Galen Healthcare Solutions: Allscripts Consultants Enterprise EHR

We recently had the opportunity to assist clients in designing and deploying interfaces to automatically import charges into Allscripts Enterprise PM from not only Allscripts Enterprise EHR, but also other vendor EHRs including Mosaic and eCW. At one particular client, AEPM served as the aggregator for all charges generated in the enterprise. In addition to the inbound charge interface, an inbound demographic interface was required to ensure that the patient exists before trying to interface and import charges for them. Thus with each generated charge in vendor systems, a HL7 ADT registration message was sent immediately preceding the HL7 DFT charge message.

When importing registrations and charges into AEPM, several matching and translation considerations need to be made. In terms of inbound registration, the following list a subset of “linking” items and their respective options for match:

• Patient
  • Name/date of birth
  • SSN
  • MRN
• Policy
  • Policy Reference Number
  • Subscriber Certificate Info
• PCP
  • Default value
  • Cross Reference Link
  • Direct Map (Abbreviation)
• Carrier (Insurance)
  • CarrierID
  • Default Carrier
  • Cross-Reference Link *Note: a cross-reference link can be likened to a translation table – simply translating an input (vendor insurance code for instance) to a corresponding output (AEPM carrier abbreviation)

Additionally, import options exist including the following subset:

• Auto-Import
  • This function will allow for the automatic import of demographics which do not have any data errors or missing cross reference links. Only those patients which pass all of the validations will be auto registered.
• Allow Update of existing Demographics?
  • Answer Yes – if you wish to allow existing demographic information for patients to be changed to match the data that was imported.
• Default to update existing Demographics?
  • Answer Yes – if you will be updating information for all existing patients.
  • Answer No – if you wish to update patients one at a time or if you do not wish to import all of the patients included in the file.

Lastly, we can selectively block certain fields from importing. This will facilitate certain fields in AEPM to be maintained manually instead of receiving update when importing data. An example of this would be for indicating the Patient Student Status, or Employment Status, which may be required for billing purposes.

The following demonstration illustrates the process for importing interfaced charges and demographics into AEPM:

Tags: ADT, AEPM, AIE, Allscripts Enterprise EHR, Allscripts Enterprise PM, Charge, Data Conversion, Demographic, DFT, eCW, Enterprise EHR, Integration, Interfaces, Interoperability, Mosaiq, Practice Management

Our clients environments are both sophisticated and complex, often times with different vendors in the fold for the different healthcare information systems that are utilized by the organizations. For those clients that are Managed Service Organizations (MSOs) or have different sub-entities, this is even more pronounced. Consider for a moment a scenario where an Integrated Delivery Network (IDN) consists of four physician groups under its umbrella. Some of these physician groups were added via acquisition – and as such were using existing systems such as EHRs or PMs from vendors different than those of the organization they were joining. The following mosaic illustrates such a case:

Given the graphic above, one can appreciate the complexity involved with the following core enterprise organizational functions:

• Interoperability – Most systems do not easily interoperate with one another and thus require interfaces to be developed to facilitate communication between the systems
• Patient Matching – uniquely identifying a patient across the enterprise in a system-agnostic fashion.
• Reporting and Analytics – Each of the systems may have different database technologies at their core, and additionally the structure of the data is sure to be different.  This creates a challenge in reporting metrics to exhibit adherence to meaningful use criterion for instance or to
• Trust – Which patient data should be shared across which systems?

A recent presentation at a NEHIMSS last month illustrated these points above and did a great job of communicating how Partners Healthcare is addressing the Healthcare Information System (HIS) mosaic via their COMPASS project. The COMPASS project is an aggressive initiative which implements a common administrative system and processes to streamline revenue cycle management and help manage costs through a “holistic, patient-centric, workflow-driven approach.”

