The Value of Universal Interoperability ehealth Exchange. ehealth Exchange and HIETexas

Transcription

1 The Value of Universal Interoperability ehealth Exchange Eric Heflin, CTO ehealth Exchange and HIETexas Twitter Handle: #CAT14

2 Learning Objectives Describe the organization s strategies used to provide seamless interoperable healthcare across disparate systems. Identify real-life examples of interoperability in action and proven methods shown to improve patient care and safety and demonstrate value. Discuss the costs involved with widespread interoperability and how savings will be achieved long-term. Summarize collaborative efforts and synergies of organizations with other industry initiatives.

3 Agenda Eric Heflin Interoperability, testing, and real-world examples at a national level John Donnelly Interoperability Workgroup / state perspective on interoperability Amit Trivedi Certification/testing vendor perspective on interoperability

4 ehealth Exchange ehealth Exchange originated as ONC nationwide health information network initiative Spun out as a non-profit, now known as the ehealth Exchange Interoperability approach: Test once, exchange anywhere In production since 2007 One unified trust, operational and legal framework Our large operational exchange has resulted in many valuable lessons learned that we seek to freely share so we can learn together Approach is to seek to onboard larger regional groups (like states)

5 Seamless Interoperability Highly constrained specifications Send strictly, receive liberally (can be expensive) Key is to focus on the basics (simple is difficult enough!) Collaborate early to ensure the strategy is not siloed Very precise specifications are elusive If a spec is testable then you ve won the battle (or at least a skirmish) Transport, security, web services are not the complete picture Patient matching Consent Content Workforce Flexibility and optionality are the enemy of interoperability --Wes Rishel Vice President & Distinguished Analyst Gartner

6 Examples of Interoperability ehealth Exchange Production Participants currently include: 41 participants live in production (with 4 Federal Agencies, 6 States, 8 Beacon Communities, and more than a dozen Health Information organizations and health systems) 800 hospitals 6000 medical groups 850 pharmacies 750+ dialysis centers 69 organizations in test status 50 million patients

7 How Much Data Is Really Flowing? In 2013, based on a partial survey: 26 million transactions pushed 250,000 transactions pulled Expecting 100 million patients by mid-2014 Data includes: CDA/C32/Care Summaries, quality data, administrative data, C-CDA, unstructured data, and more

8 Costs And Savings ehealth Exchange has a non-profit, co-op business model Seeking to provide services as close to free as possible Leveraging a mutual investment in process, collaboration, specifications, tooling Shared savings model ehex testing is not a profit center Test once, exchange anywhere goal Upfront costs result in lower downstream costs by shifting expenses forward in timeline where they are less expensive Adding optional vendor/product testing allowing additional shifting of costs to even earlier in the timeline Automation is the absolute key (quality, fast turnaround loop, continuous testing, cost-efficient)

9 New Era Why are we still talking about interoperability? What takes sooo long and so much $$$$ to get data flowing? What can we do to accelerate the industry? I firmly believe the answer includes establishing a next generation of collaboration beyond just the current pockets and efforts.

10 Collaboration History is being made THIS WEEK! New Directions area downstairs (Mon Tue) Collaboration with the IWG, states, vendors (EMR, HIE, Direct, testing), federal government active involvement (ONC), ehealth Exchange, IHE-USA all working together on a solution to one of our most pressing problems: A viable specification for (Federated) Provider Directories For use by Direct / States / ehealth Exchange / Emergency Resp. / others Open standard, includes test tooling, Reference Implementation, implementable specs Based on IHE Healthcare Provider Directory profile

11 Healtheway Members

12 ehealth Exchange Participants Alabama One Health Record Centers for Medicare and Medicaid Services (CMS) Childrens Hospital of Dallas Community Health Information Collaborative (CHIC) Conemaugh Health System Department of Defense (DOD) Department of Veterans Affairs Dignity Health Douglas County Individual Practice Association (DCIPA) Eastern Tennessee Health Information Network (ethin) EHR Doctors Hawaii Pacific Health Geisinger Health HealthBridge HealtheConnections RHIO Central New York HEALTHeLINK (Western New York) Idaho Health Data Exchange Indiana Health Information Exchange (IHIE) Inland Northwest Health Services (INHS) Kaiser Permanente Lancaster General Health Marshfield Clinic Medical University of South Carolina (MUSC) MedVirginia Michigan Health Information Network (MiHIN) MultiCare Health System National Renal Administrators Association (NRAA) New Mexico Health Information Collaborative (NMHIC) North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) OCHIN Quality Health Network San Diego Beacon Social Security Administration (SSA) South Carolina Health Information Exchange (SCHIEx) South East Michigan Health Information Exchange (SEMHIE) Strategic Health Intelligence University of California, Davis Utah Health Information Network (UHIN) Walgreens Wright State University

