1. Interoperability in Our Community January 23, 2018
Laura Fitzmaurice MD, CMIO, Children’s Mercy Hospitals and Clinics
Mike Dittemore RN, BS, eMBA, Executive Director,
Lewis And Clark Information Exchange (LACIE)

2. Interoperability Definition2
Interoperability Definition
In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. Data exchange schema and standards should permit data to be shared across clinician, lab, hospital, pharmacy, and patient regardless of the application or application vendor.
HIMSS Board, April 5, 2013

3. Interoperability “Facilitators”3
Public Health Information Exchanges
National Health Information Organizations
Regional Health Information Organizations (RHIOS)
Community Based Health Information Organizations
EMR Vendor Based Exchanges
Private Health Information Exchanges
Health Information Service Providers (HISP)

4. National HIEs 4
eHealth Exchange – 501(c)(3) supported by The Sequoia Project
Formally known as Healtheway
Formally known as National Health Information Network (NHIN)
Formally known as Nationwide Health Information Network (NwHIN)
In 2012, eHealth Exchange transitioned from the Office of the National Coordinator for Health IT to a private sector initiative
The eHealth Exchange is a network of exchange partners who securely share clinical information over the Internet across the U.S.
By leveraging a common set of standards, legal agreement and governance, eHealth Exchange participants are able to securely share health information with each other, without additional customization and one-off legal agreements

5. National HIEs, cont. 5
eHealth Exchange is currently the only way to connect to Federal Agencies such as the VA, DoD, and Social Security Administration
Connecting to eHealth Exchange does not automatically guarantee that other eHealth Exchange members will allow a connection to them
eHealth Exchange uses strictly federated connections: no patient ADT information is sent to a central location to assist with patient matching
Carequality is an initiative of The Sequoia Project; operational in July 2016
Participants commit to connecting to other organizations that have a Use Case recommended by the Advisory Council and approved by the Steering Committee
A significant number of organizations that participate in the eHealth Exchange initiative also participate in the Carequality Interoperability Framework
Participation in Carequality is not required to participate in the eHealth Exchange

6. National HIEs, cont. 6
CommonWell Health Alliance is a not-for-profit trade association dedicated to achieving cross-vendor interoperability that assures provider access to health data regardless of where care occurs
CommonWell members believe that provider access to this data must be built into health IT at a reasonable cost for use by a broad range of health care providers and the people they serve
CommonWell and Carequality have announced they will work together for improved interoperability
CommonWell is more focused on interoperability between vendors where The Sequoia Project has an emphasis at the organizational level
Local participants with CommonWell through Cerner include Truman Medical Centers, Children’s Mercy Hospitals and Clinics, and MOSAIC Life Care

7. RHIO Connectivity in GKC7
Lewis And Clark Information Exchange (LACIE) connects directly to Tiger Institute and Kansas Health Information Network (KHIN)
LACIE connection requested to Missouri Health Connection (MHC) through eHealth Exchange when available
Tiger Institute has a verbal commitment from MHC to connect through eHealth Exchange (likely 2018)
KHIN connections: LACIE, MHC, Southeast Texas Health Information Exchange, Iowa Health Information Network, Delaware Health Information Network, Colorado RHIO
“One Hop Rule”: As a rule it is not permissible to connect to a “primary” HIO and be able to query information from another HIO through the same connection
Example: KHIN to LACIE permissible with appropriate executed agreements
Example: KHIN to LACIE to Tiger Institute not permissible, a separate direct connection would be required between KHIN and Tiger

8. Types of Participant Connections8
Centralized Bi-directional: All data, that is available for query from a participant, is sent to a centralized data repository. This includes patient demographic data that significantly enhances patient matching through a Master Patient Index (MPI). Participant has ability to query HIO centralized data repository.
Federated Bi-directional: No data is sent to the HIO for storage and retrieval by the participant. An edge server is deployed by the participant that contains an up to date copy of the information from the EMR database the participant is willing to share. There is no patient demographic information provided to the exchange making patient matching more of a challenge. Participant has ability to query HIO centralized data repository.
Hybrid Bi-directional: Limited data is sent to the HIO, in most cases this is patient demographic data that is used for patient matching. Clinical data remains at the participant’s location, usually on an edge server that can be queried by other HIO participants. Participant has ability to query HIO centralized data repository.
View Only Uni-directional: No data is sent to the HIO, participant can only query exchange. Depending on the type of connections other organizations have from which the participant is attempting to view information, the patient matching and return of information can be very low, i.e. view only participants attempting to view information from each other.