The efficiency of the mosaic of systems (ala Claude Shannon for those EE nerds out there) is subpar at best. But this is the environment organizations find themselves. The alternative would be to consolidate to utilize one vendor across all systems ala the COMPASS project. However, some vendor systems are better at functions than others and the cost for conversion may be prohibitive or in some instances not feasible. For those organizations seeking out advice or recommendations for healthcare information systems, check out the folks at Software Advice as they offer great resources.

Contact us today if your organization seeks assistance with data conversion or integration of healthcare information systems.

Tags: Data Conversion, IDN, Integration, Interfaces, Interoperability, Meaningful Use, MSO, Multi-Org, Reporting

A recent article in Health Management Technology – Poised to touch all things -  highlighted the importance of Picture Archiving and Communication System (PACs) and offered the opinions of where PACs is headed from various leaders within the industry.

Additionally, as presented in a recent article in Health Data Management -  Is a Picture Worth a Thousand Interfaces?: “integrating imaging workflows – and images – in EHRs can be costly. But the benefits keep many trying.”

Many organizations utilizing Allscripts Enterprise EHR are unaware that image integration capability exists, and those that do figure it is too costly to implement.

In this demo, we will present Allscripts Imagelink capability. Imagelink is an Allscripts add-on that can be used to integrate outside systems with Allscripts Enterprise EHR.

More specifically, Imagelink provides organizations access to images and other documents associated with a result from a variety of different systems that have a web-based image viewer - from within the EHR.

With this solution, users of the EHR are presented with the clinical data they need to interpret, comment on, review or validate a particular result – without leaving the EHR application.

Just a few of the vendors we have experience in integrating to the Enterprise EHR via Imagelink include (but not limited to):

• NovaRad
• Stryker
• SCImage
• GE

Be sure to look out for one of our upcoming free webcasts covering Imagelink configuration within the AE-EHR and implementation of corresponding result interface dependencies.

Contact us today to see if your organization can realize the compelling benefits of Enterprise EHR Imagelink integration.

Tags: Allscripts Enterprise EHR, Demonstration, Enterprise EHR, Extensibility, Imagelink, Integration, Interfaces, Interoperability, Meaningful Use, Results Interface

Integrating other web applications into the EHR is a dream for many.

Here, we take the risk calculator built based on the Framingham Heart Study, and integrate it into the Allscripts Enterprise EHR.  With the integration from Galen, the EHR sends the required fields into the Framingham Risk Calculator, like patient age, blood pressure and cholesterol, reducing the data entry and number of clicks for the clinician.

Now’s it’s as simple to calculate the patient’s risk of heart attack, as it is to view their chart, all while in the EHR.

UPDATE: this is now part of eCalcs, the integrated health calculators.

As we mention in the video, the Framingham Risk Calculator is just one example of integrating a website or web application into the EHR.

Galen has worked with groups on many types of EHR to web application integration – what would you add to the EHR, if you could?

Tags: Extensibility, Interfaces, Interoperability, Meaningful Use

One of the “Menu Set” CMS Final Rule Meaningful Use Stage 1 objective and measures specifies that “at least 40% of all clinical lab tests ordered whose results are in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.” Additionally, the Certification Commission for Health Information Technology (CCHIT  - certifying body for EHRs) indicates via IO-AM 07.02 that “The system shall provide the ability to receive and store microbiology laboratory results with organisms recorded as free-text. (Not MU).” This brings to question the handling of interfacing microbiology results into the EHR.

Microbiology results are often longer, textual results including sensitivities. Additionally, microbiology results can have 3 levels of hierarchy:

1. Orderable item(s) (Urine Culture)
2. Culture(s)/Organism(s) (Light Growth Escherichia Coli)
3. Susceptibility(ies) (Amplicillin)

The problem is that most EHRs are not well-suited to rendering interfaced results with three-levels of hierarchy; rather, the EHR is suited for just two levels of hierarchy:

1. Orderable(s)
2. Resultable(s)

When the interfaced result is sent by the vendor as a “discrete” result, the result likely will not render in the EHR properly:

To accommodate for this, most vendors have the capability of sending the interfaced result as “non-discrete,” or in other words, sending a free-text version of the result.  However in an instance where the vendor is able to send “discrete” microbiology results only, the interface analyst is charge with developing a interface customization to translate the “discrete” result to file into the EHR as a “non-discrete”:

The disadvantages of filing the result as “non-discrete” include the likely lack of ability to aggregate or report on these types of results.

