champ software topical webinar health information exchange july 28, 2015
TRANSCRIPT
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.
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…
