Current Stats 5/16/2014. NDHIN Update

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1 NDHIN Update Dakota Conference on Rural Health Health IT Advisory Committee (HITAC) *Chair-Lynette Dickson, Associate Director Center for Rural Health, UND School of Medicine and Health Sciences * Vice Chair - Dan Kelly, CEO McKenzie County Healthcare System Lisa Feldner, CIO State of North Dakota, North Dakota University System Dr. Alex Talebdoost, Physician, Trinity Health *Barb Groutt, CEO North Dakota Healthcare Review Courtney Koebele, Director of Advocacy North Dakota Medical Association *Caryn Hewitt, CIO Sanford Health System, Fargo Dave Molmen, CEO Altru Health System/Chair Hospital Association Janis Cheney, Executive Director AARP Jennifer Witham, IT Director North Dakota Department of Human Services Jerry Jurena, President North Dakota Healthcare Association Jim Long, CEO West River Health Systems Laurie Peters, RHIT, Past-President North Dakota Health Information Management Assoc. Lisa Clute, Executive Officer First District Health *Tony Tardugno, CIO BCBS of North Dakota Mike Ressler, CIO, State of North Dakota Neil Frame, Operations Director Metro Area Ambulance Representative Robin Weisz North Dakota Representative Senator Judy Lee North Dakota Legislature Shelly Peterson, President Long-term Care Association Tami Wahl, Sr. Policy Advisor-HHS Governor s Office Darin Meschke, North Dakota Department of Health Todd Bortke, Director of Information Systems, St. Alexius Medical Center *Executive Committee 07/09/2013 Current Stats 150+ Organizations have signed Participation Agreements and Business Associate Agreements with NDHIN 700+ users set up for NDHIN Direct (Direct Secure Messaging) Onboarding over 35 organizations right now, who are ready to provide data (data providers) Hospitals, Clinics, Public Health Starting engagement with LTC EHRs Onboarding and training for clinical portal access has begun! (data consumers) We re LIVE! 280,000+ Unique Patients 1

2 Push Services Example: I have a piece of information and want to send it to someone else securely. Direct Secure Messaging Orion Health Trust Network DSM Web Basic Direct Secure Messaging Web-based access client access Managed Direct Secure Messaging Client-deployed hardware device Monitored by OH Managed Services DSM Connect HPD MSG CERT DSM Direct Direct Secure Messaging with EHR System integration Encrypted S/MIME access Encrypted XDR access Direct Secure Messaging 2.0 DSM Web/DSM Direct (XDR) Phases Organizational-level Security Certificates for each Participating Org Sub-domain under NDHIN domain, or Sub-domain under Organization s domain (i.e. direct.sanfordhealth.org) Requires some additional paperwork to be completed Creating User Accounts Organization Administrator Role Provider Directory HISP-to-HISP How do we send messages to Direct Users that use other HISPs? Direct Trust/NATE 2

3 XDR Interfaces Progress Organization Vendor DOI XDR Request Form Onboarding Started Sanford EPIC Essentia Health EPIC Pull (Query based) Services Example: I have someone in the ER/office that I know little or nothing about. How can I get information from other sources to help me make sound medical decisions quickly and efficiently? Query the NDHIN for information! The NDHIN Model NDHIN Hospital Gathers and assembles the patient s records using MPI Clinician Office Diagnostic & Imaging Patient demographics LTC/More 3

4 Data Feeds to HIE Admission, Discharge, Transfer (ADT) Patient Demographics Encounter History Allergies Diagnosis Procedures Observation Results (ORU) Lab Results Imaging Studies Radiology Reports/Documents Medical Document Management (MDM) (Clinical Documents) Work Types Discharge Summaries H&P s ED Visit Notes Consult Reports Operative Notes Immunizations (VXU) CCD/C-CDA Exchange Participant Onboarding Status Participant Name Admissions, Lab Radiology Immunizations Clinical Discharges, Results Results Docs Transfers w/ DoH Jamestown Regional Going to Epic Medical Center 6/1/2014 Sanford Fargo/Bismarck St. Alexius Altru Health Essentia Health Reportable N/A N/A Trinity Health Local Public HU s using N/A N/A N/A CHAMP Software (13) Coal Country Community Health Testing (or Testing Prep) End User Validation Testing Production CCD s NDHIN Production Statistics (As of April 26) Unique Patient ID's

