New Hampshire Health Information Organization

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2 What is NHHIO Building? - 2 -

3 New Hampshire Health Information Exchange Plan June 2010 created multi-stakeholder groups The plan is the result of collaborative planning among over 80 stakeholders 380 stakeholder comments were addressed in the current version Approved by ONC September 2010 The plan will continue to evolve as we refine the strategy, obtain broader stakeholder input, and add more detail Current strategic plan is posted at

4 NHHIO Board of Directors Board Member Representation Board Member Representation Mary Beth Eldredge IT Director Dartmouth Hitchcock Deb Mullen Concord VNA Kirsten Platte CHAN Carol LaCross CFO - Retired Denise Purington CIO Elliot Hospital NHHIO Chair, Board Member at Large Hospitals NHHIO Vice Chair, Homecare Association NHHIO Secretary, Bi-State Primary Care Association NHHIO Treasurer, Volunteer & Consultant Past President Board Member at Large David Briden, CIO Exeter Hospital Patricia Witthaus IT Director Valley Regional Hospital Dr. Richard Lafleur, Anthem BC/BS Michael Lehrman, Catholic Charities Lorraine Nichols IT Consultant NH Hospital Association, Large Hospitals NH Hospital Association, Critical Access Hospitals Board Member at Large, Health Plans Board Member at Large, Skilled Nursing Providers and NH Health Care Assoc. Board Member at Large, Dr. Daniel Waszkowski Derry Medical Center William Baggeroer NH DHHS Office of the Commissioner NH Medical Society David Querusio, Harvard Pilgrim Healthcare Board Member at Large, NH DHHS, Office of the Commissioner Dr. Christine Rosenwasser Dartmouth Hitchcock Pediatrics Board Member at Large, Health Plans Board Member at Large, Physicians Victor St. Pierre Consumer Advocate Board Member at Large, Consumers Mark Guptill Community Partners NH Community Behavioral Health Association Vacant Pharmacy Board - 4 -

5 NH HIE Facts: (RSA 332-I:2) Only a health care provider, for purposes of treatment, may access PHI in a HIE does not include patients or payors Individual must be given an opportunity to opt out of sharing his/her name, address, and PHI through a HIE information not sent to HIE, does not prevent public health reporting SB288 Authorized reporting to Department of Health and Human Services (DHHS) AHEDD, Cancer Registry, Immunization Registry A HIE must maintain an audit log of health care providers who access PHI central site will maintain transmission logs When federal certification standards are established, a HIE must be certified to be in compliance with nationally accepted interoperability standards and practices NHHIO is using Direct standards for message transport - 5 -

6 Our Changing Environment ARRA Signed Feb 2009 ACA Signed Mar 2010 ONC Approves SOP Sep 2010 HB489 Creates NHHIO Jul 2011 SB288 DHHS Reporting Jun 2012 Stage 2 MU RSA 332:I PHI Use 2009 DHHS begins HIE development Nov 2009 NH ACO Pilots Jun 2010 Stage 1 MU 2011 Pioneer ACO Dec 2011 PCMH, P4P, ACO

7 NHHIO Legislative Updates Update Definitions to Fully Align with HIPAA Undefined terms leads to ambiguity and misinterpretation of meaning Healthcare Services is not defined in provider definition Treatment is not defined under use and disclosure Update Use and Disclosure to Fully Align with HIPAA Variability of transmission methods drives inconsistency and increased cost Allow all parties currently receiving and reviewing PHI to do so using safe, secure and auditable methods Patient engagement increases self-management, self-regulation, and informed decision making process for clinical and cost effectiveness - 7 -

8 Senate Bill 229 AN ACT relative to the use and disclosure of protected health information. SPONSORS: Sen. Bradley, Dist 3; Sen. Boutin, Dist 16; Sen. Gilmour, Dist 12; Sen. Hosmer, Dist 7; Sen. Pierce, Dist 5; Sen. Stiles, Dist 24; Sen. Reagan, Dist 17; Sen. Cataldo, Dist 6; Sen. Larsen, Dist 15; Sen. Odell, Dist 8; Rep. Harding, Graf 13; Rep. G. Chandler, Carr 1; Rep. Butler, Carr 7; Rep. McMahon, Rock 7; Rep. M. Smith, Straf 6 COMMITTEE: Health, Education and Human Services ANALYSIS This bill clarifies the term health care provider for the purposes of the medical records law. This bill also declares that a patient may transmit his or her protected health information through the health information organization and that such information may only be used in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

9 NHHIO Architecture and Health Information Service Provider (HISP) Services CHAN Health Centers VNA / Homecare Public Health (DHHS) ASCC Inter-state communications Security NH Statewide Network Backbone Node addressing Provider addressing Relationship Listing Service (EMPI) Audit Phase I: Direct Secure Messaging (DSM) Inter-state gateway Provider Practices Hospital MD MD MD MD MD NH Hospital Diagnostic testing Behavioral Health SNFs Long-term care Phase II: Relationship Listing Service (RLS) Electronic Master Person Index (EMPI) - 9 -

