Health-e-cITi NJ

Presented by:

Newark Beth Israel Medical CenterIGI HealthINTEL

Infrastructure

IntroductionProposed PartnersHow we got here

Infrastructure

Non Technical ConsiderationsCommon Vision and PurposeLeadershipGovernanceOther Stakeholder Participation Collaboration and CompetitionFocus and PrioritiesBenefits and Value to StakeholdersFinancial FeasibilityData Sharing AgreementPrivacy and Security

Newark Beth Israel Medical Center

East Orange General Hospital Trinitas Medical Center

UMDNJ

Physician

Patient

Ambulance

Nursing Home

Home Care

FQHC

TheThe ChallengeChallenge

St. Michael’s Medical Center

Clara MaassMedical Center

NJ State


East Orange General Hospital

Trinitas Medical Center

UMDNJ

HIE Solution – Model 1HIE Solution – Model 1


Clara MaassMedical Center

NJ State

Physician PortalPatient Portal

SharedService

DataMarts

VPN

VPN

HIE Solution – Model 2

Simplify & scale healthcare information interoperability among participants



East OrangeGeneral Hospital

UMDNJ

Physician PortalPatient Portal

SharedService

DataMarts

VPN

VPNVPN

VPN

VPN


East Orange General Hospital

Trinitas Medical Center

UMDNJ

Community HIE SolutionCommunity HIE Solution

St. Michael’s Medical Center Clara Maass

Medical Center

NJ State

Patient

FacilitiesPhysician

FQHC

Ambulance Home Care

Nursing Home

Physician Portal

Patient Portal

Access virtual EMRs & sharing of longitudinal patient data

Provide instant access to lab results

Capture patient consent for data sharing

Interface with clinical data repositories and EMR’s

Manage interface to State Immunization System

Transfer Patients between internal and external facilities

Establish referral workflows & continuity of care

Use e-prescribing to fill prescriptions

Using the ORBIT portal framework, hospitals can deliver a broad set of services:

Physician PortalPhysician Portal

TheThe Clinical SolutionClinical Solution

EMR – API Connectors

ORBIT Physician Portal

ORBIT Patient Portal

Newark Beth Israel

Clinical DataRepository

PatientIndex

RecordLocator

ORBIT Shared Services

Other

EMRDB

PatientPHR

EMRLite

HospitalStaff

Physicians

Patients

PhysiciansEMR

HIE “ALL” ConnectionsHIE “ALL” Connections

Orders ResultsReports

EligibilityReferralPre Auth Claims/ERA

Clinical DataADTRecord LocatorPatient Search

Portals HIE

Co-PayRecurring PayRemittance

Documents

ORBIT Repository

ClinicalRepositoryHospital Z

New RxRefillsFormulary

StateState ImmunizationRecordsBirth & Death Certificates EMPI

Messages

HospitalStaff

Physicians

Patients

PhysiciansEMR

Healthcare Standards

IHE Profiles XDS.a

–Document Source–Document Consumer

XDS.b–Document Source–Document Consumer

PIX–v.2 & V.3 Consumer

PDQ–v.2 & V.3 Consumer

ATNA–Secure Application

CT

HITSP Profiles Manage Sharing of

Documents Transaction Package

Patient ID Cross-Referencing Transaction Package

Patient Demographics Query Transaction

Collect and Communicate Security Audit Trail Transaction

Secured Communication Channel Transaction

Templates for all versions and transactions of HL7, EDI X12, HIPAA, and NCPDP

All HL7, v2 and v3 (XML)

ADT, ORR and ORX Continuity of Care (CCD) Clinical Data Architecture (CDA) Patient Transfers (UT) Order Entry and Results

New Rx and Refill Medication history

Document Attachments Pre/Post Operative Documents Lab Reports & Images Secure Messaging (Level A4)

Real-Time Transactions: Eligibility & Member Benefits Referrals & Authorizations Claim Status & Remittance Advice Profession/Dental Claims WC, P&C, Secondary UB inpatient, outpatient, LTC, AMCBatch Transactions: Claims, Referrals, Eligibility Enrollment, Electronic Remittance Advice (ERA)

Co-payments Credit Card payments Check guarantee Electronic Funds Transfer (EFT) FSA/HSA Account Link

ADMINISTRATIVE HIPAACLINICAL HL7

FINANCIAL SWIFT

MEDICATIONS NCPDP

DOCUMENT SHARING

Healthcare Standardscontinue

Consent Management Hospital Consent Forms Physician Consent Forms Patient On-Line Consent

PHR Data SHARING Case 1 View Access

Control Case 2 Complete Control Case 3 Partial Data Access Case 4 Date Range Access Case 5 Send PHR as CCD Case 6 Get CCD to load

PHR

MS HealthVault Case 1 Save PHR Case 2 Import Data Case 3 Synchronize Data

Patient Consent

Why INTEL & IGI?

