accessing patient data from across the community · 2018. 12. 6. · nextgen connect analytics...
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Muhammad Chebli & Curtis Bailey
1/23/2018
Accessing Patient Data from Across the CommunityNow, easier than ever with NextGen Health Data Hub
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Muhammad ChebliDirector, Connected Health Solutions
Presenter
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Curtis BaileySolutions Architect, Connected Health Solutions
Presenter
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Agenda
What is Health Data Hub?
Journey to the Cloud
Architectural Principles
Use Cases
Client Profiles
Q&A
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What is Health Data Hub?An Overview
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Most
Improved
What’s an EHR Company Doing Here?
Interoperability: Real Progress with Patient-record Sharing (November 2018)
Most
Improved
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I think we should start with the Mirth origin story
Pre-Connect
days
2006Connect
2008Results
Mail, Care
2013NextGen
Acquisition
2018Health
Data Hub
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What is Health Data Hub?
When you aggregate clinical data
you can turn community-wide patient information
into insights that improve patient care.
NextGen Health Data Hub (HDH) is a fully redesigned data aggregation platform to meet expanding market demand
for robust data sharing, aggregation, and community access. It was built from the ground-up to provide
comprehensive, continuous access to aggregated patient health data. It provides a robust, reliable, performant
platform that will lower client ownership costs, enable system-wide connectivity, and supporting growth needs for
large ambulatory organizations.
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Evolving Requirements of Information Management
Today’s healthcare IT
applications must:
• Be faster to launch, integrate, and
use
• Incorporate more data from more
sources
• Be simpler to build and manage
• Work seamlessly with existing
infrastructure
• Scale on demand
• Support wide-range of industry
standards and configurable
proprietary data sources
Point-
to-point
Centralized
HIE
Federated
HIE
Intelligent
information
exchange
Complexity and variety of data
Nu
mb
er
of e
nd
po
ints
• Longitudinal record
• Regulatory focused exchange
• IHE protocol support
• National network connectivity
• Clinical and financial data
• Episodic document exchange
• Organization centric
• End-point management
• Clinical or financial data
• Rules driven exchange
• Curated data & quality management
• Proactive notifications
• Actionable insights
• Innovation enabling
• Clinical, financial, and
socioeconomic data
Connected Health Continuum
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HIE Market – Consolidation and Down Market Trending
FEWER HIEs,
GREATER
COVERAGE
– Funding shift from gov to community2
– 70% of states are covered by HIE data exchange1
– Vendor-driven document exchange has grown
substantially
TECHNOLOGY
ADOPTION
– As gov funding has dried up, the number of stand-
alone HIE vendors has declined3
– Providers choosing to use EHR-based solutions
NEW DATA
EXCHANGE
MODELS
– HIE 2.0 requires new data exchange mechanisms
– EHR-based interop (Carequality, Direct,
CommonWell, etc.)
– API & app integration to power the data business4
PRIMARY DRIVERS FOR DOWN MARKET FOCUS
106 HIEsin 2014
VS119† HIEs in 20121, *
† State & Regional - not counting public HIES
1. Health Affairs July 2016 - The Number Of Health Information Exchange Efforts Is Declining
* 7 HIEs merged in 2014; source
2. HIE Sustainability Model 2016 – Survey Results and Analysis
3. HIE Market Trends – Chilmark Research
4. Value remains a problem -
HIE Market Size As of August 02, 2017, HIMSS Analytics, ~35
Health Systems are "shopping" for a new HIE solution.
Projected Growth Expanding - $3.73B (2021) from $2.0B
(2016). Product (Interface Engine, Medical Device Integration, Media
Integration), by Service (Implementation, Support, Training), by
Application (Hospital, Laboratory, Radiology, Clinics) - Global
Forecast to 2021, “The global healthcare IT integration market is
expected to reach USD 3.73 Billion by 2021 from USD 2.30 Billion in
2016, at a CAGR of 10.2% from 2016 to 2021.” According to the new
market research report "Healthcare Integration Market.” Per the
details above from the HIMSS Workforce study, this growth may be
attributed to academic medical centers, national health systems, or
multi-hospital systems that have budgets and profit margins to
support innovation programs.
