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Interoperability
within the
Florida Health Information Exchange
(Florida HIE)
1
Florida HIE Governance
• The Agency for Health Care Administration is the
governing body of the Florida HIE
• Harris Corporation, as the HIE vendor, operates the
Florida HIE services and the gateway to the eHealth
Exchange
2
Florida HIE Services
Patient Look Up (PLU)
• Connects existing health care provider networks to exchange health information across a statewide information highway
Direct Messaging Service (DMS)
• HIPAA compliant email service that allows participants to send and receive messages and attachments containing a patient’s clinical data
• Outsourced to Inpriva
• Supports Direct Trust certificates and standards
Event Notification Service (ENS)
• Provides alerts to health plans about their members’ hospital encounters
• The health plan then notifies the patient’s primary care provider for care coordination
3
Interoperability – ONC Roadmap • http://www.healthit.gov/sites/default/files/nationwide-interoperability-
roadmap-draft-version-1.0.pdf
• Build upon existing health IT infrastructure – Clinician EHRs remain the same for HIE connections
• One size does not fit all – On-boarding process has been unique for each participant
• Architecture modifications between implementations
– Federated model allows uniqueness
• Empower individuals – Basic principle of Florida HIE is for clinicians to easily gain knowledge and assist in
decision making
• Leverage the market – Common geographical areas is where the most success has been achieved
• Simplify – Common gateway connection for more complex PLU interface
4
Interoperability– ONC Roadmap (con’t) • Maintain Modularity
– Vendor alterations while common gateway/interface remains
• Consider current environment – Federated model allows participant environment to remain stable
• Focus on Value – Metrics of exchanges between organizations
– Metrics of notifications to subscribers
– User Group discussions
• Protect privacy and security – Florida HIE certificate authority
– Auditing / FairWarning®
– Secure connections
• Scalability – Use National standards to increase common needs
– Outreach to increase numbers
5
Patient Look-Up (PLU) Service • PLU connects regional HIEs through a federated model
• Provides transport only - no centralized patient database
• Each participating organization:
– maintains its own records
– ensures required safeguards are in place
– is responsible for vetting user access
– utilizes EHR patient matching algorithm
• Participants can audit to verify that users of the PLU service are in
compliance with the consent policy
6
PLU Participants • Ten health care systems are live with PLU, covering 23% of all hospital
beds in Florida.
• These systems are made up of approximately 522 different health care
organizations, which include hospitals, clinics, and long-term care
providers.
• PLU also enables cost effective participation in the nationwide eHealth
Exchange
7
Interoperability within PLU
• Being on the front end of changes in technology
• Different vendors
• Security
• Business rules
• Standards evolve during implementation
• Reporting
• Competing interests
8
Interoperability within PLU – Different Vendors
• Challenge: Different HIE Vendors
• Solution: Common gateway installation at each
organization to talk the same ‘language’ (still federated)
9
Interoperability within PLU – Different Vendors
• Express gateway infrastructure facilitates sites
communicating point-to-point, federated model
– Patient Discovery (PD), Query for Documents (QD),
Retrieve Documents (RD)
10
Express
Lite
Participant 1 HIE HIE
Express
Lite
Participant 2
EHR
EHR
EHR
EHR
EHR
EHR
Interoperability within PLU – Different Vendors
• Challenge: Common gateway communication with
different HIEs
• Solution: 2 services to talk with common gateway,
language only slightly different
– Entity – new software development
– Nhin – matches Nhin standard
11
HIE
Express
Lite
Interoperability within PLU – Security
• Challenge: Common certificates to ensure secure,
private exchanges
• Solution: Florida HIE certificate authority, secure and
signed by Florida HIE
• Challenge: Security teams at each organization
installing Florida HIE certificate
• Solution: Communication, documentation and limited
duration of domain approval
12
Interoperability within PLU – Business Rules
• Challenge: Different business rules pertaining to
patient information available, affects matching
• Solution: Small number of parameters required to find
a patient
– First Name
– Last Name
– Date of Birth
– Gender
13
Interoperability within PLU – Business Rules
• Challenge: Format and amount of data in documents
• Solution: Best practices document, communication,
validation packet, User Group, Technical User Group,
leverage on ONC validation
– Working with participants to be able to handle large
documents
– Discussions on document data limited to certain dates
14
Interoperability within PLU – Business Rules
• Challenge: Variation in consent models
– Florida HIE utilizes ‘consent to query’
• No query should be initiated without a signed consent form
• All participants should respond with all data available
• Solution: Participants establish unique business rules
for Florida HIE exchanges
15
Interoperability within PLU – Evolving Standards
• Challenge: Evolving standards
– Nhin 2010
– Nhin 2011
– FHIR – still evolving
• Solution: Best practices, validation, ability to
exchange between Nhin standards
16
Interoperability within PLU – Reporting
• Challenge: Collecting metrics on Participant
Exchanges
• Solution: Common gateway collection and reporting of
audit data
– Daily reports of exchanges
– Daily reports ingested into FairWarning® 3rd party audit
application
17
Interoperability within PLU – Reporting
• FairWarning® - ingests Audit Data
– Each site has a Privacy Manager
– Each site has an Audit Plan
– Privacy Manager Reports
18
Interoperability within PLU – Competing
Interests
• Challenge: Healthcare information technology has
many facets
– ICD-10
– Meaningful Use
– Internal maintenance
• Solution: Flexibility in meeting times, online meetings
with screen share, meeting goals, notifications
between participants
19
Interoperability within PLU – Success
• Participants are exchanging data!
