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Connectivity

Know enough to be dangerous: interoperability 1011

Speak the language: ask the right interoperability questions2

What’s a CCD? Show and tell3

Back to basics: why use an HIE? 4

Open the door to success with the right patient portal5

Connecting the dots6

Get Connected. Be Interoperable. Start now.

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Welcome!It all starts with connectivity. For a healthcare organization like yours in today’s environment, it’s vital. It’s non-negotiable. It’s the only way you can ensure the health of your patients, while safeguarding the health of your business.

How do you get connected? You need a powerful, integrated, interoperable EHR to start. However, few EHRs are even integrated, let alone interoperable. And, lack of interoperability is a real obstacle to improving patient care. Where does your organization stand on this key issue? Do you use an integrated EHR? What about a Health Information Exchange (HIE) or Patient Portal?

Every day, our team of connectivity experts strategizes with clients on their connectivity and interoperability challenges and goals. Our implementation team and Engagement Managers solve

those challenges and get our clients up and running. Like a jolt of caffeine, getting connected really invigorates a

healthcare organization—and like water, it is the essential lifeblood of your business. I truly love working with our

clients to get them better connected and seeing the value that it brings to their organization and their patients.

In this eBook, we’ll talk about what basics you need to know about interoperability to be “dangerous.” We’ll help you ask potential vendors the right interoperability-related questions. We’ll explain crucial industry terms related to connectivity and interoperability. Finally, we’ll go back to basics and explain why you can benefit from an HIE—and how your organization can increase its odds of success with a patient portal.

Happy reading!

Bob Barker Vice President, Connectivity Solutions NextGen Healthcare

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1

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Know enough to be dangerous: interoperability 101.

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That applies twofold when you’re talking about interoperability. Many prospective technology users

feel unsure about interoperability standards. To get a baseline on your level of expertise, here are

some key questions to ask yourself:

You don’t knowwhat you don’t know.

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Do you know the various interoperability methods available today?

Do you understand the technology used to create interoperability?

Do you understand the type of data being included, the frequency of transmission, and your data sharing consent policy?

Do you know what a CCD looks like? Do you understand CCD configuration options?

Do you know the difference between a CCD and a CCDA? (And if you don’t know what a CCD is, see Chapter 3.)

If you’re not sure

how to respond to

these questions, or

your answers don’t

give you confidence,

ask your current

or prospective

vendor to explain

interoperability

standards to you.

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Also, tap into the resources below to learn more:

NEWSHealthcare IT News: General healthcare IT news source

NHINWatch: News /guide to the Nationwide Health Information Network

INDUSTRY ORGANIZATIONSHealtheWay: Non-profit public/private partnership supporting the eHealth Exchange (formerly NHIN)

EHRA: HIMSS Electronic Health Record Association which helps shape public policy, regulations, and vendor engagement

IMPORTANT GOVERNMENT SITESONC-Interoperability: The HealthIT.gov website provides policy researchers and implementers a wealth of tools and

programs to help spur interoperability development

CHPL: The Certified Health IT Product List of certified EHRs

Federal Advisory Committees: Governing body of Health IT Standards, Clinical Quality, Implementation, and other

committees charged with developing standards and making recommendations to help improve interoperability

This ONC site is for interoperability initiatives. Many of these go into Meaningful Use requirements. www.siframework.org

INFLUENTIAL BLOGSGartner’s Wes Rishel: Writes about Interoperability and HIT standards for Gartner Research

Geekdoctor: Life as a Healthcare CIO. John Halamka, MD. Vice chair of Health IT Standards Committee, former CIO

at Harvard Medical School, current CIO at Beth Israel Deaconess.

HealthITBuzz: ONC’s blog covering the government’s efforts to improve the national drive towards healthcare IT

Healthcare IT Guy: writes about general IT issues and experiences in healthcare

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Speak the language: ask the right interoperability questions.It can sometimes feel like no two organizations speak the same interoperability “language.” Education and understanding about interoperability standards are often up for interpretation. It’s common for diverse organizations to interpret data requirements differently, and to prioritize one type of data exchange over another.

