ASSESSING ASSESSING THE THE TECHNICAL TECHNICAL

CAPABILITY OF CAPABILITY OF A HIE A HIE ORGANIZATIONORGANIZATION

Lori Jefferson, MBA,MSHIT Manager/Grant Manager

New Jersey Healthcare Facility Financing Authority

Kennedy Ganti, MD,DABFM

Medical Director- Primary Care Research

Virtua Lumberton Family Physicians

Chair- NJ Health IT Commission

HIE PROGRAM ASSESSMENTHIE PROGRAM ASSESSMENT

Platform Infrastructure

Hardware & Software

Platform Architecture

Based on Strong Business Requirements

Platform Operation

Rate & Reliability

Interventions & Services that use the Platform

Preparation

ADDITIONAL ASSESSMENTSADDITIONAL ASSESSMENTS

EHR Interoperability & Options

Robust Interfaces

Security

Internet Presence

Resources – Expertise /Collaboration/Funding

A TECHNICAL REVIEWA TECHNICAL REVIEW

OF NEW JERSEY HEALTH OF NEW JERSEY HEALTH

INFORMATION EXCHANGESINFORMATION EXCHANGES

NEW JERSEY HIE OVERVIEWNEW JERSEY HIE OVERVIEW

• Jersey Health

Connect

• Health-e-Citi

• Camden

• South Jersey

• Jersey Health Connect [McKesson]

Atlantic Health

Hackensack University Medical Center

Hunterdon Healthcare

Newton Memorial Hospital

Robert Wood Johnson Health System

Saint Barnabas Health Care System

Saint Clare’s Health Services

Saint Peter’s Healthcare System

Solaris Health System

Somerset Medical Center

Trinitas Regional Medical Center

Summit Medical Group (physician group)

VISTA Health System, IPA

• Health-e-cITi-NJ [IGI Orbit]

Newark Beth Israel Medical center

East Orange General Hospital

Trinitas Medical Center

Clara Maas Medical Center

St. Michael’s Medical center

UMDNJ

St. Joseph’s Healthcare System

Meadowlands

Jersey City Medical Center

• Camden HIE [Noteworthy]

Lourdes Health System

Cooper University Hospital

Virtua Camden

ONC-Funded Regional Exchanges

• St. Joseph’s Healthcare [eClinicalWorks]

• Clara Maas [Axolotl]

• Hunterdon Healthcare [InterSystems]

• Trenton HIE [vendor TBD]

Capital Health

St. Francis (CHE)

• Monmouth-Ocean HIE [ICA]

Meridian

CentraState [Also in vendor selection process]

• Virtua Health [Wellogic]

• South Jersey HS [MobileMD]

• Central Jersey HIE

(physician-based HIE)

Other HIE Initiatives

NJ Medicaid HIE

• EMRX-SJ [Wellogic]

AtlantiCare, South Jersey Health System, Shore Memorial Hospital

Cape Regional Medical Center, SeaShore Gardens (nursing Home)Updated: July 14, 2010

CAMDEN COLLABORATIVECAMDEN COLLABORATIVE

CAMDEN TECHNICAL ARCHITECTURECAMDEN TECHNICAL ARCHITECTURE

Web-Based HIE Platform /Hub connector/EMR

Noteworthy

Patient Portal, Mobile Tools

DocVia

EMR Alternative for Providers

SpringCharts

CAMDEN CURRENT INFRASTRUCTURECAMDEN CURRENT INFRASTRUCTURE

Centralized Database

Construction of a Local MPI that will Connect to

State MPI

Exchange of Lab Data with Decision Support

Support of Transfers Between Settings with

Discharge Data

Access via Provider Coalition Website

CAMDEN COLLABORATIVE PREPARATIONCAMDEN COLLABORATIVE PREPARATIONHISTORICAL LESSONS LEARNED FROM OTHER HIE INITIATIVES

CAMDEN HIE IMPLEMENTATION GOALS

Overly ambitious vision

Lack of clinical Involvement

in planning

Expensive & Unsustainable

Infrastructure

Lack of Stakeholder

Involvement to surmount the

complex legal, technical, and

funding hurdles.

Phased Implementation with

value added components

Strong Clinician Leadership

Cost effective strategies with

sustainable overhead.