5 NDHIN Clinical Portal Comprehensive View of Patient Information Customizable User Interface Notifications/Subscriptions Timeline View Normalization of Data Lab Results Problems Allergies and Medications Integrated Health Data Architecture Data Feeds to HIE Admission, Discharge, Transfer (ADT) Patient Demographics Encounter History Allergies Diagnosis Procedures Observation Results (ORU) Lab Results Imaging Studies Radiology Reports/Documents Medical Document Management (MDM) (Clinical Documents) Work Types Discharge Summaries H&P s ED Visit Notes Consult Reports Operative Notes Immunizations (VXU) CCD/C-CDA Exchange 5

6 Interfaces Type of Data Interface Approach User Interface (Front end View) Patient HL7 ADT Demographics to Homepage Demographics EMPI Patient Search Patient Summary Demographics & Emergency Contacts Encounter History HL7 ADT(PV1 segment) Inbound Patient Summary Encounter History Windowlet Laboratory Results HL7 ORU Inbound Numerical and Textual (e.g. Pathology and Microbiology) Radiology Reports HL7 ORU Inbound Textual Document Tree/Results Viewer Normalized to LOINC Document Tree/Results Viewer Transcribed Reports HL7 Or MDM Inbound or PDFs/Scanned documents Document Tree/Results Viewer Interfaces Continued Type of Data Interface Approach User Interface (Front end View) Allergies HL7 ADT (AL1 segment) Patient Summary Allergies Windowlet Inbound Normalized to SNOMED Diagnosis HL7 ADT(DG1 segment) Inbound Patient Summary Encounter History Windowlet Problems HL7 PPR Patient Summary Problems Windowlet Normalized to ICD 9/10 or SNOMED Procedures CCD can be parsed from the CCD into the CDR Patient Summary Procedures Windowlet Normalized to ICD 9/10 or CPT4 Senate Bill 2250 Three Options of HIE Participation In (Default) Allows the individually identifiable health information of an individual to be searchable by a provider Opt-Out of Participation Individual s identifiable health information may not be accessed by search by a health insurer, government health plan, or healthcare provider other than the provider who originally created or ordered the creation of the individually identifiable health information Conditional Opt-Out Information is not available for search, like the first option. However, if a health care provider determines access is required because of a medical emergency, the health care provider can break the privacy seal and search for the information 6

7 Patient Consent Patient Consent Opt Out/Opt In of HIE managed by manually, within NDHIN Participant Staff NDHIN Staff Patient Consent 7

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9 Viewing CCD s 9

10 Notifications Subscriptions/Notifications Providers can subscribe to their patients and be notified when specific events/triggers happen based on HL7 messages Inpatient Admission Inpatient Discharge Abnormal Lab Result (includes all abnormal results) Above High/Low Abnormal OR Panic Lab Result (subset of abnormal lab result) New Final Radiology Result Patient is admitted to the ER 10

11 Imaging HealtheWay Example Integration (Epic) Single Click access to Clinical Portal 11

12 Example Integration (Cerner) Single Click access to Clinical Portal Audit Log NDHIN Next Steps PDMP Integration Patient Portal ehealth Exchange Imaging Full Direct Trust Accreditation May Jun Jul Aug Sep Oct Medications Business Intelligence Reporting 12

13 NDHIN Benefits to Providers Public Health Reporting Electronic Lab Reporting Syndromic Surveillance Bi-Directional Interface to ND Immunization Registry Clinical Portal/Patient Portal Statewide Advance Directive Repository Prescription Drug Monitoring Program access ehealth Exchange Connectivity Connect to other HIE s/federal Agencies across country Image Exchange View images from PACS networks across state Disease Registries NDHIN Direct Simplifying Future Interface Work and much more!! What about the data? Workgroup involvement Looking for volunteers!! Clinical Workgroup Data Use Workgroup Data Stratification Discreet Data is essential Lots of Potential but rules/use need to be defined ACO, MSSP PCMH Research Community Needs Assessments More Chad Peterson