1. Interfacing with a Health Information Exchange for Electronic Physician Reporting David Rust, MS Kentucky Cancer Registry June 11, 2013 NAACCR Annual Conference 2013 Austin, TX

2. Overview Comparative Effectiveness Research Project Kentucky Health Information Exchange Transaction Models Message Format Current Status Challenges

3. Comparative Effectiveness Research(CER): KY Special Projects 3 (SP3) Objective – Increase completeness of cancer treatment data captured by the Kentucky Cancer Registry Goal – Implement direct EHR reporting from oncology providers in Kentucky by September 2013

4. Kentucky Health Information Exchange Use as a hub for a secure electronic reporting network KHIE hired contractor, Xerox, to maintain technical infrastructure KHIE/Xerox implemented reporting to the statewide immunization registry prior to cancer reporting The existing infrastructure requires cancer report to be: – Compressed (Gzipped) – Base 64 Encoded – wrapped in HL7 Pipe delimited message (in OBX-5 segment) KCR developed a method to deconstruct this message and obtain original cancer report

5. KHIE to KCR Transmission Began work with KHIE in February 2011 – KCR using PHIN-MS to receive cancer reports – Xerox testing PHIN-MS in house September 2011 – Xerox will not maintain Java environment i.e. No PHIN-MS server at KHIE – PHIN-MS no longer supports the use of the Web Services Adapter March 2012 – BizTalk server proposed as final solution for transmitting messages April 2012 – KCR developed code to decode and decompress incoming CDA messages – Successful KHIE transmission to KCR

6. EHR to KHIE Transmission September 2011 – KCR contacted pilot EHR vendor, Ulrich Medical Concepts (UMC) December 2011 – UMC and KHIE/Xerox begin process to interface May 2012 – EHR Vendor must prepare cancer report for transmission: Cancer record is compressed (GZipped) Compressed record is Base-64 encoded Encoded record is wrapped in HL7 pipe delimited (v. 2.5.1 MDM T02) message Message is transferred through SSL using the Web Service – UMC progressed to highest security level at KHIE August 2012 – Test message sent from UMC to KHIE to KCR

7. Routing through KHIE Ambulatory healthcare providers submit every record containing a cancer code as primary diagnosis This data is routed to the KCR KHIE does not read our store cancer records – KHIE analyzes MSH segments of HL7 message to determine final destination October 19, 2012 – KCR received first real-time cancer patient data from ambulatory healthcare provider!

8. KHIE Kentucky Cancer Registry PHIN-MS KHIE sends encrypted patient reports to KCR PHIN-MS decrypts message and stores in PHIN-MS database BizTalk EHR Healthcare Provider Healthcare Provider completes documentation on patient KHIE Web Service EHR notices cancer diagnosis trigger, and it constructs CDA document in an HL7 message Message is submitted through secure internet connection via KHIE Web-service KCR program pulls, decodes, and decompresses CDA message from HL7 message

9. HL7 2.5.1 Message MSH|^~\&|TCC|PaducahDerm^DNS|KCR PHINMS Receiver^ISO|KCR... PID|1||KYMC|KYMC|SMITH^JOHN^^^L|||||1 TEST AVE^^TEST CITY^KY^46035|||| PV1|1|N OBX|1|ED|48769-4^Continuity of Care Panel^LN^CCD||CDA MESSAGE ||||||F

10. Current Status Ulrich Medical Concepts has refined the CDA in the latest version of their product – Product has not been pushed to clients Collaborating with additional EHR vendors Awaiting KHIE to move the message exchange to their production environment

11. Challenges Xerox searching for an alternative method to PHIN-MS Vendor attaining multiple levels of security clearance was an obstacle

12. Acknowledgements This project was funded as part of the American Recovery and Reinvestment Act (ARRA) Comparative Effectiveness Research activities through the CDC. Partnerships CDC KHIE / Xerox KY-REC Ulrich Medical Concepts Paducah Dermatology, PLLC KCR Informatics Staff Eric Durbin Sheena Batts York Dobyns

13. Questions?