Transcript OneHealthPort - HIMSS Washington Chapter

THE FUTURE OF HEALTHCARE
IN WASHINGTON STATE
Leveraging the C-CDA for
Health Information Exchange
Today’s Presentation
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Introduction
OneHealthPort Health Information Exchange
Leveraging the C-CDA
The Information Exchange Continuum
Future State of Health Information Exchange
OneHealthPort – Who we are
Created by and for the local healthcare community, OneHealthPort solves information
exchange and workflow problems shared across healthcare organizations.
• Founded in 2002 by leading NW health care organizations.
– Delivers variety of services, best known for the Single-sign-on (SSO)
service
• Initiated a Health Information Exchange (HIE) in 2009.
– Serves as the WA state HIE and has independent oversight
– Diverse transaction offerings, financially stable
• First HIE phase, an Exchange – data transformation, routing.
• Second HIE Phase, 2015 – a Clinical Data Repository (CDR).
– Responding to increasing interest in standardized clinical info exchange
OneHealthPort HIE Vision
Accelerate adoption and use of standards
Support push and pull between healthcare organizations
Not focused on Direct (secure email)
Foster use of web services
Meet community needs by “filling gaps”
Leveraging the C-CDA
The Consolidated-Clinical
Data Architecture is a set of
“building blocks” (clinical
information components in
certified EHR systems) that
can be assembled into
documents or messages for
information exchange.
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Allergies
Medications
Problem List
Procedures
Results
Family History
Physical Exam
General Status
Functional Status
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Clinical Information Components
Functional Status
Immunizations
Plan of care
Advance Directives
Social History
Vital Signs
Assessments
Chief Complaint
History of Present Illness
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Encounters
Medical Equipment
Mental Status
Nutrition
Payers
Patient demographics
Reason for Visit
Review of Symptoms
Assessment and Plan
Leveraging the C-CDA:
Continuity of Care Document
Continuity of
Care Document
(CCD)
Optional “Additional” Clinical
Information Components for CCD
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Advance Directives
Encounters
Functional Status
Medical Equipment
Payers
Required Clinical Information
Components
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Allergies
Medications
Problem List
Procedures
Results
Family History
Immunizations
Plan of Care
The Information Exchange Continuum
Secure
Websites
Secure
E-Mail
Health
Information
Exchange
Single Sign-On
Mediated
Web Services
Clinical Data
Repository
Web Services/
APIs
Health
Information
Exchange
Single Sign-On
simplifies logging
into over 30
different websites
to find business
and clinical
resources.
Secure email used to PUSH
the reports from a variety of
sources means various new
logins. Person to person
messaging.
HIE uses secure methods to
assist PUSH of messages to
any connected trading
partners.
OneHealthPort hosted
application gathers
data needed for query
from authenticated
user and returns
request
CDR is used to
aggregate data and
perform population
analytics.
The EHR system is
able to start a query
from within a workflow
and accept a response
from another system.
• Authenticate
connections
• Use Provider Directory
to route messages
• Facilitate exchange of
standard data
• Host API/web services
• API Directory
• Standards
Propagation
“Push” data to trading partners
Clinic
“PUSH” between any two participants
can be C-CDA, XML, HL7
Hospital
Payers
Leveraging OneHealthPort Identity
Management Services Use with the HIE
• Identity management or Single Sign-On (SSO) account needed to
start an HIE contract – free to any healthcare organization.
• SSO login used to register facilities that participate in the HIE.
• Allows access to HIE Provider Directory web application.
• Provides access to C-CDA Validation tools.
• SSO Administrator can assign CDR Access roles to users in the
organization who need access to the CDR clinical and reporting
portals.
• SSO login allows a subscriber to start a hosted secure query of the
CDR or a participating HIE organization willing to respond to
queries.
Web Service
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OneHealthPort hosts
web service query
through application
accessed by SSO
login.
Provider organization
EHR would need to
accept a web service
query.
Provider
organization’s EHR
replies with their
clinical information.
