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A Presentation of the Colorado Health Institute1576 Sherman Street, Suite 300Denver, Colorado 80203-1713

Public Health Data Standards ConsortiumExpert Panel in Electronic Data Exchanges

Convened in Partnership with the Health Resources and Services Administration (HRSA) Fairmont Hotel

2401 M Street NW, Washington DC 20037

Arthur Davidson, MD, MSPH Denver Public Health, Denver Health

December 5-6, 2006and the

Colorado Health Information Exchange, an AHRQ-funded State and Regional Demonstration Project

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Overview

• Community eHealth Data Exchanges:   Purpose/Value Proposition for Public Health and Clinical Providers in the community

– Role of the Health Department in Being a Resource for Providers– Engaging Providers in the Public Health Mission of Protecting the Public from

Health Threats and improving the effectiveness of Primary Care– Examples of Emerging eHealth Exchanges and how they are bringing together

public health and providers

• Key Implementation activities, choices, and problems • Accomplishments and Lessons Learned

• Building a Shared Vision - Suggestion for the Roadmap on Building eHealth Data Exchanges between Public Health and Clinical Settings

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Colorado: Data Sharing Progress

Mesa County

The Children’s Hospital

Boulder IPN

Larimer

Weld

Denver Health

El Paso County

MedSouth IPA University Hospital

Kaiser Permanente

Exempla

Rose Medical Group

Colorado Care Collaborative (RMD)

Payer # 1 – # X

Pharmacy #1 - # X Independent

3rd party hosted

“Community” patient index

Standard vocabulary and messaging

Vendor neutral

Rural /small practice access ?

CHCN - Health Center?

Colorado Immunization Information System

Centura

CDPHE

SureScripts

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Business Lines of Service

– Point of care (for patient and/or provider)• Aggregation of clinical information from other hospital/ providers

– Immunization history (Colorado Immunization Information System)– Individualized medication lists (Pharmacy Benefits Managers/Retailers)– Allergies, laboratory, radiology, procedures, EKG, ….

• Decision support for clinical guidelines– Clinical messaging (from provider to provider)

• Laboratory test orders/results exchange (to/from CDPHE, LabCorp, Quest)• ePrescribing• Case reporting, electronic laboratory reporting• Ancillary/referral service results (e.g., radiology, consultant reports)

– Administrative (for provider and payer)• Claims submission • Eligibility, credentialing

– Population/public health (for provider, payer and/or public health)• Analysis of quality, disparities, morbidity monitoring, pay for performance• Registry development• Registry support: immunization• Bio-surveillance• Community health assessments

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Record Locator Management Services· cohieLoad· Remove Patient

Record Locator Services· cohieSearch

Provider Services· Retrieve Clinical Data

Subscriber Authentication Services· AuthenticateUser· Retrieve User Roles

Provider Services· Retrieve Clinical Data

COHIE Partner Entity

Master Patient Index

COHIE Central

Other Store

Clinical Decision Support

Web Services

Presentation

Patient Index

Patient MatchingClinical Data Aggregation

Common Vocabulary Engine

Business Services

Data AccessAudit/Logging

Core Services

Presentation Manager Clinical View Manager

- Data Standardization- Mappings- COHIE Central User Auth

Clinical Decision Support· Patient Guidelines

Point of Care Business Line - Logical Architecture

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ClientGuideline Services

Guideline Service Facade

Patient Guideline

ExecuteGuideline( ExecuteGuidelineRequest )

InfereneEngine (NxBRE) PatientBinder

ExecuteGuideline( ExecuteGuidelineRequest )

Execute(PatientInformation)

Process

BeforeProcess

AssertFact

OnNewFact

Recommendation Collator

Add

AfterProcess

ResolveGuidelines

Common Vocabulary Engine

GetRecommendationsById

RecommendationCollector

ExecuteGuidelineResponse

ExecuteGuidelineResponse

Patient Guideline Sequence Diagram

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Level 1 Trauma Center Level 1 Trauma Center

Public HealthPublic Health

Rocky Mountain Poison/Drug

Center

Rocky Mountain Poison/Drug

Center

Metropolitan Medical Response System

Metropolitan Medical Response System

Center for Public Health Preparedness

Center for Public Health Preparedness

TelemedicineTelemedicine

Community Health

Community Health

911/EMS911/EMS

Rocky Mountain Center for Medical

Response

to Terrorism, Mass Casualties, and Epidemics

(RMCMR)

