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Identity Architecture and Management of Health Information ...


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Identity Architecture and Management of Health Information ...

  1. 1. Identity Architecture and Management of Health Information Exchange Tracy W. Smith Lovelace Clinic Foundation [email_address] Stephen D. Burd New Mexico Telehealth Alliance [email_address]
  2. 2. Presentation Overview <ul><li>New Mexico Telehealth Alliance – Technology and Infrastructure </li></ul><ul><li>New Mexico Health Information Cooperative – Technology and Infrastructure </li></ul><ul><li>Infrastructure Gaps </li></ul><ul><li>National Health Information Network </li></ul>
  3. 3. New Mexico Telehealth Alliance <ul><li>The New Mexico Telehealth Alliance (NMTHA): </li></ul><ul><ul><li>is a non-profit 501c3 corporation </li></ul></ul><ul><ul><li>represents present and potential telehealth users and providers in New Mexico </li></ul></ul><ul><ul><li>has a partnership with New Mexico Technet to provide: </li></ul></ul><ul><ul><ul><li>network planning and operation </li></ul></ul></ul><ul><ul><ul><li>equipment acquisition </li></ul></ul></ul><ul><ul><ul><li>telehealth program coordination and resource sharing </li></ul></ul></ul>
  4. 4. NMTHA Operational Telehealth Projects <ul><li>Screening, Brief Intervention, Referral and Treatment (SBIRT) </li></ul><ul><ul><li>Counseling and intervention for substance abuse </li></ul></ul><ul><ul><li>Connects patients in rural clinics and schools to service providers in Santa Fe. </li></ul></ul><ul><ul><li>Video conferencing to provide services and training </li></ul></ul><ul><li>New Heart </li></ul><ul><ul><li>Monitoring and consultation for cardiac rehabilitation </li></ul></ul><ul><ul><li>Connects patients at rural facilities to cardiac specialists in Albuquerque </li></ul></ul><ul><ul><li>Video-conferencing and remote exercise telemetry </li></ul></ul>
  5. 5. NMTHA Current State <ul><li>Current NMTHA-supported programs use, a state network connecting higher education institutions </li></ul><ul><li>Most locations connect to via leased T1 lines </li></ul><ul><li>Video conferencing bridges and management software are managed by NM Technet </li></ul><ul><li>End point hardware is owned by member programs and institutions and shared on a capacity-available basis </li></ul>
  6. 6. NMTHA Future State <ul><li>Additional or alternative backbone network capacity will eventually be required as users and traffic increase </li></ul><ul><li>Centralized network and administrative services must be added to support: </li></ul><ul><ul><li>Fault tolerance </li></ul></ul><ul><ul><li>End point scheduling </li></ul></ul><ul><ul><li>Authentication and authorization </li></ul></ul><ul><ul><li>Medical record access </li></ul></ul>
  7. 7. NMHIC Overview <ul><li>Community-wide effort </li></ul><ul><li>Health information exchange </li></ul><ul><li>Lead / grant administrated by Lovelace Clinic Foundation </li></ul><ul><ul><li>$1.5 million AHRQ grant </li></ul></ul><ul><ul><li>$1.5 million in-kind </li></ul></ul>Vision: To provide a sustainable statewide health information exchange that transforms health care quality, safety, efficiency and outcomes.