HIE is one component of

initiatives of the Camden

Coalition of Healthcare

Providers

JERSEY HEALTH CONNECTJERSEY HEALTH CONNECT

JERSEY HEALTH CONNECT JERSEY HEALTH CONNECT

INFRASTRUCTURE STRATEGYINFRASTRUCTURE STRATEGY

The intent of the Collaborative is to create an

open and standards-based platform to provide

for the seamless exchange of health

information

Design with HITSP, HL7 and others standards

as a requirement

JERSEY HEALTH CONNECTJERSEY HEALTH CONNECT

TECHNICAL ARCHITECTURETECHNICAL ARCHITECTURE

HIE Platform is based upon a software as a

service (SaaS) platform

Cloud-based model for Health Information

Quick scale deployment & Data Sharing

using EHRs

Utilize PHRs such as Microsoft HealthVault

or Google Health.

Leverage the numerous and disparate

repositories of patient information.

JERSEY HEALTH CONNECT JERSEY HEALTH CONNECT

TECHNOLOGY DEPLOYMENTTECHNOLOGY DEPLOYMENT

• Personal Health Records

• Health Summary Manager

• Patient Messaging services

• Colleague Messaging

• Clinical Document and Results Manager

• Electronic Prescribing

• Automated, Proactive Eligibility

• Registration Manager

JERSEY HEALTH CONNECT PREPARATIONJERSEY HEALTH CONNECT PREPARATION

Prior to Grant Funding:

700 Providers & 2 Hospital Systems Sharing Data

Over 400,000 Patient Records Connected

25,000 Patient Actively Connected

Transmitting 10,000 electronic prescriptions and

over 45,000 clinical documents and lab results per

month.

HEALTHHEALTH--EE--CITICITI

HEALTHHEALTH--EE--CITICITI NJNJ

TECHNICAL INFRASTRUCTURETECHNICAL INFRASTRUCTURE

Federated Approach

Based on Service Oriented Architecture

applied to the IHE profiles, PIX/PDQv3, XDS.B and AT9A and is in conformance with the HITSP Integration profiles.

Enterprise Master Patient Index

Terminology Translation Service

Enterprise Service Bus

Standards Compliant Web-Based User Interface / Portal

Open Architecture seamlessly adds new facilities to Join the Health Information Gateway.

HEALTHHEALTH--EE--CITICITI TECHNICAL ARCHITECTURETECHNICAL ARCHITECTURE

Two Tiered Approach of Edge Servers To connect provider securely

To normalize data to HL7 format

Core Servers for Shared Services Orbit Portal

Apelon Terminology Service

Initiate Enterprise Master Patient Index

Intel SOA Expressway connect Providers Message gateway

Mediation engine

A security policy enforcement point

This solution can handle an average of 500 HL7v2 to HL7v3 conversions per second, allowing Health-e-cITi-NJ scalable capacity throughout the exchange.

HEATLHHEATLH--EE--CITICITI ARCHITECTURE DIAGRAMARCHITECTURE DIAGRAM

MDS Component with industry leading probabilistic matching algorithm to link records. Reduces duplication in the patient index

HEALTHHEALTH--EE--CITICITI PREPARATIONPREPARATION

Clinical Data sharing between Newark Beth Israel and Federally Qualified Health Centers (FQHC)

Interface to State immunization system and links across state lines to other State systems

Interface to facility internal patient data warehouse

Connection to NJ Medicaid for medication histories (1st meaningful use delivery under the Medicaid transformation grant)

Automated workflow in ED at Newark Beth Israel using HL7 standards to eliminate nurses double entry of labs and radiology orders

HEALTHHEALTH--EE--CITICITI-- NJNJ

SOUTH JERSEYSOUTH JERSEY

SOUTH JERSEY ARCHITECTURE FEATURESSOUTH JERSEY ARCHITECTURE FEATURES

Web-based Utility

Designed to Facilitate Interoperability and Clinical Data Exchanges.

