THE FUTURE OF HEALTHCARE IN WASHINGTON STATE Leveraging the C-CDA for Health Information Exchange

Today’s Presentation Introduction OneHealthPort Health Information Exchange Leveraging the C-CDA The Information Exchange Continuum Future State of Health Information Exchange

OneHealthPort – Who we are Created by and for the local healthcare community, OneHealthPort solves information exchange and workflow problems shared across healthcare organizations. Founded in 2002 by leading NW health care organizations. –Delivers variety of services, best known for the Single-sign-on (SSO) service Initiated a Health Information Exchange (HIE) in –Serves as the WA state HIE and has independent oversight –Diverse transaction offerings, financially stable First HIE phase, an Exchange – data transformation, routing. Second HIE Phase, 2015 – a Clinical Data Repository (CDR). –Responding to increasing interest in standardized clinical info exchange

OneHealthPort HIE Vision Accelerate adoption and use of standards Support push and pull between healthcare organizations Not focused on Direct (secure ) Foster use of web services Meet community needs by “filling gaps”

Leveraging the C-CDA The Consolidated-Clinical Data Architecture is a set of “building blocks” (clinical information components in certified EHR systems) that can be assembled into documents or messages for information exchange. Allergies Medications Problem List Procedures Results Family History Physical Exam General Status Functional Status Immunizations Plan of care Advance Directives Social History Vital Signs Assessments Chief Complaint History of Present Illness Encounters Medical Equipment Mental Status Nutrition Payers Patient demographics Reason for Visit Review of Symptoms Assessment and Plan Clinical Information Components

Leveraging the C-CDA: Continuity of Care Document Allergies Medications Problem List Procedures Results Family History Immunizations Plan of Care Required Clinical Information Components Continuity of Care Document (CCD) Advance Directives Encounters Functional Status Medical Equipment Payers Optional “Additional” Clinical Information Components for CCD

The Information Exchange Continuum Health Information Exchange Single Sign-On simplifies logging into over 30 different websites to find business and clinical resources. Secure used to PUSH the reports from a variety of sources means various new logins. Person to person messaging. HIE uses secure methods to assist PUSH of messages to any connected trading partners. Secure Websites Secure Health Information Exchange Single Sign-On Mediated Web Services Web Services/ APIs OneHealthPort hosted application gathers data needed for query from authenticated user and returns request The EHR system is able to start a query from within a workflow and accept a response from another system. Clinical Data Repository CDR is used to aggregate data and perform population analytics.

Authenticate connections Use Provider Directory to route messages Facilitate exchange of standard data Host API/web services API Directory Standards Propagation “Push” data to trading partners Clinic Hospital “PUSH” between any two participants can be C-CDA, XML, HL7 Payers

Leveraging OneHealthPort Identity Management Services Use with the HIE Identity management or Single Sign-On (SSO) account needed to start an HIE contract – free to any healthcare organization. SSO login used to register facilities that participate in the HIE. Allows access to HIE Provider Directory web application. Provides access to C-CDA Validation tools. SSO Administrator can assign CDR Access roles to users in the organization who need access to the CDR clinical and reporting portals. SSO login allows a subscriber to start a hosted secure query of the CDR or a participating HIE organization willing to respond to queries.

Register organizations and users Secure web portals and applications Authenticate users Collect and share Provider Directory Info Use APIs to pull information to hosted applications Query using API Response to API Query SSO Mediated Query/Response (Web Service): OneHealthPort mediates the web service call and delivers the response to the requester. Response can be a pdf or xml C-CDA document. Hospital Clinics Web Service OneHealthPort hosts web service query through application accessed by SSO login. Provider organization EHR would need to accept a web service query. Provider organization’s EHR replies with their clinical information. OneHealthPort has no access to data exchanged and does not store the data This would be a very future state for most small practice vendors. Clinics Hospital

Clinical Data Repository OneHealthPort offers a shared community CDR based on a sponsor hosting lives that the community can access and provide clinical documents about. The CDR can take claims and other data feeds as well as C-CDA documents from clinical organizations. The CDR is an aggregation option that can support population analytics and shared clinical records. Someone sponsors the lives at an annual fee per life. Sponsor defines who can have access and who can contribute data. All organizations accessing the CDR must participate in the HIE. ONLY the sponsor pays for the lives in the CDR.

Authenticate connections Use Provider Directory to route messages Facilitate exchange of standard data Host API/web services API Directory Standards Propagation C-CDA Response to API Query from/to EHR Provider EHRs push C-CDA to CDR after each Medicaid encounter. After a critical mass of data is reached, providers can draw C-CDA from CDR into their EHR through the HIE, or view CDR through secure portal. Push EHR pushes C-CDA to CDR View only use of the CDR using Portal Sponsor bulk loads claims and eligibility data Sponsor and other authorized parties can access reports and/or data Clinics Providers Hospitals

Web Services –Make airline reservations –Get offers for rental car, hotel and entertainment at my destination –Web services used to get the latest data to meet my needs –Very fast response to a very specific question – destination city, dates, times –Data enriches my workflow – saves me time We’re all familiar with web services in other industries – like travel

Web Services Continued Unsolicited clinical and business messages pushed to other organizations can create workflow issues for the receiving organization. “Asking” for information as needed (query/response) has some distinct advantages. –Can be fully automated so people are not “touching” each record request –Is fully audited by systems so you know what has been asked and answered –Can leverage standards that reduce one-off handling –Can incorporate external data sources in the regular workflow without users doing side lookups

XCA Query Protocol Cross Community Access (XCA) protocol allows one entity to query another in a series of web service calls. –First – match the patient between systems –Second – identify clinical documents available for that patient –Third – determine which documents you want as either structured data or unstructured pdf documents OneHealthPort created a secure application to launch XCA queries to any participating HIE organization that is willing to accept/respond. Process tested with Epic development staff. OneHealthPort can broker non-Epic requests to Epic organizations.

Authenticate connections Use Provider Directory to route messages Facilitate exchange of standard data Host API/web services API Directory Standards Propagation Query using API C-CDA Response to API Query Clinic Hospital Query/Response using a Web Service/ API leverages standard APIs to facilitate any organization capable of starting a query to any organization able to respond to a query on a shared patient. SSO Mediated Web Services

Future State of Health Information Exchange Payer and Provider systems have matured to the point that APIs are embedded in workflows. All parties work in their preferred workflow system and embedded APIs are used to communicate with other systems. The HIE brokers security and authentication information to assist parties to “Trust” web services. C-CDA documents are the standard leveraged for clinical information exchange. This is an Ideal Future State that we grow to by moving up the continuum.

OneHealthPort OneHealthPort - visit our website at – Kelly Llewellyn, Senior Account Manager –OneHealthPort HIE