1. 1 GE Healthcare eHealth Solutions Data Dictionary February 22, 2012

2. 2 Architecture / Data Sources Data Types: Demographics & Clinical Monthly Metrics HIE Data Dictionary AGENDA

3. 3 PATIENT Personal Health Records PRIMARY CARE PHYSICIANS Practice Management EMR LAB Results PUBLIC HEALTH Registries PHARMACY/PBMs RX History SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive PAYERS Claim Data Document Repositories Patient ID Manager Document Registry GE eHealth Information Exchange Key Components

4. 4 SPECIALTY PRACTICE Practice Management EMR HOSPITAL 2 EMR/PM’s Lab PACS Archive PRIMARY CARE PHYSICIANS Practice Management EMR PATIENT Personal Health Records PRIMARY CARE PHYSICIANS Practice Management EMR MRN 111 MRN 222 MRN 333 PUBLIC HEALTH Registries PHARMACY/PBMs RX History SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive PAYERS Claim Data LAB Results Patient ID Manager John DoePCP11199 John DoeSpecialty22299 J. DowHospital 233330 NameSiteMRN% Patient Identity Feed IHE PIX

5. 5 SPECIALTY PRACTICE Practice Management EMR PATIENT Personal Health Records PRIMARY CARE PHYSICIANS Practice Management EMR PIX QUERY: MRN 111 PIX QUERY: MRN 111 PIX RESPONSE: MRN 222 PIX RESPONSE: MRN 222 LAB Results PUBLIC HEALTH Registries PHARMACY/PBMs RX History SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive PAYERS Claim Data Patient ID Manager John DoePCP11199 John DoeSpecialty22299 J. DowHospital 233330 NameSiteMRN% Patient Identity Cross-Reference IHE PIX

6. 6 PRIMARY CARE PHYSICIANS Practice Management EMR PRIMARY CARE PHYSICIANS Practice Management EMR PATIENT Personal Health Records SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive PAYERS Claim Data LAB Results PHARMACY/PBMs RX History PUBLIC HEALTH Registries CCD Allergies Problems Meds Etc, Etc. REGISTER DOCUMENT REGISTER DOCUMENT PUBLISH Patient ID Manager Document Registry Publish Documents IHE PIX

7. 7 PATIENT Personal Health Records PRIMARY CARE PHYSICIANS Practice Management EMR REQUEST DOCUMENT 1 REQUEST DOCUMENT 1 RETRIEVE RETRIEVE LAB Results PUBLIC HEALTH Registries PHARMACY/PBMs RX History SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive PAYERS Claim Data SPECIALTY PRACTICE Practice Management EMR RETRIEVE DOCUMENT 1 RETRIEVE DOCUMENT 1 CCD Allergies Problems Meds Etc, Etc. Patient ID Manager Document Registry REQUEST REQUEST Query for Documents IHE PIX

8. 8 Technical Diagram of Data Sources ADT MDM ORU ADT MDM ORU

9. 9 Architecture / Data Sources Data Types: Demographics & Clinical Monthly Metrics HIE Data Dictionary AGENDA

10. 10 Data Type Patient Demographics “R” Required

11. 11 Document Example XD*LAB

12. 12 Document Example XDS*SD

13. 13 Architecture / Data Sources Data Types: Demographics & Clinical Monthly Metrics HIE Data Dictionary AGENDA

14. 14 Monthly Metrics: # of Patients

15. 15 Monthly Metrics: # of Clinical Documents

16. 16 Architecture / Data Sources Data Types: Demographics & Clinical Monthly Metrics HIE Data Dictionary AGENDA

17. 17 Schemas / Tables / Data Elements Schemas (HIE+MPI has ~5), plus POL, CDT, CCD, etc Tables each schema has 11 to 168 tables Columns = Data Elements Each table has ~10 columns (or data elements) Column Definitions 1 2 3

