ihe conference june 11, 2007. who are we? multi-state region 750,000 patients ( 2 / 3 in tn, 1 / 3...
TRANSCRIPT
IHE ConferenceJune 11, 2007
Who are we?
• Multi-State Region
• 750,000 Patients• (2/3 in TN, 1/3 in VA)
• 18 Hospitals• 2 Large Community-Based
Health Systems
• 1,200 Physicians• Many Rural and Smaller
Practices
• No dominant payor • 25% Medicare, • 20% Medicaid• 18% uninsured• 2-20% Other
• Few Large Employers• Eastman Chemical –
(7,000) is the largest• Government and
healthcare entities next largest
Innovative Regional Cooperation To Improve Health
Active, representative membership, including• Employers: Eastman Chemical Company, CGI• Payors: Blue Cross Blue Shield, John Deere Health, Cariten PHP• Hospitals: Mountain States Health Alliance, Wellmont Health System, Frontier Health, Johnston Memorial Hospital, Quillen V.A. Medical Center, Laughlin Memorial• Physicians: Holston Medical Group, Highlands Wellmont Health Network, Health Alliance PHO, Cardiovascular Associates, ETSU University Physicians, Clinch River Health Services, Rural Health Services Consortium• Education: East TN State University School of Medicine, College of Nursing, College of Public and Allied Health•Public Health: Regional Health Departments: Sullivan and Northeast Regional in TN, Cumberland Plateau and Lenowisco in VA• Community: Kingsport Tomorrow, United Way of Kingsport, Rotary Club of Kingsport• Patient Advocates: American Cancer Society, Minority Health Coalition• Technology: Intellithought, LucentGlow, eTechSecurityPro, Holston Technology, the CreativeTrust, ntara, OnePartner
CareSpark Mission
To improve the health of people in
Northeast Tennessee and Southwest
Virginia through the collaborative
use of health information
Regional Population Has High Disparities of:
• Diabetes
• Cardiovascular Disease
• Hypertension
• Lung Disease
• Cancer
CareSpark region has $2,400 higher per capita patient care coststhan other regions of the country
Goals & Priorities – Parallel Pathways
1. Interoperable EHR Adoption – Encourage and support increased use of EHRs (with e-prescribing and decision support tools) among providers
2. Regional HIE Platform – Implement infrastructure and connectivity for sharing of information among providers, payors, public health
• Align with AHIC national standards and Nationwide Health Information Network infrastructure to connect with other networks
• Align with statewide initiatives in Tennessee and Virginia
3. Public Health Improvement – Increased biosurveillance, community-wide aggregation and study, improved disease reporting, prevention services and chronic disease identification, management and outcomes
4. Financial Incentives – Implement financial incentives for payor and provider participation
CareSpark’s Core Values
• Cooperation
• Privacy
• Integrity
• Inclusiveness
• Community Accountability
• Continuous Improvement Process
• Stakeholder Parity
CareSpark RHIO Consortium
National / International: Local / Regional:
ActiveHealth the Creative TrustAllScripts eTechSecurityProCGI Holston TechnologyCisco IntellithoughtCovisint LucentGlowDell OnePartnerGE HealthcareInitiate State:Intel TennesseeMcKesson VirginiaMisysOracleQuovadxSiemensSureScripts
Physi
cian
Adopti
on
Physi
cian
Adopti
on
Phase 1.2 Inputs and Outputs
EMR 1EMR 1 EMR 3EMR 3EMR 2EMR 2
HelpdeskHelpdesk
Hardware and Software InfrastructureHardware and Software Infrastructure
Security (C/I/A) InfrastructureSecurity (C/I/A) Infrastructure
PhysiciansPhysicians Application
Use Application Use
PharmacyHL7 Rx Orders
Healt
h Info
rmati
on E
xch
ange
Healt
h Info
rmati
on E
xch
ange
Inte
rface
En
gin
eIn
terf
ace
En
gin
e
RHIO MasterPatient IndexRHIO MasterPatient Index
Providers
Term
