Post on 11-Jun-2018
ASSESSING ASSESSING THE THE TECHNICAL TECHNICAL
CAPABILITY OF CAPABILITY OF A HIE A HIE ORGANIZATIONORGANIZATION
Lori Jefferson, MBA,MSHIT Manager/Grant Manager
New Jersey Healthcare Facility Financing Authority
Kennedy Ganti, MD,DABFM
Medical Director- Primary Care Research
Virtua Lumberton Family Physicians
Chair- NJ Health IT Commission
HIE PROGRAM ASSESSMENTHIE PROGRAM ASSESSMENT
Platform Infrastructure
Hardware & Software
Platform Architecture
Based on Strong Business Requirements
Platform Operation
Rate & Reliability
Interventions & Services that use the Platform
Preparation
ADDITIONAL ASSESSMENTSADDITIONAL ASSESSMENTS
EHR Interoperability & Options
Robust Interfaces
Security
Internet Presence
Resources – Expertise /Collaboration/Funding
A TECHNICAL REVIEWA TECHNICAL REVIEW
OF NEW JERSEY HEALTH OF NEW JERSEY HEALTH
INFORMATION EXCHANGESINFORMATION EXCHANGES
NEW JERSEY HIE OVERVIEWNEW JERSEY HIE OVERVIEW
• Jersey Health
Connect
• Health-e-Citi
• Camden
• South Jersey
• Jersey Health Connect [McKesson]
Atlantic Health
Hackensack University Medical Center
Hunterdon Healthcare
Newton Memorial Hospital
Robert Wood Johnson Health System
Saint Barnabas Health Care System
Saint Clare’s Health Services
Saint Peter’s Healthcare System
Solaris Health System
Somerset Medical Center
Trinitas Regional Medical Center
Summit Medical Group (physician group)
VISTA Health System, IPA
• Health-e-cITi-NJ [IGI Orbit]
Newark Beth Israel Medical center
East Orange General Hospital
Trinitas Medical Center
Clara Maas Medical Center
St. Michael’s Medical center
UMDNJ
St. Joseph’s Healthcare System
Meadowlands
Jersey City Medical Center
• Camden HIE [Noteworthy]
Lourdes Health System
Cooper University Hospital
Virtua Camden
ONC-Funded Regional Exchanges
• St. Joseph’s Healthcare [eClinicalWorks]
• Clara Maas [Axolotl]
• Hunterdon Healthcare [InterSystems]
• Trenton HIE [vendor TBD]
Capital Health
St. Francis (CHE)
• Monmouth-Ocean HIE [ICA]
Meridian
CentraState [Also in vendor selection process]
• Virtua Health [Wellogic]
• South Jersey HS [MobileMD]
• Central Jersey HIE
(physician-based HIE)
Other HIE Initiatives
NJ Medicaid HIE
• EMRX-SJ [Wellogic]
AtlantiCare, South Jersey Health System, Shore Memorial Hospital
Cape Regional Medical Center, SeaShore Gardens (nursing Home)Updated: July 14, 2010
CAMDEN TECHNICAL ARCHITECTURECAMDEN TECHNICAL ARCHITECTURE
Web-Based HIE Platform /Hub connector/EMR
Noteworthy
Patient Portal, Mobile Tools
DocVia
EMR Alternative for Providers
SpringCharts
CAMDEN CURRENT INFRASTRUCTURECAMDEN CURRENT INFRASTRUCTURE
Centralized Database
Construction of a Local MPI that will Connect to
State MPI
Exchange of Lab Data with Decision Support
Support of Transfers Between Settings with
Discharge Data
Access via Provider Coalition Website
CAMDEN COLLABORATIVE PREPARATIONCAMDEN COLLABORATIVE PREPARATIONHISTORICAL LESSONS LEARNED FROM OTHER HIE INITIATIVES
CAMDEN HIE IMPLEMENTATION GOALS
Overly ambitious vision
Lack of clinical Involvement
in planning
Expensive & Unsustainable
Infrastructure
Lack of Stakeholder
Involvement to surmount the
complex legal, technical, and
funding hurdles.