  8. 8. Architecture Overview
  9. 9. NMHIC Services <ul><li>Master Patient Index (MPI) is State resource </li></ul><ul><li>Used within the main exchange system for </li></ul><ul><ul><li>Patient Referral system </li></ul></ul><ul><ul><li>Patient records </li></ul></ul><ul><ul><li>Some limited State reporting </li></ul></ul><ul><li>Can be used or integrated (with approvals) </li></ul><ul><ul><li>Other data sharing participants </li></ul></ul><ul><ul><li>Practice management systems </li></ul></ul><ul><ul><li>Clinical management systems </li></ul></ul><ul><li>Assist with linking specific business partners </li></ul>
  10. 10. NMHIC Current State - Services <ul><li>Master Patient Index (MPI) is working well </li></ul><ul><li>Enables the sharing/exchange of patient information </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Procedures </li></ul></ul><ul><ul><li>Lab results </li></ul></ul><ul><ul><li>Encounter data </li></ul></ul><ul><li>Disease specific guidelines </li></ul><ul><ul><li>Diabetes and asthma </li></ul></ul><ul><li>Patient referral system </li></ul><ul><li>Messaging for providers and their staff </li></ul><ul><li>Secured and encrypted platform </li></ul><ul><li>Role based security </li></ul>
  11. 11. NMHIC Future State <ul><li>Discharge summaries delivery </li></ul><ul><li>Disease management </li></ul><ul><ul><li>Start with diabetes and asthma </li></ul></ul><ul><li>Enhance work flow </li></ul><ul><ul><li>DOH Newborn Hearing Screening </li></ul></ul><ul><ul><li>Other data entry forms for reporting </li></ul></ul><ul><li>Medication reconciliation </li></ul><ul><li>Scheduling, Calendaring, Reminders, and Alerts </li></ul><ul><li>Early warning and surveillance </li></ul>Not an exhaustive list
  12. 12. Combining Telehealth and HIE <ul><li>Why combine telehealth and HIE? </li></ul><ul><li>Support clinical medicine with shared health information: </li></ul><ul><ul><li>Medical records </li></ul></ul><ul><ul><li>Clinical decision support </li></ul></ul><ul><ul><li>Interfaces to existing support services (e.g., Health X-Net) </li></ul></ul><ul><li>Support health information applications with detailed clinical information </li></ul><ul><ul><li>Public health </li></ul></ul><ul><ul><li>Legal and regulatory </li></ul></ul><ul><ul><li>Homeland security </li></ul></ul>
  13. 13. Telehealth/HIE Combination Benefits <ul><li>More effectively use scarce resources including: </li></ul><ul><ul><li>Network capacity </li></ul></ul><ul><ul><li>Technical support staff </li></ul></ul><ul><ul><li>Funding </li></ul></ul><ul><li>Avoid duplication due to similar needs and characteristics: </li></ul><ul><ul><li>Users and sites </li></ul></ul><ul><ul><li>Security and confidentiality </li></ul></ul><ul><ul><li>Low-level (infrastructure) services </li></ul></ul>
  14. 14. Telehealth/HIE Combination Challenges <ul><li>Complexity </li></ul><ul><ul><li>Separating the networks divides the “problem” into to smaller/simpler pieces </li></ul></ul><ul><ul><li>Combining the networks increases management and other challenges. </li></ul></ul><ul><li>Different network traffic types </li></ul><ul><ul><li>Telehealth traffic tends to be continuous, video-intensive, and real-time </li></ul></ul><ul><ul><li>HIE traffic tends to be more bursty and less time-sensitive </li></ul></ul><ul><li>Policies and procedures are required to deal with contention </li></ul><ul><ul><li>For example, which applications receive priority when network capacity is limited or overloaded? </li></ul></ul><ul><li>Electronic health record (EHR) adoption levels are low </li></ul><ul><li>Data exchange and other needed standards are relatively new </li></ul>
  15. 15. Key Integrative Components <ul><li>A backbone network with sufficient capacity and the ability to handle all traffic types </li></ul><ul><li>Low-level services including: </li></ul><ul><ul><li>Master patient, provider, and user indexes </li></ul></ul><ul><ul><li>Security services (encryption, authentication, and authorization across organizations) </li></ul></ul><ul><ul><li>Messaging </li></ul></ul><ul><ul><li>Scheduling </li></ul></ul><ul><li>A management structure to support/run the network and help connect data/service consumers and producers </li></ul>
  16. 16. NHIN Issues <ul><li>Standards </li></ul><ul><ul><li>Development is being driven at the national level </li></ul></ul><ul><ul><li>We’ll be followers/adopters – we can’t afford to be on the bleeding edge </li></ul></ul><ul><li>Network models and prototypes – we need to adopt best technologies and practices from others, including: </li></ul><ul><ul><li>Existing RHIOs </li></ul></ul><ul><ul><li>NHIN RHIO Prototypes </li></ul></ul><ul><ul><li>DOD and VA </li></ul></ul>
  17. 17. More NHIN Issues <ul><li>EHRs </li></ul><ul><ul><li>High EHR adoption is a prerequisite to a successful statewide network </li></ul></ul><ul><ul><li>We must tap NHIN resources (certification, $, expertise, etc) to the maximal extent to fully deploy EHRs in NM </li></ul></ul><ul><li>Access to service providers </li></ul><ul><ul><li>NM has limited access to many services (e.g., speciality care) </li></ul></ul><ul><ul><li>As the NHIN develops, we must use it to expand access to service providers elsewhere in the country (and the world?) </li></ul></ul>
  18. 18. For further information <ul><li>These slides: </li></ul><ul><ul><li> </li></ul></ul><ul><li>RHIO- and telehealth-related NM organizations: </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li>Please send additions to </li></ul></ul>