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Interoperability to Improve Healthcare

HIMSS EHR Vendors Association

Hugh ZettelHugh ZettelGE HealthcareGE HealthcareDirector, Government & Industry RelationsDirector, Government & Industry RelationsVice Chair, HIMSS EHRVAVice Chair, HIMSS EHRVA

HL7 HL7 HIMSS Annual ConferenceHIMSS Annual ConferenceFebruary 28, 2008February 28, 2008

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Today’s Agenda

• EHR Vendors Association (EHRVA) Overview• Why Interoperability?• EHRVA Interoperability Roadmap• Where is Interoperability Today?

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EHRVA Overview• Mission

– To improve the quality of patient care and the productivity of the healthcare system through the rapid, widespread adoption of EHRs and interoperable systems

• Founded in 2004– Provides unified voice and a forum for cooperation for

the EHR vendor community• All major EHR suppliers in US market

– Large and small companies serving ambulatory and acute care provider organizations of all types

• Support accelerated EHR adoption– Interoperability Roadmap– Certification – Advocacy / Public Policy

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EHRVA Member Organizations

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EHRVA Member Organizations

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Why Interoperability?

• High-quality care across the continuum • Patient safety: reduced medical errors • Clinical decision support: standardized, coded

data• Streamlined workflow: results reporting• Population health: quality reporting• Emergency management: disaster response

and recovery• Reimbursement: claims attachments• Empowering consumers: personal health

records (PHRs)• Local, regional and national networks

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Industry Engagement

• EHR Certification– 3 members appointed as Certification Commission for

Health Information Technology (CCHIT) commissioners– >30 members participate in various CCHIT workgroups– 31 member companies certified since 2006

• Health Information Technology Standards Panel (HITSP)– EHRVA represents vendors on HITSP Board– Member participation in HITSP workgroups

• American Health Information Community– Participation in Quality and EHR workgroups

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Interoperability Initiatives

• EHRVA Interoperability Roadmap– Collaboratively developed to provide guidance to

EHR vendors and other industry stakeholders– Aligns with CCHIT and HITSP direction

• Demonstration/Adoption of Roadmap in Products– Integrating Healthcare Enterprise (IHE)

Interoperability National Showcase & Regional Implementations

– Implementation in NHIN and international pilots– Building upon IHE to create common immunization

registry use-cases, as well as implement HISPC activities (e.g., the consent work in CT, the use of CCD in Iowa)

• Outreach to organization and communities• ASTM/HL7 Continuity of Care Document (CCD)

Quick Start Guide

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Interoperability StandardsHHS

RecognizedEfforts

• Health Information Standards Panel (HITSP)– Defines the standards to use– Interoperability specs

• Certification Commission for Health Information Technology – Requires the standards

Industry Interoperability

Efforts

• IHE Interoperability Showcase– 77 disparate vendors

• EHRVA Interoperability Roadmap– Outlines path to provide

“packaged” interoperability

EHRVA Members Working Together to Achieve

Interoperability

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HITSP Readiness EHRVA Member June ’07 Survey*

• 76%** have assessed HITSP specifications

• 76%** expect CCD to be required in 2008

• 72% see synergy of CCD w/ other HL7 CDA requirements

• Limited member experience with IHE– 32% - 48% with various

interoperability profiles

* 28 total responses; 61% of respondents ambulatory EHR vendors

** Agree or Strongly Agree; 0% Disagree or Strongly Disagree

“The survey feedback from our members, especially small ambulatory vendors that comprise the majority of EHRVA member companies, underscores the growing consensus and collaborative effort in our industry to implement a single set of standards using the HITSP process.”

Don Schoen, CEO, Medinotes Corporation

EHRVA Chair

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Phone Network Provider•Phone number•Routing•Call services

“Mega-Phone”•Mute•Speaker•Conference•Speed Dial

Rotary Dial

“Do the Job Phone”

Interoperability: An Analogy

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Health Information Technology Interoperability

HIT System A HIT System BInteroperability

Standards

Patient Information Patient Information

• Patient matching• Information Location

Conformance to interoperability standards “out of the box” reduces communication costs

NetworkCommunication

and Services

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EHRVA Interoperability Roadmap