Phased Implementation with
value added components
Strong Clinician Leadership
Cost effective strategies with
sustainable overhead.
HIE is one component of
initiatives of the Camden
Coalition of Healthcare
Providers
JERSEY HEALTH CONNECT JERSEY HEALTH CONNECT
INFRASTRUCTURE STRATEGYINFRASTRUCTURE STRATEGY
The intent of the Collaborative is to create an
open and standards-based platform to provide
for the seamless exchange of health
information
Design with HITSP, HL7 and others standards
as a requirement
JERSEY HEALTH CONNECTJERSEY HEALTH CONNECT
TECHNICAL ARCHITECTURETECHNICAL ARCHITECTURE
HIE Platform is based upon a software as a
service (SaaS) platform
Cloud-based model for Health Information
Quick scale deployment & Data Sharing
using EHRs
Utilize PHRs such as Microsoft HealthVault
or Google Health.
Leverage the numerous and disparate
repositories of patient information.
JERSEY HEALTH CONNECT JERSEY HEALTH CONNECT
TECHNOLOGY DEPLOYMENTTECHNOLOGY DEPLOYMENT
• Personal Health Records
• Health Summary Manager
• Patient Messaging services
• Colleague Messaging
• Clinical Document and Results Manager
• Electronic Prescribing
• Automated, Proactive Eligibility
• Registration Manager
JERSEY HEALTH CONNECT PREPARATIONJERSEY HEALTH CONNECT PREPARATION
Prior to Grant Funding:
700 Providers & 2 Hospital Systems Sharing Data
Over 400,000 Patient Records Connected
25,000 Patient Actively Connected
Transmitting 10,000 electronic prescriptions and
over 45,000 clinical documents and lab results per
month.
HEALTHHEALTH--EE--CITICITI NJNJ
TECHNICAL INFRASTRUCTURETECHNICAL INFRASTRUCTURE
Federated Approach
Based on Service Oriented Architecture
applied to the IHE profiles, PIX/PDQv3, XDS.B and AT9A and is in conformance with the HITSP Integration profiles.
Enterprise Master Patient Index
Terminology Translation Service
Enterprise Service Bus
Standards Compliant Web-Based User Interface / Portal
Open Architecture seamlessly adds new facilities to Join the Health Information Gateway.
HEALTHHEALTH--EE--CITICITI TECHNICAL ARCHITECTURETECHNICAL ARCHITECTURE
Two Tiered Approach of Edge Servers To connect provider securely
To normalize data to HL7 format
Core Servers for Shared Services Orbit Portal
Apelon Terminology Service
Initiate Enterprise Master Patient Index
Intel SOA Expressway connect Providers Message gateway
Mediation engine
A security policy enforcement point
This solution can handle an average of 500 HL7v2 to HL7v3 conversions per second, allowing Health-e-cITi-NJ scalable capacity throughout the exchange.
HEATLHHEATLH--EE--CITICITI ARCHITECTURE DIAGRAMARCHITECTURE DIAGRAM
MDS Component with industry leading probabilistic matching algorithm to link records. Reduces duplication in the patient index
HEALTHHEALTH--EE--CITICITI PREPARATIONPREPARATION
Clinical Data sharing between Newark Beth Israel and Federally Qualified Health Centers (FQHC)
Interface to State immunization system and links across state lines to other State systems
Interface to facility internal patient data warehouse
Connection to NJ Medicaid for medication histories (1st meaningful use delivery under the Medicaid transformation grant)
Automated workflow in ED at Newark Beth Israel using HL7 standards to eliminate nurses double entry of labs and radiology orders
SOUTH JERSEY ARCHITECTURE FEATURESSOUTH JERSEY ARCHITECTURE FEATURES
Web-based Utility
Designed to Facilitate Interoperability and Clinical Data Exchanges.
