workflow in organizations, and ensuring that data is properly and consistently used when sent to another organization or program.

Without technical standards data cannot flow reliably from one location to another. But without semantic standards – terminology standards – one cannot ensure that the meaning of the data transmitted will be understood as it was intended. And without standards related to how data is used in practice its meaning may be misapplied or confounded.

In the coming months we will address a variety of issues related to standards, including:

• The evolving national policy framework for standards development and harmonization
• Activities of important standards development and harmonization organizations like HL7, IHE, and HITSP
• Real “standards in use” case studies from HIE projects that demonstrate successful use of standards in practice

Reference
1. Gibbons, Patricia, et al, 2007 Coming to Terms: Scoping Interoperability for Health Care Health Level 7 Electronic Health Record Interoperability Workgroup, February 2007. Accessed on Oct. 30, 2009.

Noam H. Arzt, PhD, FHIMSS, is president and founder of HLN Consulting, LLC, San Diego, and does consulting in healthcare systems integration, especially in public health. He serves on the HIMSS HIE Steering Committee and can be reached at arzt@hln.com.

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ADVOCACY AND PUBLIC POLICY

Healthcare Reform Timeline Unclear; HHS Convenes Meaningful Use Meetings; U.S. Surgeon General Confirmed
After weeks of working to harmonize different versions of healthcare reform legislation, House Democrats have unveiled a final bill for consideration on the House floor. H.R. 3962, the Affordable Health Care for America Act, retains a public option, calls for a study by the Institute of Medicine (IOM) on Medicare reimbursement, and allows for the creation of "State Health Insurance Compacts" to allow for the sale of insurance across state lines. Similar to H.R. 3200, H.R. 3962 calls for immediate investments in administrative simplification, establishment of a Center for Comparative Effectiveness Research, establishment of an Assistant Secretary for Health Information, development of quality measures, and expansion of the Physician Quality Reporting Initiative (PQRI) timeframe. In both the House and Senate, it is still unclear whether Democratic leadership has the votes needed to pass healthcare reform legislation that includes some form of a public option.

Also last month, both the HIT Policy Committee and the HIT Standards Committee Implementation Workgroup met.  Speaking at the Policy Committee, National Coordinator for Health Information Technology
David Blumenthal, MD, MPP, noted that meaningful use, standards, and certification regulations are "in advanced stages of drafting," and proceeded to identify areas where ONC would like the Policy Committee to focus: privacy and security; recommendations for meaningful use for specialty providers in 2013 and 2015; health IT adoption with an emphasis on EHRs; standards development and harmonization (with the possibility of federal resources to support closing gaps in current standards and developing new standards); a rethinking of the "network of networks" model for the Nationwide Health Information Network; coordinating meaningful use efforts between state Medicaid and federal Medicare; and advising ONC on updates to its strategic plan.  Dr. Blumenthal identified privacy and security, the NHIN, and state HIEs as "time-sensitive topics."

Finally, Dr. Regina Benjamin has been confirmed as Surgeon General of the United States.  Dr. Benjamin has experience converting to a paperless environment under extreme circumstances following Hurricane Katrina, and is a strong advocate for rural and underserved populations.

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Tool/Resource of the Month

HIE Liaison Roundtable Webinar Explores Quality Improvement via HIEs

Last month’s HIMSS Chapter HIE Liaison Roundtable Webinar, “Quality Improvement via Health Information Exchange—Re-Engineering Communities,” discussed the value of community collaboration as well as trust and transparent governance using HIE. Speaker Dick Thompson, executive director of Quality Health Network, an HIE in Grand Junction, Co, described how his organization provides a wide variety of services to facilitate quality improvement, improved efficiencies and lower costs for participants – all contributing to financial viability and long-term sustainment of business operations. Click here to access the presentation from this webinar. And be sure to read next month’s issue of HIELights. Quality Health Network will be featured in the HIE Spotlight.

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Calendar of Events

Upcoming HIMSS Chapter HIE Roundtable Calls

Thursday, Nov. 19, 12 pm ET

Navigation Skills for HIEs: Setting your Course, Casting Off, Shooting the Rapids, Running Aground, and Smooth Sailing

Speaker:  Liesa Jenkins, Executive Director, CareSpark

Listen to one organization’s story about startup, lean funding, overcoming obstacles and managing operations in times of lean and plenty.

Register now.

HIMSS Middle East Health IT Leadership Summit
Nov. 15-17
Muscat, Oman 

Takin’ HIT to the Streets: The ARRA Era
Dec. 4
Dallas, Ft. Worth, Texas

Takin’ HIT to the Streets: The ARRA Era
Jan. 15, 2010
Chicago

2010 Annual HIMSS Conference & Exhibition
March 1-4, 2010
Atlanta, Ga.

2010 World of Health IT Conference & Exhibition
March 15-18, 2010
Barcelona, Spain

HIMSS AsiaPac10 Exposition
May 26-28, 2010
Beijing, China

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Editor’s Note: The inclusion of an organization name, product or service in this newsletter should not be construed as a HIMSS endorsement of such organization, product or service, nor is the failure to include an organization name, product or service to be construed as disapproval.

HIMSS HIELights is your official source for timely, comprehensive coverage and analysis of today’s HIE and RHIO initiatives. We hope you have enjoyed HIMSS HIELights. If you and your colleagues would like to permanently subscribe to each and every complimentary edition, click here.

HIMSS Healthcare Information Systems Team
Pat Wise, Vice President of Healthcare Information Systems, 706-650-1482
Pam Matthews, Sr Director of Healthcare Information Systems, 706-838-0583
Nancy Vitucci, Editor of HIMSS HIELights, nvitucci@himss.org, 312-915-9238
230 E. Ohio St, Suite 500
Chicago, IL 60611