inolo
gy/N
orm
aliz
ati
on
Term
inolo
gy/N
orm
aliz
ati
on
Port
al Pla
tform
Port
al Pla
tform
PhysicianPortal
PhysicianPortal
PatientPortal
PatientPortal
BusinessIntelligence/
Reports
BusinessIntelligence/
Reports
HelpdeskHelpdesk
Hardware and Software InfrastructureHardware and Software Infrastructure
Security (C/I/A) InfrastructureSecurity (C/I/A) Infrastructure
RHIO RecordLocation Service
RHIO RecordLocation Service
RHIO ClinicalData Repository
RHIO ClinicalData Repository
HL7 DemographicsDischarge Summaries
Rx Orders, Results
UserManagement
Physicians
Patients
PublicHealth
PerfMeasures
P4P Pilot
Portal
Reports
Reports
Reports
Access Request
s
HL7 Clinical/Demographic/
CC Data
ProviderEMR
Labs
Pharmacy HL7 Orders
HL7 Results
Care Consideration
s
ActiveHealth
Deci
sion
Support
Deci
sion
Support
Payors Provider List
Member List ActiveHealth
Care EngineActiveHealthCare Engine
Care Consideration
s
messages
HL7 Clinical Data
HL7 DemographicsDischarge Summaries
Rx Orders, Results
Portal/EMR-Lite
Proposed CareSpark IHE Architecture
CareSparkCareSpark
XDSDocumentRegistry
XDSDocumentRegistry
XDS PatientIdentitySource(MPI)
XDS PatientIdentitySource(MPI)
PortalPortal
Wellmont Phys PortalWellmont Phys Portal
IHE DocConsumer
IHE DocConsumer
Wellmont McKessonWellmont McKesson
IHE DocConsumer
IHE DocConsumer
MSHA Phys PortalMSHA Phys Portal
IHE DocConsumer
IHE DocConsumer
MSHA SiemensMSHA Siemens
IHE DocConsumer
IHE DocConsumer
HMG AllScriptsHMG AllScripts
IHE DocConsumer
IHE DocConsumer
Clinical Data RepositoryClinical Data Repository
Clinical Data RepositoryClinical Data Repository
Clinical Data RepositoryClinical Data Repository
Other ProvidersOther Providers
FILTERFILTER
Clinical DataRepository
Clinical DataRepository
Public HealthData Mart
Public HealthData Mart
De-IdentifiedData Mart
De-IdentifiedData Mart
For
Pat
ient
Car
e
For
Pub
lic H
ealth
Im
prov
emen
t
CareSpark IHE-compatible Architecture
Provider XProvider XLabLab
IHE EmbeddedRepository
IHE EmbeddedRepository
TranscriptionTranscription
Email/Paper/Rich Media
Email/Paper/Rich Media
Legacy AppLegacy App
App withoutRepository
App withoutRepository
CareSparkCareSpark
IHE XDSDocumentRegistry
IHE XDSDocumentRegistry
IHE PDQDemographics
Server
IHE PDQDemographics
Server
Wellmont Phys PortalWellmont Phys Portal
IHE DocConsumer
IHE DocConsumer
Wellmont McKessonWellmont McKesson
IHE DocConsumer
IHE DocConsumer
MSHA Phys PortalMSHA Phys Portal
IHE DocConsumer
IHE DocConsumer
MSHA SiemensMSHA Siemens
IHE DocConsumer
IHE DocConsumer
CareSpark PortalIHE
DocConsumer
CareSpark PortalIHE
DocConsumer
HMG AllScriptsHMG AllScripts
IHE DocConsumer
IHE DocConsumer
IHE DocSourceIHE DocSource
IHE DocSourceIHE DocSource
IHE DocSourceIHE DocSource
EHR SystemEHR System
PACSPACS
Other ProvidersOther Providers
CareSpark commitment to IHE-compatible architecture
• Accommodates both federated and centralized document repositories and clinical data repositories (hybrid model)
• Utilization of internet between secure nodes via encrypted, dual-authenticated links
• Centralized audit management, security, and consent policies
• IHE is promoted and supported by Federal standards bodies which worked to define standardized data sets and formats
That CareSpark Will Leverage The IHE Cross-Enterprise Document Exchange (XDS) ProfileThat CareSpark Will Leverage The IHE Cross-Enterprise Document Exchange (XDS) Profile
Compliance with US National Health Info NetworkHITSP Interoperability Specs and CCHIT Roadmap
Patient Demographics Query
Patient Identifier Cross-referencing
Map patient identifiers across independent identification
domains
Cross-Enterprise Document Sharing
Registration, distribution and access across health enterprises of clinical