Service oriented application
Data transport services
Transformation and Integration Services
Data Access Services
Rules Management and Execution Services
Auditing, Personalization, Configuration, Context and other Framework Services
Presentation Services
Wellogic HIE Platform
SOUTH JERSEY INFRASTRUCTURESOUTH JERSEY INFRASTRUCTURE
Hybrid Model
Clinical Data Repository located Central Site
Major Data Contributors
Smaller Wellogic Platform
CDR on Edge Server protected by Firewall
Intermediate Data Store
EMR Lite option to support Provider Adoption
Alternate CCHIT Certified EMR Options
SOUTH JERSEYSOUTH JERSEY
ENTERPRISE BUS / INTEGRATION LAYER ENTERPRISE BUS / INTEGRATION LAYER
FEATURESFEATURES
Communication
Parsing of data interchange standards, including XML, HL7, CCR, CCD, ASTM X.12N, NCPDP, and DICOM
Nomenclature Service
Community Master Patient
Registration
HIPAA-supporting auditing
Alerts
Messaging infrastructure
Web-based Administrative Application for role-based system configuration and management
SOUTH JERSEY VENDOR STANDARDS AND SOUTH JERSEY VENDOR STANDARDS AND
CERTIFICATIONSCERTIFICATIONS
Well Logic Platform – NHIN Functionality
Certified by CCHIT
Certified by the IHE standards
EVALUATION OF THE HIE PLATFORM:EVALUATION OF THE HIE PLATFORM:
Steers the design of the project
May be used to monitor the ongoing operation
Offer Lessons Learned to other projects
KEY HIE EVALUATION ISSUESKEY HIE EVALUATION ISSUES
Transferring Data & Accuracy of Data Transfer
Completeness
Timeliness
Success in Matching Patients
Confidentiality Breaches
HIE EVALUATION CONSIDERATIONSHIE EVALUATION CONSIDERATIONS
Range of HIE Models
Different Evaluation based on Format
Range of HIE Service
Evaluate each service
Outcome
Revenue
Range of Evaluations
Analysis
PLATFORM LEVEL MONITORINGPLATFORM LEVEL MONITORING
Measuring Data Movement by User & Data
Type
Data Exchange Platform
Primary Use Case for the Platform
Secondary Use Case
PLATFORM LEVEL MONITORINGPLATFORM LEVEL MONITORING
Information Exchange Infrastructure
Initial Evaluation
Monitored over the course of the project
Data Transfer Assessment
Accuracy
Completeness
Timeliness
Patient Mapping Verification
EMR SOFTWARE ASSESSMENTEMR SOFTWARE ASSESSMENT
Uptime / Downtime
Performance
Functionality / Templates / Customization
Interoperability
SERVICE / INTERVENTION MONITORINGSERVICE / INTERVENTION MONITORING
Service Impact
Messaging
Results Push
AQA Measures
HIE HIE
INCENTIVES FOR PROVIDER PARTICIPATION INCENTIVES FOR PROVIDER PARTICIPATION
Lower transaction costs of acquiring
information when patients visit your hospital;
Reducing the costs of distributing clinical
information to your referring community.
COMMON EVALUATION STRATEGIESCOMMON EVALUATION STRATEGIES
Reduce Duplication of work
Supports Meta-analysis
PROGRAM ANALYSIS PROCESSPROGRAM ANALYSIS PROCESS
Gather Baseline information Early
Monitor Unintended Consequences
Evaluate ROI
Conduct Program Evaluation Across Several
Projects
Financial Benefits
Clinical Benefits
HIE GOAL: HIE GOAL:
APPLICATION AND LOCATION INDEPENDENT APPLICATION AND LOCATION INDEPENDENT
DATA SHARINGDATA SHARING
A standards-based enterprise
Storage management system that is independent of the application and transmits data is critical to
achieving the goals of:
Interoperability between clinical applications
Increased productivity
Decreased operational cost and
Facilitate implementation of an Electronic Health Record (EHR) systems
HIE EVALUATION CONCLUSIONHIE EVALUATION CONCLUSION
Architecture
Infrastructure
Resources / Leadership
Preparation / Strategy