NV RHIO Infrastructure Committee Report

1
NV RHIO Infrastructure Committee Report

• March 1, 2007

2
Outline

• Infrastructure Committee
• Infrastructure Model
• Work Breakdown Structure/Project Plan
• Implementation Phasing
• Lessons from the Health Information Management
  Systems Society (HIMSS) 07 Conference

3
Top Level EHR Components
Personal Health Record (PHR) or Personal EHR
Healthcare Provider or Clinical EHRs
Payer Records or Payer EHRs
Glue
Other Healthcare System Records
4
Infrastructure Committee Member Organizations
System Integration (Glue)
Patient Advocate (PHR)
Healthcare Provider (and Clinical EHRs)
Payer (Claims Records)
Other Healthcare System Elements
5
Infrastructure Committee Members
System Integration (Glue)
Healthcare Provider (and Clinical EHRs)
Patient Advocate (PHR)
Payer (Claims Records)
Other Healthcare System Elements
6
RHIO Data Architecture Options
Pure Centralized
Pure Federated
Hybrid
7
NV RHIO Architecture Scenarios

• Scenario 1 Upload Patient Safety Data to a
  Central Database
• Scenario 2 Upload Enhanced Quality of Care Data
  to a Central Database
• Scenario 3 Provide Patient and EMT Access to
  Personal Health Information
• Scenario 4 Longitudinal Coordination

8
Patient Demographic Data

• Name
• Address
• Insurance Provider/ID Number
• Telephone Number
• Cell Phone Number
• Provider ID/Patient ID
• Next of Kin

9
Patient Demographic Data Sources
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Patient Safety Data

• ALLERGIES
• MEDICATIONS
• IMMUNIZATIONS
• CRITICAL DIAGNOSES (PATIENT PERMISSION to
  include)
• LAB RESULTS (APPROVED BY PROVIDER for transfer to
  RHIO)
• RADIOLOGY RESULTS

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Patient Safety Data Sources
12
Scenario 1 Patient Safety
13
Scenario 1 Patient Safety
a
Rocky Run Web Browser
Portal Functionality
HIPAA compliant Identification, Authentication,
and Access
Comm. Ortho. Office Records
Comm. Ortho. Light EHR Client
HCA/RHIO Records
Repository Management

• Person Services (Identity Resolution, ?)
• Terminology Management
• Security and Auditing
• Messaging Services

INOVA/RHIO Records
VHC/RHIO Records
Pharmacy Office Records
Integration Engine
SureScripts/ Rx Hub
Quest Lab Records
Quest Client SW/HW
Patient Safety Data Meds Labs Rads
RHIO Master Patient Index
Radiology Records
Radiology Client SW/HW
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Patient Safety Scenario Infrastructure Status
from HIMMS

• There are multiple vendors for both integrated
  and best of breed infrastructures
• The Integrating the Healthcare Enterprise
  Industry Consortium has developed
  interoperability profiles for a document-based
  architecture
• There is an alternative Web Services/SOA
  architecture
• There are alternative policy architectures for
  data ownership RHIO, Health Data Bank,
  Combinations
• Phasing is an important consideration
• Best advice appears to be to start small
  Medications is a recommended starting point

15
WBS/Project Plan

• The Committee has produced an initial WBS based
  on Tampa Bay
• Helayne Sweet has produced an initial project
  plan extending the WBS

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Implementation Phasing
Scenario 2 (Enhanced Care)
Scenario 1 or Subset (Patient Safety)
or
(could define Scenario 1 Subset)
(could follow Scenario 2)
(Sequence could change depending on
funding Sources)
Scenario 3 (EMT Access)
Scenario 4 (Longitudinal Record)
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Lessons from the HIMSS 07 Conference

