Why Initiate:The foundation for healthcare interoperability

Lorraine Fernandes, RHIASenior Vice President, Healthcare Practice

Bill KlaverProduct Manager

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About Initiate Systems and interoperability

Over 2 billionrecords analyzed

1,400 healthcare facilities use Initiate technology

Typically discover duplication rates of 15-30% in “clean” files

Installations from500K to 500M+ records

Search and link across 150M records in sub second

Offices Chicago, CA,TX, AZ, Australia,UK, Canada

… Establish patient identity

… Provide meds history profile

… Create national prototype

… Determine a member

… Access clinical info on demand

… Enable complete 360° Rx view

… Advanceinteroperability

… Share data securely

… Create a national EHR

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The healthcare reality

Volume of patient data increasing exponentially

Quality of patient data declining

Fragmented, duplicate and conflicting patient information within and across databases andtouch points

Regulatory and safety issues drivenew requirements

ADTRob Johnson

1000 Main St.

ADTRob Johnson

1000 Main St.

PACSBob Johnson

(555) 123-4567

PACSBob Johnson

(555) 123-4567

LabRobert Johnsonrobj@aol.com

BillingBobby M. Johnsoncredit card# 5555-55-1234

BillingBobby M. Johnsoncredit card# 5555-55-1234

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Patient identification enables the interoperability of tomorrow’s virtual health record

EHRs, RHIOs and NHIN EHRs, RHIOs and NHIN

Improve patient care and reduce medical risks

Improve efficiencyby reducing redundant care activities

Support consumer directed health information management

Comply with regulations

Enhance operational productivity and efficiency

ROI

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Interoperability challenges in healthcare ecosystem

Clinics, Labs, Imaging

Hospital1

Hospital1

Hospital2

Hospital2 Hospital

3Hospital

3

Physicians Network

Physicians Network

ClinicalSystemClinicalSystem

Pharmacy&

Pharmacy Benefits Mgmt.

Pharmacy&

Pharmacy Benefits Mgmt.

Hospitals(for Inpatients & Outpatients)

Hospitals(for Inpatients & Outpatients)

Labs & ImagingLabs & Imaging

Lab SystemsLab Systems PhysicianPhysician

Public HealthPublic Health

CountyGeneralCounty

General

GeneralGeneral

Real-t

ime

Query

API

Nightly U

pdate

XML

Real-timeQuery

API

Real-timeUpdates

SOAP

SearchFlat File

Real-tim

e

Updates

HL7

NCPDP

Real-timeQuery

IdentityIdentity

IdentityIdentityIdentityIdentity

IdentityIdentity

IdentityIdentity

IdentityIdentity

IdentityIdentityEHR,RHIO, NHIN

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Interoperability with Initiate starts with the Identity Hub

P&C policyholder dataP&C policyholder data

Claims and billing dataClaims and billing data

Debbie BeckerNULL5555-55-1234

Local identifierDBECKER1234

Commercial policyholder dataCommercial policyholder data

Debbie Becker9146 E VILLA DEL SOLNETOWN, CA 45885

Local identifierHOSPABC98765

Store #3908, Zip =

Debbie Dozier -Becker9146 E VIA DEL SOLNETOWN, CA 45883

Local identifier12/19/61 – 727

Debbie DozierNEED INFO5555-55-1234

Local identifier12345ABCDE

Web self service dataWeb self service data

Debbie Becker9146 VIA DEL SOL480-473-3486

Local identifierBECKER4804733486

InitiateIdentity Hub™ software

1. Derives & standardizes data for efficiency2. Finds all potential matches3. Use sophisticated probabilistic statistics to

compare many attributes & score records4. Puts results in 3 buckets – link, don’t link,

needs manual review

Trusted systemof record

Trusted systemof record

1: 12/19/61 – 7272: DBECKER12343: 12345ABCDE4: HOSPABC987655: BECKER4807343486

Debbie Becker9146 VIA DEL SOLNETOWN, CA 45883480-473-34865555-55-1234

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By answering these questionsDo I know this person? Query (IHE PIX Manager) By ID information from both source and generated at the PIX Manager By demographics enhanced by multiple sources contained in the PIX Manager (PDQ

capabilities)

Where do I know this person from? Source demographics (IHE PIX & PDQ functionality)

Source identity information is never lost from within and across sources

What do I know about this person? Event demographics (IHE PDQ functionality) Information about events (i.e. patient chart, diagnosis, etc.) that have triggered a

patient record

How do I know this person? Linkage summary (IHE PIX Manager) Record of truth view across sources including the most current attributes

Is there anything else I know about this person? Household information (Extended IHE PIX Manager)

Information on patient relationships either household information within source across sources

What can I do with this information? HL7 message integration (IHE Interoperability)

Send, received, and updated via HL7 messaging

How Initiate fits in with IHE?

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EMPI questions that drive interoperability

What “View” of the patientare you allowed to see?

What other information do we know about the patient?

What can we do with this patient information?

Do we know the patient?

Is this the correct patient?

How do we keep the patient information in-sync?

How do we get to the other information about the patient?

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EHR

Healthcare ecosystem – interoperability applications

Laboratory management

Laboratory management Radiology

management Medication

management

Patient financial management

Medication management

Medicalmanagement

Medical management

Patient portal

On ramp to RHIO

Patient financial management Composite

public data

On ramp to RHIO

Medical management

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Healthcare expectations that drive interoperability

CustomerPortal

Specific views – Create common view of “customer” per organization’s objectives and marketing requirements. May address consumer, member, patient portal.

Public Health

EHR - Create virtual EHR of public databases such as immunization, disease-specific, biosurveillance, - with option to be payer specific for state funded healthcare.

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Billing

Care delivery Purchasing

Research

Diagnosis Treatment

Scheduling

Communications

The invocation of the necessary

services to provide the most accurate information to the right place at the

right time

Registration

ProcessProcessProcessProcess

Interoperability defined

PatientPatient PayorPayor ProviderProvider PBMPBM SupplierSupplier PharmacyPharmacy PublicHealthPublicHealth

RadiologyRadiology RHIORHIO

PeoplePeoplePeoplePeople

PhysicianPhysician Etc.Etc.

ERPERP ClinicalClinical RxRx ResourceResource FormularyFormularyFinancialFinancial ResearchResearch

DataDataDIDIPatientPatient 3rd party/

Ref. data3rd party/Ref. data

Etc.Etc.ProviderProvider

Pri

vacy,

Secu

rity

, S

tan

dard

s,

Reg

ula

tory

Com

plian

ce

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Solution

Reference architectureLabmgt

EMPIEMPI HISHIS ClinicalClinical FinancialFinancial ProviderProvider 3rd party3rd party

Radiologymgt

Customerportal

Business

Integration

Hosting

Medicalmgt

Medicationmgt

Sticky applications

On rampto RHIO

Business Logic

Infrastructure

Application ServicesApplication Services

Core Business ServicesCore Business Services

Messaging Services and Source AdaptersMessaging Services and Source Adapters

Data ServicesData Services

Identity ServicesIdentity Services

Con

su

lting

Data ServicesData Services

Security ServicesSecurity ServicesInitiate

Sta

nd

ard

s

Service