13 ehealth Exchange Industry Collaboration ONC CCC IWG/New York EHRA HIMSS IHE/IHE-USA NATE Direct Trust

14 Collaboration ehealth Exchange wants to collaborate with you! Testing approaches (ehex gives our test cases/data/etc. away) Content Standards ehex feeds knowledge back to the IHE via Change Proposals In 2014, ehex is targeting pressing national-scale problems including: Consent, Provider Directories, Targeted Queries, Patient Matching Easier ways to achieve clinical data exchange For more information:

15 The Value of Universal Interoperability EHR HIE Interoperability Workgroup John Donnelly President, IntePro Solutions Inc Twitter Handle: #CAT14

16 Topics EHR HIE Interoperability Workgroup (IWG) and the HIE Certified Testing Programs Cross-Initiative Interoperability Harmonization

17 EHR/HIE Interoperability Workgroup (IWG) Win-Win-Win Strategy Vendors Differentiate product in highly fragmented market by developing a product that offers plug and play solutions deployed in many states (superior interoperability) Build interface once, use for many different HIEs, HISPs and EHRs Better utilize limited resources to focus on product functionality improvements and customer adoption State and Regional HIE Ability to rapidly deploy interconnection of systems by having standard interfaces and interface approaches Minimize costs associated with connection fees by individual EHRs each time a new connection is made Providers Increase value proposition of individual EHRs Eliminate HIE and HISP connection cost as prohibitive barrier for adoption

18 Background Initiated in 2011 by New York e- Health Collaborative (NYeC) to leverage existing standards and develop consistent implementation guides for interoperability between HIE software platforms, and EHRs that interface with them Serves as the financier of all administrative and project management activities and is the formal contractual entity The public-private organization operating ehealth Exchange (formerly NwHIN) collaborated with the IWG in 2013 to establish HIE Certified testing programs

19 Workgroup Members Over 52% of the US Population STATES EHR VENDORS HIE/HISP VENDORS Arkansas Nebraska Alere ACS Epic 1MEDiX Med3000 California New Jersey Allscripts GE Alere ACS MedAllies Florida New York CareVoyant Greenway ApeniMED MedFx Georgia Oregon Cerner McKesson dbmotion Medicity Illinois Rhode Island CureMD MDClick Data Motion Mirth Kansas Utah Data Strategies MTBC GE Misys OS Solutions Kentucky Vermont DeFran Systems NextGen GSI Health NextGate Maryland Virginia Dr. First Nortec Software Harris OmniMD Michigan West Virginia eclinical Works Prosocial Applications HealthUnity Missouri emds Siemens iphysicianhub Optum OmniXchange EMR Direct TenEleven Group ICA Orion Health Vitera Health InterSystems RelayHealth

20 Key Components of IWG Specifications Send and Receive Patient Record Exchange (Push) NwHIN Direct (Foundation) Main expansion beyond Direct is locating the provider through querying Provider Directory and finding digital cert per S&I (HPD +) Provides implementation examples on how data model can be backed by relational database, and how to search for Direct addresses in various ways. Tighter, testable transactions between edge systems and full service HISP (SMTP & XDR transaction) Statewide Patient Data Inquiry Service (Pull) Register and Query patient Identity, Provide and Register/Query and Retrieve Patient Documents MPI search through PIX/PDQ and XCPD, Access management (XUA), provide and register document (XDS), and query and retrieve document (XCA/XDS); Consent management (ACP) discussed Statewide Consumable Continuity of Care Document CCD based on C32/C83 (aka, Bridge-C32) C-CDA r1.1 Tighter data element requirements based on C32 semantics and syntax. (Additional R/R2 items from C154 per states and Beacons as they relate to C32 based documents).