Rocky Mountain Center for Medical

Response

to Terrorism, Mass Casualties, and Epidemics

(RMCMR)

Correctional CareCorrectional Care

School-based ClinicsSchool-based Clinics

Family Health CentersFamily Health Centers

Patient Care Education Research

Nurse lineNurse line

HospitalHospital

Acute Care Acute Care

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HealthDocApp

BizTalk

Hea

lthD

ocdb

Openlink

Invision

MYSIS

HL7ORM

HL7ORR, OSU, ORU

XML Outbound

XML Inbound

Potentials Errors- Getting a HL7 message with an unidentifiable attribute - Getting a lab result which doesn’t match the clinical order # assigned by Invision

HealthDoc to MYSIS Data FlowFuture Flows in gray

Openlink does the communication between Invision and MYSIS, there is no direct Invision –

MYSIS Interface

HL7 Messages- ORM = Lab Order message - ORR = Lab Order confirmation message w/ clinical order #- OSU = Lab Results Status message- ORU = Lab Results message

OUTBOUND from BTS ORM (MSH, PID, PV1, ORC and OBR)

INBOUND to BTS ORR ()OSU (MSH, PID, ORC, and OBR)ORU (MSH, PID, OBR and OBX)

XML (outbound) file will be sent to BTS when an order is triggeredXML (inbound) file will be sent to HD when clinical order #, lab result status or lab results are available

Integrated Data Repository (IDR)

COHIE

XML Outbound(existing Send to

State via HD)

CDPHE Domain

Colorado Electronic Disease Reporting System

)CEDRS)

Laboratory Information

System(LITS)

New Born Screen, others?

Tuberculosis Clinical

Documentation System (TBDB)

App

Version 2.1 (AD)7/17/06

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Patient

Provider Office

LabExternal provider

Seek treatm

ent / present complaint

Seek info and exam

Provide specim

ens

Pro

vide

spe

cim

en

Local Health Dept

(LHD)

Payer(Private/

Public/CMS)

Request additional info

Provide additional info Provide claim & Dx

Provide im

proved treatment / R

x plan

Claim & lab results

Payment

Pharm Benefits Mgr

Pro

vide

res

ults

Community Health Center (CHC)

Pharmacy

Request record level diagnosis

Provide line list

Prov

ide

scrip

t

Provi

de R

x

Prov

ide

info

State Health(CDPHE)

Quality Org.(QIO)

Hospital

Req

uest

ca

reP

rovi

de b

ette

r ca

re

Rep

ort d

iabe

tes

care

Request diabetes info

Researcher

Request infoProvide info

COHospitalAssoc

Report all hospital D

x

DM Admissions

Request info

Registry quality improvements

Info

rm p

atie

nt /

enro

ll of

fer

3rd party Disease Mgt

Eng

age

Offe

r bet

ter s

ervi

ce

Provide payment

Provide medical claim

Employer

Request info Pro

vide

aggr

.

data

Inform

Re: p

atient

Provide info

Man

date

d M

/C r

epor

ting

Mem

ber

responsibility

CCGC

Provide info Request info

Request info

Provide info

DM Registry Use – Context Diagram

Infolinks WorkgroupSeptember 9, 2006

Provide info

Request info

Provid

e gu

idan

ce Provide

guidance

Provid

e registry info

Req

uest re g

i str y i nfo

Info

rmat

ion

to im

p rov

e q

ualit

y

Request info

Return info

Diabetes Registry

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Provider Office – Patient CareRegistry Creation:

generating electronic data Patient presents

Registration

Insurance?

Collect demographics

Determine PCP

Triage

A

A

Collect history

Perform examination

Review medical records

Require more assessment

information ?

Documentation of visit

Need external resources?

Create plan & provide patient

direction

Prepare bill (using ICD-9)

Submit claim

Refer patient

Refer patient?

·

· Self-monitoring· Follow-up date· RX / Supplies· Use of e-mail for follow-up·

May use flow sheet

Provide in-office resources (i.e., test blood sugar,

cholesterol, etc.)

Test(s)

Patient monitoring feedback

Patient monitoring feedback?

Request other

external resources

Yes

Yes

No

Patient care complete

Store / generate on own?

·· Store in tracking system· Chart· Flow sheet· Home cn? list·

Store

Yes

Yes

No

Refer elsewhereNo

Yes

Patient presents with DM

No

No

Yes

RWJ Information LinksSeptember 9, 2006

No