Accessing Patient Data from Across the Community · 2018. 12. 6. · NEXTGEN CONNECT ANALYTICS...

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Muhammad Chebli & Curtis Bailey

1/23/2018

Accessing Patient Data from Across the CommunityNow, easier than ever with NextGen Health Data Hub

Confidential – Propriety Information – For Use By Authorized Parties Only. Do Not Distribute. 2

Muhammad ChebliDirector, Connected Health Solutions

Presenter


Curtis BaileySolutions Architect, Connected Health Solutions

Presenter


Agenda

What is Health Data Hub?

Journey to the Cloud

Architectural Principles

Use Cases

Client Profiles

Q&A


What is Health Data Hub?An Overview


Most

Improved

What’s an EHR Company Doing Here?

Interoperability: Real Progress with Patient-record Sharing (November 2018)

Most

Improved


I think we should start with the Mirth origin story

Pre-Connect

days

2006Connect

2008Results

Mail, Care

2013NextGen

Acquisition

2018Health

Data Hub


What is Health Data Hub?

When you aggregate clinical data

you can turn community-wide patient information

into insights that improve patient care.

NextGen Health Data Hub (HDH) is a fully redesigned data aggregation platform to meet expanding market demand

for robust data sharing, aggregation, and community access. It was built from the ground-up to provide

comprehensive, continuous access to aggregated patient health data. It provides a robust, reliable, performant

platform that will lower client ownership costs, enable system-wide connectivity, and supporting growth needs for

large ambulatory organizations.


Evolving Requirements of Information Management

Today’s healthcare IT

applications must:

• Be faster to launch, integrate, and

use

• Incorporate more data from more

sources

• Be simpler to build and manage

• Work seamlessly with existing

infrastructure

• Scale on demand

• Support wide-range of industry

standards and configurable

proprietary data sources

Point-

to-point

Centralized

HIE

Federated

HIE

Intelligent

information

exchange

Complexity and variety of data

Nu

mb

er

of e

nd

po

ints

• Longitudinal record

• Regulatory focused exchange

• IHE protocol support

• National network connectivity

• Clinical and financial data

• Episodic document exchange

• Organization centric

• End-point management

• Clinical or financial data

• Rules driven exchange

• Curated data & quality management

• Proactive notifications

• Actionable insights

• Innovation enabling

• Clinical, financial, and

socioeconomic data

Connected Health Continuum


HIE Market – Consolidation and Down Market Trending

FEWER HIEs,

GREATER

COVERAGE

– Funding shift from gov to community2

– 70% of states are covered by HIE data exchange1

– Vendor-driven document exchange has grown

substantially

TECHNOLOGY

ADOPTION

– As gov funding has dried up, the number of stand-

alone HIE vendors has declined3

– Providers choosing to use EHR-based solutions

NEW DATA

EXCHANGE

MODELS

– HIE 2.0 requires new data exchange mechanisms

– EHR-based interop (Carequality, Direct,

CommonWell, etc.)

– API & app integration to power the data business4

PRIMARY DRIVERS FOR DOWN MARKET FOCUS

106 HIEsin 2014

VS119† HIEs in 20121, *

† State & Regional - not counting public HIES

1. Health Affairs July 2016 - The Number Of Health Information Exchange Efforts Is Declining

* 7 HIEs merged in 2014; source

2. HIE Sustainability Model 2016 – Survey Results and Analysis

3. HIE Market Trends – Chilmark Research

4. Value remains a problem -

HIE Market Size As of August 02, 2017, HIMSS Analytics, ~35

Health Systems are "shopping" for a new HIE solution.

Projected Growth Expanding - $3.73B (2021) from $2.0B

(2016). Product (Interface Engine, Medical Device Integration, Media

Integration), by Service (Implementation, Support, Training), by

Application (Hospital, Laboratory, Radiology, Clinics) - Global

Forecast to 2021, “The global healthcare IT integration market is

expected to reach USD 3.73 Billion by 2021 from USD 2.30 Billion in

2016, at a CAGR of 10.2% from 2016 to 2021.” According to the new

market research report "Healthcare Integration Market.” Per the

details above from the HIMSS Workforce study, this growth may be

attributed to academic medical centers, national health systems, or

multi-hospital systems that have budgets and profit margins to

support innovation programs.