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Yesterday’s HIE vs. Today’s HIE
• Yesterday
- 1 primary technology vendor
- Simple use cases – “turning on
connectivity”• ADT & EMPI
• Document shipping A→B (CCD,
images, notes, etc.)
• Web-portal as primary touch-point
- Grant dependent
• Today’s Successful HIEs
- 10-20 technology vendors
- Dynamic use cases – “optimizing
community sharing” • Microservices & API integrations
• Analytics and CQM
• Prescription Drug Management
• Disaster relief & recovery• Natural & ransomware
• Aligned with payers (pop-health) and
pharma (research)
- Community & constituent funded
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Connected Health SolutionsNational Interoperability
NextGen ShareCarequality/Surescripts
Data AggregationPlug-and-Play / APIs (FHIR)Transactional Data Exchange
HL7, Labs, Radiology, Referrals, HIEs,
Device
Health Data Hub
Direct Messaging
Connect
Match EMPI
Rosetta
Connect
NextGen Share
Direct Messaging
Carequality
Enterprise API
FHIR
App Marketplace
Payer Connectivity
Clinical Registries
For NGE Customers
For any EHR
Health Data Hub - API
Connect - FHIR
Surescripts Record
Locater & Exchange
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Data Aggregation Solutions
Exchange, normalize, and aggregate
community-wide data to enable a
longitudinal view of patient records.
Key Solutions
• NextGen® Health Data Hub:
community-wide data aggregation
• Built-in patient matching & EMPI
• NextGen® Connect: vendor-agnostic
integration engine
• NextGen ® Direct Messaging:
seamless clinical messaging with
external providers & organizations
DOCUMENTSNEXTGEN
CONNECT
ANALYTICS
DIRECT
MESSAGE
IN-PATIENT
AMBULATORY
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Key Features
A cloud-based platform supporting the exchange, normalization, and
aggregation of community-wide data to enable a longitudinal view of patient
records.
• Clinical content management: Full support for clinical data types in use by ambulatory and
in-patient systems.
• API: An API first approach enables full system, configuration and data access
• User portal: A user-accessible front-end for the display of patient data.
• Consent & data protection: Secure patient data management for sharing & access
permissions.
• Cloud-hosting: Single cloud-deployed solution leveraging AWS
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Key Benefits
• Data Fidelity: HDH ensures that you can trace all patient data back to its original API call /
point of origin. The system retains data provenance and provides seamless merge and
unmerge capabilities.
• Usability: Easy to navigate, simple to understand controls, and powerful UI configurations
allow all users to feel empowered when interacting with patient data and system
configurations.
• Scalability: Replaces vertical scaling with horizontal scalability (leveraging AWS, we allow
clients to focus on their data sharing use cases)
• Configurability: Increases configurability to adapt to unique implementation requirements
(clients have control over their end-user experience)
• Open Access: Extends interoperability through enriched RESTful API access
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Journey to the CloudWhat & Why?
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Software as a service (SaaS) is a
software licensing and delivery
model in which software is
licensed on a subscription basis
and is centrally hosted.