OneHealthPort has
no access to data
exchanged and does
not store the data
This would be a very
future state for most
small practice
vendors.
Hospital
Clinics
• Register
organizations
and users
• Secure web
portals and
applications
• Authenticate
users
• Collect and
share Provider
Directory Info
• Use APIs to
pull
information to
hosted
applications
Hospital
Query using API
Response to API
Query
Clinics
SSO Mediated Query/Response (Web Service):
OneHealthPort mediates the web service call and
delivers the response to the requester. Response
can be a pdf or xml C-CDA document.
Clinical Data Repository
• OneHealthPort offers a shared community CDR based on a sponsor
hosting lives that the community can access and provide clinical
documents about.
• The CDR can take claims and other data feeds as well as C-CDA
documents from clinical organizations.
• The CDR is an aggregation option that can support population
analytics and shared clinical records.
• Someone sponsors the lives at an annual fee per life. Sponsor
defines who can have access and who can contribute data.
• All organizations accessing the CDR must participate in the HIE.
• ONLY the sponsor pays for the lives in the CDR.
EHR pushes C-CDA
to CDR
Hospitals
Clinics
Providers
Push
• Authenticate
connections
• Use Provider
Directory to route
messages
• Facilitate exchange
of standard data
• Host API/web
services
• API Directory
• Standards
Propagation
Sponsor bulk
loads claims and
eligibility data
View only use of
the CDR using
Portal
Hospitals
Clinics
Providers
C-CDA Response
to API Query
from/to EHR
Provider EHRs push C-CDA to CDR after
each Medicaid encounter. After a critical
mass of data is reached, providers can
draw C-CDA from CDR into their EHR
through the HIE, or view CDR through
secure portal.
Sponsor and other
authorized parties
can access reports
and/or data
Web Services
• We’re all familiar with web
services in other industries –
like travel
– Make airline reservations
– Get offers for rental car,
hotel and entertainment
at my destination
– Web services used to get
the latest data to meet
my needs
– Very fast response to a
very specific question –
destination city, dates,
times
– Data enriches my
workflow – saves me
time
Web Services Continued
• Unsolicited clinical and business messages pushed to
other organizations can create workflow issues for the
receiving organization.
• “Asking” for information as needed (query/response) has
some distinct advantages.
– Can be fully automated so people are not “touching” each record
request
– Is fully audited by systems so you know what has been asked
and answered
– Can leverage standards that reduce one-off handling
– Can incorporate external data sources in the regular workflow
without users doing side lookups
XCA Query Protocol
• Cross Community Access (XCA) protocol allows one
entity to query another in a series of web service calls.
– First – match the patient between systems
– Second – identify clinical documents available for that patient
– Third – determine which documents you want as either
structured data or unstructured pdf documents
• OneHealthPort created a secure application to launch
XCA queries to any participating HIE organization that is
willing to accept/respond.
• Process tested with Epic development staff.
• OneHealthPort can broker non-Epic requests to Epic
organizations.
• Authenticate
connections
• Use Provider Directory
to route messages
• Facilitate exchange of
standard data
• Host API/web services
• API Directory
• Standards
Propagation
Clinic
Hospital
Query using API
C-CDA Response to API
Query
SSO Mediated Web
Services
Query/Response using a Web
Service/ API leverages standard APIs
to facilitate any organization capable of
starting a query to any organization
able to respond to a query on a shared
patient.
Future State of Health Information Exchange
Payer and Provider systems have matured to the point that APIs are
embedded in workflows.
All parties work in their preferred workflow system and embedded APIs
are used to communicate with other systems.
The HIE brokers security and authentication information to assist
parties to “Trust” web services.
C-CDA documents are the standard leveraged for clinical information
exchange.
This is an Ideal Future State that we grow to by moving up the continuum.
OneHealthPort
• OneHealthPort - visit our website at
– http://www.onehealthport.com/
• Kelly Llewellyn, Senior Account Manager
– OneHealthPort HIE
– [email protected]