Page 1 January 22, 2014

Overview of an Enterprise HIE at Virtua Health

Julia Staas IS Director of Integration

Virtua

4 Acute Care Hospitals

4 Major Outpatient Centers

45 Physician Office locations

2 Long-Term Care Facilities

2 Home Health Agencies

7 Ambulatory Surgery Centers

3 Fitness Centers

About Virtua

2009 Requirements Gathering and System Selection

Voice of the Customer Approach

Physician Centric

Standards Based

Established Governance

HIE Policy Committee (now Privacy & Security)

HIE Usage Committee (Physicians)

HIE Council (Decision making body)

Virtua HIE Journey

1. ADT (Pt Demographics) 2. Problems 3. Allergies 4. Medication Orders 5. Family History 6. Social History 7. Immunizations 8. Procedures 9. Vital Signs 10. Encounter Documentation (Practice EMR) 11. Lab Orders & Results 12. Radiology Orders & Results 13. Discharge Summaries & Transcribed Reports (from

Virtua) 14. RxHub/SureScripts

Voice of the Customer - Data to be Available in the Virtua HIE

Internet

Internet

SureScripts

Prescription

Database

Lab Corp

(Lab Results &

Orders)

Virtua’s

Hospital Clinical

Data

CIS

Virtua Medical Group

NextGen EMR

eClinicalWorksAllscripts

GE Centricity

2009 VisionHealth Information Exchange

Microsoft Amalga

Clinical Data

Repository & Data

Warehouse

Virtua HIE

Wellogic

Community

Master Patient

Index

Master

Provider

index

Security/

Access

Control Usage Logs

Record

Locator

Service

Inte

rface

s

Inte

rfa

ce

s

Virtua PHR (MS HealthVault)

Quest

(Lab Results &

Orders)

Virtua PACS &

RIS

Diagnostic Images

GE Centricity

South Jersey

Radiology Assoc

PACS GE Integrad

RIS Sage Intergy

Physician Portal

Larchmont

Imaging

PACS GE

Centricity

RIS Sage Intergy

HL7 &

CC

D

HL7 &

C

CD

HL7 &

CC

D

HL7

DIC

OM

for I

mage V

iewin

g

DICOM fo

r Image V

iewing

HL7

HL7

HL7 &

CC

D

HL7 & C

CD

STI Chartmaker

Atlanticare HIE

Wellogic

Fox Chase HIE

MEDecisionCamden HIE

Noteworthy

PIX

PD

Q

XD

S.b

PIX

PD

QX

DS

.b

PIX

PD

Q

XD

S.b

Sage

NextGenHL7 & CCD

EHS

HL7 & CCD

Virtua

(Lab Results &

Orders)

HL7Pulse

HL7 & CCD

Wellogic

EMR-Lite

SJ Healthcare

HIE

Mobile MD

PIX

PD

QX

DS

.b

Fully integrated

DICOM for Image Viewing

HL7 &

CCD

Real Tim

e HL7 via O

penLinkC

CD

What is the HIE’s Policy Structure?

The HIE operates under these formal policies and procedures:

1. Applicability and Definitions 2. Patient Participation and Choice 3. HIE Participants 4. Authorized Users 5. Compliance with Law and HIE

Policies 6. Notice of Privacy Practices 7. Access 8. Authentication 9. Permitted Uses and Prohibited

Uses 10. Information Subject to Special

Protection

11. Minimum Necessary 12. Workforce, Agents and Business

Associates 13. Security Incidents and

“Breaches” of Unsecured Data 14. Auditing 15. Enforcement and Sanctions 16. Patient Rights 17. Data Quality and Integrity 18. Complaints 19. Governance and Oversight

Copies of these documents may be found at

Consent Model & Sensitive Data

Permitted and Non-Permitted Uses of Data

Virtua HIE Consent Model: Opt-Out Patient data is available in the HIE unless the patient Opts-Out

