HIE Update
Opportunity This project has the opportunity to leverage Health Information Exchange technology at a national level in order to effect measurable improvements in the care and treatment of patients afflicted with asthma and diabetes.
Objectives 1. Share continuity of care (CCD) documents within the SE MN BEACON region, between provider organizations and with the 11 County Healthcare Communities & a subset of the schools (school nurses). 2. Share asthma action plans between providers and with the 11 County Healthcare Communities, & a subset of schools (school nurses) 3. Collect assessments and measures on asthmatic children enrolled in the BEACON program to validate improvements and determine appropriate interventions within the region. 4. Share diabetic care plans between providers and with the 11 County Healthcare Communities. 5. Collect assessments of measures on adults with diabetes who are enrolled in the BEACON program to validate improvements and determine appropriate interventions within the region. 6. Implement any additional interventions deemed appropriate by the practice community and approved by the BEACON Governance Committee.
Phase I 1st Stage Requirements Milestone / Deliverable Completion Date Scope approval June 11, 2010 Team kick off June 9 18, 2010 Requirements Management Plan June 9 18, 2010 Identify all the conceptual users July 2010 Defined questions for solicited feedback July 2010 Site System Knowledge Transfer (EMRs, PhDoc, Amalga,etc.) July 2010 Requirement Workshop(s) July 2010 Scenario/Use Case documentation August 2010 Data Flow Model(s) August 2010 Structured Process Flow Walkthrough Sept 2010 Document Requirements Analysis Sept 2010 Project Deliverables: High level set of Functional Requirements & their attributes to be delivered for prioritization Documented existing and potential hypothetical User Scenarios/Light User Stories High level Data Flows & Analysis Requirements Assessment Recommendations Final Report
Overview of Technologies (Pre-Beacon) Mayo Clinic Rochester GE/Centricity EMR; limited decision support Nascent population management (EDT/Amalga) Mayo Health System Deploying Cerner EMR (complete 4/2011) Olmsted Medical Center IC-Chart (locally co-developed) EMR for outpatient County Public Health Departments PhDoc client management system not integrated with practices. 3 of 11 counties lack the system. Winona Health System Cerner EMR; integrated EHR and PHR. esuite video
Conceptual Infrastructure May 2010 Portal EMR s Public health (NH s, schools, home health) Portal Portal Portal Mayo MHS MN HIE exchange Analysis (and reporting to practice) Portal Portal OMC WHS Portal Population management Portal
BEACON Requirements HIE Document Exchange Patient cross-correlations between providers and county healthcare case clients. Pulling CCD, AAP, Care Plan documents to render appropriate patient care. Pulling / Pushing Assessments back to clinicians Establish suite of solutions for various provider capacities (from significant to minimal capacity)
Participant Requirements Varying collaborative partner capacity requires multi-dimensional exchange approach Significant Capacity NHIN CONNECT standards based document exchange. Intermediate Capacity Standards based Single Point to Single HIO document exchange Minimal Capacity Web portal with ability to provide feedback
Alternative Strategies MN-HIE Hub & spoke strategy using mixture of NwHIN CONNECT and MN-HIE adapter solution. Utilizing MN-HIE: Sites use CONNECT or load their patient demographics into Secure Patient Directory. Sites use CONNECT or provide feeds of resources or documents to the Record Locator Service. Supporting XDS.b, w/ adapters for CORE II, REST, or proprietary interfaces CONNECT Peer to peer connectivity strategy using NwHIN CONNECT solution. Utilizing NwHIN CONNECT: Each site maintains a patient correlations via CONNECT. Utilizing direct communication between BEACON partners, each site maintains their set of documents to share. Reference implementation for NwHIN which Interoperates with State HIE initiatives nationally.