documents forming a patient
electronic health record
Cross-Enterprise Document Media Interchange
Emergency Referrals Format of the Document Content
and associated coded vocabulary PHR Extracts/Updates
Format of the Document Content and associated coded vocabulary
ECG Report Document
Format of the Document Content and associated coded vocabulary
Lab Results Document Content
Format of the Document Content and associated coded vocabulary
Scanned Documents Format of the Document ContentImaging Information
Format of the Document Content and associated coded vocabulary
Medical Summary (Meds, Allergies, Pbs)
Format of the Document Contentand associated coded vocabulary
Patient ID MgmtPatient ID Mgmt
Consistent TimeCoordinate time across networked
systems
Audit Trail & Node Authentication
Centralized privacy audit trail and node to node authentication to create
a secured domain.
Basic Patients Privacy Consents
Establish Consents & Enable Access Control
Document Digital Signature
Attesting “true-copy and origin
SecuritySecurityClinical and PHR ContentClinical and PHR Content
Health Data ExchangeHealth Data Exchange
Request Formfor Data Capture
OtherOther
Cross-Enterprise Document Reliable Interchange
Accepted by HITSP&CCHIT in 2006Accepted by HITSP&CCHIT in 2006
Candidates for HITSP&CCHIT in 2007Candidates for HITSP&CCHIT in 2007
Notification of Document Availability
Public Health Reporting
Gaps for IHE and CareSpark
• Patient Consent• Identity Management• Central Repository for public health
improvement• Clinical Data Presentation
Patient Consent –CareSpark and IHE
CareSpark Consensus:• Passive enrollment mechanism• Control consent at the patient/provider level• Providers help patients manage their consent• CareSpark never stores or transfers non-consensual data
Questions for IHE:• How do IHE solutions accommodate patient consent?• How does consent connect to EMPI and IHE network?• Is Basic Patient Privacy Consent ready for prime-time
use? Are there demonstration projects?
Identity Management –CareSpark and IHE
CareSpark Consensus:• Develop federated trust network across CareSpark
providers• Minimize overhead of identity management at
CareSpark level
Questions for IHE:• What is practicality of XUA implementation across
Vendor Consortium solutions?• Are there demonstration projects we should look to
as a reference?
Centralized Repository – CareSpark and IHE
CareSpark Consensus:• “Easy” way to report health metrics and monitor
public health• # of Patients 18-75 with ICD-9 code of 250.00-250.99
(Diabetes) and having two HgA1c values at least 91 days apart during the 12 months prior to the date of data gathering
• Reporting and analysis (research, surveillance)Questions for IHE:
• What part of XDS and/or vendor solutions address this?
Clinical Data Presentation – CareSpark and IHE
CareSpark Consensus:• Present RHIO data in clinician’s native systems (not
a separate portal whenever possible)• Have physician-centric view of XDS clinical data
within providers’ native EHR systems• Integrated with local data• Not a big list of “other HIE data”
Questions for IHE:• What are vendors doing to make document-centric
XDS data usable to physicians?• Have directions been defined about document
grouping for display?
Why does CareSpark matter?
• Voluntary commitment to interoperability (local, regional, state, national, international)
• Participation in NHIN prototype demonstrations, state-level pilots
• Private-sector, market-driven approach to assure sustainability
• Attention to outcomes and measurable results
Who are we?
CareSpark plans to be “RHIO Done Right”
Better Health for Central Appalachia
www.carespark.com
Liesa Jenkins, Executive Director423-963-4970