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Alabama – Health Information Exchange Alabama Medicaid

Alabama - Health Information Exchange Leveraging the Nation-wide Health Information Network (NHIN). AL-HIE Stakeholders Primary Provider Pharmacy EMT Hospital/Clinic Health Organization/Center Payor Wellness Community Personal Health Records ….

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Alabama – Health Information Exchange Alabama Medicaid

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  1. Alabama - Health Information Exchange Leveraging the Nation-wide Health Information Network (NHIN) • AL-HIE Stakeholders • Primary Provider • Pharmacy • EMT • Hospital/Clinic • Health Organization/Center • Payor • Wellness Community • Personal Health Records • … Alabama – Health Information Exchange Alabama Medicaid Initiative Director: Kim Davis-Allen, Alabama Medicaid Agency Kim.Davis-Allen@medicaid.alabama.gov Presented By: Thomas E Marshall, PhD, Auburn University thomasemarshall@gmail.com

  2. NHIN Affiliations The Certification Commission for Health Information Technology (CCHIT) Health Information Technology Standards Panel (HITSP) The Community is a federally-chartered commission that provides input and recommendations to HHS on how to make health records digital and interoperable and ensures that the privacy and security of those records are protected in a market-led way. National eHealth Collaborative (NeHC) The Health Information Security and Privacy Collaboration (HISPC) Nationwide Health Information Network (NHIN) Architecture Projects • These five organizations • were created to reach the • goal of interoperability. Introduction to NHIN and NHIN Connect and IHS - alaskatribalhealth.org https://www.alaskatribalhealth.org/events/loader.cfm?csModule=security/getfile&pageid=5580

  3. NHIN What does it stand for: Nation-wide Health Information Network ? Network of Health Information Networks ? Network of Health Information Organizations ? Network of Health Information Exchanges What does NHIN mean to AL-HIE? Standards, open interoperability, security, … Continuity of Care Document Improved Clinical Support Community Health Awareness Improved Health Evidence-Based Medical Discoveries Presentation Sources: NHIN Enterprise Architecture, Kevin Puscas Version: 1.0 http://healthit.hhs.gov NHIN University - http://www.nationalehealth.org/NHIN-U/ http://HITSP.org

  4. The ultimate goal of the NHIN Reference Enterprise Architecture is to support the Health IT Business Cases. These Health IT Business Cases are implemented as interoperability orchestrations of the services provided by the Capability Framework, which are specified as bindings to the Technology Platform. The Technology Platform provides specifications for the implementation of the Operational Infrastructure. The Operational Infrastructure is defined and managed according to the policies, rules and governance practices defined in the Policy, Legal, and Governance Foundation. LHIO Driven by Local Needs Standard Interface & Technology NHIN Community Figure 2 - NHIN Enterprise Reference Architecture Kevin Puscas

  5. NHIN Technology • Open Source – Open for Innovation, not free • Service Oriented Architecture (SOA) • Web Services – Discovery, Interface Definition • Orchestrated service-based applications Software Engineering Concepts: • High Cohesion – highly defined module focus • Loose Coupling – independence between modules

  6. System Interface - reuse

  7. Gateway Birmingham AL–HIE Stakeholders Communicating via the NHINArchitecture Gateway Auburn Medicaid Gateway • AL-HIE Stakeholders • Primary Provider • Pharmacy • EMT • Hospital/Clinic • Health Organization/Center • Payor • Wellness Community • Personal Health Records • … Gateway Stakeholder Mobile

  8. CMS FED TN Medicaid Gateway Gateway Gateway Birmingham GA Medicaid Gateway Gateway Auburn Medicaid Gateway Gateway MS Medicaid Gateway Mobile AL–HIE Stakeholders Exchanging Health Information viaNHIN Gateways to the NHIN

  9. NHIN Enterprise Architecture The ultimate goal of the NHIN Reference Enterprise Architecture is to support the Health IT Business Cases. These Health IT Business Cases are implemented as interoperability orchestrations of the services provided by the Capability Framework, which are specified as bindings to the Technology Platform. The Technology Platform provides specifications for the implementation of the Operational Infrastructure. The Operational Infrastructure is defined and managed according to the policies, rules and governance practices defined in the Policy, Legal, and Governance Foundation. LHIO Driven by Local Needs Standard Interface & Technology NHIN Community Figure 2 - NHIN Enterprise Reference Architecture Kevin Puscas

  10. reflect complex information exchange flows targeted to specific healthcare scenarios Emergency Responder-Electronic Health Record Electronic Health Record – Lab Results Medication Management Consumer Empowerment-Consumer Access to Clinical Information Consumer Empowerment- Registration and Medication History Quality Biosurveillance - patient look-up, - document query and retrieve, and - event based mechanisms for specific information. - services can be composed and choreographed into complex health care information exchanges. Services Registry – technical information of services used to locate and utilize these services by other NHIN participating organizations UDDI Security – public key infrastructure PKI Operational Monitoring - … allows for timely managing any type of disruptions to the NHIN as a whole Service Oriented Architecture approach non-proprietary and implementation agnostic. Based on the use of web services NHIN Enterprise Reference Architecture … underlying organizational and cooperative constructs required to create a virtual information exchange network among the participating NHIOs. Including Data Use and Reciprocal Support Agreement (DURSA)

  11. NHIN Operational Architecture Static View of the NHIN Operational Architecture

  12. HITSP • http://HITSP.ORG • IS 01 • Electronic Health Record (EHR) Laboratory Results ReportingThe Electronic Health Records Laboratory Results Reporting Interoperability Specification defines specific standards to support the interoperability between electronic health records and laboratory systems and secure access to laboratory results and interpretations in a patient-centric manner. • IS 02 • BiosurveillanceThe Biosurveillance Interoperability Specification defines specific standards that promote the exchange of biosurveillance information among healthcare providers and public health authorities. • IS 03 • Consumer EmpowermentThe Consumer Empowerment and Access to Clinical Information via Networks Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via networks.