For reference the original printed report from the Laboratory Information System (LIS) for the example above (recall that if an interface is not setup, this is the report that is usually provided by the LIS via fax).

Please contact sales@galenhealthcare.com if you or your organization would like assistance in interfacing discrete/non-discrete results to your EHR.

Tags: Allscripts Enterprise EHR, CCHIT, Certification Commission for Health Information Technology, ConnectR, Database, Enterprise Order, HL7, Integration, Interfaces, Interoperability, Laboratory Information System, LIS, Meaningful Use, Microbiology Results

Organizations exploring Computerized Physician Order Entry (CPOE) might first pursue low-hanging fruit and implement an electronic workflow for results and keep a paper workflow for orders. Often times, electronic order entry can be cumbersome for end users and cause longer workflows.  As alluded to in a previous blog article, the benefits of implementing a solicited result interface are compelling – reducing paper and scanning, and offers the capability for automated result tasking.

In the Allscripts Enterprise EHR (AE-EHR), results can tie back to existing orders, facilitating completion of the order. This functionality is enabled and configured within the results interface deployed at a particular group and can be achieved in one of two ways:

• Order Number: the Order Number EXT generated from Allscripts is sent back with the results. The Order Number is tied directly to a specific order – a specific CBC order in a patient’s chart.
• Requisition Number: the Req Number EXT generated from Allscripts is sent back with the results. The Requisition Number is tied one or more orders – all orders on a single requisition. A requisition is defined by the Patient, Encounter, Performing Location and Ordering Provider.

For some organizations, a paper order work flow may be utilized, in which a paper requisition is presented to the lab instead of an electronic order. However, the Laboratory Information System (LIS) may not allow for discrete capture of the Allscripts-generated order number or requisition number. For that matter, the LIS also may not have the capability to send back this number in the result interface (typically a HL7 ORU result message).

Additionally, most organizations encounter a percentage of solicited results that do not complete the order. In the latter scenario, a lab may manually enter the order introducing the possibility for human error and can cause issue with not only reconciliation of the order, but potentially patient or provider matching.

Furthermore, if a lab has to change an order for any reason (for instance, changing the orderable item), the corresponding result will likely not reconcile the order (with the AE-EHR, the correct protocol would be to cancel the order and place a new order with the desired changes).

This situation can cause nightmares for organizations that are trying to gain semblance as to where lab vendors stand in terms of order fulfillment.  Additionally, order reconciliation reporting will likely be inaccurate.

This is especially pronounced in v11 AE-EHR, in which solicited results that are unable to reconcile to the original order create a “reported order.’ The original order is left unreconciled and a “duplicate” order renders in the patient chart:

We have resources available on our wiki to guide an organization through interfaced result-driven order reconciliation and can assist those organizations looking to gain control of order fulfillment and reconciliation. Please contact sales@galenhealthcare.com for more information.

Tags: Allscripts Enterprise EHR, CPOE, Crystal Reports, Custom Reports, Integration, Interfaces, Interoperability, Meaningful Use, Order Interface, Reconciliation, Reporting, Requisition, Results Interface

Currently, exchange of clinical data in and out of the Allscripts Enterprise EHR is facilitated via stored procedures. This  application programming interface (API) approach certainly comes with its downsides. In this article, we propose a re-design of the API to segment out the data and the configuration components of clinical data exchange.

