BMH

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HIE Interfacing and Electronic Lab Results
Delivery
Lauri Scharf, VITL Jon Farina, Brattleboro
Memorial Hospital Bill Howard, GE
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VITL Vermont Information Technology Leaders
Lauri Scharf, VITL
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Background

• VITL Vision
• A transformed health care system where health
  information is secure and readily available when
  people need it, positioning Vermont as a national
  example of high quality, cost effective care.

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Background

• VITL HIE Services
• Medication History Service
• Connectivity Services
• Lab results orders
• Radiology reports orders
• Vermont Blueprint for Health
• Immunization Reporting (pilot phase)
• Advanced HIE (bi-directional document exchange)
• Other VITL Services
• EHR Program
• e-Prescribing Project

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Background

• VITL HIE Services
• Medication History Service
• Connectivity Services
• Lab results orders
• Radiology reports orders
• Vermont Blueprint for Health
• Immunization Reporting (pilot phase)
• Advanced HIE (bi-directional document exchange)
• Other VITL Services
• EHR Program
• e-Prescribing Project

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Sample order in an EHR
CBCPLTS w/ DIFF
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Sample result in an EHR
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How does it work?
Bill Howard, GE
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GE Centricity HIE Services Hosting Center
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AMBULATORY
HOSPITAL
SAFP
Connectivity Service
Hoosick
Rutland
PCHP N55 (Multiple Locations)
Bennington
Brattleboro
GE HIE SERVICES
Timberlane
CornerMedical N8 (StJohnsbury)
NMC (St.Albans)
Richford (4)
Alburg (3)
Notch N11 (Richford)
Enosburg (2)
FAHC (Burlington)
Swanton (2)
Dr.Moore (1)
FAHC N10 (Burlington)
Aesculapius (9)
RRMC (Rutland)
BFP N5 (Bennington)
SVMC (Bennington)
MtA N24 (MtAscutney)
BMH (Brattleboro)
NCHC N21 (St.Johnsbury)
Michl N1 (Manchester)
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Brattleboro Memorial HospitalCase Study
Jon Farina, Brattleboro Memorial Hospital
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VITL Lab Results Interface

• The BMH Story

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BMH Overview

• 70 affiliated Physicians

• Process 70,000 Lab Orders a Month

• Siemens MedSeries4 HIS

• Orchard Harvest LIS

• There are 60 Beds at BMH

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In The Beginning

• Aug 08 BMH Implements Med History with VITL
• Create VPN Connection to VITL for data transport
• Utilize existing HL7 engine for transaction
  activity

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Meanwhile

• PCHP to implement Allscripts EHR in all practice
  sites
• Demonstrate HIE capability with Lab Result tie-in
  to local hospitals
• PCHP and VITL absorbed all direct costs

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PCHP EHR Rollout
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BPC EHR Rollout

• 11 Physicians 13 Clinical Staff 12 Support
  staff
• Implementation started Fall 2008
• EHR Go-Live Mar 2009
• Lab Result Go-Live Jun 2009

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BPC-BMH-VITL Environment
BMH
MedSeries4 HIS
BPC Allscripts EHR
VITL HIE (GE)
Orchard LIS
Siemens Openlink HL7
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Scope Decisions

• Automate orders?
• NO issues with registration
• All physicians?
• YES too much administrative overhead otherwise
• All Lab tests?
• YES too confusing for physicians otherwise
• Reuse VITL VPN?
• YES, but new IP Port destination

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Target Workflow
Brattleboro Memorial Hospital
Brattleboro Primary Care
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Project Plan
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LOINC Conversion

• BMH downloaded codes from Orchard to Excel
• VITL forwarded to 3M for conversion
• BMH reviewed final conversion list

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HL7 Interfaces

• ORUs
• BPC Order
• NPI physician code
• Filter by specific physicians at BMH

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Order Forms

• Allscripts paper order
• Reconcile to BMH order form
• Issues
• Adjust BPC descriptions to facilitate manual
  match
• Draw times?
• Comments
• Future adopt a statewide order codeset

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Testing

• Smoke test checking transaction throughput
• Basic in-house test
• 33 of tests
• Tested most common out-sourced tests at FAHC
  Mayo
• Copy-to physician functionality (CC docs)
• Cancels (had to build this specifically for BPC
  sent as result code iso ORM)
• Advice keep sample lab tests for future EMR
  testing

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Move to Production

• 6.0 Activation
• 6.1 Acceptance
• 6.2 Configuration of Live Environments
• 6.3 Coordination of  Initial Loads ( where
  applicable)
• 6.4 Coordination of Real-Time Feeds
• 6.5 Support

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Production Testing

• Minimal testing, mostly for throughput

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Training

• BPC Physicians staff (PCHP)
• BMH Lab staff

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GO LIVE

• 6/17
• Drop-off specimens to start
• Controlled process watched input and output
  carefully
• Duplicate paper orders for 2 weeks
• Checked paper results against electronic results
  for accuracy
• 8/17 stopped printing reports

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What went well

• In-house LOINC translation
• Go live very smooth
• GE PCHP very good to deal with
• Testing all participants on at same time
• Staffed and planned for project with appropriate
  resources
• IS analyst with lab tech experience
• IT staff with experience

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What could have been better

• Reference lab tests
• LOINC translation verification
• Testing of LOINC translation
• Solutions
• LOINC coding at reference labs
• Automated testing

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Benefits

• Results to physicians faster
• Eliminates clerical paper handling
• Eases workload for Medical Records
• Will allow future trending of data

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What do we need from you?
Lauri Scharf, VITL
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Network Connectivity

• Virtual Private Network to the HIE
• Firewall settings
• TCP/IP
• Bandwidth needed for lab results modest

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Code Sets

• Provider Identifier NPI
• Abnormal Flag HL7
• Result Status HL7
• Result Code Normalized to LOINC

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Provider Routing

• Based on NPI-to-Location relationship
• Managed in the HIE
• Messages without a destination are dropped

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LOINC

• LOINC National standard for observations
• Logical Observation Identifiers Names and Codes
• Lingua franca of the HIE for lab results
• Options
• Lab maintains LOINC codes natively in its LIS
• Lab maintains LOINC translation in-house
• HIE maintains crosswalk of lab catalog to LOINC

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HITSP Lab Order Codes gt LOINC
http//wiki.hitsp.org/docs/C80/C80-3.html
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Reference Tests

• LOINC for FAHC and Mayo results
• Currently HIE translates to LOINC upon delivery
  to EHR
• Under consideration LOINC included in HL7 from
  FAHC and Mayo to the lab

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HL7 Message Format

• Standard HL7 version 2.x
• ORU sections MSH, PID, PV1, OBR, OBX, NTE
• ACK sections MSH, MSA
• One format for your lab, regardless of
  destination
• Potentially use for delivery of other
  results/reports

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Hospital Implementation

• Workflow considerations
• Specimen labeling
• Order entry at the lab
• Order dictionary improvements
• Technical repercussions of process changes
• Requisition format and contents (see sample)

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SAMPLE
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Questions to ask your IT Staff or Vendor

• HL7 format requirements and samples
• Patient demographic registration requirements
• LOINC crosswalk who will support this task?
• Order requirements

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QA