SUBMITTED BY RHIO WORKGROUP MEMBERSHIP

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1 V.04 RHIO Global Plan SUFFOLK CARE COLLABORATIVE REGIONAL HEALTH INFORMATION ORGANIZATION INTEGRATION STRATEGY SUBMITTED BY RHIO WORKGROUP MEMBERSHIP SUDD [Company address]

2 Contents 1.0 Introduction & Management Approach Stony Brook Hub RHIO Strategy Achieving RHIO Connectivity from the SCC Population Health Platform Catholic Health System Hub RHIO Strategy Northwell Hub RHIO Strategy Use of Secure Messaging & Alerts RHIO Alert Processing State (Cross QE) Alert Processing Alerts, Secure Messaging and DIRECT Partner Training... 9

3 1.0 Introduction & Management Approach The SCC PPS consists of three Hubs, namely, Northwell Health, Catholic Health System and the Stony Brook Medicine (SBM). The SCC PPS recognizes that each Hub has their own unique data sets, technology and business requirements and therefore allows each Hub to select the RHIO of their choice based on their business and technical connectivity requirements. This document has been written to provide an overview of the RHIO integration strategy that is being adopted across each Hub and how each implementation will ultimately be interoperable under the wider initiatives of the Statewide Health Information Network of New York (SHIN-NY). 2.0 Stony Brook Hub RHIO Strategy Within the Stony Brook hub the responsibility of assuring providers are connected and actively sharing data with a RHIO falls under the charter of the SBM Technical On-boarding team. The Stony Brook Hub Technical On-boarding process and RHIO integration strategy divides providers into two categories: a> those providers whom are already connected and activity sending data to a RHIO b> those providers who are not connected to a RHIO For those providers who are already connected to a RHIO no further action is required as we do not want to disturb their existing connectivity and associated clinical workflows. For those providers who are not connected to a RHIO the SBM Technical On-Boarding team assists them in both the development of their HL7 and CCDA interfaces as well as their last mile connectivity into the NY Care Information Gateway (NYCIG) RHIO Achieving RHIO Connectivity from the SCC Population Health Platform A core piece SCC s RHIO connectivity and integration strategy is the concept of aggregating multiple provider specific inbound HL7 connections into a single set of outbound HL7 connections to the RHIO (NYCIG). Where, each outbound HL7 connection is based on a specific HL7 message type (i.e. ADT, ORU etc). This approach eliminates the need for each provider to establish direct connectivity to both the RHIO and the SCC Population Health Platform. As shown in Figure 1 all message aggregation is performed by the Stony Brook Interface engine, which is a sub-component of the SCC Population Health Platform, depicted within the diagram as the green circle labeled SCC HIE. It is important to note that the data content of the provider s original messages is not altered in anyway but the format of the message may in some cases be altered to accommodate the technical requirements of the receiving RHIO system.

4 Figure 1: Logical Architecture for the SCC Population Health Platform 3.0 Catholic Health System Hub RHIO Strategy Within the Catholic Health Services (CHS) hub, the responsibility of assuring providers are connected and actively sharing data with a RHIO resides under the IT Population Health Management Department. Catholic Health Services is actively working with the Healthix RHIO to prioritize PPS Partner QE participant agreements based on DSRIP milestones and NYS DOH requirements. At present, all six acute care hospitals are connected to Healthix and participating in HL7 data exchange and RHIO consent management via ADT. Additional scopes of work include integrating the RHIO into clinical workflows via single sign on with the EMR, CCD-A exchange, and LOINC normalization of RHIO data. For CHS owned and affiliated ambulatory practices that are on Epic, data will be sent to Healthix through the existing interface setup. Participant consent authority will still be managed and respected by individual participant agreements in the interface pipeline. CHS is currently working with Healthix on assessing implementation of a community consent based model to help manage access of information across the Medicaid population and assist with real time event notification from the RHIO. For those providers who are not on Epic, Catholic Health Services will work with the hub partners to setup their HL7 and/or CCDA interface connections to send data to the RHIO. The CHS interface engine in turn will send data to the CHS population health management platform and RHIO. For those providers who are already connected to Healthix, an assessment will be made to determine what current information is being sent to the RHIO and if there is an opportunity to expand the richness of the contributed data by existing participants.

