Transcript Orion Health HIE clients globally

CHAMP Software Topical Webinar
Health Information Exchange
July 28, 2015
Top Barriers to EHR Implementation,
after financial resources
Ambulance
Obsolescence issues
X
Difficulty achieving
acceptance among staff
X
Chiropractic
Clinic
Hospital
LTC
Optometry
X
X
X
X
X
X
X
Difficulty in justifying
expense or return on
investment
Concern over
completeness and
accuracy of records
X
Current reimbursement
system
X
Inability of technology to
meet your needs
Prescription transaction
Public
Health
X
X
Difficulty changing work
flow patterns
Not enough time for
training
Pharmacy
X
X
X
X
4
Health IT Loan
•24 loans to hospitals and clinics
• $11.4 Million Dollars
•
ND Legislature
• Bank of North Dakota
• 1% interest – 10 years
6
Electronic Health Records
Reported Live EHRs as of February 2014
100%
80%
60%
2008
40%
2012
20%
Current EHR
0%
* Patient care record
7
E-Prescribing
• ND Ranks 6th in 2013
E-Prescribing Activity
(Surescripts Ranking)
•
•
•
15th in 2012
18th in 2011
47th in 2010
2013 Primary Mode for Pharmacies to Receive Prescriptions
• E-Prescribing
2012 Primary Mode for Pharmacies to Receive Prescriptions
• Phone
• Fax
NDHIN Stats
• 170+ Organizations have signed Participation
and Business Associate Agreements with NDHIN
• 6 Prospective Payment Hospitals
• 36 Critical Access Hospitals
• Public health organizations, long term care, pharmacies, clinics etc.
• Direct Secure Messaging
• Web based Direct – 680+ users
• XDR Direct – 2,000+ users
• Query Based Services
• Continually Onboarding data providers – AND data consumers
• Unique Patient Records –
690,000 (May 2015)
• User Accounts set up to access patient data – 1,000 + providers
Push Services
Example: I have a piece of
information and want to send it to
someone else securely.
Our Experience with Direct
• Pre-Orion Health
• DSM 1.0
• DSM 2.0
• XDR
• Patient Portal
• HISP to HISP
ONC Mandate a Phased Implementation
• Phase 1
• Implement Direct
• Phase 2
• Implement more robust exchange of data in a test environment
• Phase 3
• Rollout data exchange statewide
The Direct Project:
Secure Internet-based Point-to-Point Messaging
Direct Project specifies a simple, secure,
scalable, standards-based way for
participants to send encrypted health
information directly to known, trusted
recipients over the Internet.
[email protected]
[email protected]
• Simple. Connects healthcare stakeholders through universal addressing using simple push of
information.
• Secure. Users can easily verify messages are complete and not tampered with in travel.
• Scalable. Enables Internet scale with no need for central network authority.
• Standards-based. Built on common Internet standards for secure e-mail communication.
DSM 1.0
• Signed contract with Orion Health in April 2013
• DSM 1.0 First Deliverable
• LIVE with existing Direct users in late May/Early June 2013
• Developed Key Use Cases
• Smoking Cessation Referrals
• ND Medicaid Claims Attachments
• Trauma Coordinators
• UAT Validation
• Approx 800 users at peak
• HISP to HISP with Healthvault
Direct Secure Messaging
DSM
Orion Health
Trust Network
Basic Direct Secure Messaging
• Web-based access
• Email client access
Web
Managed Direct Secure Messaging
• Client-deployed hardware
device
• Monitored by OH Managed
Services
DSM
Connect
HPD
CERT
Direct Secure Messaging with
EHR System integration
• Encrypted S/MIME access
• Encrypted XDR access
MSG
DSM
Direct
Migration to DSM 2.0
• Began in 2014
• Deadline for users to move to 2.0 was December 1
• Complete with the exception of one organization
Direct Secure Messaging
DSM
Orion Health
Trust Network
Basic Direct Secure Messaging
• Web-based access
• Email client access
Web
Managed Direct Secure Messaging
• Client-deployed hardware
device
• Monitored by OH Managed
Services
DSM
Connect
HPD
CERT
Direct Secure Messaging with
EHR System integration
• Encrypted S/MIME access
• Encrypted XDR access
MSG
DSM
Direct
DSM Direct
• Sanford Health
• Essentia Health
• Altru Health
• 2000+ XDR Mailboxes
• Onboarding Process/Testing
• Other HISPs – like Cerner – work fine because of Direct
Trust relationship
XDR Interfaces Progress
Organization
Vendor
DOI
XDR
Request
Form
Onboarding
Completed
Sanford
EPIC
✔
✔
✔
Essentia Health
EPIC
✔
✔
✔
Altru Health
EPIC
✔
✔
✔
Patient Portal
• 3 Critical Access Hospitals use Orion Health Patient
Portal
• Provider Mailboxes for MU Transition of Care are with different
HISP
• Hospitals use NDHIN for DSM Web (but not DSM Direct)
• EMR-based HISP needs to be set up with HISP to HISP with Orion
Health Patient HISP
• Updox
• NDHIN believes getting Orion Health to join NBB4C Consumer
bundle is a way to deal with this rather than setting up individual
HISP to HISP connections between Patient Portal HISP and each
EMR-based Provider HISP
NDHIN Direct Secure Messaging
DSM
Orion Health
Trust Network
Web
HPD
CERT
Basic Direct Secure Messaging
• Web-based access
• Email client access
Direct Secure Messaging with
EHR System integration
• Encrypted S/MIME access
• Encrypted XDR access
MSG
DSM
Direct
Orion Health
Patient HISP
NBB4C
(NATE)
HISP to HISP
• Added connectivity to Veterans Administration via HISP to
HISP in Spring 2015
• MS Healthvault
Pull (Query based) Services
Example: I have someone in the ER/office that I
know little or nothing about. How can I get
information from other sources to help me make
sound medical decisions quickly and efficiently?
