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March/April 2012

From the Executive Director

McCrary_Laura_webLaura McCrary Ed.D

Health Information Exchange in Kansas is close to becoming a reality. Many of the remaining barriers are reaching resolution including the establishment of a Certificate of Authority process by the Kansas Health Information Exchange (KHIE) with anticipated awards to the Kansas Health Information Network (KHIN) and the Lewis and Clark Information Exchange (LACIE) by the end of the month. The consumer-facing materials that are necessary to "go live" are in development with delivery expected before June 1. The complicated task of establishing the state's "opt-out" process for patients who do not want to participate in the exchange is being finalized under the watchful eyes of the Office of the National Coordinator (see related article). Lastly, the early adopter hospitals and clinics are in the final stages of data testing and user acceptance testing.

So with many barriers removed KHIN anticipates a "Go Live" date for the KHIN early adopters of July 2012. Facilities that are scheduled to "go live" in July 2012 include Via Christi Hospitals in Wichita, HCA Wesley in Wichita, Hutchinson Clinics, Pratt Regional Medical Center and HaysMed. LACIE already has several facilities that are live with health information exchange in Missouri and anticipates that several additional hospitals in the Kansas City area will go live in July 2012. Thus, if all goes as planned by Fall 2012 it is expected that approximately 1,500,000 unique patients will be in the exchange representing approximately half of the total Kansas population.

Other KHIN early adopters who will be close behind the initial group include Kansas University Hospital, several hospitals that are part of the Great Plains Health Alliance, the Community Health Center of Southeast Kansas, Newton Medical Center and Salina Regional Medical Center.

Facilities are sharing data in a variety of formats including HL7 discrete data and Care Summaries or Continuity of Care Documents (CCDs) transported via XDS.b. These include a minimum data set of demographic information, allergies, medications, diagnosis and procedures, diagnostic test results including labs and immunizations. Initially, KHIN will display the HL7 data as discrete elements and the care summaries as a single document similar to a PDF of the relevant information related to the specific patient and the encounter. However before the end of the year KHIN's technology vendor, ICA has indicated that they have developed the functionality to deconstruct the CCD and populate KHIN with discrete data from the CCD.

I wish to thank everyone who has worked so hard to help Kansas get to this point. It is a very exciting time. If you would like more information, please contact Laura McCrary Ed.D at lmccrary@khinonline.org.

Opt-out process nears completion

Typing hands_stethoscope

In May 2011 the Kansas Legislature passed the Kansas Health Information Technology and Exchange Act referred to as K-HITE. This act established Kansas as an opt-out state. This means that all Kansas consumers have their health data in the exchange unless they take proactive action to opt themselves out of the exchange.

K-HITE provided additional protections for consumers by stipulating that KHIE must approve the organizations providing health information exchange. If an organization was not approved by KHIE then a facility working with a non-approved provider would be required to revert to an opt-in approach; meaning patients would have to "sign themselves into the exchange."

There is one federal exception to the Kansas opt-out rule and that is for patients receiving substance abuse treatment. Under federal law they are required to "opt in" to exchange by providing written consent of their willingness to share their health information. The Office of National Coordinator (ONC) for health information exchange has recently offered additional guidance to the states to ensure that patients can make "meaningful decisions" regarding the inclusion/exclusion of their health data in the exchange.

While the process noted above is complex it provides a significant amount of protection to Kansas consumers. Through policy KHIE has addressed and clarified a variety of other related issues. First, the decision was made that a Kansas consumer was either "all the way in the exchange" or "all the way out of the exchange". This means that a consumer cannot block a portion of their health data while releasing other portions or release it to some providers but not others. This decision was based upon a number of factors including the capacity of the exchange technology to accurately and completely block specific data and the concern expressed by providers that the viability of the exchange was reduced significantly if the provider did not know what data had been blocked by the patient.