Original MN-HIE Option A D B C E F How to Host? A B G C D E F G
NwHIN CONNECT Option Provider EMR Systems OMC CONNECT A D CONNECT MIRTH CONNECT Public Health Case Management PH-DOC PH-DOC Systems PH-DOC Systems Systems MCR B 11 SE MN Counties MHS WHS CONNECT CONNECT C Direct Document exchange via NHIN CONNECT Software CONNECT E Portal System School Portal Access G EMR data flows to Repository HL7 / CCD Data Flows Flow back for Population Management SE MN Repository How Regenstrief to Host? INPC Interface In Interface Out CONNECT SE MN BEACON Repository Data Data Master Patient Index w/ Cross References F MPI A B C D E F G Sources of Data CCD, Action Plans, Care Plans CCD, Action Plans, Care Plans CCD, Action Plans, Care Plans Assessments Assessments Various Reports HL7 Messaging / Batch Loads
NwHIN CONNECT NwHIN CONNECT is an open source software solution that supports health information exchange both locally and at the national level. CONNECT seeks to improving the coordination of care information among hospitals, laboratories, physicians offices, pharmacies, and other providers. Deployment options: Set up a health information exchange within an organization. Establish a direct exchange at the regional level, between peer providers, without broker or third party. Tie an exchange into the Nationwide Health Information Network.
NwHIN CONNECT How do we simply the deployment options for smaller organizations wanting to directly exchange information? Mirth Connect is a widely adopted, standards-based open source healthcare integration engine that securely filters, maps, and routes messages between health information systems. Mirth Connect has been adapted to use NwHIN CONNECT and can fast-track last mile integration with back-end systems. Mirth calls this product MUx Lite.
Mirth MUx Lite Mirth offers MUx Lite, which bundles MIRTH CONNECT with NwHIN CONNECT. MIRTH also supports additional add-on products: Mirth Results, Mirth Match, and Mirth Appliances. MIRTH offers: Open source products that are fully service-backed. Training services, one-day starter training to full five-day immersion. Professional services team can get you up and running fast. Appliances can standardize and streamline the HIE deployment.
Mirth MUx Lite Supporting NwHIN CONNECT Mirth CONNECT Using Mirth Mux Lite, many health information exchange use cases can be served without the need for an intermediary organization or technology stack. Mirth Mux Lite can also be used by multi-entity organizations to quickly implement data exchange and NHIN interoperability.
Mirth Appliance options Mirth Appliances provide a ready-to-run healthcare messaging platform that is stable, secure, and scalable. With full commercial support and a simple management control panel, there is no easier way to run Mirth with confidence in your organization. Since Mirth is based on open-source technology, there are no server license fees or per-message charges. The cost of a Mirth Appliance is very attractive when compared with alternatives, listed below are a number of platform options offered directly by Mirth Corp. $1,999 $6,999 $14,999
CONNECT & MPI The concept of an MPI is an integral to the operation of NwHIN CONNECT. It is utilized to facilitate "correlating" patients among organizations / gateways. It is envisioned that in a production environment, CONNECT will support the use of adapters to access local implementations of Registration or enterprise level MPI solutions. For those groups wanting to localize the cross walks between their identifiers and other external identifiers, MIRTH provides an add-on; MIRTH Match, to manage the cross walks. As CONNECT is based on point to point correlations, the full cross reference of patients identifiers will be in Regenstrief s repository.
NwHIN & Security The Nationwide Health Information Network establishes a trust fabric via the combination of operating procedures, the data use and reciprocal sharing agreement (DURSA) and the Nationwide Health Information Network service interface specifications. The DURSA is the legal basis for the trust fabric, the operating procedures encapsulate Nationwide Health Information Networkspecific operating policies forming the operational and management basis for trust. Question: Will all parties have to on-board to NwWIN, or can a local DURSA be established for the SE MN BEACON project?
