From HELP2 to EDEN via HL7: EDRS interoperability in Utah.

1. From HELP2 to EDEN via HL7: EDRS interoperability in Utah. Jeffrey Duncan and Barry Nangle NAPHSIS Annual Meeting St. Louis, June 2010

2. Acronym Translator • EDEN = OVR’s EDRS • HELP2 = IHC’s EMR • HL7 =US standard for HIE

3. Presentation Outline • The problem: why EDRS are often not real time. • How Health Information Exchange could help. • Utah’s private/public approach • Interoperability project update

4. Current Death Registration Workflow Is MD EDEN user? FD initiates EDEN record (demographics) MD certifies death certificate in EDEN Yes Death FD = Funeral Director MD = Physician LHD = Local Health Department No FD prints paper death certificate LHD registers death Death is reported to NCHS FD delivers to MD Office MD signs Paper Certificate (cause of death) FD delivers to LHD LHD keys Paper certificate into EDEN Drop-to-paper process

5. EDRS Participation in Utah • Virtually 100 % Funeral Director participation • Only 545 of approximately 5,000 physicians participate. • Medical certification is all electronic in 60 % of cases, Feb. 2010.

6. Reasons Physicians Do Not Participate • About 75 % of physicians that do certify do <1 death certificate per year. • They account for about 35 % of all DC’s • Difficult to maintain EDEN skills • Lack of incentive

7. Interoperability with the EHR: a Market-based Approach • “Mandates” unwelcome in Utah healthcare • Legislation requiring physician EDR use rejected in Committee • Public Health does adopt standards for electronic health information exchange

8. Partners in CDC-funded Demonstration of EMR/EDR Interoperability • Office of Vital Records and Statistics • Modified EDEN to Accept HL7 message • Intermountain Healthcare • Cause-of-Death module in Help2 EMR • Utah State University • Developed matching algorithm

9. Intermountain Market Share • Provides healthcare to approximately one-half the Utah population. • During 2007-2009, Intermountain physicians certified 39 % of Utah deaths. • 52 % of Electronic certifications (within EDEN) come from Intermountain physicians.

10. Use of EDRS by Intermountain Physicians Grouped by Number of Deaths Certified per Month

11. Transmit Cause of Death Certification From EMR to EDEN Intermountain HL7 Message Server Cause of Death Interface Intermountain EMR HL7 Over VPN Tunnel UDOH HL7 Message Server (Rhapsody) EDEN Master Database EDEN Cause of Death Table Matcher & Merger

15. New Death Certificate Workflow With Electronic Interface to Intermountain EMR Death New Intermountain process FD notifies MD that cause of death data is needed FD initiates EDEN record (fact-of-death) MD enters cause of death data in EMR Is MD an EDEN user? No Data transmitted electronically to state Yes OVRS matches MD-provided data against FD-provided data to complete record MD certifies death certificate in EDEN LHD registers death FD = Funeral Director MD = Physician LHD = Local Health Department Death reported to NCHS

16. EDEN Matching Flow Chart Front-end Matcher Matching Request Candidate-set Matching Rules Candidate Set Builder EDEN Master Database Application Program Interface Candidate Set Classification Rules Classifier Result Set

17. Workflow Among Matcher, Merger, and Deferred Match Resolver Cause of Death Table Matcher EDEN Master Database Cause of Death Data Loader Merger Deferred Match Table Deferred Match Resolver

18. Physician Login to EDEN Through UHINet Web Interface UHINet Web Interface https redirect to EDEN https POST with physician identifying information, UHIN server login and password EDEN User Table EDEN Web Interface