ACS Update TFQ Quarterly Meeting April 9, 2008

1. ACS Update TFQ Quarterly MeetingApril 9, 2008

2. Provider Benefits • Web-enabled EHR solution for providers without an EMR • Enable push/pull interchange of data for providers with EMR systems • Provide data sharing for providers without HL7 capabilities • Push Care Management Alerts and Reporting • Share data among various systems to present a full EHR record on a patient. • State Data • Public Agency Databases • Payer Data • EMR Data • Provider Data

3. Development Completed • Established transactional database and code to support real time HL7 • Completed Data request and response with BCBS • Established application database and code to support real time data exchange • Created CCD (Continuity of Care Document) HL7 standard Patient History Transaction to EMRs • Currently Actively Testing with BCBS on data exchange • Data recently received from EDS (Medicaid MMIS data). Applying data and data mappings • Screen Design Complete; Coding underway • Completed Draft ADSS workflow coding; Beginning ADSS Workflow Testing • Test Case Creation proceeding • EMR Connection Security Coding Underway

4. High Level EHR Data Design Data is pulled in real and batch modes from several sources to enable a full Patient record to be displayed in the system

5. Health Information Exchange HL7 is promoting it as THE mechanism for routing a PHR record within clinical systems EMR systems will send an HL7 request for the CCD/CDA document. The ACS system will receive the HL7 request and send back an appropriate CCD response contained within an HL7 transaction. CCHIT certified EMR systems must be able to handle the CCD and CDA documents QTool System is seeking its CCHIT Interoperability certification after the Test Cases are released late 2008

6. EMR Testing Status • 4 EMR systems are actively being worked with to request and exchange and CCD • Weekly Meetings take place to check Pilot EMR status and questions on CCD • EMR Next Steps: • ACS CCD with Narrative Section • 4/16 • ACS Implementation Guidebook Updated with Security Section Information • 4/18 • ACS EMR Testing 1rst Round • End of April • ACS EMR Testing – Full Security Model • Mid May

7. Components of CCD/CDA Health Record Components • Patient History • Medical History • Medication History • Vital Statistics • Lab Results • Clinical Alerts • Medication Therapy Alerts • Case Management/SOAP notes CCR – CCD – THR = Support of Patient Summary Information

8. BCBS Testing • Provided CCD specifications for delivery of data • Actively Working with BCBS since Jan • CCD testing Successful • Able to request and receive a CCD of BCBS data real-time for qualified BCBS InfoSolutions Providers who make a request in our system • QTool Providers must identify their BCBS InfoSolutions Number to the System for the system to send to BCBS during Patient data requests • Part of QTool Administrative Set Up for Providers • Only Authorized BCBS InfoSolutions Providers may have access to data • Starting Load Testing

9. User Acceptance Testing (UAT) • First Round of Testing – Read Only Patient Screens • Mid May • Second Round of UAT Testing – Data Entry and Site Administration • Early June • UAT Testing • Comes after ACS Internal System Testing is complete and has passed Test Criteria Guidelines (at least 80% of Test Cases Passing) • User Acceptance Testers • Need core group of State and Provider Volunteers • ACS will provide core Test Case Scenarios to Execute • Testers will have access to a special UAT Test Environment • Test different roles, User Interface screens, and data searches, and data combination and presentation within the system

10. Phased Pilot Timeline

11. Pilot Release (1.0) (June) • Initial Pilot functionality to include: • Enable system to support HL7 Patient History Transaction exchange with other EMRs • Selected EMRs are: MdSoft, Children’s Health System, EHS, Docworks • Enable system to exchange Patient data HL7 Patient History Transaction in standard, secure format with BCBS • Provide Q Tool Patient Web Application for Providers • Provider Q Tool Web Application User Administrative and Site Search Screens for Providers • Master Patient Indexing Logic to ensure Patient unique identification • Enable Care Management Rules in System and display alerts to Provider • Enable ADSS Workflow functionality

12. Release (1.1) (August) • Enable the Provider Message Center Functionality in Q Tool. This includes the following functions: • Add Prior Authorization feed from HID (batch) • Add E-RX functionality from system • Surescripts Certification is required. • Add Internal Referral functionality and ability to E-mail outside Referrals to other providers • Enable ADSS Audit Functionality • Integrate ADSS workflow in TFQ EHR system

13. Release (1.2) (Sept) • Enable Patient Provider Encounter Workflow (SOAP) • Allow providers to enter and view patient visit records using template-driven logic and calculate supported office billing codes • Enter patient Chief complaints, • Subjective analysis • Objective analysis • Review of Systems • Physical Exam • Plan of Care • Patient Encounter Summary • Links to Referrals from Encounter • Links to E-RX from Encounter • Enable Provider Dashboard (Provider Comparison) Reporting • IMMPRINT Exchange

14. Proposed Provider Dashboard

15. Provider Reporting • Application will allow for CCD to be printed for Each Patient • Short Version of CCD (Recent History Patient Report) • Provider Patient Reporting Data • Data available will include all real time and batch resources • State and Provider Profiling Data • Will include only Provider Entered and Batch data Stored in the Database

16. Patient Care Standards Report

17. Provider Encounter (SOAP) ACS will be distributing SOAP Design for TFQ Provider Review

18. Demo • Demo of Preliminary Screens

19. Alerts – Asthma and Diabetes • Patient Care Alerts Available for Clinical Decision Support • Over 500+ available clinical rules in ACS Rules Engine based on standard guidelines • Asthma • Diabetes • Includes lab values • Immunizations (Seasonal) • – Influenza, Pneumococcus

20. Alerts

21. 68 Days and Counting !!! • Training • Will include Individual and Group Training Sessions • Training Materials and Help Desk will be available • Tight timeframe < 68 Days till Pilot Go-Live • System Success Needs from Providers: • Commitment to Testing • Commitment to Training • State and ACS will be setting up Training Schedules Soon • Commitment to EMR Connectivity Set up and Testing