Vermont Health Information Exchange

1
Vermont Health Information Exchange

• Greg Farnum, VITL
• Bill Howard, GE Healthcare
• Lauri Scharf, VITL

2
Agenda

• Vermont Health IT Plan (VHITP) Highlights
• HIE core components and demo
• VITL background and national network
• Poll QA Your priorities?

3
Health Information
Exchange

• HIT Health Information Technology
• HIT is the infrastructure and data that allow for
  automation of healthcare processes
• HIE Health Information Exchange
• The part of HIT that enables interoperability
  between systems and organizations.
• HIEN Health Information Exchange Network
• An HIEN provides the infrastructure for the
  exchange to operate.

4
Health Information Exchange

• What it is

• Standardization
• Normalization
• Security
• Privacy
• Indexing
• Interface

5
Health Information Exchange

• What it isnt
• Computers or related equipment within hospitals,
  physician practices, pharmacies, labs, etc.
• Software systems for patient care except where
  those systems intend to interface with the Network

6
The Goal of HIE
7
The right Information

• Master patient index identifies the patient
• Data Locator identifies where patients health
  information resides
• Format standards describe the contents of the
  message
• Code standards provide the actual clinical detail

• Assumptions
• All parties adhere to standards (or HIEN provides
  standardization)
• All parties use the same clinical terms (or HIEN
  provides normalization)

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to the right Person (and Place)

• Mutual trust (sender and receiver) allow
  transmission
• Messaging standards deliver the data (envelope)

• Assumptions
• Patient consent and authorization granted
• Provider is assigned the minimum necessary access
• Agreements have been established between
  organizations
• Adequate patient identifiers available
• Data sources available via Internet connection

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at the right Time

• Clinicians can view the right information
• In preparation for patient visit
• During patient visit
• After exams/tests
• ED visit

• Assumptions
• Internet connection
• A fully automated system responding within
  seconds

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HIE Demo
11
(No Transcript)
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Other HIEs
13
HITSP / IHE
Key Components
Personal Health Record
Results
Patients
Labs
PIX/EMPI
XDS Rep
XDS Reg
Payers/PBM
Other HIEs
Claim Data
14
IHE PIX
Patient Identity Feed (ITI-8)
Personal Health Record
Results
Patients
Labs
Payers/PBM
Other HIEs
Claim Data
15
Patient Identity Cross Reference
IHE PIX
Personal Health Record
Results
Patients
Labs
PIX / EMPI ID7979
Name
Site