• Metrics are being collected
20
Interoperability within PLU – Success
• Number of queries growing
21
Num
ber
of
Quer
ies
Event Notification Service (ENS)
• ENS provides timely notice of a patient’s hospital
encounter to the patient’s health plan
• ENS can benefit hospitals, patients, and health plans
– Enhanced care coordination
– Supports efforts to shift the setting of care for non-urgent
conditions from the emergency department to primary care
provider
– Reduced readmissions rates for hospitals
22
How ENS Works
23
How ENS Works • Participating hospitals provide the Florida HIE with notice of
patient hospital encounters (via ADT messages) as they occur
• Health plans subscribe by providing the Florida HIE with a list of
active members
• ENS compares hospital notices to the health plan member lists;
if a match is made, notice of the patient’s hospital encounter is
securely delivered to the subscribing plan
– Matching is based on patient demographics (name, DOB,
etc.), not self-reported health plan membership
– Hospital notices are discarded after subscribers are alerted
24
ENS Hospitals
0
50
100
150
200
4
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67
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161
177
206
Nu
mb
er
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ospita
ls "
Liv
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on E
NS
25
Interoperability within ENS
• Hospital connections
• ADT variations
• Amount of data
• Maintenance
26
Interoperability within ENS – Hospital
Connections
• Challenge: Connecting 206 hospitals
• Solution: Provide 2 connection strategies
– Secure socket layer (SSL)
– Virtual private network (VPN)
27
Interoperability within ENS –
ADT variations
• Challenge: Nuances in ADT
– Different precision in date of birth
– Location of hospital identifiers in header
– Diagnosis location, complete data
– ER admits are treated differently across EHRs
(registrations vs admits)
• Solution: Collect interface metadata, communication
with hospitals, translations when necessary
28
Interoperability within ENS –
ADT variations
29
MSH|^~&|CPSI^1.3.6.1.4.1.27248.1.17^ISO|DOCTORS HOSP^2.16.840.1.113883.3.0^ISO|Receiving
Application^X.XX.XXX.X.XXXXXX.X.XX.X.X^ISO|Receiving
Facility^X.XX.XXX.X.XXXXXX.X.XX.X.X^ISO|20141119091047||ADT^A01^ADT_A01|2014111909104765|P|2.5.1||
SFT|SRC|19|SRC|1916.80||20141111
EVN|A01|20141119091046|20141113000000|03|dmh00006|2014111909104679|DOCTORS HOSP
PID|1||99999999999^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^MR^DOCTORS HOSPFacility
OID&ISO~FLENS001^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^VN^DOCTORS HOSP&Facility
OID&ISO~00041694^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^PN^DOCTORS HOSP&Facility
OID&ISO~000000000^^^HL7&2.16.840.1.113883.4.1&ISO^SS^DOCTORS MEMORIAL HOSP&Facility
OID&ISO||DOE^JOHN^K^^^^L|^^^^^^U|19550505^YYYYMMDD|M||W^WHITE^|33 MAIN ST^APT
45^BONIFAY^FL^32425^USA^M^HOLMES^HOL|HOL|8505551212^PRN^PH^^1^850^5551212~8505552121^ORN^CP^^1^850^5
552121|8505551221^WPN^PH^^1^850^5551221|English^^HL70296|S^^HL70002|U^UNKNOWN^HL70006|FLENS001^^^&1.3.6.1.