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.1439

http://www.ihie.org/healthaffairsletter/

https://qsinextgen.sharepoint.com/sites/MIR/Research Library/2013-07-01 HIE Market Trends Report.pdf


Yesterday’s HIE vs. Today’s HIE

• Yesterday

- 1 primary technology vendor

- Simple use cases – “turning on

connectivity”• ADT & EMPI

• Document shipping A→B (CCD,

images, notes, etc.)

• Web-portal as primary touch-point

- Grant dependent

• Today’s Successful HIEs

- 10-20 technology vendors

- Dynamic use cases – “optimizing

community sharing” • Microservices & API integrations

• Analytics and CQM

• Prescription Drug Management

• Disaster relief & recovery• Natural & ransomware

• Aligned with payers (pop-health) and

pharma (research)

- Community & constituent funded


Connected Health SolutionsNational Interoperability

NextGen ShareCarequality/Surescripts

Data AggregationPlug-and-Play / APIs (FHIR)Transactional Data Exchange

HL7, Labs, Radiology, Referrals, HIEs,

Device

Health Data Hub

Direct Messaging

Connect

Match EMPI

Rosetta

Connect

NextGen Share

Direct Messaging

Carequality

Enterprise API

FHIR

App Marketplace

Payer Connectivity

Clinical Registries

For NGE Customers

For any EHR

Health Data Hub - API

Connect - FHIR

Surescripts Record

Locater & Exchange


Data Aggregation Solutions

Exchange, normalize, and aggregate

community-wide data to enable a

longitudinal view of patient records.

Key Solutions

• NextGen® Health Data Hub:

community-wide data aggregation

• Built-in patient matching & EMPI

• NextGen® Connect: vendor-agnostic

integration engine

• NextGen ® Direct Messaging:

seamless clinical messaging with

external providers & organizations

DOCUMENTSNEXTGEN

CONNECT

ANALYTICS

DIRECT

MESSAGE

IN-PATIENT

AMBULATORY


Key Features

A cloud-based platform supporting the exchange, normalization, and

aggregation of community-wide data to enable a longitudinal view of patient

records.

• Clinical content management: Full support for clinical data types in use by ambulatory and

in-patient systems.

• API: An API first approach enables full system, configuration and data access

• User portal: A user-accessible front-end for the display of patient data.

• Consent & data protection: Secure patient data management for sharing & access

permissions.

• Cloud-hosting: Single cloud-deployed solution leveraging AWS


Key Benefits

• Data Fidelity: HDH ensures that you can trace all patient data back to its original API call /

point of origin. The system retains data provenance and provides seamless merge and

unmerge capabilities.

• Usability: Easy to navigate, simple to understand controls, and powerful UI configurations

allow all users to feel empowered when interacting with patient data and system

configurations.

• Scalability: Replaces vertical scaling with horizontal scalability (leveraging AWS, we allow

clients to focus on their data sharing use cases)

• Configurability: Increases configurability to adapt to unique implementation requirements

(clients have control over their end-user experience)

• Open Access: Extends interoperability through enriched RESTful API access


Journey to the CloudWhat & Why?


Software as a service (SaaS) is a

software licensing and delivery

model in which software is

licensed on a subscription basis

and is centrally hosted.