MRN
John Doe
Primary
99
111
John Doe
Specialist
99
222
J. Dow
NY HIE
60
333
Payers/PBM
Other HIEs
Claim Data
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IHE PIX / XDS
Publish Documents (Labs, D/Cs, Image
Reports/Links, etc.)
Personal Health Record
Results
Patients
EHR
Hospitals
Labs
Lab
PIX
XDS Rep
XDS Reg
Payers/PBM
Other HIEs
Claim Data
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Consume Documents (Labs, D/Cs, Image
Reports/Links, etc.)
IHE PIX / XDS
Personal Health Record
Results
Patients
Labs
Query for Patient
PIX
XDS Rep
XDS Reg
Payers/PBM
Other HIEs
Claim Data
18
Live Demo
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
HITSP / IHE ArchitectureOther EHR Vendors
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CDA Gallery
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HITSP / IHE ArchitectureMore Details
25
Example - Document Publisher (IHE XDS, PIX, BPPC,
ATNA)
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Example - Document Publisher (IHE XDS, PIX, BPPC,
ATNA)
CCD / CDA
HL7_ORU_1
Normalize to LOINC
Standardize to CCD / CDA
Lab1
CDALOINC
Normalize to EMPI
HL7_ORU_2
Lab2
CDALOINCEMPI
Attach Security
XDS Document
HL7_ORU_3
Labn
XDS Registry
XDS-LAB Document
XDS Repository
Consent
EMRn
De-ID / Limited Dataset
Quality Reports
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Example - Document Publisher (IHE XDS, PIX, BPPC,
ATNA)
CCD / CDA
EMR1
HL7_ORU_1
Normalize to LOINC
LOINC
Standardize to CCD / CDA
Lab1
CDALOINC
Normalize to EMPI
EMPI
HL7_ORU_2
CDALOINCEMPI
Lab2
Attach Security
Security
XDS Document
HL7_ORU_3
XDS Registry
XDS
Labn
XDS-LAB Document
XDS Repository
Audit
Consent
De-ID / Limited Dataset
EMRn
Quality Reports
28
HITSP / IHE Background
29
AHIC Leavitts HIT change mechanism
American Health Information CommunityChair Sec.
Leavitt
Confident., Privacy Sec.
Population Health
Personalized Health
Chronic Care
Consumer Empower.
EHR
Quality
AHIC Use-cases Consensus Policy
Office of the National Coordinator (ONC)Dr. Rob
Kolodner
Privacy/SecuritySolutionsContractor
StandardsHarmonizationContractor
HISPC
HITSP
ComplianceCertificationContractor
NHINPhase - 2
RHIOHIE / EHRHIT vendors
30
AHIC Leavitts HIT change mechanism
American Health Information CommunityChair Sec.
Leavitt
Confident., Privacy Sec.
Population Health
Personalized Health
Chronic Care
Consumer Empower.
EHR
Quality
Consumer Empowerment EHR Exchange IHE XDS -
Cross Cross-Enterprise Document Sharing IHE PIX
- Patient Identification Cross-Referencing IHE
PDQ - Patient Demographics Query
StandardsHarmonizationContractor
HITSP
31
AHIC Leavitts HIT change mechanism
American Health Information CommunityChair Sec.
Leavitt
Confident., Privacy Sec.
Population Health
Personalized Health
Chronic Care
Consumer Empower.
EHR
Quality
ComplianceCertificationContractor
32
Integrating the Healthcare Enterprise
Over 100 vendors and 20 professional societies
involved worldwide5 Technical Frameworks and 40
integration profilesTesting at Connectathons and
Demonstrations at Major Conferences Worldwide
1999
2000
2001
2002
2003
2004
2005
2006
2007
33
Integrating the Healthcare Enterprise
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HIMSS/IHE Vendor Participation
35
IHE XDS - Cross Enterprise Document Sharing
Worldwide
UK CfH (Radiology WF)
Denmark (Funen) Italy (Veneto) Spain (Aragon)
FranceDMP
Quebec, Toronto,Alberta, British ColumbiaCanada
Infoway 2007-8 XDS-I
AustriaQ4-2006
Italy 2005(Conto Corrente Salute) 4 hospitals,
500 physician offices CDAPDF, CDA R2, XDS-LAB
MA-Share MA 2006-7, XDS-MS, XDS-Lab
THINC- New York NCHICA N. Carolina
State Project NY
Philadelphia HIE 2005 5 Hospitals, Imaging
CenterPublic Health XDS-I
JAPAN-Nogaya Imaging Info Sharing
CHINA-MoH Lab results sharing
CHINA-Shangai Imaging Info Sharing
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VITL Update
37
Summary

• HIE provides right info, person, place, time
• HIE assumes consent / authorization for sharing
• HIE is based on HITSP / IHE standards
• HIE can integrate data into EHR workflow

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What led us to where we are?

• 2004
• VT hospitals want to leverage HIT VAHHS HIT
  Summit
• Presidential Executive Order EHRs by 2014
• National Coordinator for HIT established in HHS
• 2005
• VITL incorporated
• VITL surveys providers and advisory group
• American Health Information Community chartered
• Healthcare Information Technology Standards Panel
  founded
• 2006
• VITL RFP and Contract
• VT Legislature
• 2007
• VITL designated by statute to operate the sole
  HIEN in VT
• VITL Medication History Live

39
What led us to where we are?
Collaboration
40
Current Projects

• Medication History
• Blueprint Chronic Care Information System
• EHR Pilot

41
Potential Connections
Other HIEs
42
Your Priorities

• Todays poll

43
How to engage with the HIEN

• Tell us your priorities (poll)
• Engage with VITL to
• Assess your organizations readiness
• Establish agreements on sharing
• Install software to optimize your workflow
• Implement connections to the HIEN
• Evaluate progress and identify new needs