1. DIGITAL CARE MANAGEMENT PLATFORM
Client is a California based healthcare company, they uniquely combine
technology, services and analytics to produce scalable, high touch care
models that enrich the patient-provider experience and reduce the cost of
care.
The digital care management platform empowers people with
personalized actionable data and consultations to help them achieve
better health.
ABOUT PROJECT:
The Digital Care Management Platform enables wellness and CCM patients to log their day to day
activities such as food intake, exercises, medicines, etc. and receive suggestions and
recommendations about achieving better health from the care management team of clinicians
(nutritionists, fitness experts and health experts) based on their personalized Care Plan. The
platform consists of the following four components :
iOS and Web App
• The iOS app/ web app enables the user to
receive personalized coaching from the nurse,
clinicians, nutritionist etc.
• It facilitates real-time health, by syncing health
and fitness apps.
• It allows full circle conversation loop with the
team of clinicians
• The web app is accessible to clinicians and the
patients, whereas the iOS app is only accessible
by the patients.
• Clinicians have access to other functionalities
needed to manage the health updates of each
of the patient via the web app.
CMA(Chronic Care Management Agent)
Portal
• CMA portal facilitates the registration and
activation of new patients onto this platform.
• This portal specifically helps in onboarding
CCM patients on the platform.
Integration with Wellness Devices
• The platform is integrated with lot of
wellness devices which enables it to
track all patients’ activities.
• Patients sync their devices with the
platform, which enables it to track all
their activities and provide a
personalized care plan.
Integration with EHR systems of
different hospitals
• Seamless integration with EHR systems,
enabled value based care.
• Mirth connect interfaces, which are a
secure and HIPAA-compliant channel to
share details of the patient’s care plan
from the EHR with the platform, has
been implemented.
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2. I MIRTH CONNECT INTERFACE
• Mirth Connect interface, establishes communication between EHR systems and platform’s back
end.
• This interface facilitates data sharing between two or more systems to fulfil the following high
level requirements:
1. All CCM eligible patients in EHR system are automatically enrolled in the portal as a proof of
care.
2. The messaging information related to the care provided to the patients via web and iOS app
is be stored in EHR system.
3. Care plan of a CCM eligible patient in the EHR system is accessible to clinicians.
4. Medical practitioner, provider and patient visit information is visible to the clinicians.
PLATFORM ARCHITECTURE
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3. • Implemented the Mirth interfaces,
a secure and HIPAA-compliant
channel to share details of the
patient’s care plan from the EHR,
with the Digital Care Management
Platform.
• API developed for the platform
can easily connect to any EHR
irrespective of the technology EHR
is built in.
There are discretely 4 types of integrations between the EHR and the Digital Care Management
Platform :
EHR System exposing Database for Integration:
Some legacy EHRs do not have an API, however exposes their databases. The platform accesses
the database to fetch and push details such as patient demographics, care plan, messaging
interactions, etc.
EHR System exposing APIs for Integration:
API format can either be XML or JSON. Some EHRs may send CCD as an API response (XML
format CCD). So, based on what is being received, the relevant parser (XML or JSON) is used
before sending information to the Mirth Connect database.
EHR System exposing CCD Documents for Integration:
XML parsers have been built to extract information from CCD documents received from the EHR
and this information is then sent to Mirth Connect database. Mirth Connect database is
connected to Digital Care Management.
EHR System Exposing ADT feed:
ADT feed consists of HL7 messages. This feed is in XML format and needs to be parsed before it
can be sent to Mirth Connect database.
II EHR INTEGRATION
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4. III INTEGRATION WITH HEALTH AND FITNESS DEVICES :
• Digital Care Management Platform is integrated with different health and fitness
devices, it enables the platform to track patient activities and empower the clinicians to
provide better care.
• The patient can login into the platform and on the settings page the patient can add
devices he or she uses. Health parameters can be tracked from more than one device.
• Patients with health and fitness devices can sync their device with iOS app, as a result
of which the data is automatically uploaded to the system.
• Patients can also log their activities manually using the “Log an Activity” button on the
iOS app.
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Application API

5. V BILLING
• Details of the time spent with a particular
patient for a non-face to face consultation are
captured via the mobile/web app.
• This data is then transmitted (and stored) to
the EHR via the mirth channel.
• In case of the consultation done via mail;
billing is done based on the medical booklets
received from CCM patients by the clinician
team.
• Billing PDF Format is as follows:
1. Name of the patient
2. ICD Codes
3. Clinician messages + minutes
4. Clinician notes + minutes
5. Summation of the time spent
IV PATIENT REGISTRATION PROCESS
There are three methods by which the patients can be registered in the system:
1. ADT feed from EHR: Patients are created based on the HL7 messages received in the ADT feed
from EHR. The codes may refer to creating a new patient, update details of the patient,
updating the vitals, demographics, etc.
2. CSV bulk upload: In case of manual registrations of patients, all the details are added in a CSV
file by the platform representatives and this CSV is then bulk uploaded into the system in a
batch process.
3. Registrations via the CMA (CCM Management Agent) Portal: The CMA portal is connected
with Digital Care Management Platform, thus information about new patient registration along
with their medical records is available in the system.
Two actions are performed during this process:
- Registration of the CCM patient
- Fetching the CCD of that patient, thereby activating the patient on the system.
Information about patient, flows from the CMA portal to the platform backend while the CCD and
other records of this patient are pulled from relevant EHR back to the platform backend.
Clinicians
Web App
Platform
Backend and DB
Billing Data
EHR 1 EHR 2 EHR 3
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6. BENEFITS:
With the platform, client could combine technology, services, and analytics to produce scalable and
high touch care models that :
• Equip the care-provider with a robust toolkit with all information needed about a patient
suffering from a chronic disease in a timely fashion.
• Seamless integration with multiple EHRs, avoided data repetition and discrepancy among the care
providers, this resulted in the right care and consultation provided to patients.
• Digital health delivery, with personalized dashboards, care team communication, nutrition and
food journaling, activity logging, etc.
• The Chronic Care Management module, enables clinicians/ practitioners to provide special non
face to face care to CCM patients hence leveraging the benefits from Medicare as per Obama’s
new healthcare policy.
• JAVA, . NET
• Mirth Connect Integration
TECHNOLOGY:
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7. CONNECT WITH US !
Faichi Solutions, LLC
640 W. California Ave Suite 210 Sunnyvale, CA 94086
Phone: +1 (408) 769-4941
Email: sales@faichi.com
©2016 Faichi Solutions Pvt. Ltd.