1. From HELP2 to EDEN via HL7: EDRS interoperability in Utah. Jeffrey Duncan and Barry Nangle NAPHSIS Annual Meeting St. Louis, June 2010

2. Acronym Translator EDEN = OVR’s EDRS HELP2 = IHC’s EMR HL7 =US standard for HIE

3. Presentation Outline The problem: why EDRS are often not real time. How Health Information Exchange could help. Utah’s private/public approach Interoperability project update

4. Death FD initiates EDEN record (demographics) Is MD EDE N user? MD certifies death certificate in EDEN LHD registers death Death is reported to NCHS FD prints paper death certificate MD signs Paper Certificate (cause of death) LHD keys Paper certificate into EDEN Yes No FD delivers to MD Office FD delivers to LHD Drop-to- paper process FD = Funeral Director MD = Physician LHD = Local Health Department Current Death Registration Workflow

5. EDRS Participation in Utah Virtually 100 % Funeral Director participation Only 545 of approximately 5,000 physicians participate. Medical certification is all electronic in 60 % of cases, Feb. 2010.

6. Reasons Physicians Do Not Participate About 75 % of physicians that do certify do <1 death certificate per year. They account for about 35 % of all DC’s Difficult to maintain EDEN skills Lack of incentive

7. Interoperability with the EHR: a Market-based Approach “Mandates” unwelcome in Utah healthcare Legislation requiring physician EDR use rejected in Committee Public Health does adopt standards for electronic health information exchange

8. Partners in CDC-funded Demonstration of EMR/EDR Interoperability Office of Vital Records and Statistics – Modified EDEN to Accept HL7 message Intermountain Healthcare – Cause-of-Death module in Help2 EMR Utah State University – Developed matching algorithm

9. Intermountain Market Share Provides healthcare to approximately one-half the Utah population. During 2007-2009, Intermountain physicians certified 39 % of Utah deaths. 52 % of Electronic certifications (within EDEN) come from Intermountain physicians.

10. Use of EDRS by Intermountain Physicians Grouped by Number of Deaths Certified per Month Death Certs./Month % of All Death Certifiers % of All Death Certs. % Certified Electronically <1 96.5%35.4%28.0% 1-2 1.8%11.7%89.8% 2-3 0.4%4.7%98.6% 3-4 0.4%6.6%99.6% 4-5 0.1%1.1%99.3% >5 0.7%40.5%99.9%

11. EDEN Master Database EDEN Cause of Death Table Matcher & Merger UDOH HL7 Message Server (Rhapsody) Intermountain HL7 Message Server Intermountain EMR Transmit Cause of Death Certification From EMR to EDEN Cause of Death Interface HL7 Over VPN Tunnel

15. New Death Certificate Workflow With Electronic Interface to Intermountain EMR Death FD initiates EDEN record (fact-of-death) Is MD an EDEN user? MD certifies death certificate in EDEN Death reported to NCHS LHD registers death New Intermountain process FD notifies MD that cause of death data is needed MD enters cause of death data in EMR OVRS matches MD- provided data against FD- provided data to complete record Data transmitted electronically to state FD = Funeral Director MD = Physician LHD = Local Health Department No Yes

16. EDEN Matching Flow Chart EDEN Master Database Application Program Interface Matching Request Candidate Set Result Set Front-end Matcher Candidate Set Builder Classifier Candidate-set Matching Rules Classification Rules

17. Workflow Among Matcher, Merger, and Deferred Match Resolver Cause of Death Table Deferred Match Table EDEN Master Database Cause of Death Data Loader Matcher Merger Deferred Match Resolver

18. Physician Login to EDEN Through UHINet Web Interface EDEN Web Interface UHINet Web Interface https redirect to EDEN EDEN User Table https POST with physician identifying information, UHIN server login and password