champ software topical webinar health information exchange july 28, 2015

CHAMP Software Topical WebinarHealth Information Exchange

July 28, 2015

4

Top Barriers to EHR Implementation, after financial resources

Ambulance Chiropractic Clinic Hospital LTC Optometry PharmacyPublic Health

Obsolescence issues  X              

Difficulty achieving acceptance among staff X              

Difficulty in justifying expense or return on

investment

  X X X X X   X

Concern over completeness and accuracy of records

  X X       X  

Difficulty changing work flow patterns

      X   X    

Current reimbursement system

      X        

Not enough time for training         X X    

Inability of technology to meet your needs

              X

Prescription transaction fees

            X  

Health IT Loan

•24 loans to hospitals and clinics• $11.4 Million Dollars

• ND Legislature• Bank of North Dakota• 1% interest – 10 years

Electronic Health Records

Ambu

lance

*

Chirop

ract

ic

Clinics

(Ind

epen

dent

)

Denta

l

Opt

omet

ery

Long

Ter

m C

are

Public

Hea

lth

Hospit

al0%

20%

40%

60%

80%

100%

2008

2012

Current EHR

2015 Prediction

6

Reported Live EHRs as of February 2014

* Patient care record

7

E-Prescribing

• ND Ranks 6th in 2013 E-Prescribing Activity (Surescripts Ranking)

• 15th in 2012• 18th in 2011• 47th in 2010

2013 Primary Mode for Pharmacies to Receive Prescriptions• E-Prescribing

2012 Primary Mode for Pharmacies to Receive Prescriptions• Phone• Fax

NDHIN Stats

• 170+ Organizations have signed Participation and Business Associate Agreements with NDHIN

• 6 Prospective Payment Hospitals• 36 Critical Access Hospitals• Public health organizations, long term care, pharmacies, clinics etc.

• Direct Secure Messaging• Web based Direct – 680+ users • XDR Direct – 2,000+ users

• Query Based Services• Continually Onboarding data providers – AND data consumers

• Unique Patient Records – 690,000 (May 2015)• User Accounts set up to access patient data – 1,000 + providers

Push Services

Example: I have a piece of information and want to send it to

someone else securely.

Our Experience with Direct• Pre-Orion Health• DSM 1.0• DSM 2.0• XDR• Patient Portal• HISP to HISP

ONC Mandate a Phased Implementation

• Phase 1• Implement Direct

• Phase 2• Implement more robust exchange of data in a test environment

• Phase 3• Rollout data exchange statewide

The Direct Project:Secure Internet-based Point-to-Point Messaging

• Simple. Connects healthcare stakeholders through universal addressing using simple push of information.

• Secure. Users can easily verify messages are complete and not tampered with in travel.

• Scalable. Enables Internet scale with no need for central network authority.

• Standards-based. Built on common Internet standards for secure e-mail communication.

Direct Project specifies a simple, secure, scalable, standards-based way for

participants to send encrypted health information directly to known, trusted

recipients over the Internet.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

DSM 1.0• Signed contract with Orion Health in April 2013

• DSM 1.0 First Deliverable• LIVE with existing Direct users in late May/Early June 2013

• Developed Key Use Cases• Smoking Cessation Referrals• ND Medicaid Claims Attachments• Trauma Coordinators• UAT Validation

• Approx 800 users at peak• HISP to HISP with Healthvault

Direct Secure Messaging

DSM Web

DSM Direct

DSMConnect

• Direct Secure

Basic Direct Secure Messaging• Web-based access• Email client access

Direct Secure Messaging with EHR System integration• Encrypted S/MIME access• Encrypted XDR access

Managed Direct Secure Messaging• Client-deployed hardware

device• Monitored by OH Managed

Services

HPD CERT

MSG

Orion Health Trust Network

Migration to DSM 2.0• Began in 2014

• Deadline for users to move to 2.0 was December 1• Complete with the exception of one organization

Direct Secure Messaging

DSM Web

DSM Direct

DSMConnect

Basic Direct Secure Messaging• Web-based access• Email client access

Direct Secure Messaging with EHR System integration• Encrypted S/MIME access• Encrypted XDR access

Managed Direct Secure Messaging• Client-deployed hardware

device• Monitored by OH Managed

Services

HPD CERT

MSG

Orion Health Trust Network

DSM Direct• Sanford Health• Essentia Health• Altru Health

• 2000+ XDR Mailboxes

• Onboarding Process/Testing

• Other HISPs – like Cerner – work fine because of Direct Trust relationship

XDR Interfaces ProgressOrganization Vendor DOI XDR

Request Form

Onboarding Completed

Sanford EPIC ✔ ✔ ✔

Essentia Health EPIC ✔ ✔ ✔

Altru Health EPIC ✔ ✔ ✔

Patient Portal• 3 Critical Access Hospitals use Orion Health Patient Portal

• Provider Mailboxes for MU Transition of Care are with different HISP

• Hospitals use NDHIN for DSM Web (but not DSM Direct)• EMR-based HISP needs to be set up with HISP to HISP with Orion

Health Patient HISP• Updox

• NDHIN believes getting Orion Health to join NBB4C Consumer bundle is a way to deal with this rather than setting up individual HISP to HISP connections between Patient Portal HISP and each EMR-based Provider HISP

NDHIN Direct Secure MessagingDSM Web

DSM Direc

t

Basic Direct Secure Messaging• Web-based access• Email client access

Direct Secure Messaging with EHR System integration• Encrypted S/MIME access• Encrypted XDR access

HPD CERT

MSG

Orion Health Trust Network

Orion Health Patient HISP

NBB4C (NATE)

HISP to HISP• Added connectivity to Veterans Administration via HISP to

HISP in Spring 2015• MS Healthvault

Pull (Query based) Services

Example: I have someone in the ER/office that I know little or nothing about. How can I get

information from other sources to help me make sound medical decisions quickly and efficiently?