10 Electronic Health Record (EHR) Integration NHHIO Trust Network DSM Web Basic Direct Secure Messaging Web-based access client access HISP-HISP Capability Managed Direct Secure Messaging Client-deployed hardware device (LAND Appliance) Monitored by OH Managed Services DSM Connect HPD MSG CERT Direct Secure Messaging with EHR System integration Encrypted S/MIME access Encrypted XDR access DSM Direct

11 HISP-HISP Connections

12 Connecting with HIEs Across New England ME VT NH NY MA CT R I

13 What is the Healthcare Provider Directory? The Healthcare Provider Directory (HPD) is a searchable directory of individual and organizational healthcare providers Individual Provider A person who provides healthcare services, such as a physician, nurse practitioner, physician assistant or nurse Organizational Provider An organization that provides or supports healthcare services such as hospitals, health centers, or practices It allows discovery of a provider's electronic messaging details, in particular, the Direct address It stores demographics, contact information, specialties, organizational relationships, and other information for delivery of messages

14 Who should be listed in the Healthcare Provider Directory? Direct Secure Messaging (DSM) is the encrypted exchange of information between providers and is generalized as the replacement for current faxing and paper based transmission of information The Healthcare Provider Directory (HPD) is the phonebook that would replace the contact fax numbers or mailing address of your individual and organizational providers The HPD is the phonebook presented to the NHHIO community for referral provider information How do you want to be seen in the directory? All providers? All departments? A consolidated view?

15 Direct address components Endpoint Domain Direct Address Domain: The domain of the address is used for location of delivery, and transport method of delivery if any conversion is required.(xdr S/MIME) DSM Connect (LAND Appliance) DSM Direct DSM Web ( product) HISP-HISP (ie. Surescripts, eclinicalworks) Endpoint: The final destination for delivery within the EHR application or other DSM product

16 Can a provider have multiple Direct addresses? Yes: Although the endpoint (provider) may be the same, the provider may work in multiple domains (organizations). Domain: The domain for the endpoint (provider) could exist in multiple organizations and may be using multiple methods of connectivity based on local EHR capabilities. DSM Connect (LAND Appliance) DSM Direct (connect through EHR) DSM Web ( product) HISP-HISP (ie. Surescripts, eclinicalworks, Greenway) Example: John.smith@direct.exeterhospital.nhhio.com John.smith@direct.surescripts.com

17 Can a provider have multiple Direct addresses? HPD Dr. Smith DSM Connect Dr.Smith #1 Dr. Smith DSM Web Dr. Smith #3 Dr.Smith #2 Dr. Smith DSM Direct Dr. Smith works in 3 facilities in the State. He connects through his EHR at site #1 (XDR) and site #2 (S/MIME) but uses Webmail at site

18 Can an organization have multiple domains? Yes: Based on the integration methods of the EHR systems, an organization may have an inpatient and outpatient domain, or may be using the domain provided by another HISP: Example: Inpatient system is connected by DSM Connect (LAND Appliance) and NHHIO provides HISP services: Outpatient system (GE) is connected to Surescripts HISP:

19 Can an organization have multiple domains? Parent Organization HPD MR LAND Appliance Specialist Specialist PCP PCP MR Provider Practices EHR Vendor HISP

20 Can multiple providers use a single Direct address? Yes: The endpoint of the address is used by the local EHR to determine the final delivery location of the information. Based upon the functionality of your EHR vendor, or based upon your current staff resources and workflows, multiple providers can use the same Direct address to centralize delivery of information Example: System is connected by DSM Connect (LAND Appliance) and NHHIO provides HISP services: Dr. John Smith: orthopedics@direct.dartmouthhitchcock.nhhio.com Dr. Sue Jones: orthopedics@direct.dartmouthhitchcock.nhhio.com

21 Can multiple providers use a single Direct address? HPD Specialist Specialist PCP PCP MR MR *message details in clinical documentation will determine final destination*

22 HISP Communication Pathways Hospital Organization Hospital A Vendor HISP #1 Inpatient EHR HISP Practice B/EHS NHHIO HL7 (ADT,LAB/RAD,AHEDD) LAND Appliance DPH DHMC/EHS Specialist PCP MR Outpatient EHR HISP Vendor HISP #2 Practice A EHR HISP No State Law Applies PA Not Required State Law Applies

23 NHHIO Resources

24 Project Contact Information 125 Airport Road, Concord, New Hampshire, Office. (603) Fax. (603) Jeff Loughlin Executive Director c: (508) o: (781) Jackie Baldaro Project Manager c: (339) o: (781)