NwHIN CONNECT The Core Services Gateway provides services to: Locate patients at other organizations Request and receive documents associated with the patient Record auditing transactions for review by patients and others A mechanisms for authenticating network participants A means to formulate and evaluating authorizations A means to honor consumer preferences The Enterprise Service Components provides: a Master Patient Index (MPI) XDS.b Document Registry and Repository Authorization Policy Engine Consumer Preferences Manager HIPAA-compliant Audit Log
Exchange Providers Technical Economic Legal Sustainability Portal MN HIE Proprietary State Connectivity Immunization Records on MIIC CCD Exchange pending Payer data Value add services (MA eligibility/ medications filled, eprescribing) $729K (500K Association Fees; $329K development) <$500K Prelim HIO State Certification (Final Pending) Opt-Out consent process established $1.5M annual - Association fees SE MN Development fees above/beyond budgeted amount ~300K CONNECT Open Source National Connectivity Immunization Records on MIIC CCD Exchange pending Certification Process Consent Process necessary $100-200K annual Maintenance support SEMN
Health Information Exchange excluding repository services Ranking of Service Requirements OMC MCR MHS WHS PH-DOC Exchange CCD Documents H H H H H Exchange AAP Documents H H H H H Exchange Diabetic Care Plans H H H H H Exchange Assessment Documents H H H H H Access Payer Medication Data L L L L H Access* some Medicare Patient Data M M M M L Access to Immunizations in MIIC L L L L L Access to eprescribing L L L L M Note: Individuals covered by traditional Medicare only are not currently included in the MN HIE patient directory. However, MN HIE does include over 328,000 individuals covered by a Medicare insurance product offered by a health plan.
Technical Next Steps Sites implement NwHIN CONNECT gateway: Integrate their Patient / Client demographic store (MPI) EHR Systems: Establish interface to send CCD, Asthma Action Plans and Care Plans Establish interface to receive CCD, Asthma Action Plans, Care Plans Establish interface to receive Assessment documents from PH-DOC PH-DOC Establish interface to send Assessment documents from PH-DOC Establish interface to receive CCD, Asthma Action Plans, Care Plans Note : Portal implementations will require access via NwHIN CONNECT to access documents available within the region.
Big Picture GH KP Consortium IMH MN HIE NHIN G Mayo FL AZ Public Health OMC WHS MHS Cerner MCR small providers (schools, home care, etc.) SE MN Beacon
Challenges Issues to be managed: How do we provide documents in a timely manner? Do we attempt to create CDA documents for AAP, Care Plans and Assessments, or go with RTF? Does a direct exchange between providers, using CONNECT require the establishment of an Minnesota HIO or HDI or federal NwHIN on-boarding? How would a Beacon Portal relate to existing provider portals? Stand-alone, integrate, be temporary
Project Timelines Years 2011 2012 2013 Quarters 2 3 4 1 2 3 4 1 2 3 4 Site System Knowledge Transfer Vendor Demos Requirements Metrics Collection Data Flow Models Metrics Collection HIEInfrastructure Technical Training Installation Implement CDRInfrastructure HL7 feeds Implement Portal Infrastructure Design Develop Test Implement Support Services
Risks Seq # General Area 1 Resources Risk Event Probability (L 0 35%, M 35 65%, H>65% chance) Other projects in flight at each partner organization making resource deployment challenging. M H Severit y (L, M, H) Mitigation Engaged site leaders for existing project reprioritization & resource allocations. 2 Resources Required new hire recruitment may extend beyond current timelines M M Bridge gap with existing resources (risk seq#1) and adjust timeline as feasible 3 Timeline Tight timelines M M Engage community & ONC on task prioritization 4 Resources 5 Scope and functionalit y 6 Resources equipment, space, infrastructure and training and documentation, reimbursement M L Each practice site IT team might be focused on site specific needs. A common repository for population management and reporting might not fulfill expectations of 4 different practices. There are 3 different EMR s( GE Centricity, Cerner and IC 10) currently in use in the SE MN and each practice is currently following a different trajectory M M Other projects in flight at each partner organization making resource deployment challenging. M H Prioritize and rescope because of budget reductions for SE MN Beacon from ONC We will work with all practices to come to a census regarding overall needs for meaningful use, population management, cost and quality reporting. We will utilize resources form REACH, Stratis health to educate and train our providers and allied health staff. We will use a combination process improvement methods to facilitate work flows and methods used to get asthma action plans in place. Engaged site leaders for existing project reprioritization & resource allocations. 7 Timeline Tight timelines M M Engage community & ONC on task prioritization