Transcription
Experiences ImplementingHealth Information ExchangeEdward Marx, CIO UHJoseph Yelanich, AE FCGMarch 29, 2007
Gratuitous Speaker SlideEd Marx Colorado State University (MS, BS)Past President OH & TN HIMSS ChaptersPast Chair HIMSS Membership ServicesVarious Healthcare IT PositionsHealthcare Start; Housekeeping & EMT2003 Pic, Right Before I Became CIOWe will all work collaboratively Where did the hair go?I am no longer allowed to wear colored shirts or gold necktiesWhen did brown fade to gray? FCG 2007 Slide 2March 20074th HIT Summit
Gratuitous Speaker SlideJoe Yelanich Michigan State University (BA)Memberships HIMSS, eHI, HL7, NCPDPHIT Consulting background (EDS, Accenture, E&Y, Cap)Senior Account Executive, FCGBusiness developer for HIE product FirstGateways jyelanich@fcg.com or 877.321.GATE FCG 2007 Slide 3March 20074th HIT Summit
Agenda National Front Regional Experiences Local Setting First Things First The Next Generation FCG 2007 Slide 4March 20074th HIT Summit
National Front National Health Information Network New York HEAL Cleveland Seattle, Knoxville, So. Cal, Waterbury Provincial Canada FCG 2007 Slide 5March 20074th HIT Summit
Scottsdale Institute“The Napster ofMedical information”Scottsdale InstituteFebruary 2003 FCG 2007 Slide 6March 20074th HIT Summit
Regional Experiences United Way Healthy Communities Initiative Northeast Ohio RHIO Community Hospitals– Southwest General– Sisters of Charity FCG 2007 Slide 7March 20074th HIT Summit
Local Setting Tertiary Physicians Federally Qualified Health Centers Skilled Nursing Facilities Joint Venture Hospitals FCG 2007 Slide 8March 20074th HIT Summit
First Things First 8 Hospitals 15 Base Applications in Academic Health Center Disparate Clinical Applications amongst Community Hospitals 6 Lab Order Systems 5000 Physicians 700 Thousand Unique Patients 70 Million Data Elements Captured and Rising FCG 2007 Slide 9March 20074th HIT Summit
The Time Was February 2004The ProblemUH needed a way to improve theInformation that was available to caregivers at the point of care while theydeveloped their Enterprise Wide EMRstrategy.The Final outcome would be a NationallyRecognized Physician Portal that would bechosen as a National RHIO demonstrationsite to develop future community datasharing Solutions AND 4,800 HappyPhysicians.Lets Take a Look! FCG 2007 Slide 10March 20074th HIT Summit
FCG 2007 Slide 11March 20074th HIT Summit
What Were the Requirements?A Solution that would enable UH to provide enormous value to their clinicalcommunity by providing:A branded, virtual ElectronicMedical Record that integratespatient-specific data from acrossinpatient and outpatientenvironments.Create a data warehouse thatcan serve as the foundation foryour immediate and strategicinformation needs.It must include seamless sign-onand web access to thesedisparate systems from anylocation – hospital, clinic, office,or home.Had to work well enough toextend the life of UH’ existinglegacy applications.Provide enough information toimprove clinical decision makingat the point of care. FCG 2007 Slide 12March 20074th HIT Summit
Solution Goals and Requirements Solution Goals– Primary goal is to help influence theextent to which physicians arealigned with the strategic goals ofUHC and UH Facilitate communication– New care paths– Standard order sets– Lessons learned from malpractice events– New institutional policies Become central to physicians’ dayto-day patient care activities Attract physicians to portal byproviding patient care tools andinformation FCG 2007 Slide 13March 20074th HIT Summit
Solution Goals and Requirements Priority Requirements– Ease of use– Content-rich information– Ubiquitous access to: Full clinical results includingtranscribed notes News Training Other information– Highly secure, HIPAA-compliantenvironment FCG 2007 Slide 14March 20074th HIT Summit
Here is What the CMO is SayingOur Portal is a valuable solution for theclinical users associated with ourAcademic healthcare system. Thissystem will not only provide aconsolidated view of patient data fromacross more than 15 clinicalapplications and multiple acute carefacilities, it will also provideseamless access to othercrucial data sources, suchas medical research,clinical drug trials, andcustomized newsand information.The portal is currently in useat our academic medical center,and it has been received withenthusiasm by our physicians.― Dr. Nathan Levitan,Chief Medical OfficerUniversity Hospitals FCG 2007 Slide 15March 20074th HIT Summit
How it Works at a High LevelPhysician requests1 information using s12GatewaysInterfaceEngineGatewayssends arequest/responsemessage toretrieve thelocal data33Gatewaysgathers,Formats, andtransmits thedata2GatewaysWebServerGatewaysCache FCG 2007 Slide 16March 2007DictaphoneGEPicisMcKessonSite’s existingapplications,systems, andknowledge sources4th HIT Summit
How it Works, a Little More DetailFirstGateways AccessFirstGateways Back OfficeMaps Patientacross MD PortletBrowserRelates physiciansto patients andpoints to facilitiescontaining BSDRLSOraclePatienteIndexPointers tionServerXMLSSLWireless HubRouterTablet PC802.11 SolutionFirstGatewaysFacility A (Acute)HISXMLWebServerFirstGatewaysClinical Data ServicesHL7HL7FirstGateways ClinicalData ServicesXMLHL7 or XMLFirstGateways ClinicalData ServicesFirstGatewaysData StoreFirstGatewaysData Store(MS SQL 2K)(MS SQL 2K)TranscriptionService FCG 2007 Slide 17FirstGatewaysFacility B(Non-Acute)HL7, XML,or ysCentral ServiceXMLMarch 2007TranscriptionService4th HIT Summit
Is it a Portal, or is it a RHIO engine?Lets Examine! Enable secure access toclinical information at the pointof care regardless of thephysical location of thatinformation Provide HIPAA-compliantsolution for transfer of clinicalinformation Focus on Clinical Data–––––Problem list/diagnosisLabs, allergies,Medications, immunizationsTranscribed notesSome images Not administrative FCG 2007 Slide 18March 20074th HIT Summit