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Does your vendor “play nice?”From an interoperability standpoint, how can you

be sure that a healthcare information technology

provider delivers solutions that “play nice” with

others? How can you tell if a vendor will really be

able to help you meet your interoperability goals?

Demand success statistics.Most importantly, any trusted vendor will have a large number

of successful implementations. Think hundreds or thousands

of proven, strong connections and success stories. You should

ask for the number of live interfaces and the number of systems

with which your potential vendor connects. Again, the numbers

should be impressive.

Ask about MU.You can look at certifications, but these have become almost “cost-

of-entry” type deliverables. Every vendor worth your time should have

them. Ask potential vendors if they can help you meet Meaningful Use

(MU) Stage 1 and 2 requirements. Interoperability testing and validation

are part of these standards. Be sure to confirm each vendor’s listing on

the Certified Health IT Product List (CHPL) to view certification details:

http://oncchpl.force.com/ehrcert/CHPLHome.

User experience trumps all.Most importantly, ask current users of

the technology about their experience

and, if possible, observe their use of any

prospective systems first-hand. You want

to be part of a winners’ club of happy

connectivity technology users!

Ask the RIGHT questions first.

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Workgroups: These groups include members of the healthcare information

technology community and its stakeholders, such as ONC,

Medicare, or large hospital groups. These entities get together

in workgroups to solve a particular interoperability challenge.

For example, NextGen Healthcare representatives have a

long history of leading or contributing to EHRA, Standards

& Interoperability, and ONC workgroups. Your potential

vendor should be very active in these types of workgroups—

and its leaders should be chairing committees for them.

Why? Because standards are developed in these workgroups,

and having a “seat at the table” is important for vendors.

Ask your potential vendors for their workgroup-related

involvement and achievements.

Pilot Projects: Active involvement in industry workgroups invariably leads to

pilot projects at the cutting edge of interoperability technology

and workflows. Within the last 12 months, NextGen Healthcare

participated in nearly a dozen successful pilot programs

including the Beacon Community EMR Vendor Affinity Group,

ONC’s Prescription Drug Monitoring Program, the MedAllies

Direct Pilot, and the Clinical Decision Support Consortium.

Connect-a-thons:Whether your potential vendor participates in connect-a-thons

is very telling. During these events, vendors test exchanges

of nearly every clinical document type through a variety of

workflows, including HIE (Health Information Exchange), EHR,

and cross-community exchanges. At the end of the event,

vendors publish a conformance statement, which lists the

types of standards against which each company’s technology

is certified. Ask your vendor what it has tested in the context of

these events—and ask to see its outcomes.

No industry visibility? No thank you.In addition, any vendor worth your time and resources will have a strong presence and high visibility at healthcare industry events that test and prove interoperability skills. For example:

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3

CHAPTER

What’s a CCD? Show and tell.A continuity of care document (CCD) can be a thing of mystery. Many healthcare professionals may not really understand what it is, what it looks like, or what it can do. But CCDs are critical to your organization’s connectivity, interoperability, and HIE participation and success. CCD generation is required to meet one component of Meaningful Use. We’ll also explain the importance of the consolidated clinical document architecture (CCDA) along with the various methods to transport these clinical documents.

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What is a CCD?

A CCD is an electronic document standard for sharing patient summary information. These summaries include

the most commonly needed pertinent information about a patient’s health status, demographics, insurance and

healthcare provider information, medications, allergies, and recent medical procedures.

What does a CCD do?

A CCD is a type of CDA (Clinical Document Architecture). A CDA is the architecture that helps identify the content/

document types that are being exchanged. A CDA’s primary purpose is for exchange, specifically exchanging patient

content from one care setting to another. It’s not intended to be a complete medical history for a patient. Instead,

its purpose is to include only the information that’s critical to continue care. Also, one of the most important

characteristics of a CCD is that it must be human-readable, using any standard Web browser—so any patient or

clinician can open a CCD and view patient health data. CC

D

See expanded view of a CCD below.

