galen ace 2010 presentation
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TRANSCRIPT
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Copyright © 2010 Allscripts-Misys Healthcare Solutions, Inc.
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Integrate with a Health Information Health Information Exchange
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Presenters
› Dr. Robert White
Clinical Informatics Director
Lovelace Clinic Foundation
ABQ Health Partners
› Justin Campbell
Copyright © 2010 Allscripts-Misys Healthcare Solutions, Inc.
Senior Consultant
Galen Healthcare Solutions
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Agenda
› Meaningful Use
› HIE Benefits
› NMHIC Overview
› NMHIC Architecture & Approach
› ABQHP AE-EHR <-> NMHIC HIE
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› What/How information is shared
› Design Process
› Design Decisions
› NMHIC: Lessons Learned
› The Future: CED
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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
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− 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
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› 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
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− 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
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Patient Consent Required Strong passwords, 90 day expirations
Comprehensive Auditing Two levels of authentication
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How NMHIC Works
HIE Network
Hospital
Clinician Office
Locatesthe Patient’s
Records
State Public Health Depts.
PRIVACY PRIVACY PROTECTEDPROTECTED
Patient
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Nationwide Health Information Network (NHIN)
ClinicianLab
Emergency
Room
Gathers andAssembles the Patient’s
Records
PROTECTEDPROTECTED
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NMHIC Federated Architecture
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NHIN
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DEMO
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ABQHP AE-EHR <-> NMHIC HIE
› Existing Health Level 7 (HL7) Data Exchanges Developed by Galen
− Registrations
− Appointments
− Radiology Results
− Documents
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› 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.
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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
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› 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
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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
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› 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
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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
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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)
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› 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-
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› Most efficient means of data exchange between the AE-EHR and HIE is CED
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Questions / Contact Information
Questions?
Contact Information
Dr. Robert White
Clinical Informatics Director, Lovelace Clinic Foundation
Copyright © 2010 Allscripts-Misys Healthcare Solutions, Inc.
Justin Campbell
Senior Consultant, Galen Healthcare Solutions
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to win special ACE giveaways!
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