21 HIE Certified Programs

22 HIE Certified Community - Testing Program o Scope & Objectives: Full set of Community test cases (~ 750) Community-Community Test Cases aligned with HIE Certified Network program Leverage NIST and other open-source/public domain code Development to be informed by Community Comment Program feedback, NIST TT activities, and other testing tool activities o Status: New IWG Testing Tool in development by Stella Technology Alignment with HIE Certified Network CTP where appropriate On target for a January 2014 completion Pilot program to be executed as an integral part of CTP rollout

23 HIE Certified Direct - Testing Program o o Scope and Objectives: Direct messaging TT will leverage existing tools from ONC & NIST to the largest degree possible Largest gap is for XD-related test cases IWG with Stella Tech developed test case matrix with reference to tool and actors (HISP, Edge system) involved Provider Directory TT options as per HPD+ plans noted below Harmonization with PD ModSpec TT development activities Status: Stella Technology engaged to add Direct components to the IWG Testing Tool Detailed project plan being finalized Target completion Mar Pilot program to be executed as an integral part of CTP rollout

24 Topics EHR HIE Interoperability Workgroup (IWG) and the HIE Certified Testing Programs Cross-Initiative Interoperability Harmonization

25 ONC s Exemplar HIE Governance Entities Grant Project Q ONC awarded an Exemplar HIE Governance Entities Program Grant to NYeC on behalf of the EHR HIE Interoperability Workgroup (IWG) Illuminate the implementation challenges facing the exchange of health information requiring the querying of provider directories between Health Information Services Providers (HISPs) The cooperative agreement allowed the IWG to continue its efforts in developing robust implementation specifications for plug and play interoperability

26 Four Pilots Undertaken/Monitored Snowbird Pilot- Michigan Health Information Network, Surescripts, Florida Health Information Exchange New York ehealth Collaborative and Western New York Regional Health Information Organization (HEALTHeLINK) National Association for Trusted Exchange: Utah Health Information Network, California Health equality State of California Pilot, managed by California Health equality: Santa Cruz HIE, North Coast Health Information Network, UC Davis Health System, RAIN Central Coast HIE, Orange County Partnership Regional Health Information Organization, Sujansky & Associates

27 PD Pilot Lessons Learned Situation Multitude of standards and IG s published over the past couple of years PD Federation out-of-scope in existing HPD IG s Differences in chosen data nomenclatures also impacted interoperability across PDs Scalability of DSML and LDAP based solution could become performance issue Result Incompatible set of PD deployments across the country Federation attempts assembled on custom basis depending on the PD standards deployed Queries for provider specialties failed Multiple queries required to accomplish primary use case of obtaining Direct address

28 Next Steps already underway at CAT14!! Announced collaboration between IHEUSA and ONC s PD Modspec project to create updated IHE HPD profile Publication of updated IWG specification regarding HPD deployment to reflect lessons learned from PD Pilots Incorporation of PD testing requirements for EHR-HPD and HPD-HPD interoperability into IWG HIE Certified Direct testing program Leverage ONC s PD Modspec Test Harness

29 initiatives working together and leveraging IHE s work in order to deliver a harmonized testing and certification ecosystem to the healthcare industry

30 The Value of Universal Interoperability IHE USA Certification Amit Trivedi Program Manager Healthcare, ICSA #CAT14

31 Learning Objectives Organizational strategy to provide seamless interoperable healthcare across disparate systems Real-life examples of interoperability in action and proven methods shown to improve patient care and safety and demonstrate value Costs involved with widespread interoperability and how savings will be achieved long term Collaborative efforts and synergies among 3 organizations.