4.1.27248.2.1427.1&ISO^AN^DOCTORS HOSP&Facility
OID&ISO|000000000^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^SS^DOCTORS HOSP&Facility OID&ISO|||N^Not Hispanic or
Latino^HL70189|^HOSPITAL|||||W||N
PD1|U|||999999^DOCTORS^HOSPITAL|||||||||||N|U
NK1|1||EMR|^^^^^USA|||E^Other^HL70131||||||SELF EMPLOYED||||||||||||||||Employer
PV1|1|I^I/P^10|001^003^^DOCTORS HOSP &Facility
OID&ISO|N|||999999^DOCTORS^HOSPITAL^^DR^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^L^^^FI^DOCTORS HOSP - &Facility
OID&ISO~1366431702^^^^^^^^National Provider
ID&2.16.840.1.113883.4.6&ISO^^^^NPI|999999^DOCTORS^MEM^HOSPITAL^^DR^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^L^^^FI^D
OCTORS HOSP - &Facility OID&ISO~1366431702^^^^^^^^National Provider
ID&2.16.840.1.113883.4.6&ISO^^^^NPI|^^^^^DR^^^&1.3.6.1.4.1.27248.2.1427.1&ISO^L^^^FI^DOCTORS
Interoperability within ENS – Amount of
Data
• Challenge: Amount of data
– ADTs represent admits, discharges, transfers and updates
• Solution: Work with data sources to limit data to
admits/discharges
30
Interoperability within ENS – Health Plan
patient data
• Challenge: Format of Health Plan patient data
• Solution: Examine the Excel® formatted patient data
before loading
– Leading 0’s in patient ids
– Middle initial in same field as first name
– Lack of gender
31
Interoperability within ENS –
Maintenance
• Challenge: Maintaining hospital connections
• Solution: Flexibility and working with each data source
– Communication
– Monitoring interface
– Communication, communication, communication
32
Interoperability within ENS –
Maintenance
• Challenge: Maintaining busy interfaces with updates
– Data sources
– HIE
– Subscribers
• Solution: Flexibility and working with each data source
– Communication
– Queue messages during maintenance
33
Interoperability within ENS – Success
• Hospitals are providing data!
34
Interoperability within ENS – Success
• Data is flowing within ENS!
35
206
Hospitals!
Interoperability within ENS – Success
• Subscribers are receiving notifications daily!
• Health plans contact providers sooner for care
coordination
36
Bio – Lisa Stotz
Lisa Stotz, a software engineer with 17 years experience, has been
working on the Florida HIE Technical team since March, 2011. She
started on the team to test the software implementation and is
currently the Agile Scrum Master and Technical Lead. Prior to
working on the HIE, Lisa has worked at GE Aerospace, United
Space Alliance, Quantum Technology Sciences, SAIC and also as
a math tutor. Lisa has a B.S. in Computer Science from
Rensselaer Polytechnic Institute and a Master’s degree from
University of Pennsylvania. Lisa feels that her contributions to
healthcare interoperability has a great impact on our country, its
health and the future.
37
Bio – Gizelle Cowart
Gigi Cowart has over 30 years of experience working for Harris
Corporation and is currently the Florida HIE Program Manager in
charge of executing the successful HIE implementations. Gigi
assisted with the execution the in-place, comprehensive Florida
HIE sustainability plan. Gigi has a BA from the University of Central
Florida and is PMP credentialed.
Bio – Christine Phillips
Chris Phillips grew up in the north-east of England and graduated
from Liverpool Polytechnic with a degree in Computer Studies. She
has architected, designed and implemented mission-critical
systems such as the FBI’s NCIC 2000 used by the nation’s police
force and Field Operations for the 2010 Census. She has worked
for Oracle, GE and Harris.
For the last five years Chris has worked in Harris Healthcare
Solutions and is the Business Area Manager for state HIEs. She
architected the initial Florida HIE and services and was the
technical manager.
Learn More…
AHCA Health IT Symposium
Going Digital: Helping Florida Get Connected
June 26, 2015 in Tallahassee
Connect with us through Social Media: • www.AHCA.myflorida.com
• www.Florida-HIE.net
• https://www.facebook.com/AHCAFlorida
• @AHCA_FL
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