Massachusetts: Transforming the Healthcare Economy

1. Massachusetts: Transforming the Healthcare Economy John D. Halamka MD CIO, Harvard Medical School and Beth Israel Deaconess Medical Center

2. Massachusetts Healthcare IT Organizations • Massachusetts Health Data Consortium • Massachusetts eHealth Collaborative • New England Healthcare Exchange Network • Massachusetts Technology Collaborative

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4. CDX Rx Gateway • Publishing Service • Pharmacy Directory • Formulary Service • Record Index Management Core Gateway • Drug Eligibility • Record Locator Service • Medication History • Security • Trading Partner Registry • Logging • Validation • Translation • Routing • Guaranteed Delivery • EHR Adaptors • eRX Adaptors • XDS Repository Adaptor • Prescription Routing NEHEN • NEHEN Express • Direct Data Entry • Billing / PMS Adaptors • ADT Adaptors The NEHEN Appliance • Built on a common messaging gateway framework • Placed on the network of each participating institution

5. Hosted Portal • Hosted by service provider (MA-SHARE) • Provides document / data storage, HTTP viewing for subscribers, and common provider index for dissemination to local gateway participants • Network Subscriber • No infrastructure support requirement – just Internet connection, fax or e-mail Local Gateway Participant • Local Gateway Participant • Local gateway users control integration, etc. • Can leverage infrastructure for internal integration • Interfaces can be direct or use interface engine or similar tools Internet / Network Architecture Overview Published Patient Data Published Patient Data EMRs and Other Enterprise Systems Interface Engine or Portal Interface Engine or Portal EMRs and Other Enterprise Systems Local Provider Directory Local Provider Directory HIE Application Server / Gateway HIE Application Server / Gateway CCD Standard Messages, e-mail or fax encapsulation Secondary Local System Secondary Local System E-Mail Server Web Server Fax Server Fax Server Web Server E-Mail Server Summary / Results Viewer Summary / Results Viewer CCD Standard Messages, HTTP encapsulation E-mail, fax or HTTP encapsulation Summary / Results Viewer Published Patient Data Web Server E-Mail Server Fax External Networks Community Provider Directory HIE Application Server / Gateway Printer

6. Visit/Discharge Summary ExchangeSend / push / route hospital data to interested parties • As a result of a referral, admission, or emergency, patient registers in hospital • Patient receives care and details are noted in hospital medical record • HIE service checks provider directory for routing instructions • Standard format discharge summary or ER report is transmitted to HIE network • Consents and provider routing preferences are sent to HIE service • Patient is discharged from hospital • Patient visits PCP or specialist and establishes trusted relationship and consents for release of data • HIE service routes discharge summary to PCP, specialist or other interested and trusted party (e.g., health insurance case manager)

7. ReferralsSend / push / route visit and other data in support of referral consultation • Provider refers patient to a specialist, hospital or other provider for consultation or service • HIE service checks provider directory for routing instructions and sends referral request with pertinent patient information / history, diagnosis and service requested to consulting provider; business rules can be stored in HIE service for elements of real-time decision support • HIE service submits referral authorization request to payer for approval and referral # • Standard format visit summary with consultation notes transmitted to HIE network • HIE service routes visit summary to PCP, specialist or other interested and trusted party (e.g., health insurance case manager) • Patient visits consulting provider, receives services, and details are noted in patient chart , electronic medical record or other result is created (e.g., at lab) • Patient visits PCP or specialist and establishes trusted relationship and consents for release of data; consents and provider routing preferences are sent to HIE service

8. Admission NotificationSend / push / route admission notification to payers and providers • Consents, provider routing preferences, and admission notification notice are sent to HIE service • HIE service checks provider directory for routing instructions and sends admission notification to patient’s preferred payer and provider • Patient visits hospital or other provider and establishes trusted relationship and consents for release of admission notification data • Authorized payers and providers are notified of patient hospital admission

9. Laboratory Results • Consents, lab results, and provider routing preferences are sent to HIE service • HIE service checks provider directory for routing instructions and sends laboratory results to patient’s preferred provider • Patient undergoes tests from his or her physician, establishes trusted relationship and consents for release of laboratory data • Authorized providers can access patient’s laboratory results

10. Standardized Quality DataSend / push / route visit and other data for standardized quality reporting (and other reporting) • Consents, provider routing preferences and applicable data are sent to HIE service • Standard format visit summary or batch with data for determining quality metrics is sent to payer, government agency or other quality metrics organization based on patient consent and business rules in HIE service • Patient visits PCP, specialist, hospital or other provider and establishes trusted relationship and consents for release of data

11. Community Provider Directory • HIE service consolidates organizational provider information into a single community provider directory • Provider organizations track and maintains internal provider directory • Provider information from each provider organization is sent to HIE service • Authorized HIE users can access community provider directory

12. Healthcare / EHR Delivery Challenges 7

13. EHR Systems Overview 26