32 IHE USA s Testing & Certification Partner 20+ Years Security & Privacy Testing Experience - One of the oldest and most extensive certification programs in security ANSI Accredited ONC-Authorized Certification Body Certifying EHR Technology tested to meet federal clinical, interoperability, privacy and security requirements Analyst Expertise in HIPAA Compliance, Meaningful Use Regulations and Required Standards NVLAP Accredited Test Lab for Health IT ISO 9001:2008 Certified, ISO 17025:2005 Accredited, ISO/IEC Guide 65 Accredited 33

33 Why IHE USA Certification? The Goal Affordable health information systems that are interoperable, secure, meet privacy requirements and don t introduce new risks to the safety of patients The Need Purchasers/Users need a way to confirm that all products that are part of their integrated HIT ecosystem will interoperate and conform to privacy, security and safety requirements Vendors need a cost effective way to demonstrate that their products interoperate and conform to privacy, security and safety requirements The Solution 3rd party testing & certification provides additional assurance to purchasers & users of health IT that the products will: support specific clinical workflow objectives and standardized exchange of clinical information while meeting baseline levels of privacy and security functionality 34

34 IHE USA Certification Meaningful Use is a Foundation Leverages an industry standard testing and certification framework Focuses testing on specific, industry vetted IHE specifications necessary to achieve (and go beyond) Meaningful Use: Transport standards (IHE XD*) Patient Identification (IHE PIX/PDQ) Security requirements (IHE ATNA) Expands testing to include patient care devices, and other IHE domains Patient Care Devices, Radiology, Lab, Public Health, etc.

35 IHE USA Certification Program Highlights Certification, once achieved is valid for 2 years Product Update process streamlines the inheritance of certification for updated and enhanced products Surveillance component ensures that certified products continue to function as tested Virtual testing to complement testing at the Connectathon and throughout the year. Certified products showcased by IHE USA and ICSA Labs year-round in the new HIMSS Innovation Center. 36

36 2013 IHE USA Certified Products 37

37 New for 2014 Expanding to four new domains: 2013 IHE USA Certification included 12 different profiles in two IHE domains: IT Infrastructure (ITI) and Patient Care Devices (PCD) In 2014, over a dozen additional profiles have been selected from the four new domains: Laboratory (LAB), Patient Care Coordination (PCC), Quality Research and Public Health (QRPH), Radiology (RAD) 38

38 Profile Selection Criteria Maturity - In the 2013 IHE USA Certification program all profiles tested were in final text Activity and interest based on North American Connectathon participants Relevance to U.S. market requirements profiles selected complement Meaningful Use 3-year Roadmap Identifies future IHE profiles and domains to be tested To be published in Q for stakeholder feedback 39

39 Provisional Testing New Concept: Provisional testing of select profiles in Trial Implementation Accelerate adoption of key profiles and movement to final text Provide feedback to technical committees Conduct testing with same rigor and as if the profile was in final text Align profile development with resources 5 key new profiles provisionally tested in 2014: Healthcare Provider Directory (HPD), Retrieve Form for Data Capture (RFD), Pulse Oximetry (POI), Infusion Pump Event Communication (IPEC), and Clinical Research Documents (CRD) 40

40 Profiles Offered for Certification in 2014 Domain Profile Description ITI ATNA Audit Trail and Node Authentication ITI CT Consistent Time ITI HPD Healthcare Provider Directory ITI PDQ/PDQv3 Patient Demographics Query ITI PIX/PIXv3 Patient Identity Cross-Reference ITI RFD Retrieve Form for Data Capture ITI XCA Cross-Community Access ITI XDM Cross-Enterprise Document Media Interchange ITI XDR Cross-Enterprise Document Reliable Interchange ITI XDS.b Cross-Enterprise Document Sharing ITI XUA Cross Enterprise User Assertion LAB XD-Lab Sharing Lab Report Profiles marked are new in 2014 Profiles marked will be tested PROVISIONALLY in 2014 RED Domain Profile Description PCC IC Immunization Content PCC XDS-MS Cross-Enterprise Document Sharing Medical Summary PCC XPHR Exchange of Personal Health Record Content PCD ACM Alert Communications Management PCD DEC Device Enterprise Communication PCD IPEC Infusion Pump Event Communication PCD PIV Point of Care Infusion Verification PCD POI Pulse Oximetry QRPH CRD Clinical Research Document RAD XDS-I.b Cross-Enterprise Document Sharing for Imaging RAD SWF Scheduled Workflow 41

41 Examples and Use Cases IHE USA Certification targets high value interoperability use cases related to: Data exchange Patient Identification Patient Safety Secure nodes, authentication, and Audit Trails