Solution that will overlay on an existing framework

Integration through healthcare data standards compliance

Out-of-the-box semantic mapping and pluggable healthcare services

Connecting to all EDI Healthcare Transactions Admin Health Plans Clinical Hospitals and Labs Rx PBM and Pharmacies Financials Banks

Portal Solution & Exchange in place since 2003 EMR Lite for physicians with limited EMR Patient Portal integrated with clinical data sets Robust API’s for existing EMR

Portal Implementations Affiliated Physician Portal Community Health Web Health Information Exchange Employer Portal Consumer/Patient Vendor/Clearinghouse

Portal Features Federated Model User level security Dynamic Menus Audit Trails Single Sign On Configurable

Available Models Private-labeled Componentized Self-Managed or Hosted

Portal Solution

SOA ExpresswaySOA Expressway

04/09/2316 04/09/2316

Healthcare Development Kit & Integration Engine• Pre-built data maps, web services and integration workflows

• Integration engine with “any” to “any” mapping technology

• HL7, EDI, X12, HIPAA and IHE XDS support

Codeless Designer• Visual IDE for workflow & data map design-eliminates coding

High Performance Runtime• Optimized for Intel Multi-Core. Scales on standard Intel servers

Soft-Appliance• Software delivers appliance-like manageability, upgrade flexibility and Mgt UI

• OS (Red Hat, Suse, Windows) and VM (Xen, VMWare, Microsoft)

• Protects, Secures, Governs, & Accelerates Healthcare transactions

Open Architecture Fits cleanly into Existing Investments

Newark Beth Israel Medical CenterNewark Beth Israel Medical Center

Provider Solution Provide single sign-on Give clinicians web-based access to EMR/PHR at point of care Integrate referral and consult messaging Allow clinical and administrative users of the system to coordinate

Patient Solution Create a patient-centric tool, allowing disparate systems to be viewed as one Aggregate complete patient demographic, events, and clinical results into one PHR

HIE Solution Allow for interoperability among legacy systems Deploy meaningful clinical value in less than a year Offer an affordable, cost-effective and highly-valued solution Comprehensively improve care and outcome throughout the enterprise

The Challenge Establish an enterprise-wide technologyProvide interoperability among community care giversDeliver a comprehensive patient recordCreate a flexible and scalable platform

Infrastructure

Application Server Windows 2003 R2 Server / Linux WebSphere / Glassfish / JBoss IP Monitor

Database Server Windows 2003 R2 Server / Linux MS SQL / ORACLE / My SQL

Intel SOA Server

Linux Enterprise Edition

Universal Transfer Form (Patient Transfer / Discharge)

Universal Transfer Form (UTF)Universal Transfer Form (UTF)

NJ State Department of Health and Senior Services (DHSS) Regulation A state-wide, mandatory use “transfer form” Assumption that the Mandate will be in place in fall of 2009 Inpatient/resident transfers between all licensed health care facilities & programs.

Transfer from Facility Transfer to Facility

Hospital Hospital

Hospital SNF, NF, ALF, Sub-acute Care, Home Care

SNF, NF, ALF, Sub-acute Care, Home Care

SNF, NF, ALF, Sub-acute Care, Home Care

Emergency Dept. Emergency Dept.

Emergency Dept. Return to LTC New Born, Others

Selective exclusions:

Mandate Task ForceMandate Task Force

NJDHSS (Dept. of Health) Home Care Association NJ NJHA (Hospitals/LTCFs) Center for Lifelong Learning

NJAHSA (Non-Profit LTCFs)

NJ Hospice & Palliative Care Organization (NJHPCO)

HCANJ / NJALC (LTCFs) AMDA – NJ Chapter

HQSI (QIO of NJ) Various facility / provider

ER / ED Nurses (NJ-ENA) Medical Society of NJ

representatives NJ Association of DONA

Benefits of Universal Transfer FormBenefits of Universal Transfer Form

Improves accuracy of information shared about the patient

Increases efficiency in providing care (for the receiving facility)

Promotes patient safety by minimizing opportunities for errors

Enhances quality of care through improved accuracy and timeliness of information shared

Enables staff productivity because of standardization of information

Focuses attention on most important clinical areas

In electronic form, could draw data from existing data sources and manage documents – minimizing opportunities for error even further

Promotes greater patient, family and clinical staff satisfaction with the coordination of care

Helps increase staff satisfaction and retention

Improves rapport between providers serving the patient

Makes better use of scarce clinical resources

Helps decrease liability risk

Universal Transfer Form HistoryUniversal Transfer Form History

Paper pilot occurred in 2008 with over 50 organizations participating from five Paper pilot occurred in 2008 with over 50 organizations participating from five regions of the state, each with a “hub” hospital system and several post-acute regions of the state, each with a “hub” hospital system and several post-acute partners (LTC, home care, assisted living, etc.) partners (LTC, home care, assisted living, etc.)

IGI contacted by HCANJ and NJHA to develop an electronic version of the paper IGI contacted by HCANJ and NJHA to develop an electronic version of the paper formform

Automated Pilot–Began March 4th, Meridian HealthAutomated Pilot–Began March 4th, Meridian Health

• Establish clean workflow with a good sampling Establish clean workflow with a good sampling of casesof cases

• Refine form data elementsRefine form data elements• Manage attachmentsManage attachments• Expand pilot participationExpand pilot participation• Record Results Record Results

11stst HL7 import/export (CCD, ADT) requested to start in 2 other regions, with 1 HL7 import/export (CCD, ADT) requested to start in 2 other regions, with 1stst most likely being Seashore Gardensmost likely being Seashore Gardens

Automated User BaseAutomated User Base

Riverview MedicalCenter

Patient

Jersey ShoreUniversity Medical Center

Ocean Medical Center

Meridian @ Home

Meridian Sub-Acute

Expanding to other

interested facilities

AristacareWhiting – 1st

External facility

Alert Ambulance

Health-e-cITi NJ

Documents

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