Query the NDHIN for information!

Consolidated

view of

Patient Information

How NDHIN Works

Hospital

Clinician

Office

Diagnostic

& Imaging

Emergency

Department

NDHINSystem

Gathers and assembles

the patient’s records using MPI

Patient demographics

NDHIN Clinical Portal

NDHIN Clinical Portal

• Comprehensive View of Patient Information• Customizable User Interface• Notifications/Subscriptions• Timeline View• Normalization of Data

• Lab Results• Problems• Allergies and Medications

Integrated Health Data Architecture

Senate Bill 2250• Three Options of HIE Participation

• In (Default)• Allows the individually identifiable health information of an individual to

be searchable by a provider

• Opt-Out of Participation • Individual’s identifiable health information may not be accessed by

search by a health insurer, government health plan, or healthcare provider other than the provider who originally created or ordered the creation of the individually identifiable health information

• Conditional Opt-Out• Information is not available for search, like the first option. However, if a

health care provider determines access is required because of a medical emergency, the health care provider can “break the privacy seal” and search for the information

Patient Consent• Patient Consent

• Opt Out/Opt In of HIE managed centrally, within NDHIN• Participant Staff• NDHIN Staff

Patient Consent

Data Feeds to HIE• Typically VPN Connection to Data Providers

• Other options, as well

• HL7• Admission, Discharge, Transfer (ADT)• Labs• Radiology Reports/Documents• Clinical Documents• Immunizations

• CCD/CDA Exchange

Data Feeds to HIE• Admission, Discharge, Transfer (ADT)

• Patient Demographics• Encounter History• Allergies• Diagnosis• Procedures

• Observation Results (ORU)• Lab Results• Imaging Studies• Radiology Reports/Documents

• Medical Document Management (MDM) (Clinical Documents)• Work Types

• Discharge Summaries• H&P’s• ED Visit Notes• Consult Reports• Operative Notes

• Immunizations (VXU)• CCD/C-CDA Exchange

Subscriptions/Notifications• Providers can “subscribe” to their patients and be notified

when specific events/triggers happen – based on HL7 messages• Inpatient Admission • Inpatient Discharge • Abnormal Lab Result (includes all abnormal results) • Above High/Low Abnormal OR Panic Lab Result (subset of

abnormal lab result) • New Final Radiology Result • Patient is admitted to the ER

Notifications

Viewing CCD’s

NDIIS Bi-directional Interface

Prescription Drug Monitoring Program

HealtheWay

Audit Log

Example Integration (Cerner)Single Click access to Clinical Portal

HIE

HIE User Community

User AuthenticationPatient ID & Consent

Workflow Tools

eHealth Technologies

Web Services

Results Reporting

Imaging Provider(s)

PACS

DICOM

eHealthGateway CV

PACS

EHR or RIS

DICOM

eHealthGateway CE

PACS

EHR or RIS

DICOM

EHR or RIS

eHealth Gateway

SEImage Access

Architecture

Viewing Images With Rad Result

eHealthViewer® ZF

NDHIN – Benefits to Providers• Public Health Reporting

• Electronic Lab Reporting• Syndromic Surveillance• Bi-Directional Interface to ND Immunization Registry

• Clinical Portal/Patient Portal• Statewide Advance Directive Repository• Prescription Drug Monitoring Program access• eHealth Exchange Connectivity

• Connect to other HIE’s/Federal Agencies across country

• Image Exchange• View images from PACS networks across state

• Disease Registries• NDHIN Direct• Simplifying Future Interface Work – and much more!!

What about the data?• Workgroup involvement

• Clinical Workgroup• Data Use Workgroup

• Data Stratification• Discreet Data is essential

• Lots of Potential – but rules/use need to be defined• ACO, MSSP• PCMH• Research• Community Needs Assessments• More…

• Statewide Data Hub?

Additional (Essential) Information• The Koble Group, LLC

• Applying to be an HIO in MN (July 2015)• Will use same basic model as NDHIN• Initially will serve organizations previously working with CHIC

• Orion Health

• Goal – Provide stable, sustainable Health Information Exchange Services to Minnesota Providers and citizens.• HISP (Direct)• Query-Based Exchange

• New Tools – FHIR, Web API’s, more…

Two Last Thoughts…• Exchange doesn’t stop at the border

• Cross Geographic/State Borders

• Health Information Exchange isn’t the end game…• Data Analytics• Population Health• More…