Wikipedia


Results CDR Health Data Hub


Journey to the Cloud

NextGen Results CDR first launched in 2008

On-premise Hosted Cloud-based SaaS

- Total ownership of the application lifecycle by the development teams

- We manage the hosting, deployment, upgrades, and maintenance for all client

environments


Technical Achievements

Greenfield project using modern technologies

- API first development approach using a REST API

- Horizontally scalable services based architecture

Heavily leveraging managed services from AWS

- Focus on meeting both current and future client needs

- Autoscaling to meet client demands


Continuous Delivery Pipeline

• Continuous integration & automated

testing

- Release with high degree of confidence in

quality

• Potentially deployable updates to

production at any time

• Zero downtime blue-green deployments

• Continuous incremental value delivery to

clients


Health Data Hub Delivery Model• Single Application

- One deployed version

- Shared infrastructure

• Multiple Environments

- Unique URL

- Unique user pool

- Isolated data stores

• Continuous Delivery

- Frequent updates

- Automated data migration

- Backwards compatibility

- Zero downtime

• Release Management (new features and workflows)

- Managed customer notifications

- Managed feature preview opportunities

Gmail

Google Accounts

Bug fixes and

improvements

Preview the new look

and feel


Customer support is not an

expense to be minimized, but an

opportunity to be maximized.

Dharmesh Shah, co-founder – HubSpot


Levels of Support• Product feature support

- Consent

- Data Access Constraints

- Automated Workflows & Notifications

• API usage support

- Integration

- Implementation

- Interoperability

• Environment support

- Data store sizing

- Data store scaling

• Service support

- Infrastructure as code

- Service reliability

- Service scaling

Develo

pm

ent

Support


Architectural PrinciplesHow we build


Architectural Principles

• Data Fidelity

• Usability

• Scalability

• Configurability

• Open Access


Data Fidelity

• Collect and present data as accurately as possible

• Trace all data back to its original source (message or API request)

• Address challenges with merging, moving, and removing data

Transaction

Local Patient Encounter Lab Medication Immunization

Original Message

...

{

"id": "3077-OZGP-6",

"name": {

"first": "Miles",

"last": "Caplin"

},

"dob": "Feb 4, 1962 12:00:00 AM"

"gender": {

"code": "Male",

"label": "Male"

}

}

Processed Message


Patient Data Modeling

H H HH

Hoag Quest

Q Q Q

H H H HQQ Q

Patient

Local

Patient

Local

Patient

H

Transaction

Q

Transaction

Data

Source

Data

Source

Patient Matching


Usability

• Holistic approach to the user interface

- Provide consistency

- Match the user’s intent

• Internal design language to ensure that future development will

remain consistent


Usability


Patient Summary


Cards


Scalability

• Services based architecture is horizontally scalable to meet

demand

• Application automatically scales both up and down

• Individual client data stores scale independently of application


Configurability

• Feature requests are often specific to each client’s use cases

• Designed to empower clients and users to configure their own

views and manage their own data

- Patient Summary

- Automated Workflows

- Worklists

- Patient merging/unmerging

- Provide creation/mapping


Patient Summary

Worklists

Provider Mapping


Open Access

• Health Data Hub is the foundation

• Enable clients to build their own applications

and workflows on top of it

• Guaranteed access to the data through the rich

REST API


MR2 vs HDHHow does NextGen Health Data Hub compare to Mirth Results?

Solution designInitially built to gather and share lab results, it expanded in later

years to include other clinical use cases.

Built to provide a single integrated HIE solution to exchange,

aggregate, and manage data across the widest range of

stakeholders in a scalable, affordable, and integrated fashion.

API first architecture.

Release cadenceAnnual large software releases with intermittent patch releases

requiring large time and resource commitments for testing

Continuous delivery requiring little to no downtime. Always up-

to-date.

Hosting options• Mirth appliance hosted by NextGen

• Mirth appliance hosted by client

Hosted in Amazon Web Services and fully-managed by

NextGen.

Patient matching Utilizes Mirth Match for EMPI services, or 3rd party integrations Native Patient Matching and Management built-in.

Content mergingPatient, provider, and other merges are challenging and very

difficult to resolve.

Patient & Provider: Merge/Move Alias fully supported and easy

to manage. Data Provenance ensures clinical information is

bound to the patient

Pricing considerations

• SaaS pricing based on patient lives

or

• Perpetual license model + hosting + hardware fees +

maintenance

Subscription based on patient lives


Health Data Hub – Timeline


Health Data Hub Demonstration


Q&A

Accessing Patient Data from Across the Community · 2018. 12. 6. · NEXTGEN CONNECT ANALYTICS...

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