Transcript Slide 1

Public Health Data Standards Consortium
Expert Panel in Electronic Data Exchanges
Convened in Partnership with the Health Resources and Services Administration (HRSA)
A Presentation of the
Colorado Health Institute
1576 Sherman Street,
Suite 300
Denver, Colorado
80203-1713
Fairmont Hotel
2401 M Street NW, Washington DC 20037
Arthur Davidson, MD, MSPH
Denver Public Health, Denver Health
December 5-6, 2006
and the
Colorado Health
Information
Exchange, an
AHRQ-funded State
and Regional
Demonstration
Project
1
Overview
•
Community eHealth Data Exchanges: Purpose/Value Proposition for
Public Health and Clinical Providers in the community
– Role of the Health Department in Being a Resource for Providers
– Engaging Providers in the Public Health Mission of Protecting the Public from
Health Threats and improving the effectiveness of Primary Care
– Examples of Emerging eHealth Exchanges and how they are bringing together
public health and providers
•
Key Implementation activities, choices, and problems
•
Accomplishments and Lessons Learned
•
Building a Shared Vision - Suggestion for the Roadmap on Building eHealth
Data Exchanges between Public Health and Clinical Settings
2
Colorado: Data Sharing Progress
Colorado Immunization Information System
Larimer
Payer # 1 – # X
CDPHE
Boulder IPN
Centura
Pharmacy
SureScripts
#1 - # X
Independent
Rural /small
practice access ?
CHCN - Health Center?
3rd party hosted
Weld
Exempla
“Community” patient index
Mesa
County
Colorado Care
Collaborative (RMD)
Standard vocabulary and
messaging
Vendor neutral
The Children’s
Hospital
Kaiser
Permanente
Denver Health
University
Hospital
MedSouth IPA
Rose Medical
Group
El Paso
County
3
Business Lines of Service
– Point of care (for patient and/or provider)
• Aggregation of clinical information from other hospital/ providers
– Immunization history (Colorado Immunization Information System)
– Individualized medication lists (Pharmacy Benefits Managers/Retailers)
– Allergies, laboratory, radiology, procedures, EKG, ….
• Decision support for clinical guidelines
– Clinical messaging (from provider to provider)
•
•
•
•
Laboratory test orders/results exchange (to/from CDPHE, LabCorp, Quest)
ePrescribing
Case reporting, electronic laboratory reporting
Ancillary/referral service results (e.g., radiology, consultant reports)
– Administrative (for provider and payer)
• Claims submission
• Eligibility, credentialing
– Population/public health (for provider, payer and/or public health)
•
•
•
•
•
Analysis of quality, disparities, morbidity monitoring, pay for performance
Registry development
Registry support: immunization
Bio-surveillance
Community health assessments
4
Point of Care Business Line - Logical Architecture
COHIE Central
Presentation
Presentation Manager
Clinical View Manager
COHIE Partner Entity
Web Services
·
·
·
Provider Services
Retrieve Clinical Data
Subscriber Authentication Services
AuthenticateUser
Retrieve User Roles
Record Locator Management Services
· cohieLoad
· Remove Patient
·
Provider Services
Retrieve Clinical Data
·
Clinical Decision Support
Patient Guidelines
·
Record Locator Services
cohieSearch
Business Services
Clinical Decision Support
Patient Index
Clinical Data
Aggregation
Common Vocabulary
Engine
Audit/Logging
Data Access
Patient Matching
Core Services
Master Patient Index
Other Store
- Data Standardization
- Mappings
- COHIE Central User Auth
5
Patient Guideline Sequence Diagram
Client
Guideline
Services
Guideline
Service
Facade
Patient
Guideline
InfereneEngine
(NxBRE)
PatientBinder
Recommendation
Collator
Common
Vocabulary Engine
ExecuteGuideline( ExecuteGuidelineRequest )
ExecuteGuideline( ExecuteGuidelineRequest )
Execute(PatientInformation)
Process
BeforeProcess
AssertFact
OnNewFact
Add
AfterProcess
ResolveGuidelines
GetRecommendationsById
RecommendationCollector
ExecuteGuidelineResponse
ExecuteGuidelineResponse
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Level 1 Trauma Center
911/EMS
Hospital
Acute Care
Rocky Mountain
Poison/Drug
Center
Rocky Mountain
Center for Medical
Response
to Terrorism, Mass Casualties,
and Epidemics
(RMCMR)
Metropolitan Medical
Response System
Center for Public
Health Preparedness
Public Health
Family Health Centers
Community
Health
School-based Clinics
Telemedicine
Correctional Care
Nurse line
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Patient Care
Education
Research
HL7 Messages
- ORM = Lab Order message
- ORR = Lab Order confirmation message w/ clinical order #
- OSU = Lab Results Status message
- ORU = Lab Results message
HealthDoc to MYSIS Data Flow
Future Flows in gray
Invision
HealthDoc
App
XML Outbound
Openlink does the communication between
Invision and MYSIS, there is no direct Invision –
MYSIS Interface
XML Inbound
BizTalk
HL7
ORM
Openlink
COHIE
HealthDoc
db
HL7
ORR, OSU, ORU
XML Outbound
(existing Send to
State via HD)
New Born
Screen,
others?