5 Figure 2: Logical Architecture for Catholic Health Services Hub within SCC Population Health Platform 4.0 Northwell Hub RHIO Strategy The Northwell Technical On-boarding process and RHIO integration strategy involves two broad categories of providers: 1. Northwell-owned, within the Northwell Health Physician Partners group, and 2. Voluntary Providers within the Northwell Hub network of SCC. For Northwell-owned providers, Northwell integrates data via a bi-directional provider EHR interface to a central enterprise Health Information Exchange platform. This platform is bi-directionally interfaced with the Healthix QE, and will also enable connectivity with the SCC Population Health Platform, hosted by the Cerner EDW. For Voluntary providers, whom Northwell has contracted for DSRIP but who remain independent from the hospital system, Northwell will leverage the Healthix QE to interface data to the Northwell s enterprise HIE, which will, in turn, connect and provide data to the SCC Population Health Platform, hosted by the Cerner EDW.

6 Figure 3: Logical Architecture for Northwell Hub within SCC Population Health Platform 5.0 Use of Secure Messaging & Alerts Alerts are principally used within the SCC PPS to inform our Care Management teams of admission and discharge events associated with attributed SCC PPS patients. Patient affiliation to the Hub is principally derived from the DOH Roster and claims data however additional Medicaid patients can also be discovered during the technical on-boarding process as the Roster is at least 6 to 12 months old. 5.1 RHIO Alert Processing In order to receive admission and discharge Alert events from the RHIO each hub is required to send a subscription request to their respective RHIO (i.e. HealthIX or NYCIG). The subscription request effectively registers an expression of interest from the Hub to the RHIO for the given patient. When new alert events are triggered the RHIO will send the alert to the set of entities that have previously expressed interest in that patient. The RHIO will only send the Alert to the subscribing entity if the following holds true

7 a> The receiving entity has previously sent a subscription request for the patient b> The patient has consented to allow the receiving entity to review their clinical data State (Cross QE) Alert Processing In some cases a patient could be admitted to a Hospital that is in a different regional location than their local Hospital. In these cases the RHIO affiliated with the remote hospital is responsible for forwarding the Alert event onto the RHIO that the patient is affiliated with. To achieve this RHIOs leverage the Statewide Master Patient Index (SMPI) functionality of the Statewide Patient Record Look-up (SPRL). RHIOs will also forward Alert events to multiple RHIOs when a patient is affiliated with more than one RHIO. Figure 4: Cross QE Alerting illustrates the Cross QE Alert workflow. Figure 4: Cross QE Alerting 5.2 Alerts, Secure Messaging and DIRECT The following sections outline how Alerts, Secure Messaging and DIRECT are defined and used with the SCC PPS. Alert Mechanism (Transport) SCC PPS Definition Print screen example DIRECT secure transactions Use of alerts The utilization of a HISP to send data to/from and EMR or a DIRECT secure messaging mailbox connected to a HISP. The ability to alert a subscriber that an event occurred on a patient of interest either via an which they then login to a See Figure 5for a DIRECT secure messaging mailbox connected to a HISP See Figure 6

8 Use of secure messaging viewer or directly into their EMR via HL7 messaging The ability to send messages in a secure environment that does not include a HISP See Figure 6 Figure 5: NYSIG DIRECT Messaging Figure 6: NYCIG Alerts send via Secure Messaging

9 Figure 7: Healthix Event Notification via secure Figure 8: Healthix Notification & Alerts within RHIO Portal

10 6.0 Partner Training Once the QE agreement has been signed by the provider site both the Healthix and New York Care Information Gateway (NYCIG) RHIOs provide training to authorized provider staff. Training instructs authorized users how to login to the RHIO s Portal for the purpose if viewing Patient data and discharge summaries. An example discharge summary is provided in figures 9 and 10. Discharge Summaries are listed separately under Reports/Documents as shown below: Figure 9: Accessing a Discharge Summary Report Presentation of Discharge Summary upon selection from above: Figure 10: Discharge Summary Report