Development of a Single Patient Database/EMPI for a Hie

1. Development of a Single Patient Database/EMPI for a Hie Subrata Behera, Nancy Casazza, Martin Coyne, Cornelius Jemison, Abby Zimmerman Northwestern University Med Inf 403-DL

2. What is an hie? • Provides a platform through which data can be shared across various disparate healthcare systems for day to day operations • Helps to achieve a higher standard of patient care by utilizing the EMR so to maintain patient continuity of care across multiple providers • Provides participating systems with a reduction in costs associated with duplicate testing and the locating of missing patient information

3. Barriers to hie • Consumer’s fear of security problems and providers fear of liability • Reluctance of providers to share information • Insufficient leadership at the federal, state and local levels • Relatively high costs • Lack of sustainable business model, particularly in the current economic environment

4. Background • There are many HIE’s in US which allow the sharing of clinical data across a geographic location. • For this particular project we will be using the example of Healthbridge which serves the states of Ohio, Kentucky and Indiana. • Founded in 1997, Healthbridge is a non-profit organization and its provides connectivity for more than 28 hospitals, 5500 physicians, 17 health departments, 700 physician offices, Nursing Homes, Labs, and radiology centers.

5. Current functions of Healthbridge hie • Sharing of clinical data across various EMR applications • Sharing of ED discharge summaries with outpatient physician offices/clinics • Sharing of lab and radiology results performed at independent companies such as Labcorp • Provides a physician portal that enables physicians to view patient results, even if the office does not contain an EMR

6. Identified Problems • When sharing clinical data across healthcare systems each healthcare system: • generates its own set of ID’s • these numbers are not shared or stored in other systems • Individual IDs produce issues with patient validation resulting in: • manual intervention to correct HL7 messages • this manual intervention leads to erroneous data

7. Proposed solution • Create an Enterprise Master Patient Index (EMPI) which is maintained by the HIE • Create algorithms which will assign weights to each individual demographic criterion (this will be utilized in the patient matching logic) • Results are returned only if they are above a certain threshold

8. Why this solution? • Analyzed various EMPI systems currently on the market and the drawback to the various systems are that they are vendor specific, thus lead to difficulty with interoperability • This solution would be open source, having the ability to be utilized by existing vendor products with little modification

9. Proposed Workflow • All information requests will pass through the HIE • The HIE will query the EMPI with demographic information present in the HL7 message • The attributes of Patient MRN, Name (F, L, M), Date of Birth, gender, SSN will be utilized for each query • Each attribute will have an associated weight attached to them

10. Proposed Workflow cont. • The EMPI will respond to the query with the sum of weights for all the attributes • The query will then provide zero to many results • If the query does not return a possible match then a new entry may be created in the EMPI and the new ID will be relayed onto the application

11. Steering Committee development Representatives of HIE stakeholders • Single Identifier Developer Contractor • Hospital participants • Payor participants • Ancillary service participants • Monthly meetings during first 6 months • Quarterly meetings after implementation for first year

12. Development Budget for first 6 months ITEM Project Manager (0.50 FTE) Programmer/Designer (0.50 FTE) Implementation Manager (1.0 FTE) Trainer (1.0 FTE) Manual Documentation Assistant (0.25 FTE) Implementation: Travel, Hosting Admin support (0.25 FTE) COST $55,000 $50,000 $40,000 $30,500 $15,000 $6,250 $12,500 TOTAL: $195,750

13. IMPLEMENTATION (first 6 months) • Presentation of design/specifications to Steering Committee • Implementation Plan development • Presentation of Plan to Steering Committee • Formal introductory lecture to general stakeholders • Pilot implementation 2 sites • Review of implementation to Steering Committee • Implementation 4 more sites • Review of implementation experience Summary report and request for “going live” from stakeholders

14. IMPLEMENTATION QUESTIONNAIRE • Objective • Average response time • Accuracy retrieval • Subjective( scale 1-5) • Impact on workflow • Ease of use • User satisfaction

15. Training • Development of training manual • Distribution of training manual • Formal lectures explaining training manual • Small group “hands-on” training sessions

16. Application methodology • Request Application Development Domain from Google App Engine Cloud Services. • Design JAVA Database Objects (JDO) Objects that will persist in Google App Engine Cloud Services based on business case provided by business process owners. • Utilize RESTLET, an open source framework for RESTFUL based webs services, and Design REST based web services that integrate with JDO objects for the patients and providers.

17. ERD for EMPI database Model

18. Person RESTFUL Web service - http://med-404-hie.appspot.com/r/person

19. Infrastructure model

20. HIE Website http://med-404-hie.appspot.com

21. testing • Tested utilizing common JAVA source library sets like JUNIT • Any system errors received on the application side will be managed by the community support systems • Internal errors will be managed by the medical providers IT systems • Providing users with a web page to test sent data and also the ability to test system responses when there are problems with web services

22. Security**** need assist • HTTPS, Providers will only be able to access the URL • Standard ID and authentication controls will be utilized • Data will only be stored on system servers • In event of a patient emergency will utilize break-glass to elevate privileges http://www.ihe.net/Technical_Framework/upload/IHE_ITI_Whitepaper_Security_and_Privacy_2007_07_18.pdf

23. BUSINESS CASE • Elimination of test duplication (ROI) • Labor (patient, employees) (ROI) • Improved Patient Satisfaction • Improved Provider Satisfaction • Improved Quality of Care

25. Need assist • Do we need to add a demonstration of the site at the end?