– Provides concise, benefit-based, incremental approach

– Promotes industry collaboration, standards planning and convergence

– Uses industry best practices for profiling and testing standards

– Adopts a single set of interoperability standards

– Ensures standards support multiple levels of sophistication now and in future

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Requirement 1: Allow “Edge”Systems to Retain Functionality and

Autonomy• Leverage functionality of edge systems…where workflow

innovation occurs• Cost-effective… minimize core duplication of services

Edge System Edge System

Edge to EdgeCommunication

InteroperabilityFunctions Defined By

NCVHS

Edge to NHIN-CoreCommunication

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Requirement 2: Allow Flexibility to Support Multiple Architectures

• Minimize proliferation of interfaces for different data storage schemes

• Flexibility to evolve configurations between edge systems & sub-network

Edge Systeme.g. Lab

Edge Systeme.g., Inpatient EHR

Edge Systeme.g., Ambulatory EMR

Edge Systeme.g., RHIO CentralRepository

datadata

Edge to NHIN-CoreCommunication

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Requirement 3: “Thin” NHIN Core

• Limit NHIN core functions, ensuring robust interoperability between edge systems

• Ensure transparency at the boundaries between core and edge systems, as well as between edge systems

andProvider

Access

Edge System Edge System

InteroperabilityFunctions Defined By

NCVHS

Edge to NHIN-CoreCommunication

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EHRVA Interoperability Roadmap

Availablenow

6 mos to3 yrs

3 yrs +

Phase 4: Active Quality Reporting & Health Surveillance

Phase 3: Advanced Clinical Support and Dynamic Query

Phase 2: Share Diagnostic Results & Therapeutic Information

Phase 1: Share Medical Summary Information

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EHRVA Interoperability RoadmapAligns Major Industry Drivers

• Office of the National Coordinator for HIT– Open and ongoing dialog

• HITSP standards– Supported successful harmonization of care record

summary– Developed CCD Quick Start Guide

• CCHIT requirements– Collaborative, non-competitive analyses and feedback

during all public comment periods• HL7

– Worked to support development of lab result implementation guide to meet AHIC use case requirements

• AHIC priorities and use case roadmap

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EHRVA Interoperability RoadmapCCHIT EHR Certification Alignment

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 2008 2009

Development Timetable

2009 CCHIT dev.

2008 CCHIT dev.

Phase 1: Share Medical Summary Information

EHRVA Interoperability Roadmap

Continuity of Care Document (CCD)

HITSP-C32 *

Share Medical Summaries –CCD + IHE/XDS Transport; HITSP-32 / TP13 *

2010 CCHIT dev.

Phase 2: Share Diagnostic Results & Therapeutic Info.

Phase 3: Advanced Clinical Support

* Proposed in CCHIT Incremental Adoption of CCD Through HITSP Specifications, Jan. 14, 2008

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Example: Continuity of Care Document Education

• June 2007 Internal Survey Highlights Interoperability Training Needs– Standards & Interoperability Workgroup Creates CCD

Quick Start Guide Specification– Quick Start Guide delivered to Members in October, 2007

• Collaboration… Share tools with all stakeholders– EHRVA CCD Quick Start Guide Publicly Available

Free of Charge November, 2007– Over 800 downloads first four months

• Accelerate Adoption within EHRVA– EHRVA Hosted CCD Web Training– Focused on HITSP Implementation– Over 130 EHRVA Members Attend

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Operational Interoperability Today• South Shore Hospital) and Atrius Health (MA)• Community Hospitals and Physician Practice

Systems (CHAPS) project – Serving 600,000 patients with over 2.3 million visits/year– Exchanging records between hospital Emergency

Department and physician offices– "Medical Summary" to the hospital that contains patient

information including visit history, problems, medications, allergies, immunization history, medical/surgical/obstetrical history, social and family history.

• Standards-based approach from MEDITECH and Epic– CDA/CRS Medical Summary exchange profile from IHE– Use HL7 v3 specifications

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In Conclusion, EHRVA is…

• Committed to supporting national interoperability and transparency goals

• An advocate for standards that meet current market needs

• Working to leverage HIE interoperability progress to advance data sharing– Among shared customers– With other HIT suppliers– Within states, regionally and nationally

• An active participant in open standards harmonization process

• Delivering interoperability based on EHRVA roadmap TODAY

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