HIE IN EMS ADVISORY

COMMITTEE MEETING

California Emergency Medical Services Authority

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* This webinar is being recorded.

PETER KARRAS

Office of the National Coordinator for Health IT

LESLIE WITTEN-RODD

California Emergency Medical Services Authority

© 2016 California Association of Health Information Exchanges Licensed under a Creative Commons Attribution Share-Alike 3.0 License

SME Report EMSA Statewide HIE in EMS Advisory Committee

Robert M. Cothren, PhD Executive Director 26 July 2016

Agenda – Timeline for upcoming PULSE activities – Items being discussed

– Workflow for PULSE – Sustainability for PULSE

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 8

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 9

Develop Directory Services

Develop PULSE Message Broker, Portal Add Adapters, DS

Procure PULSE Operator

Inte

grat

e w

ith C

TEN

Integrate DHV

UAT

Provision Data

Center

Operate PULSE

Select HIOs

Maintain PULSE

Readiness Review – 4/26

Final Report

PULSE Drill – 5/1-12 Contingency Drill – 5/15-26 Today

Transition to Operator

Integrate DHV

Test Connectivity

Create Drill Materials

UAT

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Procurement

PULSE Workflow – Continue meetings with PULSE Workgroup – Have a working version of the storyboard – Have discussed issues concerning PULSE participation

and authorization – Next steps

– PULSE Portal mock-ups – Details of transactions between systems

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 10

PULSE Sustainability – How is PULSE exercised?

– Are there regular drills? – How is connectivity to HIOs verified?

– Should PULSE be used outside of disaster response? – What are the use cases? – Who pays for the service?

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 11

Other discussion?

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 12

Contact Information Robert M. Cothren, PhD Executive Director California Association of Health Information Exchanges

p 925-934-2280 e robert.cothren@ca-hie.org w http://www.ca-hie.org

26 July 2016 EMSA Statewide HIE in EMS Advisory Committee 13

+EMS Grant San Diego Health Connect

Mark Branning Program Manager

July 26, 2016

Business Case/Goals

• “…integrate pre-hospital care documentation seamlessly into the contemporary health information exchange (HIE) environment.”

• “…create an asynchronous bi-directional connection…” – ePCR (ambulance EMR) – HIE – Hospital EMR

• Improve decision making – At the scene – Transport/Hospital Prep

PRIMER – SDHC (SAN DIEGO HEALTH CONNECT)

San Diego Health Connect Status

• 3.5 million patients properly identified

• 2.1 million patients to share information

• 21 of 23 hospitals participating

• Over 7.5 million transactions per month

Virtual Record

EMS Grant Deliverables = SAFR

• SEARCH – HIE for patient information • ALERT – hospital re patient’s status • FILE – patient care report into hospital EMR • RECONCILE – outcome and billing

– from hospital to ePCR – quality analysis and system improvement

SEARCH

EMS Hub

30 more

Kaiser

Sharp

Scripps

UCSD

• Problems • Allergies • Meds

HIE

PatientMatch

ALERT

EMS Hub

30 more

Kaiser

Sharp

Scripps

UCSD

• Narrative+++ from Paramedic

HIE

FILE

EMS Hub

30 more

Kaiser

Sharp

Scripps

UCSD

Complete Record • Narrative • Vitals • More

HIE

RECONCILE

EMS Hub

30 more

Kaiser

Sharp

Scripps

UCSD

HIE

Ambulance/Agency • Billing • eOutcomes for quality analysis

Partners Overview: 1 hosp, 1 ePCR, 1 Agency; 3 Counties

County

ePCR HIE Hosp Ambu-lance

LEMSA Agency Pop ED Expert-ise

San Diego

WATER SDHC UCSD AMR County City SD ~1.4 High

Orange Image-Trend

OCPRHIO

UCI CARE (NA) Newport Fire

~0.1

Imperial Traumasoft

SDHC El Centro

Scha-effer

County County ~0.2

Deliverables Timeline

Attestation Complete Milestones

San Diego County

Search 03/31/17

Alert 04/14/17

File 05/18/17

Reconcile 06/05/17

Orange County

Search 04/28/17

Alert 05/15/17

File 06/17/17

Reconcile 07/05/17

Imperial County

Search 04/28/17

Alert 05/15/17

File 06/17/17

Reconcile 07/05/17

Final Reports 8/30/2017

Barriers and Risks

• Traumasoft 3.4 compliance • Orange County changes to workflow • Timeline compressed • NEMSIS 3.4 reporting Jan 1

Standards

• NEMSIS 3.4 • HL7/CCD(A) • Web services • HIE query technology – currently operational