  13. HITSP • IS 04Emergency Responder Electronic Health Record (ER-EHR)The Emergency Responder Electronic Health Record Interoperability Specification defines specific standards required to track and provide on-site emergency care professionals, medical examiner/fatality managers and public health practitioners with needed information regarding care, treatment or investigation of emergency incident victims. • IS 05Consumer Empowerment and Access to Clinical Information via MediaThe Consumer Empowerment and Access to Clinical Information via Media Interoperability Specification defines specific standards needed to assist patients in making decisions regarding care and healthy lifestyles (i.e., registration information, medication history, lab results, current and previous health conditions, allergies, summaries of healthcare encounters and diagnoses). This Interoperability Specification defines specific standards needed to enable the exchange of such data between patients and their caregivers via physical media or secure email exchange. • IS 06QualityThe Quality Interoperability Specification defines specific standards needed to benefit providers by providing a collection of data for inpatient and ambulatory care and to benefit clinicians by providing real-time or near-real-time feedback regarding quality indicators for specific patients. • IS 07Medication ManagementThe Medication Management Interoperability Specification defines specific standards to facilitate access to necessary medication and allergy information for consumers, clinicians, pharmacists, health insurance agencies, inpatient and ambulatory care, etc.

  14. IS 04Emergency Responder Electronic Health Record (ER-EHR) IS 05Consumer Empowerment and Access to Clinical Information via Media IS 06Quality IS 07Medication Management IS 08Personalized Healthcare IS 09Consultations and Transfers of Care IS 10Immunizations and Response Management IS 11Public Health Case Reporting IS 12Patient – Provider Secure Messaging IS 77Remote Monitoring IS 91Maternal and Child Health IS 92Newborn Screening IS 98Medical Home IS 107EHR-CentricThis Interoperability Specification consolidates all information exchanges and standards that involve an EHR System amongst the thirteen HITSP Interoperability Specifications in place as of the February 13, 2009 enactment of the American Recovery and Reinvestment Act (ARRA). This Interoperability Specification is organized as a set of HITSP Capabilities, with each Capability specifying a business service that an EHR system might address in one or more of the existing HITSP Interoperability Specifications (e.g., the Communicate Hospital Prescriptions Capability supports electronic prescribing for inpatient prescription orders). Greater detail on these Capabilities is provided as part this Interoperability Specification, with their underlying HITSP constructs referenced in the Complete Library on HITSP.org. IS 158Clinical ResearchThe Clinical Research Interoperability Specification covers clinical research in all its forms as it interoperates with healthcare systems, particularly EHRs. The specification spans two industries, healthcare and clinical research, and incorporates standards from healthcare (HL7 and IHE) and research (CDISC). The design leverages existing HITSP constructs and communication methodologies where applicable, and lays out new constructs as needed. The design also leverages the current players in the clinical research industry such as Electronic Data Capture (EDC) systems and research registries. HITSP Standard Processes

  15. Gateway Birmingham AL–HIE Stakeholders Exchanging Health Information via the NHINArchitecture Gateway Auburn Medicaid Gateway • AL-HIE Stakeholders • Primary Provider • Pharmacy • EMT • Hospital/Clinic • Health Organization/Center • Payor • Wellness Community • Personal Health Records • … Gateway Stakeholder Mobile

  16. Nation-wide NHIN Technology Infrastructure Authorization Consumer Preferences Document Query & Retrieval Data Transform Service Discovery Message Platform Adaptor Web Service Subject Identity Audit Log Master Subject Index Data Store NHIN Service Registry NHIN Gateway Alabama As NHIO Enterprise Service Bus Other NHIOs Authorization Engine

  17. CMS FED TN Medicaid Gateway Gateway Gateway Birmingham GA Medicaid Gateway Gateway Auburn Medicaid Gateway Gateway MS Medicaid Gateway Mobile AL–HIE Stakeholders Exchanging Health Information viaNHIN Gateways to the NHIN

  18. NHIN Affiliations The Certification Commission for Health Information Technology (CCHIT) Health Information Technology Standards Panel (HITSP) The Community is a federally-chartered commission that provides input and recommendations to HHS on how to make health records digital and interoperable and ensures that the privacy and security of those records are protected in a market-led way. National eHealth Collaborative (NeHC) The Health Information Security and Privacy Collaboration (HISPC) Nationwide Health Information Network (NHIN) Architecture Projects • These five organizations • were created to reach the • goal of interoperability. Introduction to NHIN and NHIN Connect and IHS - alaskatribalhealth.org https://www.alaskatribalhealth.org/events/loader.cfm?csModule=security/getfile&pageid=5580 23

  19. Complex Health Care Information ExchangeUse-Case Process Flow Partner Network

  20. AL-HIE Leveraging the NHINImproved Health Care Value Through eHealth Collaboration CMS FED TN Medicaid LHIO Driven by Local Needs GA Medicaid Birmingham Standard Interface & Technology Auburn MS Medicaid AL Medicaid NHIN Community NHIN Enterprise Reference Architecture Kevin Puscas Mobile

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