9. RHIO Connection Robustness9
Connectivity does not ensure data quality or the availability of meaningful data
Not all RHIO participants provide information beyond PAMI
Problems, Allergies, Medications, Immunizations
Patient demographics, lab results, and vital signs are common as well
While PAMI information can be helpful, most providers find discharge and clinic encounter summaries, along with radiology and procedure reports, much more impactful
Discharge and clinic summaries are not included in Continuity of Care Documents (CCD) and Consolidated Clinical Document Architecture (CCDA), which make up a significant portion of the data shared with and between HIO

10. Community Based HIOs 10
Very difficult for community only centered HIOs to be successful
Lack of enough organizations to shoulder the cost of the exchange
Political and business decision hurdles
Many that were started either merged with HIOs covering a larger geographical area or dissolved
Wichita Health Information Exchange (founders Kansas Medical Society and Kansas Hospital Association) merged with KHIN
Kansas City based eHealthAlign (formally Kansas City Bi-State Health Information Exchange) ceased operations in September 2011 and seeded technology vendor (ICA) participants to KHIN

11. EMR Vendor Based Exchange11
EMR Vendor Based Exchange
Cerner
Resonance: Allows Cerner EMR instances to connect to one another as well as to HIOs
HealtheIntent: Facilitation of connections to obtain data for analytics
Population health tool used by Kansas Department of Health and Environment (KDHE), Kansas Heart and Stroke Collaborative, and Truman Medical Centers
Epic
Care Everywhere: Allows Epic EMR users to share information between their organizations as well as connect to other EMRs and HIOs
Connection used by The University of Kansas Health System and Saint Luke’s
Providence Medical Center, Saint John, Saint Joseph, Saint Mary and Clinics plan to convert to Epic
Share Everywhere: focus on patients being able to contribute information from multiple sources
Allscripts – dbMotion; CareInMotion; Netsmart CareFabric; Practice Fusion Cloud-Based EHR
eClinical Works (eCW) – HUB; Care Coordination Medical Record (CCMR)

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Private HIE
Allows organizations/providers to share information between them that may not be shared in the traditional Public Exchange
Enhanced granularity over the type of data shared
Participants provide permission for specific information to be shared with organizations such as payers/organizations in pay-for-value agreements, e.g., Clinically Integrated Networks
LACIE’s Private Exchange extracts data from the native EMRs database
Ability to capture non-discrete data for quality reporting
Document retrieval
Alerts based on ADT Messages
Data movement to desired endpoint in desired format
Participants include: Kansas Clinical Improvement Collaborative, MPact Health, Kansas City Metropolitan Physician Association (KCMPA), Meritas, Signature Health, Olathe Health System, Providence Medical Center, Saint John Hospital and Clinics, Truman Medical Center, North Kansas City Hospital, Tri-County Mental Health, Blue Cross and Blue Shield of Kansas City (Medicare Advantage and CPC+ offerings)

13. Health Information Service Provider13
A Health Information Service Provider (HISP) is an organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport (Direct Messaging)
There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules
Several EMR vendors provide HISP services for their customers and other providers/organizations whose EMR does not offer a HISP/Direct Messaging Service
Multiple companies outside of EMR vendors also provide HISP services, as do some HIOs

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Conclusion
There are numerous forms of interoperability being utilized in the Greater Kansas City Area, of which not all are fully interoperable
Some interoperability solutions are not vendor agnostic
Interoperability is impacted as much, if not more, by political and business decisions as technology issues
Public HIOs are best suited for sharing of patient medical information between providers that have patient overlap
Private HIOs are better suited for Population Health

15. Questions and Contacts15
Questions and Contacts
Questions?
Contact Information
Dr. Laura Fitzmaurice,
Mike Dittemore,