Massachusetts:Transforming the Healthcare Economy

John D. Halamka MDCIO, Harvard Medical School and Beth Israel Deaconess Medical Center

Massachusetts Healthcare IT Organizations

• Massachusetts Health Data Consortium

• Massachusetts eHealth Collaborative

• New England Healthcare Exchange Network

• Massachusetts Technology Collaborative

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The NEHEN Appliance

Built on a common

messaging gateway

framework

Placed on the network

of each participating

institution

CDXCDX Rx GatewayRx Gateway

• Pharmacy Directory• Pharmacy Directory

• Formulary Service• Formulary Service

• Drug Eligibility• Drug Eligibility

• Medication History• Medication History

• eRX Adaptors• eRX Adaptors

• Prescription Routing• Prescription Routing

• Publishing Service• Publishing Service

• Record Index Management

• Record Index Management

• Record Locator Service

• Record Locator Service

• EHR Adaptors• EHR Adaptors

• XDS Repository Adaptor

• XDS Repository Adaptor

• Security• Trading Partner Registry

• Logging• Validation

• Translation• Routing

• Guaranteed Delivery

• Security• Trading Partner Registry

• Logging• Validation

• Translation• Routing

• Guaranteed Delivery

Core Gateway

Core Gateway

NEHENNEHEN

• NEHEN Express• Direct Data Entry

• Billing / PMS Adaptors• ADT Adaptors

• NEHEN Express• Direct Data Entry

• Billing / PMS Adaptors• ADT Adaptors

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

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

Architecture Overview

Local Provider Directory

Internet / Network

Published Patient Data

EMRs and Other Enterprise Systems

Secondary Local System

E-Mail Server

CCD Standard Messages, e-mail or fax

encapsulation

Interface Engine or Portal

HIE Application Server / Gateway

Fax ServerWeb Server

Network Subscriber

•No infrastructure support requirement – just Internet connection, fax or e-mail

Summary / Results Viewer

Fax

Summary / Results Viewer

E-Mail Server

Web Server

Printer

E-mail, fax or HTTP encapsulation

Published Patient Data

Community Provider Directory

Local Gateway Participant

EMRs and Other Enterprise Systems

Secondary Local System

E-Mail Server

Interface Engine or Portal

Fax Server Web Server

Published Patient Data

HIE Application Server / Gateway

Local Provider Directory

HIE Application Server / Gateway

CCD Standard Messages, HTTP encapsulation

Summary / Results Viewer

External Networks

Patient visits PCP or specialist and establishes trusted relationship and consents

for release of data

As a result of a referral, admission, or emergency, patient

registers in hospital

Patient is discharged from hospital

Standard format discharge summary or ER report is transmitted to HIE

network

HIE service checks provider directory for routing

instructions

HIE service routes discharge summary to PCP, specialist or other interested

and trusted party (e.g., health insurance case manager)

Consents and provider routing preferences are sent

to HIE service

Patient receives care and details are noted in hospital medical record

Visit/Discharge Summary ExchangeSend / push / route hospital data to interested parties

ReferralsSend / push / route visit and other data in support of referral consultation

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

Provider refers patient to a specialist, hospital or other provider for consultation or

service

Standard format visit summary with consultation notes transmitted to HIE

network

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 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)

HIE service submits referral authorization request to payer for

approval and referral #

Admission NotificationSend / push / route admission notification to payers and providers

Patient visits hospital or other provider and establishes trusted

relationship and consents for release of admission notification

data

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

Authorized payers and providers are notified of patient

hospital admission

Laboratory Results

Patient undergoes tests from his or her physician, establishes trusted relationship and consents

for release of laboratory data

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

Authorized providers can access patient’s laboratory

results

Standardized Quality DataSend / push / route visit and other data for standardized quality reporting (and other reporting)

Patient visits PCP, specialist, hospital or other provider and

establishes trusted relationship and consents for release of data

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

Community Provider Directory

Provider organizations track and maintains internal

provider directory

Provider information from each provider organization is

sent to HIE service

HIE service consolidates organizational provider information into a single community provider

directory

Authorized HIE users can access community provider

directory

Healthcare / EHR Delivery Challenges

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EHR Systems Overview

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