42 The PCD-DEC (Device to Enterprise Communications) profile allows a consuming system (DOC) to receive patient clinical information including vitals, demographics, settings, and location from a reporting device/system (DOR). *Slide Content developed by IHE and the PCD Technical Committee Example: PCD-DEC Profile (Device to Enterprise Communications)

43 Example: PCD-PIV Profile (Point-of-Care Infusion Verification) The PCD-PIV (Point-of-Care Infusion Verification) profile supports the electronic transfer of infusion parameters from a Bedside Computer-assisted Medication Administration (BCMA) system or EMR to a general-purpose infusion pump, enhancing patient safety by effectively eliminating keystroke errors. *Slide Content developed by IHE and the PCD Technical Committee

44 Example: PCD-IPEC Profile (Infusion Pump Event Communication) The PCD-IPEC (Infusion Pump Event Communication) profile enables reporting of clinical and operational events from an infusion pump to a Bedside Computer-assisted Medication Administration (BCMA) system or EMR. Clinicians can then view and validate this information for infusion documentation. *Slide Content developed by IHE and the PCD Technical Committee

45 Value of IHE USA Certification Differentiates products that go above and beyond minimum federal or Meaningful Use interoperability requirements Provides additional assurance and confidence to purchasers of health IT looking beyond EHR adoption incentives through robust testing and post market surveillance Expands product testing to new domains to connect the ecosystem (Patient Care Devices, Cardiology, Labs, Pharmacy, Clinical Research, mhealth) beyond just EHRs and HIEs Leverages industry vetted and collaboratively developed IHE technical specifications Bridges the testing of products in development at the IHE Connectathon with the verification of product capabilities in the marketplace International initiative: ICSA Labs providing support to the development of IHE International s ISO-based Conformity Assessment framework 46

46 Value of IHE USA Certification IHE USA Certification Aligns with the HIMSS Health IT Value Suite: Satisfaction: Purchasers of Health IT products will have additional assurance that products will work as tested Treatment/Clinical: High value interoperability use cases are targeted to improve care delivery Electronic Information/Data: Focuses on IHE profiles that will deliver higher levels of interoperability and data exchange Prevention and Patient Education: Security and patient safety components are addressed through IHE profiles selected Savings: Informed decision making when selecting Health IT products will help lower overall costs

47 Feedback to Technical Committees IHE Call for Proposals Profile Selection by Committees IHE Connectathon Testing IHE Technical Framework Development IHE USA Certification Certification and the IHE Development Cycle IHE Profiles Published Profiles for Trial Implementation Profiles Published for Public Comment

48 Collaborative Efforts and Synergies - IWG/Healtheway : Exploring reciprocity agreements between similar testing and certification activities; i.e. base certifications - International Collaboration: IHE International - Universal Interoperability - Multi-resource Test Tool Development: NIST / Gazelle / Mohawk College - Standards & requirements development: Health IT Policy Committee/Standards Committee, ONC Office of Certification, SI Framework, HL7

49 Next Steps Publishing a whitepaper on IHE profiles and the value of certification Kicking off testing for 2014 IHE USA Certification Program at the Connectathon and continuing with year-round virtual testing Assisting with the development of other regional and national health systems that seek to leverage a standards based testing and certification program based on IHE specifications Showcasing the IHE USA Certified products at the HIMSS Innovation Center 50

50 Background Serves as the financier of all administrative and project management activities and is the formal contractual entity for the IWG Initiated in 2011 by New York e-health Collaborative (NYeC) to leverage existing standards and develop consistent implementation guides for interoperability between HIE software platforms, and EHRs that interface with them The public-private organization operating ehealth Exchange (formerly NwHIN) collaborated with the IWG in 2013 to establish HIE Certified testing programs Certification and testing program launched in 2013 as a partnership with IHE USA to accelerate the availability of secure, interoperable HIT systems and patient care devices in the market, addressing products and functionality that go beyond baseline requirements for Meaningful Use.

51 initiatives working together and leveraging IHE s work in order to deliver a harmonized testing and certification ecosystem to the healthcare industry

52 Contact Info: John Donnelly President, IntePro Solutions, Inc. Eric Heflin, CTO ehealth Exchange/HIETexas eheflin at healthewayinc dot org Amit Trivedi Program Manager Healthcare ICSA Labs

53 Questions?