Wikipedia
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Results CDR Health Data Hub
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Journey to the Cloud
NextGen Results CDR first launched in 2008
On-premise Hosted Cloud-based SaaS
- Total ownership of the application lifecycle by the development teams
- We manage the hosting, deployment, upgrades, and maintenance for all client
environments
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Technical Achievements
Greenfield project using modern technologies
- API first development approach using a REST API
- Horizontally scalable services based architecture
Heavily leveraging managed services from AWS
- Focus on meeting both current and future client needs
- Autoscaling to meet client demands
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Continuous Delivery Pipeline
• Continuous integration & automated
testing
- Release with high degree of confidence in
quality
• Potentially deployable updates to
production at any time
• Zero downtime blue-green deployments
• Continuous incremental value delivery to
clients
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Health Data Hub Delivery Model• Single Application
- One deployed version
- Shared infrastructure
• Multiple Environments
- Unique URL
- Unique user pool
- Isolated data stores
• Continuous Delivery
- Frequent updates
- Automated data migration
- Backwards compatibility
- Zero downtime
• Release Management (new features and workflows)
- Managed customer notifications
- Managed feature preview opportunities
Gmail
Google Accounts
Bug fixes and
improvements
Preview the new look
and feel
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Customer support is not an
expense to be minimized, but an
opportunity to be maximized.
Dharmesh Shah, co-founder – HubSpot
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Levels of Support• Product feature support
- Consent
- Data Access Constraints
- Automated Workflows & Notifications
• API usage support
- Integration
- Implementation
- Interoperability
• Environment support
- Data store sizing
- Data store scaling
• Service support
- Infrastructure as code
- Service reliability
- Service scaling
Develo
pm
ent
Support
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Architectural PrinciplesHow we build
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Architectural Principles
• Data Fidelity
• Usability
• Scalability
• Configurability
• Open Access
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Data Fidelity
• Collect and present data as accurately as possible
• Trace all data back to its original source (message or API request)
• Address challenges with merging, moving, and removing data
Transaction
Local Patient Encounter Lab Medication Immunization
Original Message
...
{
"id": "3077-OZGP-6",
"name": {
"first": "Miles",
"last": "Caplin"
},
"dob": "Feb 4, 1962 12:00:00 AM"
"gender": {
"code": "Male",
"label": "Male"
}
}
Processed Message
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Patient Data Modeling
H H HH
Hoag Quest
Q Q Q
H H H HQQ Q
Patient
Local
Patient
Local
Patient
H
Transaction
Q
Transaction
Data
Source
Data
Source
Patient Matching
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Usability
• Holistic approach to the user interface
- Provide consistency
- Match the user’s intent
• Internal design language to ensure that future development will
remain consistent
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Usability
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Patient Summary
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Cards
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Scalability
• Services based architecture is horizontally scalable to meet
demand
• Application automatically scales both up and down
• Individual client data stores scale independently of application
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Configurability
• Feature requests are often specific to each client’s use cases
• Designed to empower clients and users to configure their own
views and manage their own data
- Patient Summary
- Automated Workflows
- Worklists
- Patient merging/unmerging
- Provide creation/mapping
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Patient Summary
Worklists
Provider Mapping
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Open Access
• Health Data Hub is the foundation
• Enable clients to build their own applications
and workflows on top of it
• Guaranteed access to the data through the rich
REST API
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MR2 vs HDHHow does NextGen Health Data Hub compare to Mirth Results?
Solution designInitially built to gather and share lab results, it expanded in later
years to include other clinical use cases.
Built to provide a single integrated HIE solution to exchange,
aggregate, and manage data across the widest range of
stakeholders in a scalable, affordable, and integrated fashion.
API first architecture.
Release cadenceAnnual large software releases with intermittent patch releases
requiring large time and resource commitments for testing
Continuous delivery requiring little to no downtime. Always up-
to-date.
Hosting options• Mirth appliance hosted by NextGen
• Mirth appliance hosted by client
Hosted in Amazon Web Services and fully-managed by
NextGen.
Patient matching Utilizes Mirth Match for EMPI services, or 3rd party integrations Native Patient Matching and Management built-in.
Content mergingPatient, provider, and other merges are challenging and very
difficult to resolve.
Patient & Provider: Merge/Move Alias fully supported and easy
to manage. Data Provenance ensures clinical information is
bound to the patient
Pricing considerations
• SaaS pricing based on patient lives
or
• Perpetual license model + hosting + hardware fees +
maintenance
Subscription based on patient lives
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Health Data Hub – Timeline
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Health Data Hub Demonstration
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Q&A
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