18. 18 Sample Data Elements

19. 19 Data Dictionary: Example #1

20. 20 Data Dictionary: Example #2

21. 21 Lab Result HL7 2.x ORU (FH & OH) Transformer Service (GE) HITSP/IHE XD*Lab (GE) MSH|^~\&|QDXPT|OH||STJOHMC.3|20091115205600||ORU^R01|R31061680326.3.2|P|2.2 PID|1||401017564||TESTS^PATIENTS^K^^^||19750103|F|||1313 Mockingbird Lane^^LONGVIEW^ WA^98632||""|||||80897339|572-12868 PV1|1|E|ED NA- NA|E|||31543^TRAN^MIMI^^^^MD||26837^MELGAR^GERARDO^R^^^MD||||||||31543^TRAN^MIMI^^^^MD|PH||||||||||||||||||||||||||20091115 ORC||8257603248^PLW-OIF|||||||||||||||^SJMC^^SJMC OBR|1|8257603248^PLW- OIF|LA93264515|31305^OML|S|200911152015|200911152015|||KENDUL||||200911152026|GNL^BLD|31543||||LA93264515|SJMC^PeaceH ealth Lower Columbia Region^Clinical Laboratory S|200911152056||HM|F||^^^200911152015^^S|||||||||200911152008 OBX|1|TX|300500^GLUCOSE|1|103|mg/dL|70-99|H|||F||||SJMC|WANBRU OBX|2|TX|300600^UREA NITROGEN (BUN)|1|22|mg/dL|6-20|H|||F||||SJMC|WANBRU OBX|3|TX|300700^CREATININE|1|0.7|mg/dL|0.44-1.03||||F||||SJMC|WANBRU OBX|4|TX|310100^SODIUM|1|139|mEq/L|135-145||||F||||SJMC|WANBRU OBX|5|TX|310200^POTASSIUM|1|4.2|mEq/L|3.5-5.2||||F||||SJMC|WANBRU OBX|6|TX|310300^CHLORIDE|1|107|mEq/L|95-109||||F||||SJMC|WANBRU OBX|7|TX|310400^CO2 CONTENT|1|26|mEq/L|22-32||||F||||SJMC|WANBRU OBX|8|TX|301100^CALCIUM|1|9.0|mg/dL|8.6-10.2||||F||||SJMC|WANBRU OBX|9|TX|312000^SGOT(AST)|1|24|IU/L|15-41||||F||||SJMC|WANBRU OBX|10|TX|310900^ALBUMIN|1|3.7|g/dL|3.5-5.0||||F||||SJMC|WANBRU OBX|11|TX|311700^ALKALINE PHOS|1|92|IU/L|30-110||||F||||SJMC|WANBRU OBX|12|TX|311400^BILIRUBIN,TOTAL|1|0.2|mg/dL|0.1-1.2||||F||||SJMC|WANBRU OBX|13|TX|310800^PROTEIN,TOTAL|1|6.8|g/dL|6.2-8.4||||F||||SJMC|WANBRU OBX|15|TX|311800^SGPT(ALT)|1|27|IU/L|15-54||||F||||SJMC|WANBRU OBX|17|TX|300720^GFR CALCULATED|1|>60|mL/min|>60||||F||||SJMC|WANBRU NTE|1||*estimated GFR calculated using MDRD Study equation. NTE|2||*serum creatinine affected by gender, age, race, diet, body habitus, NTE|3|| medications and creatinine method. NTE|4||*eGFR not validated in acute renal failure, extreme body size, NTE|5|| diseases of skeletal muscle, severe malnutrition, pregnancy, NTE|6|| patients with normal renal function or children. NTE|7||*multiply by 1.21 in African American patient. NTE|8||Stages of chronic kidney disease (CKD): NTE|9|| 30-59 ml/min-stage 3 NTE|10|| 15-29 ml/min-stage 4 NTE|11|| <15 ml/min -stage 5 HIE Standards: HITSP/IHE standards-based HIE Publish

22. 22 HIE Standards: HITSP/IHE standards-based HIE Consume Lab Result HL7 2.x ORU Transformer Service HITSP/IHE XD*Lab

23. 23 PRIMARY CARE PHYSICIANS Practice Management EMR PRIMARY CARE PHYSICIANS Practice Management EMR PATIENT Personal Health Records SPECIALTY PRACTICE Practice Management EMR HOSPITAL 1 EMR/PM’s Lab PACS Archive HOSPITAL 2 EMR/PM’s Lab PACS Archive LAB Results PHARMACY/PBMs RX History PUBLIC HEALTH Registries CCD Allergies Problems Meds Etc, Etc. REGISTER DOCUMENT REGISTER DOCUMENT PUBLISH HIE & Analytics Patient ID Manager Document Registry (DRR) CCD Allergies Problems Meds Etc, Etc. Parsed PAYERS Claim Data ANALYTICS CDR Labs Allergies Problems NOTE: The CFRHIO HIE Architecture allows for secure document exchange (“document” is a generic term to describe payloads that may contain freetext or discrete data (Labs, CCDs) or images (PDF, JPG, DICOM)) between authorized parties (the HIE enforces the consent policy). Policy Questions: 1. Does Patient Consent / Authorization allow for data to be used for research? 2. Does it need to be De-Identified or Pseud-onomized (which can limit its value)? 3. Who owns the aggregated data (and assumes risks / benefits)?

24. 24 GE Healthcare eHealth Solutions Bill Howard eHealth Solutions Software Architecture 802.310.2780 Bill.Howard@GE.com