Critical Success Factors Evaluation of data elements to match theidentity of patients across facilities Data quality assessment– What elements are consistently available frommessage to message, facility to facility– Timing of communication between source facilityand MPI solution Data staging and cleansing– Presentation of data to MPI in aconsistent format that optimizesthe chances for a match in theMPI Automated MPI management– Developing automated processto maintain MPI FCG 2007 Slide 19March 20074th HIT Summit
Security HIPAA Ready?RHIO Ready ? Clinical data stored at the ‘owning’hospital (no CDR)– Data housed inside hospital firewall Access policy (user rights) mirrors thatof the hospital User authentication process mirrorsthat of the hospital– Currently User ID and Password andChallenge Phrase– Capable of supporting DigitalCertificates and biometrics Virtual Private Networks (VPNs)– Secures data transmitted from Point Ato Point B Full audit logs to recreate anytransaction under question FCG 2007 Slide 20March 20074th HIT Summit
PRIVACY – Current Functionality Ability to revoke authorization touse or disclose health information– Patient can withdraw enrollment atany time Obtain an accounting ofdisclosures or health information– Full logging of all requests for PHI Support patient requests toinspect/copy health record FCG 2007 Slide 21March 20074th HIT Summit
Impact of Access and Sharing Lives saved, patient, adverseevents decreased Estimated likely benefits– Duplicate tests reduced 20-50%– Duplication in medication &diagnosticorders reduced 30-50%– Clinician satisfaction with ITimproved 25%– Patient satisfaction improved(anecdotal evidence)– Enhanced quality of care(anecdotal)– 3rd party analysis to becompleted in 2007 FCG 2007 Slide 22March 20074th HIT Summit
Is There Value to Patients? Improves medical decision makingby making otherwise difficult toobtain data available at the righttime and place May reduce the risk of medicalerrors Allows physicians and hospitals tomore easily comply with HIPAAregulations Medical research is expedited,especially studies of safety andeffectiveness Addresses needed for patientinformation instantly available evenwhen patient is physically unable todeliver this information FCG 2007 Slide 23March 20074th HIT Summit
Is There Value to Patients? Permits patient’s medical datato be viewed as authorized bythe patient Removes social securitynumber as the de facto uniquepatient identifier Patient data is never stored inan identified manner Eliminates the need foruniversal conversion to uniquepatient identifier FCG 2007 Slide 24March 20074th HIT Summit
Is There Value to Physicians? Supports medical decision-making throughaccess to community-wide patientinformation Fosters performance and productivityimprovement through secure access toclinical information at the point-of-serviceand at the place of service Provides HIPAA compliant solution fortransfer of clinical information Provides a mobile, handheld computingsolution which facilitates physicianproductivity in multiple practice locations FCG 2007 Slide 25March 20074th HIT Summit
Is There Value for UH? Creates potential for significant cost reductionsand new financial benefit for hospitals– Lower cost from reduced errors, adverse events,redundant ordering Effectively addresses the concernsof the purchaser community, and specificallythe recommendations of The Leapfrog Group Addresses HIPAA compliancerequirements for mobile computing Satisfies growing physician desire for dataat point-of-care via wireless access Saves lives and improves care by providingphysicians with the information needed to makebetter medical decisions FCG 2007 Slide 26March 20074th HIT Summit
The UH Look FCG 2007 Slide 27March 20074th HIT Summit
Results Viewer FCG 2007 Slide 28March 20074th HIT Summit
FirstGateways – A High LevelArchitecture for Health Delivery Federated Data Architecture DataAcquisition takes place at the originating facility/data source Security, User Access, Identity Management takes place in the Back Office application Highly scalable Standards-based messaging Data is sourced from HL-7 messages generated bythe originating facility XML Messages are used to communicate datawithin the application Can deal with any consistent electronic transmission Consistent presentation of dataregardless of its source¡¡Web based user interfaceUses XML Style sheets Multiple layers of Security HIPAA compliant policy-based security LDAP authentication FCG 2007 Slide 29March 20074th HIT Summit
Technical Components Oracle Apache Tomcat– Web Server– JSP and servlet container– Currently on JBOSS– Application Server Microsoft SQLServer Sun Microsystems– JAVA– eIndex MPI– eGate interface engine XML/XSLT Style Sheets FCG 2007 Slide 30March 20074th HIT Summit
Benefits of the Architecture Highly scalable– Back office, in a single instance,can uniquely identify 10M, people– System is able to scale to addingmultiple disparate data sources Processes in excess of 20,000complete transaction per second Aggregated pools of data– Alerts and reminders ( requires infosearch component )– Datawarehousing/mining/visualization Cost effective– Systems can be added withoutreproducing the entire infrastructure– Hardware a software costs areincremental after initial build FCG 2007 Slide 31March 20074th HIT Summit
UH Portal 2007:The Next GenerationClinician Portal Expanded Influence Strategic Imperative ePrescribingPatient Portal Health Care Consumerism Create Active Ownership of Health Health Care into the Home ePrescribing Strategic Imperative FCG 2007 Slide 32March 20074th HIT Summit
Interface Engine Transcription Service Transcription Service FirstGateways Data Store FirstGateways Data Store FirstGateways Clinical Data Services FirstGateways Clinical Data Services Patient eIndex Pointers & Physicians FirstGateways Database Server FirstGateways Central Service FirstGat