Query the NDHIN for information!
How NDHIN Works
Hospital
NDHIN
System
Clinician
Office
Gathers and
assembles the
patient’s records
using MPI
Diagnostic
& Imaging
Emergency
Department
Patient
demographics
NDHIN
Clinical
Portal
Consolidated
view of
Patient
Information
NDHIN Clinical Portal
• Comprehensive View of Patient Information
• Customizable User Interface
• Notifications/Subscriptions
• Timeline View
• Normalization of Data
• Lab Results
• Problems
• Allergies and Medications
Integrated Health Data Architecture
Senate Bill 2250
• Three Options of HIE Participation
• In (Default)
• Allows the individually identifiable health information of an individual to
be searchable by a provider
• Opt-Out of Participation
• Individual’s identifiable health information may not be accessed by
search by a health insurer, government health plan, or healthcare
provider other than the provider who originally created or ordered the
creation of the individually identifiable health information
• Conditional Opt-Out
• Information is not available for search, like the first option. However, if a
health care provider determines access is required because of a
medical emergency, the health care provider can “break the privacy
seal” and search for the information
Patient Consent
• Patient Consent
• Opt Out/Opt In of HIE managed centrally, within NDHIN
• Participant Staff
• NDHIN Staff
Patient Consent
Data Feeds to HIE
• Typically VPN Connection to Data Providers
• Other options, as well
• HL7
• Admission, Discharge, Transfer (ADT)
• Labs
• Radiology Reports/Documents
• Clinical Documents
• Immunizations
• CCD/CDA Exchange
Data Feeds to HIE
• Admission, Discharge, Transfer (ADT)
• Patient Demographics
• Encounter History
• Allergies
• Diagnosis
• Procedures
• Observation Results (ORU)
• Lab Results
• Imaging Studies
• Radiology Reports/Documents
• Medical Document Management (MDM) (Clinical Documents)
• Work Types
•
•
•
•
•
Discharge Summaries
H&P’s
ED Visit Notes
Consult Reports
Operative Notes
• Immunizations (VXU)
• CCD/C-CDA Exchange
Subscriptions/Notifications
• Providers can “subscribe” to their patients and be notified
when specific events/triggers happen – based on HL7
messages
• Inpatient Admission
• Inpatient Discharge
• Abnormal Lab Result (includes all abnormal results)
• Above High/Low Abnormal OR Panic Lab Result (subset of
abnormal lab result)
• New Final Radiology Result
• Patient is admitted to the ER
Notifications
Viewing CCD’s
NDIIS Bi-directional Interface
Prescription Drug Monitoring Program
HealtheWay
Audit Log
Example Integration (Cerner)
Single Click access to Clinical Portal
Architecture
Results Reporting
EHR or
RIS
eHealth
Gateway CV
PACS
DICOM
eHealth
Technologies
HIE
EHR or
RIS
Web Services
eHealth
Gateway CE
PACS
DICOM
EHR or
RIS
User Authentication
Patient ID & Consent
Workflow Tools
Image Access
HIE User
Community
eHealth
Gateway
SE
PACS
DICOM
Imaging Provider(s)
Viewing Images With Rad Result
eHealthViewer® ZF
NDHIN – Benefits to Providers
• Public Health Reporting
• Electronic Lab Reporting
• Syndromic Surveillance
• Bi-Directional Interface to ND Immunization Registry
• Clinical Portal/Patient Portal
• Statewide Advance Directive Repository
• Prescription Drug Monitoring Program access
• eHealth Exchange Connectivity
• Connect to other HIE’s/Federal Agencies across country
• Image Exchange
• View images from PACS networks across state
• Disease Registries
• NDHIN Direct
• Simplifying Future Interface Work – and much more!!
What about the data?
• Workgroup involvement
• Clinical Workgroup
• Data Use Workgroup
• Data Stratification
• Discreet Data is essential
• Lots of Potential – but rules/use need to be defined
• ACO, MSSP
• PCMH
• Research
• Community Needs Assessments
• More…
• Statewide Data Hub?
Additional (Essential) Information
• The Koble Group, LLC
• Applying to be an HIO in MN (July 2015)
• Will use same basic model as NDHIN
• Initially will serve organizations previously working with CHIC
• Orion Health
• Goal – Provide stable, sustainable Health Information
Exchange Services to Minnesota Providers and citizens.
• HISP (Direct)
• Query-Based Exchange
• New Tools – FHIR, Web API’s, more…
Two Last Thoughts…
• Exchange doesn’t stop at the border
• Cross Geographic/State Borders
• Health Information Exchange isn’t the end game…
• Data Analytics
• Population Health
• More…