At the outset of an interface project where there has been precedent set (existing Quest or LabCorp <-> AE-EHR order/result data exchange deployments), we almost always get the following questions from the vendor:

• Shouldn’t the interface be the same from client-to-client?
• Why do we need to pay Galen (vendors will often times subsidize the cost of interfaces) to design a known interface deployed across hundreds of clients?
• Why do we need to reinvent the wheel?

Now these are very valid questions. And the response is as follows: Due to the approach utilized with the Allscripts interface API, an interface designer must take care in translating data extracted from outbound stored procedures into a valid, compliant HL7 message the vendor can accept (ORM for orders) and also take care in translating an HL7 message from a vendor (ORU) into a stored procedure call which sets both data elements and configuration options. To help guide the client and vendor through design decisions, Galen provides interface-specific (document, result, immunization) questionnaires.

Back to our proposed re-design: segmentation of the data elements (patient first name, provider ID, order item code) and configuration settings (enable tasking, utilize NPI for provider matching, utilize EntryCode for item matching – setting the traditional form parameters of the inbound stored procedures). With this approach, the vendor is responsible for providing the data elements as they normally do in the HL7 message (ORU for results), and the client sets the configuration settings via a workplace within the TWAdmin context in the AE-EHR – much as they do to set application preferences:

We have covered AE-EHR inbound interfaces quite well, so let’s address proposed re-design for outbound interfaces. Instead of each client requiring a site-to-site VPN and individual interface deployment, what if Allscripts chose some of its top vendor partners (Quest, Labcorp) and offered the capability to exchange out of the box, without the need for one-off interfaces? This approach is somewhat analogous to that of Surescripts acting as the hub and router for electronic prescriptions. In the case of outbound interfaces (orders for our example), there would still be the need to segment data (patient, provider, item) from configuration settings (a setting to enable or disable sending insurance information – IN1 segment of an HL7 ORM order message).

In conclusion the Allscripts clinical data exchange API serves its purpose quite well, but it could do a better job. Much of the functionality is derived from legacy, antiquated methods. Our hunch tells us that in promoting themes of Community Exchange and Connecting, the “new” Allscripts will be addressing this in short order.

Tags: Allscripts Enterprise EHR, ConnectR, Database, Enterprise EHR, Enterprise Order, HIE, HL7, Integration, Interfaces, Interoperability, Meaningful Use, Results Interface, Technical

Last night, my colleagues and I attended a New England HIMSS event in Wellesley, MA covering Mobile Health. After battling through brutal traffic commuting from Boston to Wellesley during rush hour, we arrived and were all equally impressed with the night’s speaker -  Robert Havasy, Business Analyst at the Center for Connected Health in Massachusetts. I particularly liked the presentation technology used for his pitch – Prezi - a web-based presentation application and storytelling tool that uses a single canvas instead of traditional slides.

Some key takeaways from the presentation:

• Will the FDA regulate smart phones or mobile devices and treat them as medical devices?
• Patients are unencumbered by the regulatory process
• Two focus areas for mobile health technology
  • Capturing Data – vitals, blood sugar, etc
  • Coaching – guiding patients to make better choices
• Sunscreen adherence using mobile technology
  • Electronic monitor used to accurately measure usage of sunscreen
  • Reminder texts sent to mobile phone
  • After six weeks adherence rates for the reminder group were almost double that of the control group who did not receive reminder texts: 56 versus 30 percent.
• Utilizing text messaging to influence patient behavior -Center for Connected Health – project in Lynn, MA.
  • Two areas of focus: Opiate addiction and Teenage pregnancy
  • Localization is important – mention people by places and name
  • Who the message was from (especially doctor) meant more to patients that if it were personally addressed to them
  • Barrier to participation – cost – patients were afraid they would have to pay for the additional text messages
  • Unleash the nurses – nurse evangelist sells benefits to non-physician staff
  • Offset workflow changes in offices – take administration off of practice
  • Sustainable reimbursement structure – engage carriers – CMS – insurers – alternative quality contracts
• Northeastern University, working in collaboration with industry players, announced an incubator program for mobile health technologies. Contact Dan Feinberg, Director, Graduate Health Informatics Program at Northeastern University, President at New England Chapter of HIMSS, for more information

Tags: ehealth initiative, Extensibility, Integration, Interoperability, Meaningful Use, mHealth

Last Friday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 2 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference.