Expanded view of a CCD

A CCD includes the following content:

• Patient Information

• Intended Recipients

• Reason for Referral

• Payers

• Problems

• Family History

• Social History

• Allergies, Adverse Reactions, Alerts

• Medications

• Immunizations

• Results

• Vital Signs

• Procedures

• Encounters

• Advance Directives

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What is a CCDA?

The consolidated clinical document architecture (CCDA) is an updated standard format for clinical data. This is the

most recent, robust release of a clinical document structure, with substantial coding behind it, that is now required

for MU2. Within a CCDA, each data element visible to the user has a rich, uniquely identifiable coding system that

helps recipients parse the data and analyze its contents. Additionally, CCDAs have document templates that

support a variety of uses, such as Clinical Summary, History and Physical, Consult Note, and Discharge Summary.

What does a CCDA do?

The richer data requirements of the CCDA support expanded data sharing abilities. CCDAs can be used to

provide patient summaries, facilitate transitions of care, and to populate external systems with patient data.

Additionally, since the CCDA supports a variety of narrative text entries, we expect CCDAs to be valuable in

the support of natural language processing tools.

In addition to the original clinical content included in a CCD, a CCDA also includes:

• Cognitive status

• Functional status

• Reason for referral

• Referring or transitioning provider’s name

• Vital signs – height, weight, blood pressure, BMI

• Care plan field(s), including goals and instructions

• Procedures

• Care team member(s)

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Must-know list: Key connectivity options You’ve got choices when it comes to connectivity. Here are some of the most talked about options:

Direct via HISP

• What is Direct?

The Direct Protocol specifics a simple, secure, scalable,

standards-based way for participants to send encrypted

health information – such as a CCD or CCDA – directly

to known recipients over the Internet.

• What is a HISP?

Direct interfaces can require a Health Information Service

Provider (HISP), which is an entity that is responsible for

delivering health information messages between senders

and receivers over the Internet.

• What does it all mean?

Essentially, the HISP provides the secure transport of

the Direct Message content.

Direct via HISP is the method of transport for meeting

the interoperability requirement in MU2 (Core

Objective #15).

XDS.b to third party system

XDS.b is an IHE, industry standard to provide, register, and

retrieve documents from a third party system, such as an HIE.

• An HIE provides a data repository so other people in the

community can connect and share documents.

• The difference between XDS.b and Direct? Unlike XDS.b,

Direct messages via HISPs do not get stored in a centralized

repository. The message is transient and it is only shared

between the sender and recipient. HIEs store a copy of each

document submitted to its repository and provides users

the ability to query and retrieve clinical data.

HealtheWay: This non-profit, public-private partnership

supports the eHealth Exchange and is an ONC-approved

method for supporting the transport of CCDAs as required by

MU Core Measure # 15 – Clinical Summaries. (Formerly

the Nationwide Health Information Network Exchange). Its

mission is to enable the safe, secure, nationwide exchange

of health information.

CommonWell Health Alliance: This is a vendor-

driven effort designed to be an independent non-profit

trade association supporting interoperability. CommonWell

promotes and certifies a national infrastructure with common

standards and policies, allowing built-in EHR data access.

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4

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Back to basics: why use an HIE?

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Interoperability and coordination are key.

True clinical integration of patient care around PCMH and collaborative care ACO models requires healthcare technology

interoperability with other organizations. PCMHs need to provide coordinated, proactive care throughout their patients’

lifetime—this isn’t possible without a health information exchange (HIE). What’s more, ACOs manage risk by managing

patient populations. You can better accomplish this with shared data via an HIE.

Enable care collaboration, care quality, and patient safety.

To connect disparate technology systems and reap the associated benefits of controlled data flow, decreased costs, and

reduced errors, you need a powerful and proven HIE. Care collaboration via HIE makes all patient encounter data available

in the patient record, helping to improve care quality and safety. Plus, data-driven patient population management decisions

— enabled by your HIE—help to create your desired operational, clinical, and financial outcomes.

Make an intelligent business investment.

