galen ace 2010 presentation

Integrate with a Health Information Health Information Exchange

Presenters

› Dr. Robert White

Clinical Informatics Director

Lovelace Clinic Foundation

ABQ Health Partners

› Justin Campbell


Senior Consultant

Galen Healthcare Solutions

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Agenda

› Meaningful Use

› HIE Benefits

› NMHIC Overview

› NMHIC Architecture & Approach

› ABQHP AE-EHR <-> NMHIC HIE

Copyright © 2010 Allscripts-Misys Healthcare Solutions, Inc.4

› What/How information is shared

› Design Process

› Design Decisions

› NMHIC: Lessons Learned

› The Future: CED

Meaningful Use

› ARRA will provide incentives to physicians and hospitals for meaningful use of HIT. (2011–15)

› Meaningful Use will require HIE networks to:− Support Electronic prescribing

− Exchange summary patient documents


− Exchange summary patient documents

− Order laboratory tests and receive results electronically

− Electronically submit immunization and reportable conditions/events to public health

− Potentially convey quality reports to federal/state authorities 2012 and thereafter

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HIE Benefits

› Improved care coordination and communication

› Support to public health

› Potential for daily emergency responder use

› Potential for a natural disaster emergencies

› Elimination of duplicate tests

› Value (savings/cost reduction) to (New Mexico) payers


› Value (savings/cost reduction) to (New Mexico) payers− $11.9 million per year – extrapolated conservatively from

national study

− $6 million per year based on very conservative estimates from local data

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NMHIC Overview

› The New Mexico Health Information Collaborative (NMHIC)

− Health Information Exchange (HIE) development started 2005

− Convenes over 30 hospital, medical practice, laboratory, public health, professional, health plan, and employer organizations in a legal and trusted relationship for sharing patient information

− Connects doctors to electronic patient information across different


− Connects doctors to electronic patient information across different healthcare organizations in community and state

› NMHIC will replace fax, phone and mail exchange of medical information with secure and privacy protected electronic systems when it begins operation late 2010.

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Technical & Security FundamentalsTechnical & Security Fundamentals

Privacy Security

Network Subscription Agreement

Virtual Private Network tunnels with partners

Terms and conditions at first login

SSL Encryption, Intrusion Prevention

Copyright © 2010 Allscripts-Misys Healthcare Solutions, Inc. 8

Patient Consent Required Strong passwords, 90 day expirations

Comprehensive Auditing Two levels of authentication

How NMHIC Works

HIE Network

Hospital

Clinician Office

Locatesthe Patient’s

Records

State Public Health Depts.

PRIVACY PRIVACY PROTECTEDPROTECTED

Patient


Nationwide Health Information Network (NHIN)

ClinicianLab

Emergency

Room

Gathers andAssembles the Patient’s

Records

PROTECTEDPROTECTED

NMHIC Federated Architecture


NHIN

DEMO


ABQHP AE-EHR <-> NMHIC HIE

› Existing Health Level 7 (HL7) Data Exchanges Developed by Galen

− Registrations

− Appointments

− Radiology Results

− Documents


› Up Next (Funded by Social Security Admin. Project)− Appointments

− Allergies

− Medications

− Problems

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ABQHP AE-EHR Data Exchanges

› Built in the ConnectR interface engine

− Application Programming Interface (API) to the Enterprise EHR (AE-EHR)

− Inbound and outbound stored procedures.

› Configuration of the interfaces to the particular vendor/client.


vendor/client.

› Galen’s vast experience and expertise in deploying data exchanges to and from the AE-EHR leveraged.

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What/How information is shared

› Dependent upon clinical data currently captured and available in the Enterprise EHR

› Current implementation between ABQHP AE-EHR and NMHIC HIE is uni-directional− Outbound from Enterprise EHR to HIE

› Reg/Sched data typically comes from the Practice


› Reg/Sched data typically comes from the Practice Management system

− Pass/Map interface

› Extract routines deployed in Enterprise EHR and ConnectR to facilitate extraction of allergies, medications, problems

› Data mapped to HL7 messages (ADT, ORU, MDM)

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AE-EHR\ConnectR Extract Process


Design Process

› Technical Design Document (TDD)

› Provide representative subset of data for analysis by NMHIC

› Feedback loop− Iterative process until steady-state is reached

› Issues and Resolutions List


› Issues and Resolutions List

› Timeline & Effort− Staggered, parallel development

− Typically 8 week turn-around-time − Design

− Build

− Unit Test

− Validation

− Activation

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Design Decisions

› Patient identifiers

− Radiology Information System (RIS)

− Laboratory Information System (LIS)

− EHR

− PM

− Consistency with the Master Patient Index (MPI) across all


interfaces.

› Filtering− Mental health document types

− “Celebrity patients”

− Preliminary documents

− Unverified results.

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NMHIC: Lesson Learned

› Expansive and inclusive governance participation

› Patience and Persistence required

› Legal agreements take time

› Public benefit requires public funding

› Steadfast support from NM Department of Health Leadership


Leadership

› Complementary core team skills

› Vendor commitment

› Federated architecture

› Centralized warehouse unacceptable in our community

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The Future: CED

› A Clinical Exchange Document (CED)− Generally accepted format of patient data used to share

information between systems.

− Allscripts term to cover different formats that are supported.

› CCR and Medical Summary (a CDA)


› CCR and Medical Summary (a CDA)

› Both are xml documents,

› Both are essentially encounter summaries containing− Allergies -Problems

− Medications -Vitals

− Immunizations -Results

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Summary

› Pragmatic benefits (both clinical and financially) to exchanging data between the AE-EHR and the HIE

› Best practice, iterative design approach utilized

› Effort invested in design up-front saves in implementation

› Most efficient means of data exchange between the AE-


› Most efficient means of data exchange between the AE-EHR and HIE is CED

Questions / Contact Information

Questions?

Contact Information

Dr. Robert White

Clinical Informatics Director, Lovelace Clinic Foundation


[email protected]

Justin Campbell

Senior Consultant, Galen Healthcare Solutions

[email protected]

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