Keynote from the Surgeon General – Vice Admiral Regina M. Benjamin

• She covered how Hurricane Katrina affected her community in Alabama and the fact that due to the natural disaster, they were reliant on pharmacy chains to provide a record of what medicine the patients were taking.
• She also touched on a story of how members of her clinic were drying out the patients records after Hurricane Katrina and after they had them completely dried; a fire burned the entire clinic down. This brings to light the need for disaster recovery and collocation in some circumstances. Galen Healthcare Solutions proudly offer a downtime solution in its VitalCenter product.
• After the fire, Bentley college students came down to assist and one of those classes contacted the president of e-ClinicalWorks and convinced him to donate the EHR – integrated with both labs & referrals
• She stressed that prevention is the foundation to the National health System and as such we should be incentivizing prevention.
• She also mentioned how the EHR played a major role in prevention of errors

Getting Clarity – Developing Effective Health IT Policies and Standards

• Need to integrate claims and clinical data to provide total model for exchange
• 15 cents of every dollar in healthcare goes to administrative overhead
• Two key issues for data exchange – identity and consent
• Public Health entities currently receive data, however not every public health entity has the infrastructure to receive data
• How do we pull quality measures out of unstructured text?
  • Analogy of querying for alcoholics, but free text match is returned about using alcohol to swab skin before applying needle.
• The tough part of concerning clinical quality measures is the balance of structured and unstructured data
• Healthcare delivery is complex in that there is heavy fragmentation – 80% are solo or two physician practices
• Dr. John Halamka mentioned that we are the stewards of our own data and architecturally that is the design of the system

Jobs, Jobs, Jobs – Health IT, Business Opportunities, and Job Creation

• Healthcare workers do not have not enough IT in their educational curriculum
• Howard Messing, the President of Meditech mentioned that in Massachusetts in particular the cost of living is a barrier – Meditech actually has commuters from Atlanta.
• Girish Kumar Navani, CEO of e-ClinicalWorks indicated that they currently employ greater than 1000.
  • He anticipates hiring 500 new workers over the next 2 years for programming and business analyst positions
  • He also mentioned the analogy of the electrical socket – broadband network need to be as irreplaceable in physician office as the electrical socket.
  • He believes there is a need for a  new type of worker, the knowledge worker, who understands workflow and is able to analyze and make better decisions about population health
• Richard Reese, Executive Charmain of the Board, Iron Mountain, anticipates helping hospitals clean up paper mess.
  • He mentioned non-compliance in healthcare IT to storage and backup standards
  • Lesson in compliance can be drawn from Wall Street years ago and that healthcare organizations must design for workflow, but compliance as well
• Brad Waugh, President & CEO at Navinet, indicated that the network his company providers connects payers and providers, saving $800 million per year.
  • They currently require Microsoft .NET certified engineers and have over 30 openings
  • He indicated that the educational system must produce the folks needed in healthcare IT and currently it is just not doing so domestically
• This discussion brought to light a deeper seeded issue in American society in that as a society we are not pushing computer technology anymore as it is no longer the glamorized industry.
• There is a major need for qualified issues and it is a supply versus demand issue with the roots in education and society.
• One member of the audience mentioned that the goal of healthcare reform is to eliminate costs and the irony is that in a sense we are creating jobs to eliminate jobs
• Another member of the audience commented on the arrival of programs for night healthcare professional courses, much like it was the trendy thing to get a night MBA in the 90s
• Finally the point was made that by the middle of the current decade, we will be facing baby boomers hitting Medicaid and the amount of care they need is incredible. With less dollars, we will need to re-engineer the system and what could come as a result is care rationing