To support the wide variety of business relationships that exist between and among healthcare providers, while focusing

on the common goals of improved patient care, effective use of HIE technology is a necessary business tool, and a wise

investment. Whatever vendor you choose, ensure your success by leaning on HIE experts who can help you:

• Map out your short- and long-term HIE strategy

• Form a viable entity to support your evolving goals

• Build your scalable technology road map

• Intelligently leverage your existing technology infrastructure

• Build and deploy a clinical model/gain physician acceptance

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By effectively sharing information with other healthcare providers, you can improve care quality, coordination, and safety

The data aggregated by an HIE is critical to managing the health of your entire patient population

HIE technology can improve patient and community relations, while enhancing referral management

The HIE can enable more efficient electronic prescribing and pay-for-performance measurement/reporting

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Achieving interoperability through HIE technologyis crucial for several reasons.

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5

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Open the door to success with the right patient portal.

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If you haven’t already taken the plunge with a patient portal, your patients will be asking about it; and you’ve probably been considering it.

It’s called a “portal” for a reason.

Think of your patient portal as the virtual front door to your practice, or as the single online point of entry to your enterprise, whether

patient or provider. It’s important that your front door is easy to use and clearly indicates where your patients need to go.

Pick a smart portal.

The right portal will allow your patients to

interact seamlessly with your practice, will

automate communications to ensure they go

to the proper provider or administrator, and

will never leave your patients feeling like they

must look elsewhere for comprehensive,

collaborative care. In other words, your portal

has to be smart enough to handle medical,

financial, and scheduling tasks automatically.

When that happens, patient satisfaction will

increase and your patients’ affinity to your

practice will strengthen.

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Not every patient portal will integrate into your EHR. If it won’t, you’ll need a third-party interface. That’s a big consideration as you evaluate the right portal for your organization.

To improve care and collaboration within your organization, a Patient Portal is crucial. Why?

• Keep healthcare providers more involved and

connected to patients, and vice versa

• Help improve disease management and ensure

patients are up to date with treatments

• Enable easy scheduling of maintenance visits by

running quick reports by disease state

Become a hassle-free practice. Being part of an ACO helps you become a “hassle-free” practice. The right portal can help you achieve that goal. How?

• Tightly integrate into your workflow and your

EHR and Practice Management solution

• Quickly and easily enable prescription renewals

and facilitate online payments

• Streamline documentation, such as questionnaires,

surveys, and other online forms

• Simplify and accelerate administrative tasks such

as patient intake, calls, emails, scheduling, sharing

labs, and more

Strengthen your bottom line. Also important, a proven patient portal can help improve your bottom line:

• Reduce expenses via electronic forms and by

eliminating snail mail

• Enable productivity improvements that save

time and money

• Lower the cost of healthcare through better

coordination and improved outcomes

To achieve your MU Stage 2 and 3 goals, and hit your

PCMH or ACO objectives, a patient portal is not only

essential, but required! The right portal will deliver the

communication capabilities needed to reach these goals

and give patients a more active role in their own care

and involvement in how their data is managed, all

while enhancing your productivity.

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6

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Connecting the dots.

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No matter where you are on your connectivity journey, we hope you found this eBook interesting, educational, and helpful.

Do you now know enough about connectivity, interoperability, and the capabilities of an HIE to be “dangerous?” Do you have a better sense of what questions to ask potential vendors? Do you know how an HIE and Patient Portal can help your organization succeed?

If you still have questions, we have answers. Don’t hesitate to reach out to our experts. We’re happy to consult with you, help you solve your connectivity challenges, or just give you some peace of mind by sharing the many success stories from our 30,000 HIE provider-users.

It all starts with connectivity.

Get connected. Be interoperable. Start now!

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NextGen Healthcare Information Systems, LLC, a wholly owned subsidiary of Quality Systems, Inc., provides integrated clinical, financial and connectivity solutions for ambulatory, inpatient, and dental provider organizations. For more information, please visit nextgen.com and qsii.com.

Copyright © 2013 NextGen Healthcare Information Systems, LLC. All rights reserved.

NextGen is a registered trademark of QSI Management, LLC, an affiliate of NextGen Healthcare Information Systems, LLC. All other names and marks are the property of their respective owners. Patent pending.

EDU18-7/13