S ecure A rchitecture F or E xchanging Health Information in Central Massachusetts

1. Secure Architecture For ExchangingHealth Information in Central Massachusetts Larry Garber, M.D. Peggy Preusse, R.N. June 9th, 2005

2. Central Mass Health Information Organization: • Fallon Community Health Plan: largest payer in central Massachusetts, 172,000 members • Fallon Clinic: group practice with 240 physicians, 26 sites, and over 1 million patient visits per year • UMass Memorial Health Care: 1,500 physicians, 12,000 employees, multiple hospitals, primary care practices, ambulatory outpatient clinics, long term and home care facilities, and a 700-member faculty group practice

3. Objective • Build and operate a regional health information exchange infrastructure to securely enable real time aggregation and presentation of patients’ health information from multiple different organizations with integrated decision support in order to improve patient safety, quality of care, and efficiency of healthcare delivery.

4. High Level Design Goals • Preservation of data and transaction ownership • Secure • Protects patient privacy • No central clinical data repository • No central demographic repository • Scalable and high performance • Interoperable with other local health information infrastructures and the National Health Information Infrastructure. • No rip and replace – leveraging existing systems • Integrates into physician workflow

5. Levels of Participation • Portal access – web browser access to display patient information • Practice management system – medical summary prints out automatically when patients arrive • EHR integration – One or two-way integration with existing information systems to display patient information within those systems and supply data to the SAFE Health network. • Clinical information supplier– Ancillary systems or health plans that feed patient data to SAFE Health network.

6. Architecture

7. Electronic Health Record Portal

8. Development Status • Developed: • Federated distributed MPI with probabilistic matching • Clinical messaging with HL7 and Web services • User Authentication • Audit trails and transaction logging • In Progress: • Support industry standards HL7 CDA, CCR, etc… • Clinical data repository for local organizations • Web portal • Smart data routing to minimize network traffic • Data subscription/publication

9. Some Design Issues • Patient matching • Data standards • Patient Opt-out • Audit trails • HIPAA vs. State regulations • Interstate issues

10. Timeline • Proof of concept – completed • Alpha pilot with Technophiles– Fall 2005 • Textual notes • Billing diagnoses • Medication History • Beta pilot – Winter 2006 • Limited # of diverse MD’s • Live – Summer 2006 • Expand to Allergies, Radiology, Labs, etc…

11. Q & A • For more information, please visit: http://www.safehealth.org • Contact info: Fallon Clinic 630 Plantation Street Worcester, MA 01605 (508) 852-0600 Lawrence.Garber@Fallon-Clinic.com Peggy.Preusse@Fallon-Clinic.com