Transcript Process interoperability

Health Information Exchange
Interoperability
Minnesota Department of Health
December 2008
The information contained in this presentation is
based on proposed and working documents.
1
Proposed Working Definition of
Interoperability in Minnesota
1. Background
 Variety of definitions for electronic health record (EHR)
interoperability used nationally
− Proposed Minnesota definition draws from this work
 Minnesota definition adapted in part from:
− HL7 white paper “Coming to Terms: Scoping Interoperability for
Health Care” (HL7–2007)
− e-Health Initiative definition (ehealthinitiative.org, 2004)
 Supports statewide mandate that all health care providers adopt
interoperable EHRs by 2015
 Focuses on electronic exchange; health information exchange
can be electronic or non-electronic
2
Proposed Working Definition of
Interoperability in Minnesota (continued)
2. Principles
 Includes key conceptual components of HL7 white
paper and national e-Health Initiative definition
 Sufficient specificity to be useful
 Sufficiently dynamic to allow for necessary updating
 Logical and understandable in context of Minnesota
e-health environment
 Supports Minnesota needs related to 2015 mandate
3
Proposed Working Definition of
Interoperability in Minnesota (continued)
3. Working Definition
Interoperability of Electronic Health Records (EHR) in Minnesota means the
ability of two or more EHR systems or components of EHR systems* to
exchange information electronically, securely, accurately and verifiably, when
and where needed; comprised of “technical”, “semantic” and “process”
interoperability; the information includes transactions and standards as
defined by the Commissioner of Health and currently includes the following
transactions indicated below:
 Electronic Prescribing / Medication Management
 Immunization Information Exchange
 Laboratory Results Reporting
Anticipated transactions for 2008-09 include:
 Exchange of clinical summaries
 Public Health Surveillance and Case Reporting
* Electronic health record systems includes ancillary health information systems such as laboratory, pharmacy and radiology as
identified in Appendix B of statewide implementation plan. http://www.health.state.mn.us/ehealth/ehrplan2008.pdf
Adapted in part from: HL7 white paper “Coming to Terms: Scoping Interoperability for Health Care” (HL7–2007), e-Health
Initiative definition (ehealthinitiative.org, 2004)
4
Types of Interoperability
 Technical interoperability
 Neutralizes effects of distance
 E.g., hardware, software, networks
 Semantic interoperability
 Communicates meaning
 E.g., data content terminologies
(e.g., ICD-10, SNOMED, LOINC)
 Process interoperability
 Coordinates work processes
 E.g., work flow, user roles
Adapted in part from: HL7 white paper “Coming to Terms: Scoping
Interoperability for Health Care” (HL7–2007)
5
These three types of
interoperability are all
required for consistent
and timely exchange of
health information
among partners
Visual Depiction of Types of Interoperability
Technical
interoperability:
hardware, software, networks
Data Exchange
Partner Applications
Data Exchange
Partner Applications
HL7 Message
Standards for
representation of
data
MSH|^~\&|||||19941122100053||ORU^M01|
EVN|M01|199411181141|
PID|||661041||GARDNER^REED^M|
PV1||I|E7^703^^LDS|
OBR||^A000520|LYTES^Serum Electrolytes|
OBX|1|NM|NAS^Serum Sodium|1|138|mmol/L|
Standard Codes/Units
Semantic
interoperability:
Data content terminologies
Process
interoperability:
Process
interoperability:
People
interacting
with
systems,
workflow,
user
People interacting with systems,
workflow,
user
roles etc.,
roles etc.,
6
Standards for
representation of
data
Examples: Interoperability in Context of
Electronic Prescribing

Technical interoperability
 Appropriate hardware, software, and networks for routing prescriptions electronically
 Pharmacy information system that can integrate an electronic prescription without data re-entry
 Certification of electronic prescribing systems
 Certification of prescriber systems (EHRs) offered by CCHIT; certification of hand held e-Rx
systems to be offered in near future by CCHIT
 Certification of networks offered by SureScripts-RxHub

Semantic interoperability
 Usage of appropriate drug database
 Ability of pharmacy application to read and interpret correctly the prescription sent by the electronic
prescribing application (use of common terminology and vocabulary)

Process interoperability
 User interface guidelines
 Similar work/process flows in various electronic prescribing application
 Options and drop-downs should be similar
 Electronic prescribing process guidelines
 Guidelines on when a pharmacy application detects an error in prescription
 Guidelines on when a pharmacy application rejects an electronic prescription
7
Failure of Interoperability Examples
Three examples relating to an imaginary school bus accident:

Technical interoperability failure
An Emergency Department physician receives an electronic message from the primary care
physician of a critically injured student stating that the student has no allergies to drugs.
However, an electronic bit was inadvertently flipped during transmission; the patient dies from
an allergic reaction to the drug

Semantic interoperability failure:
An Emergency Department physician sends an electronic message to an overseas physician
asking whether there were any warnings about a visiting student’s health. The foreign doctor
sends the message code "N/A" that asserts that the information regarding allergies was never
gathered. The ED physician interprets the response as "Negative for Allergies" and gives an
antibiotic drug; the patient dies from an allergic reaction to the drug

Process interoperability failure:
The injured school children arrive at an Emergency Department (ED). The provider uses several
different EHRs and assumes that all the systems provide alerts for allergy. This particular ED
system does not have alerts implemented and thus the provider is not aware of this different
process. A drug is prescribed with potential allergic reaction to an injured child.
Adapted in part from: HL7 white paper “Coming to Terms: Scoping
Interoperability for Health Care” (HL7–2007)
8
Proposed Minnesota Roadmap for
Standards and Interoperability
Continuum
of EHR
Adoption
Achievement of
2015 Mandate
Adopt
Assess
Plan
Utilize
Select
2007
Priority
Transactions and
Standards
A. Certification of
Electronic
Health Record
Systems
B. Electronic Prescribing /
Medication Management
Advisory Committee
recommendation

Advisory Committee
recommendation

[formulary and benefit information,
eligibility, medication history,
electronic prescribing]
C. Immunization
Information Exchange
D. Laboratory
Results Reporting
E. Disease Reporting
F. Exchange of Clinical
Summaries
Advisory Committee
recommendation

Advisory Committee
recommendation

Implement
2008
Exchange
Effective Use
2009
2010
Interoperate
Readiness
2011
Interoperate
2012-13
Minn. Stat. 62J.495
Interoperable electronic
health records
requirement: Certification

Minn. Stat. 62J.497
Electronic prescription
drug program

All health care providers, group
purchasers, prescribers and
dispensers must establish and
maintain an e-prescribing system by
January 2011

2014-15