Welcome to the Champ Software Topical Webinar Series!

1. Welcome to the Champ Software Topical Webinar Series! Data Exchange for Public Health • To join the audio portion: • Dial toll free: 1-855-244-8681 • Enter access code: 664 403 537 Presented by: Nicole Sowers

2. Agenda: • Options for Exchanging Data • Direct Secure Messaging • Continuity of Care Documents • HIE • CCDs • ADT feeds • Immunization Registry Exchange • Benefits of Exchange • Challenges of Exchange • Kathy Burski – Kanabec County’s Experience • Greta Siegel – Douglas County’s Experience • Questions and Discussion

3. Direct Secure Messaging • Direct is the term given to a national encryption standard for securely exchanging clinical healthcare data over the internet. • Direct, in the context that we are using it refers to sending emails using national standards for security. • There are many companies that offer Direct email. Today, Nightingale Notes is able to display the Inbox for Inpriva (company name) HDIRECT-MAIL (product name) email. Let’s take a look at how this works, starting with a diagram of the process.

4. Inpriva has a web site where you can log into you secure email. From here you can send/receive/delete/move to folders Available to MN clients only at this time. In Nightingale Notes, when you have an Inpriva account, we can help you set it up to see your Inpriva inbox within NN and from here you can take files you receive and attach them to a client in NN.

5. More about Direct • To send a Direct Secure message, the sender and the recipient need to be in the Direct email directory. How many times can you say “direct” in a sentence?  OR • If the recipient is not in the directory, meaning they don’t have a Direct secure email OR they are using a Direct secure email from another vendor (not many secure email providers share directories yet) then: • The recipient will get an email message saying you have a secure email waiting for you. They will get a link with a temporary login to get to the secure email server and get the text and any attachments.

6. Continuity of Care Documents • CDA – Clinical Document Architecture. This is a set of standards that tells us how any clinical document should be structured for exchange. There are many types of clinical documents that use this CDA standard. One of those is the Continuity of Care Document (CCD). • Stage I Meaningful Use included a CCD as an acceptable format for clinical care summaries. • A CCD can contain: • Header (name, address, demographic information) • Problems • Procedures/Diagnosis • Family History • Social History • Payers • Advance Directives • Alerts • Medications • Immunizations • Medical Equipment • Vital Signs • Functional Stats • Results • Encounters • Plan of Care • It’s easy to read and focuses on sharing the most important patient health information between providers and because it’s shared, it acts as a history book for the patient, adding history from many providers. • In Nightingale Notes, the CCD contains 6 segments, shown above in green at this time. • A CCD can be sent to another provider or to a Health Information Exchange that accepts them. They can be sent in XML format or in PDF depending on the ability of the recipient to accept those file formats.

7. Sample Nightingale Notes CCD

10. Health Information Exchanges • Entities that have been certified by the ONC to exchange health information. • HIEs can exchange information in a few different ways depending on their capabilities and the ability of participants to send and receive information: • Query – providers can log in and query the HIE, looking for a patient’s information. This is considered a “pull” of information. • An EMR can send patient information to the HIE either on demand ( a user sends a CCD for example) or automatically, behind the scenes (Admission, Discharge and Transfer information is sent whenever the EMR detects a change to a patient record, for example). This is a “push” of information from the EMR to the HIE • Some HIEs can send patient information from their database to an EMR where a patient record is stored. This is also a “push” of data. • Nightingale Notes clients in MN have the methods in green available to them.

11. Other NWHIN Nodes Other settings Nationwide Health Information Network (NWHIN) Hospitals Private Health Data Practices Intermediary HIO #1 HIO #2 Statewide Health Information Exchange Shared HIE Services Hospitals w Directory Private Health Data w Consumer Preference Practices Intermediary Management Other settings Direct Exchange Minnesota Approach to HIE & the Role of Shared Services

12. Why Use an HIEFrom HealthIT.gov: Why Health Information Exchange Is Important • The ability to exchange health information electronically is the foundation of efforts to improve health care quality and safety. HIE can provide: • The connecting point for an organized, standardized process of data exchange across statewide, regional, and local initiatives • The means to reduce duplication of services (resulting in lower health care costs) • The means to reduce operational costs by automating many administrative tasks • Governance and management of the data exchange process Health Information Exchange Benefits: A Few Examples • Provides a vehicle for  improving quality and safety of patient care • Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations • Stimulates consumer education and patients' involvement in their own health care • Helps public health officials meet their commitment to the community • Creates a potential loop for feedback between health-related research and actual practice • Facilitates efficient deployment of emerging technology and health care services • Provides the backbone of technical infrastructure for leverage by national and State-level initiatives

13. Immunization Registry Exchange • This one is probably the easiest to understand and easiest to identify as valuable! • There are challenges though for an EMR. Here’s what we’ve found: • Each state, uses different parts of the standard HL7 immunization record and utilizes standard values in different ways. • For example, Champ utilized the CDC Public Health Information Network (PHIN) code sets for many fields, including gender. In North Dakota, the registry only utilizes a small subset of these codes. Champ has 950 race codes, NDIIS accepts 3 of those. • Even though refusals and contraindications are on the HL7 Immunization standard record, in Indiana and North Dakota, when Champ passes that information, the registries are not accepting it or updating their records with that information. • In Indiana Champ connects directly with the registry. In North Dakota Champ needs to pass Immunization records through the HIN, which then redirects them to the registry. • Champ is working to get connected with registries in each state where we have clients. Each state poses unique requirements and differences that we have to address. We will be connected to ND in March and Indiana shortly after that. We do have MN, WI, IA,KS, and WA on our list to work with in 2014 and 2015. We have several other states in line after that.

14. Stolen from a birthday card from my co-workers. We always want to think outside the box. It might be messy, but it’s worth it!

15. Why Should Public Health Agencies Pay Attention to Data Exchange • Besides the reasons listed on the last slide, please consider this: • PH can have easier access to their patient’s records and more quickly find the most relevant information. Think about the CCD. An easy-to-read, fast way to get information about a client walking into your office for the first time • Chronic Disease prevention – imagine being able to analyze and compare your interventions to those of hundreds of other agencies. Data exchange is one important step toward that goal. • What else?? Please imagine the possibilities. Maybe not yet, but in the future. Dare to think outside the box!

16. Kanabec County • Kathy Burski, Quality/Emergency Manager, Kanabec County Public Health • Kathy is the Project lead for the East Central Region of the Minnesota Health Data Exchange Project and a member of the grant Executive Committee Northwest Region East Central Region West Central Region Southwest Region

17. Douglas County • Greta Siegel, Financial Manager, Douglas County Public Health • Project lead for the West Central Region, Chair for the Super Committee and Executive Board for the Minnesota Health Data Exchange Project Northwest Region East Central Region West Central Region Southwest Region

18. Thank You! for participating in our series of Topical Webinars! Stay tuned for our next webinar! If you have any suggestions for other Topical Webinar subjects please feel free to email: norah@savardconsulting.ca