MYSIS
CDPHE Domain
Laboratory
Information
System
(LITS)
OUTBOUND from BTS
ORM (MSH, PID, PV1, ORC and OBR)
INBOUND to BTS
ORR ()
OSU (MSH, PID, ORC, and OBR)
ORU (MSH, PID, OBR and OBX)
Integrated Data
Repository (IDR)
Colorado
Electronic Disease
Reporting System
)CEDRS)
Tuberculosis
Clinical
Documentation
System
(TBDB)
App
XML (outbound) file will be sent to BTS when an order is triggered
XML (inbound) file will be sent to HD when clinical order #, lab result status or lab results are available
Potentials Errors
- Getting a HL7 message with an unidentifiable attribute
- Getting a lab result which doesn’t match the clinical order # assigned by Invision
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Version 2.1 (AD)
7/17/06
DM Registry Use – Context Diagram
Provide info
Provide info
.
inf
o
Request info
e
s
Pharmacy
patie
Inform
e
En
tter care
bet gage
ter
se r
vi c
Off
er
lan
Request care
Rx p
Provide be
Provide registry info
Request registry info
fo
st info
3rd party
Disease Mgt
Return in
Hospital
Reque
prov
nt / e
nroll
ide im
t
ber
plain
Mem ibility x
co m
lD
ons
ent
s
resp hospita
/ p re
am
ent
all
d ex
tm
n
a
o rt
trea
k
Rep
ens
k info
/
See
See
pecim tment
ide s
a
Prov ed tre
Prov
Information to improve quality
sion
vi d
D
Pharm
Benefits Mgr
State Health
(CDPHE)
dmis
MA
Researcher
Provide payment
Inform Re: patient
CO
Hospital
Assoc
info
Re
Man port dia
date
b
d M/C etes ca
re p o re
offer
rting
Re
st
que
vi d
da e a
ta gg
r
e
nc
Provider
Office
o
inf
ide
ov
fo
Pr
etes in
st diab
Reque
Request info
Provide info
Provide medical claim
Pr
o
o
inf
Payer
(Private/
Public/CMS)
Provide claim & Dx
rovements
Registry quality imp
Quality Org.
(QIO)
Pr
ov
Pr ide
s
ov
i d e cr i p t
Rx
al
fo
ion
dit
gu
info
in
itional
ad
P
gu rov
ida ide
nc
e
CCGC
ida
u e st
st a d d
ide
Pr
ov
Employer
aim
&
Pa lab
re
ym
su
en
lts
t
Req
Reque
ov
Pr
Prov
ide
sp e
Pro
cime
vide
n
r e su
ide
lts
Cl
Pr
o
External
provider
Request info
Lab
Request info
Patient
Provide info
Diabetes Registry
Local
Health Dept
(LHD)
Request record level diagnosis
Provide line list
Community
Health
Center
(CHC)
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Infolinks Workgroup
September 9, 2006
Provider Office – Patient Care
Registry Creation:
generating electronic data
Patient presents
A
Patient presents
with DM
Registration
Collect history
Insurance?
No
Perform
examination
Refer elsewhere
Review medical
records
Yes
Collect
demographics
Require
more assessment
information ?
Determine PCP
No
Yes
Request
other
external
resources
Triage
Test(s)
Need external
resources?
Yes
No
A
Patient
monitoring feedback?
Yes
Patient monitoring
feedback
Provide in-office resources
(i.e., test blood sugar,
cholesterol, etc.)
No
Refer
patient?
May use flow sheet
Store
Yes
Refer patient
Yes
Create plan &
provide patient
direction
Documentation
of visit
·
Store in tracking system
Chart
Flow sheet
Home cn? list
·
·
·
·
·
Self-monitoring
Follow-up date
RX / Supplies
Use of e-mail for follow-up
·
·
·
·
·
·
No
Store / generate on
own?
Prepare bill
(using ICD-9)
Submit claim
No
Patient care
complete
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