patient controlled health records - pchri 2007 | the ... · patient controlled health records a...
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Patient Controlled Health RecordsA national, regional and local update
John D. Halamka MDChair, HITSP
CEO, MA-ShareCIO, CareGroup and HMS
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Themes
• National Perspective from HITSP• Regional Perspective from MA-
Share/NHIN• Local Perspective from BIDMC’s
Patientsite
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HITSP and the PCHR
• What standards were chosen?• What is the impact on architecture?• What are the next steps?
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Consumer Empowerment - Registration and Medication HistoryA new context added to three established business relationships
CareProviders
Health Plans
Pharmacies
Introducing three new electronic links, Not replacing existing linksConsistency of information becomes critical
Consumers
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HITSP Registration & Medication History Document
CDA Rel2
CDA Level 3 Coded Entries
• Personal Information•• Healthcare Provider•• Insurance Provider•• Medications•• Allergies and Drug Sensitivity •• Pregnancy•• Advance Directives
A CCD Based Document
CDA Level 2 Human Rendering
)
CDA Level 1 Header
X12 X271
NCPDP Script
ASTM/CCR
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cd CE Interoperability Specification
«interoperabili ty specification»Consumer Empowerment
- docId: = IS-03
«composite standard»IHE XDS
+ Provide & Register Document Set: ITI-15+ Query Registry: ITI-16+ Register Document Set: ITI-14+ Retrieve Document: ITI-17
«composite standard»IHE PIX
- PIX Query: ITI-9
«composite standard»CAQH
«composite standard»Federal Medication
Terminologies
«base standard»ISO 15000 ebRS 2.1/3.0 «base standard»
HL7 2.5 Message
«base standard»NCPDP 8.1
«base standard»X12 270/271
«base standard»ASTM CCR 2369
«base standard»LOINC
«base standard»HL7 CDA r2
«base standard»NDC RxNorm SPL
«base standard»ASTM/HL7 CCD
«transaction»Patient
Demographics Query
+ docId: = ISTP-23
«composite standard»IHE PDQ
«component»Registration and Med
History Document(s) Content
+ docId: = ISC-32
«transaction»Patient ID Cross-
Referencing
+ docId: = IST-22
«transaction package»Manage Sharing of
Documents
+ docId: = ISTP-13
references
constrains
implementsconstrains
constrains
contains contains
constrains
constrainsconstrains
constrains
constrains
constrains
constrains
contains
constrains
constrains
implements
contains
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Manage Sharing of DocumentsLooking-up for documents, retrieving documents and submitting docs
Doc Consumer Doc IndexQuery: Which docs ?
Retrieve doc
Soap EnvelopeSoap Envelope
Soap EnvelopeSoap EnvelopeProvide Document
Doc Consumer Doc Repository
Doc Source
CCD
Only a transport envelope, doc format & content agnostic, generic search and retrieveBoth push and pull. Actors not bound to any RHIO/NHIN architecture.
CCD
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Manage Sharing of DocumentsRHIO, NHIN and Architecture Independence
A Pull service edge to edge
Doc Consumer Doc Index Query: Which docs ?
Retrieve docDoc Consumer Doc Repository
Doc Consumer Doc Index Query: Which docs ?
Retrieve docDoc Consumer Doc Repository
A Pull service edge to edge with shared index
Doc Index
Provide Document
Doc Repository
Doc Source
A Push service edge to edge
Doc Index
Provide Document
Doc Repository
Doc Source
A Push service edge to edgewith shared repository &
index
And many otherarchitectures and
configurations
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Regional Perspective
• Indivo as the regional Consumer SNO• Authentication, mapping and messaging• Caching strategy
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Implementations
Applications
OthersPartners
FoundationTransport layer: Routing, Guaranteed Delivery, Translation, Validation, Logging
Access layer: Federated authentication/authorization, Trading Partner Registry
BIDMC OthersBMC/CHCs
RX Gateway CDX GatewayFormulary
(RxHub)Routing
(SureScripts & RxHub)
Eligibility(RxHub)
Automated Renewals
(SureScripts & RxHub)
Additional Payers
(HPHC, Network Health,
MassHealth)
Medication History
(SureScripts& RxHub)
Record Locator Service
Data Aggregation
Quality Measures
Push Services
BWH/SSH
Pull Services: medications, allergies, lab results, problems,
radiology reports, notes
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Indivo across regions
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Subscription to MA Share
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RHIO Challenges
• Competition among providers• Distrust of payers• Business sustainability• Patient Controlled Health Records can
help overcome policy, political and organizational barriers, but who pays?
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Local Perspective
• Patientsite over the past 5 years• 2.5 million transactions and 40,000
monthly patient users• All the worries about provider and patient
information overload have not occurred
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Patient Access to Record
• What should they see?• When should they see it?• Who else should have access?• How should we present it?
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Personal Health Record
• Patient-entered and maintained• Data types:
– Text– Numeric data– Documents and other objects
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Educational Partners
• PreOp – Patient Education• UpToDate – Provider Edition• UpToDate – Patient Edition• Medical Dictionary• Multum – medication information
database• Lab Test Online
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Messaging Volume
• Clinical messages: 27.8*• Prescription renewals: 3.1*• Referrals: 2.1*• Appointment requests: 2.6*
*monthly volume per 100 patients
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Patients
• Wide diversity• 57% female• Median age ~43
– 4% over 70 years old
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Patient Drivers
• Secure Messaging with Provider • Access to Medical Records• Convenience
– Request Appointments– Medication Refills– Referrals to Specialists– Review Bills Online
• Education– Disease specific content by experts at CareGroup– Links to medication information– Personalized drug interaction information
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Summary
• PCHR means the patient is the steward of their data from providers, payers and self entry
• HITSP will help catalyze interoperability among stakeholders
• NHIN projects will demonstrate PCHR architectures
• Local projects are important to reduce the fear, uncertainty and doubt