Not sure if your practice is appropriately connected? Our new eBook, "Get Connected. Be Interoperable. Start Now." will help you understand the nuances of interoperability and connectivity.

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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.

2. Chapter6Welcome!Chapter1Chapter5Chapter4Chapter3Chapter2
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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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 know
what you don’t know.
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2
3
4
5
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:
NEWS
Healthcare IT News: General healthcare IT news source
NHINWatch: News/guide to the Nationwide Health Information Network
INDUSTRY ORGANIZATIONS
HealtheWay: 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 SITES
ONC-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 BLOGS
Gartner’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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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.
CCD
See expanded view
of a CCD below.

11. 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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2
3
4
Achieving interoperability through HIE technology
is crucial for several reasons.

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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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Connecting thedots.

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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