Colorado Health Information Exchange COHIE

1. Colorado Health Information Exchange (COHIE) David W. Kaplan, MD, MPH Professor Pediatrics University of Colorado School of Medicine Chief Medical Information Officer Childrens Hospital 1056 E. 19th Ave. Denver, C0 80218 Voice: 303-861-6133 E-Mail: kaplan.david@tchden.org

3. Colorado Health Information Exchange (COHIE) Consortium founding members Shared mission of training health care providers: The Children�s Hospital Largest provider of pediatric specialty care Denver Health 150,000 Denver residents (25 % of the population) Kaiser Permanente of Colorado Third largest HMO in the State University of Colorado Hospital Largest teaching hospital in Metro area Advanced IS and IT with robust EHRs (e.g., Epic, Siemens)

4. RHIO Vision

5. Just a Few Questions How do we link all of these different systems? How do we secure transmissions among over the internet? How do we identify the different 200 Mary Chavezes living in the state of Colorado? How do we eliminate duplicates? How do we combine clinical data from two patients that appear distinct but are the same? How do we handle 5,000 inquiries a day? How do we view the data? What clinical data do we want to display? How do we normalize laboratory data from different labs? How do we combine problem lists from various institutions? How do we develop a system robust enough to display large MRI records? How do we assure that allergies are correct? How do we know if the list of medications is current or old or whether the patients actually took them or not? How do we capture immunizations from various providers? How do we organize documentation? How do we filter documentation by specialty? How do we obtain nonstandard clinical studies? How do we lock confidential-sensitive data such as HIV status, psychiatric history, sexually transmitted diseases, pregnancies, and abortions? What standards do we employ? How do we authenticate bona fide users?

6. Just a Few Questions How do we let patients view their own data? How do we prevent intrusion by hackers and viruses? What do we do about HIPAA? What type of business agreements are needed? How should the governance be structured? Who gets a seat at the Board of Directors table? How do we deal with government regulation? Who should be included as partners? Should we include both for profit and nonprofit hospitals? Do we include health plans, and if so, which ones? What clinical practices do we include? What do we do with clinical practices that do use an electronic medical record? Where do we draw the line on interfacing to one-of-a-kind, small practice EMRs? How do we capture lab tests done in physicians� offices? How do we pay to establish the system? How do we pay for sustaining the system? How do we do clinical research and obtain patient consent? Do we need a data repository for research? How do we apply decision support without having a data repository? Is it necessary to have a psychiatric evaluation before embarking on this project?

7. Connecting Clinical DataIssues that need to be addressed Architecture Master Patient Index Master Interface Engine Institutional Interface Engines Web Results Viewer Scalable Applications Data Elements Demographics, Problem List, Diagnoses, Lab, Radiology, Medications, Allergies, Immunizations, Documentation, Admission, Discharge, Outpatient, ED Other Clinical Studies: EKG/Echo, PFTs Insurance How to block confidential/ sensitive data: HIV, Psych, STDs Decision Support Standards: HL-7, XML, SNOMED, LOINC Security Secure data transmission User authentication: passwords, biometrics Patient authentication Hackers/Virus Legal and Regulatory Business Agreements, HIPAA Governance Government Entity, University, 501c3 Board of Directors � who gets a seat? Partners Health Plans, Labs, Insurers/Payers Patients Hospitals For Profit, Non-Profit Providers, Clinical Practices Small, Medium, Large Funding Initial � proof of concept vs. sustainability Research Health Services, Public Policy

8. Project Phases

9. The �Primary� Scenario Clarifies the scope (common understanding) Provides a structure to focus meetings and discussion. Creates a mechanism for logging issues and decisions