• One reasonably solid recommendation
• Physicians implementing an Ambulatory EHR system
  should specify that it be certified by the
  Certification Commission for Healthcare
  Information Technology (CCHIT)
• This guarantees a minimum functionality
• The certified vendors are likely to continue to
  seek future certification, which will require
  interoperability
• Another Get data sharing agreements in place
  fast
• Lots of fuzzier guidance
• NC RHIO has put its legal documents on the web
• Potential funding source from NHIN II RHIOs
  will be the award winners

18
Backup Slides
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EHR Components - Goal
Personal Health Record
Hospital Records
PHR Client SW/HW
Hospital Client SW/HW
Physician Office Records
Private Health Insurance Carrier Client SW/HW
Insurance Records
Physician Client SW/HW
Dental Office Records
Dentist Client SW/HW
HIPAA compliant Identification, Authentication,
and Access
Medicare Medicaid FEHBP DoD, IHS Veterans Client
SW/HW
Government Program Participant Records
Pharmacy Office Records
Pharmacy Client SW/HW
Laboratory Records
Laboratory Client SW/HW
Research Records
Research Client SW/HW
Imaging Records
Public Health Records
Imaging Client SW/HW
Public Health Client SW/HW
Genomic Records
Genomic Client SW/HW
EMT Records
EMT Client SW/HW
Environmental Records
Environmental Client SW/HW
Based on a sketch by Rep. Chris Cannon of Utah
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Scenario 2 Enhanced Care
Hospital Records
Hospital Client SW/HW
Physician Office Records
Physician Client SW/HW
HIPAA compliant Identification, Authentication,
and Access
Pharmacy Office Records
Pharmacy Client SW/HW
Laboratory Records
Research Records
Laboratory Client SW/HW
Research Client SW/HW
Uploaded Data
Imaging Records
Public Health Records
Public Health Client SW/HW
Imaging Client SW/HW
Based on a sketch by Rep. Chris Cannon of Utah
21
Scenario 3 PHR and EMT Access
Personal Health Record
Hospital Records
PHR Client SW/HW
Hospital Client SW/HW
Physician Office Records
Physician Client SW/HW
HIPAA compliant Identification, Authentication,
and Access
EMT Records
EMT Client SW/HW
Based on a sketch by Rep. Chris Cannon of Utah
22
Scenario 4 Longitudinal Coordination
Personal Health Record
Anonymized Links with Trusted Reverse Channel
Links
Lifetime Full PHR
Public Health Records
Environmental Records
Prenatal and Pediatric Records
Research Records
Military and VA Records
Genomic Records
Employer and Self Insurance Carrier Records
Medicare Records
Death Certificate and Autopsy Records
23
National and NV EHR Component Inventory
Hospitals and Clinics
5,759/35
National/Northern Virginia 300,000,000/1,800,000
Patient Population
Physicians
737,500/4,422
Private Health Insurance Carriers
1,100/200
Nurses
3,060,000/18,360 RNs
HIPAA compliant Identification, Authentication,
and Access
Medicare Medicaid FEHBP DoD, IHS Veterans
Dentists
164,664/988
Pharmacies
196,100/1,176
?/?
Research
Laboratories
30,000/180
Public Health
?/?
Imaging
Genomic
EMT Units
?/10
Environmental
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EHR Standards Status
PHR Client SW/HW
Hospital Client SW/HW
None
Private Health Insurance Carrier Client SW/HW
Physician Client SW/HW
X12N, ICD-9, CPT, SNOMED, LOINC
X12N, ICD-9, CPT, NCPDP, SCRIPT
Dentist Client SW/HW
HIPAA compliant Identification, Authentication,
and Access
Medicare Medicaid FEHBP DoD, IHS Veterans Client
SW/HW
ANSI/ADA
Variable
NCPDP, SCRIPT
Pharmacy Client SW/HW
X12N for Provider to Payer
LOINC
None or Project Dependent
Laboratory Client SW/HW
None for more general exchange
Research Client SW/HW
DICOM
CDC- PHIN, BioSense
Imaging Client SW/HW
Public Health Client SW/HW
None
None
Genomic Client SW/HW
EMT Client SW/HW
None
Environmental Client SW/HW