Panel: Successful HIEs – How They Did It and How It Helps

Fallon Clinic HIE

• Emergency care was the highest reason for HIE usage
• Some quotes from physicians on the value the HIE provided
  • “Importing the CCD expedited documentation”
  • “Reduced need to ask patients questions”
  • “Expedited verification of medication and allergy list”
  • “Saved time”
  • They estimate phone calls were avoided for 75% of hospitalist and were extremely beneficial for new patient visits
  • They estimate they spent 3 years and $3 million learning and developing “trust” and $1M in building and implementing in the final 2 years
  • Lesson learned:
    • They pre-registered all of their patients in the community (bulk-load) and this helped with performance as they didn’t have to query the state
    • They felt the key to sustainability was to reduce operating expenses
    • Each organization in the HIE was responsible for server maintenance – ends up being $2000/year/organization which represents rounding error in most healthcare IT budgets
    • Key points – earn trust – utilize real-world workflows – value of low cost

Indiana Health Information Exchange

• Federated data model – 62 hospitals – 3 billion structured results – doubling time of 4 months
• They meet the providers where they are whether it be delivery of data to the EHR or physicians receiving data as PDF or view into a portal
• They view sustainability in the sense of funding via offering services
  • work with public health services for syndrome surveillance and track immunizations
  • Their business model for sustainability is such that scale is needed and again they emphasized avoiding grants for operational costs.

NEHEN

• Their sustainability model is such that their organization provides governance – decide what has value – much as a board of directors would
• Federated model works better than centralized – more accepted in the marketplace
• Lessons learn include integrating processes across the enterprise
• The case of the transfer of information to public health is needed to sustain HIEs as well as the capability to sell other products within the network.

Tags: Adoption, Business Continuity, HIE, HL7, Immunizations, Integration, Interfaces, Interoperability, Meaningful Use

Last Thursday, I attended Governor Deval Patrick’s HIT conference in Boston and present my own musings and takeaways from day 1 of the conference. Be sure to check out Dr. John Halamka’s reactions from last Thursday morning’s CEO summit at the Govenor’s HIT Conference and look for a recap of day 2 of the conference on the Galen blog this Wednesday.

Keynote Address: The State and National Vision for Health IT and HIE

Dr. David Blumenthal, National Coordinator for Health Information Technology – U.S. Dept. of HHS,  presented his own anecdotal experiences with the EHR, namely a story of how he was going to prescribe a patient a drug containing sulfa, yet the clinical decision support software in the EHR flagged him for a drug-to-drug interaction. If CDS tools within the EHR not available, would the pharmacist have caught this? Could the patient potentially been adversely affected?

Dr. Blumenthal then elaborated on two key components to which he felt would impact behavior via policy: writing regulations and spending money.

Regulations

• There have been 2000 comments received on the Interim Final Rule, with the publication of the final regulation anticipated by the end of the spring
• No comments questioned the conceptual framework nor the direction of Meaningful Use.
• The framework of Meaningful Use consists of 5 domains – quality, efficiency, patients & family, coordination of care, protection and security
• In speaking of the Interim Final Rule, Dr. Blumenthal utilized the analogy of an escalator – allow providers ease of introduction and steps for clear path of usage while lowering barriers to entry.
• Information Exchange – infrastructure is poorly developed for information to follow the patient and thus policy needed to address this. Certification will be the key to interoperability and with tighter standards, HIX should be more interoperable.
• CLIA (Clinical Laboratory Improvement Amendments): Currently, legacy regulations are being addressed such that the barriers to LDX (Laboratory Data Exchange) can be removed.
• Privacy & security: Providing authorities with the means of penalizing individuals and organizations for violations to ensure controls, access, protection