How is Sensitive Data Protected? Codified Data Rules – Based on codes such as procedure & diagnosis Text Data – 40,000+ keywords, phrases, negations rules using EnableCare solution To date over 10,000,000 documents scrubbed with just over 3% identified as sensitive

Sensitive Data Categories HIV/AIDS Venereal Diseases Drug or Alcohol Addiction Treatment Records Mental Health Facility Records, Behavioral Health Information “Psychotherapy Notes” (as defined under HIPAA and HITECH) Genetic Information Minor’s Emancipated Treatment Data related to services paid for “out-of-pocket” in full by a patient

Present State - Expanded Needs

Permitted and Non-Permitted Uses of Data

Seamless Integration for Shared Patient Care Children’s Hospital of Philadelphia

Pediatric Imaging

Population Based Management Accountable Care Organization Patient Centered Medical Home

Meaningful Use

Transitions of Care Provide Patients the Ability to View Online, Download, Transmit

NJ State

Connecting NJ’s HIOs

Pediatric Imaging Integration with CHOP

Permitted and Non-Permitted Uses of Data

The Need Two health systems sharing the care of mutual patients

Virtua providing technical services CHOP providing professional services

Clinicians work best in their native systems

The Solution Leverage Virtua HIE technology to reconcile patient identity across

the two enterprises Leverage CHOP’s ScImage solution to share images Leverage both to:

Return preliminary report Deliver finalized report

Future

Integration built to be expandable for future needs

New IT Landscape

10

Health System’s Data Warehouse

Physician Office EMR

Patient Demographics

Acute Care EMR

ER EMR

Pharmacy

Laboratory

Patient Billing

Radiology

Sample of information systems for independent health care providers Physician Office

EMRs

Nursing Home EMRs Commercial Laboratory Data Dentist Office EMRs

Commercial Pharmacy Data Diagnostic Imaging Centers

He

alth

Info

rmat

ion

Exc

han

ge

State Registries

Other HIEs

Sample of Virtua information systems

Stepwise Path to Accountable Health

Permitted and Non-Permitted Uses of Data

Comprised of :

Jersey Health Connect

Health-e-Citi

Virtua HIE

NJ Shine

Camden Coalition of Healthcare Providers

Trenton Health Team

Purpose:

Provide technical services for NJ State’s NJHIN

• Phase 1:

• Web Services Directory

• Certificate & Registration Authority

• CCD exchange across HIOs

HIE Expanded Platform

Permitted and Non-Permitted Uses of Data

To Address the Present Needs, Virtua HIE is being Expanding to

Include:

Patient Portal

DIRECT Messaging Services

Analytics to Provide Clinical Decision Support

Care Coordination Documentation Functionality

Device Integration for Home Monitoring Devices

(Glucometers, BP Monitors, etc)

Permitted and Non-Permitted Uses of Data

Virtua HIE Connections

Virtua HIE Users

Alere Connect Device Management

Health.com Patient

Consult Applications

iPad App

DIRECT Secure Messaging

Alere System Manager

Alere AnalyticsSynapse

Interface Engine

HIE PortalAlere EHRAlere EngageAlere Patient

Portal

HIE Database

Virtua HIE Participants and Data Contributors

Quest, LabCorp, Virtua Lab

Larchmont Imaging, South Jersey Radiology Associates,

Virtua Radiology

Virtua Medical Group and Community Medical

Practices

Virtua Health, Children’s Hospital of Philadelphia, Kennedy Health System,

Rehabilitation and Long Term Care

Facilities

Community Based Health Managers and Care Coordinators

Physicians, Nurses, Other Care Providers

Patients

Other Connected Community HIEs

Care Provider

Ambulatory or Acute Foreign EHR

· Real-time, Bi-Directional HL7 Interfaces· Query/Response using IHE profiles such as XDS.b, PIX, PDQ, XCPD, XCA

· DIRECT Messaging

NJ HealthNet for NJ Health Information Network (NJHIN)

SureScripts