Service oriented application

Data transport services

Transformation and Integration Services

Data Access Services

Rules Management and Execution Services

Auditing, Personalization, Configuration, Context and other Framework Services

Presentation Services

Wellogic HIE Platform

SOUTH JERSEY INFRASTRUCTURESOUTH JERSEY INFRASTRUCTURE

Hybrid Model

Clinical Data Repository located Central Site

Major Data Contributors

Smaller Wellogic Platform

CDR on Edge Server protected by Firewall

Intermediate Data Store

EMR Lite option to support Provider Adoption

Alternate CCHIT Certified EMR Options

SOUTH JERSEYSOUTH JERSEY

ENTERPRISE BUS / INTEGRATION LAYER ENTERPRISE BUS / INTEGRATION LAYER

FEATURESFEATURES

Communication

Parsing of data interchange standards, including XML, HL7, CCR, CCD, ASTM X.12N, NCPDP, and DICOM

Nomenclature Service

Community Master Patient

Registration

HIPAA-supporting auditing

Alerts

Messaging infrastructure

Web-based Administrative Application for role-based system configuration and management

SOUTH JERSEY VENDOR STANDARDS AND SOUTH JERSEY VENDOR STANDARDS AND

CERTIFICATIONSCERTIFICATIONS

Well Logic Platform – NHIN Functionality

Certified by CCHIT

Certified by the IHE standards

PLATFORM EVALUATION SUMMARYPLATFORM EVALUATION SUMMARY

Usage

Breadth

Completeness

Confidentiality

EVALUATION OF THE HIE PLATFORM:EVALUATION OF THE HIE PLATFORM:

Steers the design of the project

May be used to monitor the ongoing operation

Offer Lessons Learned to other projects

KEY HIE EVALUATION ISSUESKEY HIE EVALUATION ISSUES

Transferring Data & Accuracy of Data Transfer

Completeness

Timeliness

Success in Matching Patients

Confidentiality Breaches

HIE EVALUATION CONSIDERATIONSHIE EVALUATION CONSIDERATIONS

Range of HIE Models

Different Evaluation based on Format

Range of HIE Service

Evaluate each service

Outcome

Revenue

Range of Evaluations

Analysis

PLATFORM LEVEL MONITORINGPLATFORM LEVEL MONITORING

Measuring Data Movement by User & Data

Type

Data Exchange Platform

Primary Use Case for the Platform

Secondary Use Case

PLATFORM LEVEL MONITORINGPLATFORM LEVEL MONITORING

Information Exchange Infrastructure

Initial Evaluation

Monitored over the course of the project

Data Transfer Assessment

Accuracy

Completeness

Timeliness

Patient Mapping Verification

EMR SOFTWARE ASSESSMENTEMR SOFTWARE ASSESSMENT

Uptime / Downtime

Performance

Functionality / Templates / Customization

Interoperability

SERVICE / INTERVENTION MONITORINGSERVICE / INTERVENTION MONITORING

Service Impact

Messaging

Results Push

AQA Measures

HIE HIE

INCENTIVES FOR PROVIDER PARTICIPATION INCENTIVES FOR PROVIDER PARTICIPATION

Lower transaction costs of acquiring

information when patients visit your hospital;

Reducing the costs of distributing clinical

information to your referring community.

COMMON EVALUATION STRATEGIESCOMMON EVALUATION STRATEGIES

Reduce Duplication of work

Supports Meta-analysis

PROGRAM ANALYSIS PROCESSPROGRAM ANALYSIS PROCESS

Gather Baseline information Early

Monitor Unintended Consequences

Evaluate ROI

Conduct Program Evaluation Across Several

Projects

Financial Benefits

Clinical Benefits

HIE GOAL: HIE GOAL:

APPLICATION AND LOCATION INDEPENDENT APPLICATION AND LOCATION INDEPENDENT

DATA SHARINGDATA SHARING

A standards-based enterprise

Storage management system that is independent of the application and transmits data is critical to

achieving the goals of:

Interoperability between clinical applications

Increased productivity

Decreased operational cost and

Facilitate implementation of an Electronic Health Record (EHR) systems

HIE EVALUATION CONCLUSIONHIE EVALUATION CONCLUSION

Architecture

Infrastructure

Resources / Leadership

Preparation / Strategy

REFERENCES REFERENCES

NJ HIE Grant Applications

National Institute of Health Case Stud

The United Hospital Fund Meeting on Evaluating

Health Information Exchange, J Biomed Inform.

2007 December;40(6 Suppl): S3-10