Spending money

• Regional Extension Centers (RECs) are currently modeled after US agriculture, which was intended to disperse new info to the family farm. The goal is to ensure that HIT is reaching the family physician and providing advice in terms of selection and implementation.
• Focused on <10 provider practices such that the full benefits of HIT can be reaped by the practice. Facilitation of re-design of work flows and mobilization of information for quality and efficiency improvements
• 50 states have been funded to promote RECs.
• Different localities will have different solutions for health information exchange (HIX)
• 70 community colleges were funded for workforce training and it is anticipated this will facilitate staffing of RECs

Next Year: Direction

• Implementation
• Finalize requirements for Meaningful Use
• Beacon Community Program – Fund 15 communities around the country directly through a grant program with the intent to offer a source of lessons and inspiration. There have been over 130 applicants to the program thus far.

F/U Questions/Concerns

• Physicians are worried that HIT happens to them, not with them and that users not intimately involved with the design

Panel – Consumer-Centric: The Role of the Patient in Health IT and HIE

• John Moore from Chilmark Research introduced term the term “citizen” as the term patient can often be paternal. He mentioned a John Halamka quote – “automating bad processes will not lead to improvement”.
• David Szabo, a partner, Edward Angell Palmer & Dodge brought up the point of how do we go about engaging citizens and brought up some serious concerns over privacy, especially in regards to patient portals. The topic of behavioral advertising in PHRs was brought up and it was mentioned that  FTC may provide governance to this regard.
• A question was posed about those surveyed and focused on in regards to Healthcare IT in that they are predominately affluent and white. John Moore responded with mobile health technologies being the enabler to reach all demographics and minorities.
• A comment was made concerning the power of secondary data to pre-populate EMRs. Barbra Rabson, Executive Director, Mass Health Quality Partners, provided a response and brought up a cautionary tale in the highly publicized case of e-patient Dave as published in the Boston Globe.
• To touch on concerns about patient security and privacy in regards to the Personal Healthcare Record (PHR), John Moore also brought up a really cool Massachusetts company called “Patients Like Me”  and highlighted the fact that through this vehicle,  “citizens” currently share their healthcare stories and experiences.

Regional Collaboration Meetings (CT, ME, MA, NH, RI, VT)

Later in the afternoon a breakout session allowed public officials to meet with neighboring states to discuss current plans, areas of concern, regional interoperability and opportunities for collaboration.

• NESCO (New England States Consortium Systems Organization) represents a business model built around collaboration and their Deputy Director, Nancy Peterson, acted as the facilitator.
• The idea of health delivery system reform was immediately brought up in that the system incentivizes and currently pays for sickness instead of for health via preventative and behavioral care.
• The model of the state of ME was addressed. Currently they have an operational provider-only HIE available to facilitate treatment improvement and representative of six of the largest healthcare systems in the state. The HIE, established in 2004 and live as of the summer of 2009, covers 50% of the hospitals 46% of ambulatory care.
• Some of the questions and comments posed by the audience included the following
  • How do we bridge between standards?
  • The business case needs to be established as this will drive investment. We need to clarify a vision and clearly express the financial incentive model.
  • Challenges with the business case in that savings on one side put costs on another.
  • We need to attack some of the low-hanging fruit first by implementing a common consent framework.
  • Ownership of the data: Who owns the data? The patient?
  • HIEs need to be consumer-driven.
  • Are we focusing too much on the standards with meaningful use, whereas we should be focused on the transport and the “network”?
  • Where are the interconnections in healthcare delivery that have the highest yields in terms of clinical data?
  • We face the underlying competing entities in clinical standards versus claims standards. Integration of the two needs to be addressed.
  • We are up against perverse incentives as there are many other resistive forces towards HIE, namely disincentives, in the health system.

Tags: EHR Implementation, HIE, HL7, Integration, Interfaces, Interoperability, Meaningful Use, RHIO