Questions

EMS Hub - Architecture

30

Mission

To connect healthcare stakeholders to

deliver quality, comprehensive information for better care

Narrative from Paramedic - example

San Diego Health Connect Status

• 3.5 million patients properly identified • 2.1 million patients to share information • 21 of 23 hospitals participating • 15 of 17 FQHCs participating • Over 9.5 million transactions per month • 2015 = 3% of influenza cases reported electronically

– 2016 = 53% of influenza cases reported electronically

PULSE Development Update HIE in EMS Advisory Committee Meeting

July 26, 2016

PULSE Background

PULSE History • 2013: CalEMSA holds its first HIE in EMS Summit

• April 2014: ONC Engages Ai to evaluate use of HIE infrastructure for

disaster preparedness and response; HIE Services in Support of Disaster Preparedness and Emergency Medical Response report published

• March 2015: HHS Ideas Lab funds use case and technical architecture development of PULSE; detailed Patient Unified Lookup System for Emergencies report published

• July 2015: ONC grants EMSA a grant to advance HIE statewide during a disaster and regionally in daily EMS

• January 2016: EMSA releases PULSE Development RFO

• March 2016: EMSA awards Ai the PULSE Development contract

• July 2016: PULSE Contract Amendment signed

Ai Project Team Scott Afzal

Ai Executive Sponsor/HIE SME

Genevieve Morris Health Information

Policy SME

Chris Cimaszewski Lead, Software &

Technology

Andrew Larned Solutions

Architect/Sr. Software Engineer

Katy Ekey Software Engineer

Brian Lindsey Software Engineer

Ashiwini More QA/Test Engineer

Jeremy Wong Project Manager

Deliverables and Project Scope Review

Project Scope Overview 1. PULSE Web Portal

a. DHV integration for user authentication b. Patient query portal capability for providers c. Robust audit logs

2. PULSE Message Broker

a. Federate and aggregate requests/responses b. Interface between Web Portal and message adapter service c. Leverage CTEN Directory Services and Connection Management Services*

3. eHealthExchange Message Adapter Service

a. Allow patient and document queries to be routed to participating organizations in the eHealthExchange standard

b. Organizations' responses, including document transfer, can be conducted using the eHealthExchange standard

4. eHealthExchange Query Service a. Allow patient and document queries to be made directly from EHRs and

HIOs using the eHealthExchange standard *CTEN Directory Services, including Connection Management Services, is out-of-scope and will be developed by CAHIE

Architecture Diagram

Component Model

Key Project Deliverables Ai Development 2016 • April: Project Kickoff

• May: Requirements and Solution

Approach Document

• August: HIO Working Group Meeting, Development complete

• October: EMSA Technical Documentation signoff, End-to-end Integration and User Acceptance Testing complete

• November: Transition to Operations

2017 • February: Transition to System

Maintenance

HIO Integration 2016 • August: HIO Working Group

Meeting • December: HIO onboarding

begins 2017 • February: HIO UAT begins

• February: System

Maintenance Phase begins

• April: HIO PULSE Drill

Key Dependencies • CTEN Directory Services

• This must be developed before PULSE can be operationalized

• DHV SSO • The DHV vendor must be able to pass SAML assertions

• HIO Contracting and Onboarding

• HIO onboarding must be completed prior to the PULSE Drill

• HIO Guidance • The PULSE Workgroup must give clear and timely guidance to

inform PULSE development (e.g., on standards)

PULSE Development Update

Development Update • The following components are in the process of being built

and tested: • PULSE Message Broker Service (85%) • PULSE Web Portal Build (55%) • Audit Management Service (80%) • eHealthExchange Message Adapter Service (10%) • eHealthExchange Query Service (10%)

• As part of the Web Portal, Ai is developing an ACF

Selection feature, which requires users to select a location • This will allow users to leverage the PULSE cache

• Ai will demo the Web Portal to the PULSE Workgroup in

August

Integration Update DHV

• DHV will access an API to determine when PULSE is active

• DHV will authenticate users via SAML

CTEN Directory Services • PULSE will access connection information for HIOs,

which will be maintained by CTEN HIOs

• RFP for participation upcoming • HIO integration scheduled to begin in December

Questions for Discussion

Questions for Discussion • Which HIOs are expected to participate?

• How readily can these HIOs connect to PULSE using eHealthExchange standards?

• Who will use the eHealthExchange Query

Service?

• Is ONC comfortable with the future scalability of PULSE?

• How do you envision PULSE functionality being integrated with day-to-day EMS operations?

Questions?

RYAN STANFIELD California Emergency Medical Services Authority