The document discusses integrating electronic health records with a health information exchange (HIE). It provides an overview of the New Mexico Health Information Collaborative (NMHIC) HIE, including its benefits, architecture, and how information is shared. The presentation describes the design process used to connect an Allscripts EHR system used by ABQ Health Partners to the NMHIC HIE, including design decisions. It also discusses lessons learned and the future use of clinical exchange documents to share patient data between systems.

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2. Integrate with a
Health Information
Exchange

3. Presenters
› Dr. Robert White
Clinical Informatics Director
Lovelace Clinic Foundation
ABQ Health Partners
› Justin Campbell
Senior Consultant
Galen Healthcare Solutions
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4. Agenda
› Meaningful Use
› HIE Benefits
› NMHIC Overview
› NMHIC Architecture & Approach
› ABQHP AE-EHR <-> NMHIC HIE
› What/How information is shared
› Design Process
› Design Decisions
› NMHIC: Lessons Learned
› The Future: CED
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5. Meaningful Use
› ARRA will provide incentives to physicians and
hospitals for meaningful use of HIT. (2011–15)
› Meaningful Use will require HIE networks to:
− Support Electronic prescribing
− Exchange summary patient documents
− Order laboratory tests and receive results
electronically
− Electronically submit immunization and reportable
conditions/events to public health
− Potentially convey quality reports to federal/state
authorities 2012 and thereafter
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6. HIE Benefits
› Improved care coordination and communication
› Support to public health
› Potential for daily emergency responder use
› Potential for a natural disaster emergencies
› Elimination of duplicate tests
› Value (savings/cost reduction) to (New Mexico) payers
− $11.9 million per year – extrapolated conservatively from
national study
− $6 million per year based on very conservative estimates
from local data
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7. NMHIC Overview
› The New Mexico Health Information Collaborative
(NMHIC)
− Health Information Exchange (HIE) development started 2005
− Convenes over 30 hospital, medical practice, laboratory, public
health, professional, health plan, and employer organizations in a
legal and trusted relationship for sharing patient information
− Connects doctors to electronic patient information across different
healthcare organizations in community and state
› NMHIC will replace fax, phone and mail exchange of
medical information with secure and privacy protected
electronic systems when it begins operation late 2010.
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8. Technical & Security Fundamentals
Privacy Security
Network Subscription Virtual Private Network
Agreement tunnels with partners
Terms and conditions at first SSL Encryption, Intrusion
login Prevention
Patient Consent Required Strong passwords, 90 day
expirations
Comprehensive Auditing Two levels of authentication
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9. How NMHIC Works
State Public HIE
Health Depts. Network
Hospital
Locates
the Patient’s
Records
Patient Clinician Office
PRIVACY
PROTECTED
Clinician Gathers and
Assembles Lab
the Patient’s
Records
Emergency
Room
Nationwide Health Information Network (NHIN)
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10. NMHIC Federated Architecture
NHIN
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11. DEMO
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12. ABQHP AE-EHR <-> NMHIC HIE
› Existing Health Level 7 (HL7) Data Exchanges
Developed by Galen
− Registrations
− Appointments
− Radiology Results
− Documents
› Up Next (Funded by Social Security Admin. Project)
− Appointments
− Allergies
− Medications
− Problems
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13. ABQHP AE-EHR Data Exchanges
› Built in the ConnectR interface engine
− Application Programming Interface (API) to the Enterprise EHR
(AE-EHR)
− Inbound and outbound stored procedures.
› Configuration of the interfaces to the particular
vendor/client.
› Galen’s vast experience and expertise in deploying data
exchanges to and from the AE-EHR leveraged.
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14. What/How information is shared
› Dependent upon clinical data currently captured and
available in the Enterprise EHR
› Current implementation between ABQHP AE-EHR and
NMHIC HIE is uni-directional
− Outbound from Enterprise EHR to HIE
› Reg/Sched data typically comes from the Practice
Management system
− Pass/Map interface
› Extract routines deployed in Enterprise EHR and
ConnectR to facilitate extraction of allergies,
medications, problems
› Data mapped to HL7 messages (ADT, ORU, MDM)
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15. AE-EHRConnectR Extract Process
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16. Design Process
› Technical Design Document (TDD)
› Provide representative subset of data for analysis by
NMHIC
› Feedback loop
− Iterative process until steady-state is reached
› Issues and Resolutions List
› Timeline & Effort
− Staggered, parallel development
− Typically 8 week turn-around-time
− Design
− Build
− Unit Test
− Validation
− Activation
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17. Design Decisions
› Patient identifiers
− Radiology Information System (RIS)
− Laboratory Information System (LIS)
− EHR
− PM
− Consistency with the Master Patient Index (MPI) across all
interfaces.
› Filtering
− Mental health document types
− “Celebrity patients”
− Preliminary documents
− Unverified results.
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18. NMHIC: Lesson Learned
› Expansive and inclusive governance participation
› Patience and Persistence required
› Legal agreements take time
› Public benefit requires public funding
› Steadfast support from NM Department of Health
Leadership
› Complementary core team skills
› Vendor commitment
› Federated architecture
› Centralized warehouse unacceptable in our community
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19. The Future: CED
› A Clinical Exchange Document (CED)
− Generally accepted format of patient data used to share
information between systems.
− Allscripts term to cover different formats that are supported.
› CCR and Medical Summary (a CDA)
› Both are xml documents,
› Both are essentially encounter summaries containing
− Allergies -Problems
− Medications -Vitals
− Immunizations -Results
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20. Summary
› Pragmatic benefits (both clinical and financially) to
exchanging data between the AE-EHR and the HIE
› Best practice, iterative design approach utilized
› Effort invested in design up-front saves in
implementation
› Most efficient means of data exchange between the AE-
EHR and HIE is CED
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21. Questions / Contact Information
Questions?
Contact Information
Dr. Robert White
Clinical Informatics Director, Lovelace Clinic Foundation
Bob.White@lcfresearch.org
Justin Campbell
Senior Consultant, Galen Healthcare Solutions
Justin.Campbell@galenhealthcare.com
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