KHIE is now moving forward to operationalize the opt-out process for Kansas consumers. The procedures under development include a support desk that will receive calls, emails and mail from consumers who wish to opt-out of the exchange. The support desk will confirm the patient's identity and gather demographic information necessary for patient matching. Upon confirmation the patient information will be forwarded to KHIN and LACIE and both will globally opt out the patient.

This process will effectively block the patient data except in the event of required reporting to public health, the immunization registry and in the event of suspected child or elder abuse. Some consideration has also been given to the ability to "break the glass" to unblock the data in the event that the patient is determined to have a life threatening emergency and is unable to communicate with the clinician, but this has not been finalized at this time.

Brochures and posters are in development that further defines this process for patients. They are expected to be available in June 2012. When they are available KHIN will ensure that all KHIN Participants have them.

KHIN team reaches 10

KHIN-Logo-on-art-backgroundIt takes a lot of people to make the KHIN health information exchange a reality in Kansas. At this time there are 10 staff members working together to provide interoperability services to Kansas health care providers. However, they are not all employed by KHIN. Often there are questions about how all the staff work together and their roles and responsibilities. Please feel free to contact these individuals at their email addresses below.

KHIN has hired four staff. These include the following;

  • Tiffanie Hickman, Executive Assistant and Office Manager. Tiffanie works in Topeka and is responsible for managing the office and all scheduling.
  • Lacy Luthi, Support Staff. Lacy works in Topeka and is responsible for a wide variety of support functions including billing, website maintenance, scheduling and new user management.
  • Laura McCrary, Executive Director. Laura works in Topeka and is responsible for all aspects of the not-for profit organization.
  • Michelle McGuire, Project Manager. Michelle works in Topeka and is responsible for assisting all Kansas providers achieve interoperability with the exception of those in the Wichita, KS area.

The Wichita Health Information Exchange (WHIE) is a founding partner of KHIN. The WHIE is an integral part of KHIN and manages the development of the KHIN technology infrastructure in Wichita. The WHIE hired a full-time project manager.

  • Allen Laramore, Project Manager. Allen works in Wichita and is responsible for assisting all Kansas providers in the Wichita area.

ICA is KHIN's technology partner. ICA has four staff dedicated to KHIN interoperability across the state. All four live in the Kansas City metro area.

  • Heather Townsend, Client Manager. Heather works in Kansas City and is responsible for all aspects of the ICA team's work in Kansas.
  • Ashley Girard, Project Manager. Ashley works in Kansas City and oversees all of the ICA interoperability work with KHIN participants across the state.
  • Kay Nelson, Clinical Applications Specialist. Kay works in Kansas City and is responsible for assisting KHIN participants in identification of use cases, workflow redesign and training.
  • Bob Jones, Integration Engineer. Bob works in Kansas City and is responsible for assisting all KHIN Participants and their EHR vendor to test data and ensure interoperability.

KHIN contracts with ISG to manage its Help Desk. ISG hires a full time staff person to oversee the help desk support function.

  • Bobbi Gray, Help Desk Manager, Bobbi works in Wichita and is responsible for managing all of the help desk functions.

Behavioral health leader elected to KHIN Board

DavidJohnson colorAt the March 2012 KHIN Board Meeting David Johnson was elected as a voting member to the KHIN Board of Directors. Mr. Johnson is the CEO of Bert Nash Community Mental Health Center, Inc., located in Lawrence, Kansas. Mr. Johnson has served in this role from March 1, 2001 to the present. Mr. Johnson was recommended to the KHIN Board by his behavioral health peers based upon his knowledge and interest in health information technology and health information exchange.

In 2010, Bert Nash provided services to 6,000 Douglas County residents through the employment of psychologists, educators, case managers, employment specialists and personal attendants who focus on child, adolescent, adult and geriatric mental health care.

Mr. Johnson holds a Master of Science in Health Services Administration from the College of St Francis (now the University of St. Francis), Joliet, Illinois and a Bachelor of Arts in Secondary Education, University of Iowa, Iowa City, Iowa.

The KHIN Board is pleased to welcome its new member. Mr. Johnson's first Board meeting was on April 11, 2012.

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