The document discusses proposals for developing healthcare information sharing infrastructure and solutions across multiple healthcare providers in New Jersey. It proposes a partnership between Newark Beth Israel Medical Center and other hospitals, clinics, nursing homes and healthcare organizations to create a healthcare information exchange. It describes two potential models for this exchange and the key components, including physician and patient portals, clinical data repositories, standards-based integration, and a universal patient transfer form. The goal is to improve care coordination, access to patient information, and health outcomes across the healthcare system.

1. Presented by: Newark Beth Israel Medical Center IGI Health INTEL

2. Infrastructure Introduction Proposed Partners How we got here

3. Infrastructure Non Technical Considerations Common Vision and Purpose Leadership Governance Other Stakeholder Participation Collaboration and Competition Focus and Priorities Benefits and Value to Stakeholders Financial Feasibility Data Sharing Agreement Privacy and Security

4. Newark Beth Israel Medical Center East Orange General Hospital Trinitas Medical Center UMDNJ Physician Patient Ambulance Nursing Home Home Care FQHC The Challenge St. Michael’s Medical Center Clara Maass Medical Center NJ State

5. Newark Beth Israel Medical Center East Orange General Hospital Trinitas Medical Center UMDNJ HIE Solution – Model 1 St. Michael’s Medical Center Clara Maass Medical Center NJ State Physician Portal Patient Portal Shared Service Data Marts

6. HIE Solution – Model 2 Simplify & scale healthcare information interoperability among participants Newark Beth Israel Medical Center St. Michael’s Medical Center East Orange General Hospital UMDNJ Physician Portal Patient Portal Shared Service Data Marts

7. Newark Beth Israel Medical Center East Orange General Hospital Trinitas Medical Center UMDNJ Community HIE Solution St. Michael’s Medical Center Clara Maass Medical Center NJ State Patient Facilities Physician FQHC Ambulance Home Care Nursing Home Physician Portal Patient Portal

8. Access virtual EMRs & sharing of longitudinal patient data Provide instant access to lab results Capture patient consent for data sharing Interface with clinical data repositories and EMR’s Manage interface to State Immunization System Transfer Patients between internal and external facilities Establish referral workflows & continuity of care Use e-prescribing to fill prescriptions Using the ORBIT portal framework, hospitals can deliver a broad set of services: Physician Portal

9. The Clinical Solution ORBIT Shared Services Hospital Staff Physicians Patients Physicians EMR EMR – API Connectors ORBIT Physician Portal ORBIT Patient Portal Newark Beth Israel Clinical Data Repository Patient Index Record Locator Other EMR DB Patient PHR EMR Lite

10. HIE “ALL” Connections Orders Results Reports Eligibility Referral Pre Auth Claims/ERA Clinical Data ADT Record Locator Patient Search Portals HIE Co-Pay Recurring Pay Remittance ORBIT Repository New Rx Refills Formulary State Immunization Records Birth & Death Certificates EMPI Hospital Staff Physicians Patients Physicians EMR Documents Clinical Repository Hospital Z Messages

11. Healthcare Standards IHE Profiles XDS.a Document Source Document Consumer XDS.b Document Source Document Consumer PIX v.2 & V.3 Consumer PDQ v.2 & V.3 Consumer ATNA Secure Application CT HITSP Profiles Manage Sharing of Documents Transaction Package Patient ID Cross-Referencing Transaction Package Patient Demographics Query Transaction Collect and Communicate Security Audit Trail Transaction Secured Communication Channel Transaction Templates for all versions and transactions of HL7, EDI X12, HIPAA, and NCPDP All HL7, v2 and v3 (XML)

12. ADT, ORR and ORX Continuity of Care (CCD) Clinical Data Architecture (CDA) Patient Transfers (UT) Order Entry and Results New Rx and Refill Medication history Document Attachments Pre/Post Operative Documents Lab Reports & Images Secure Messaging (Level A4) Real-Time Transactions: Eligibility & Member Benefits Referrals & Authorizations Claim Status & Remittance Advice Profession/Dental Claims WC, P&C, Secondary UB inpatient, outpatient, LTC, AMC Batch Transactions: Claims, Referrals, Eligibility Enrollment, Electronic Remittance Advice (ERA) Co-payments Credit Card payments Check guarantee Electronic Funds Transfer (EFT) FSA/HSA Account Link Healthcare Standards continue ADMINISTRATIVE HIPAA CLINICAL HL7 FINANCIAL SWIFT MEDICATIONS NCPDP DOCUMENT SHARING

13. Consent Management Hospital Consent Forms Physician Consent Forms Patient On-Line Consent PHR Data SHARING Case 1 View Access Control Case 2 Complete Control Case 3 Partial Data Access Case 4 Date Range Access Case 5 Send PHR as CCD Case 6 Get CCD to load PHR MS HealthVault Case 1 Save PHR Case 2 Import Data Case 3 Synchronize Data Patient Consent

14. Why INTEL & IGI? Solution that will overlay on an existing framework Integration through healthcare data standards compliance Out-of-the-box semantic mapping and pluggable healthcare services Connecting to all EDI Healthcare Transactions Admin  Health Plans Clinical  Hospitals and Labs Rx  PBM and Pharmacies Financials  Banks Portal Solution & Exchange in place since 2003 EMR Lite for physicians with limited EMR Patient Portal integrated with clinical data sets Robust API’s for existing EMR

15. Portal Implementations Affiliated Physician Portal Community Health Web Health Information Exchange Employer Portal Consumer/Patient Vendor/Clearinghouse Portal Features Federated Model User level security Dynamic Menus Audit Trails Single Sign On Configurable Available Models Private-labeled Componentized Self-Managed or Hosted Portal Solution

16. SOA Expressway 06/16/09 06/16/09 Healthcare Development Kit & Integration Engine Pre-built data maps, web services and integration workflows Integration engine with “any” to “any” mapping technology HL7, EDI, X12, HIPAA and IHE XDS support Codeless Designer Visual IDE for workflow & data map design-eliminates coding High Performance Runtime Optimized for Intel Multi-Core. Scales on standard Intel servers Soft-Appliance Software delivers appliance-like manageability, upgrade flexibility and Mgt UI OS (Red Hat, Suse, Windows) and VM (Xen, VMWare, Microsoft) Protects, Secures, Governs, & Accelerates Healthcare transactions Open Architecture Fits cleanly into Existing Investments

17. Newark Beth Israel Medical Center Provider Solution Provide single sign-on Give clinicians web-based access to EMR/PHR at point of care Integrate referral and consult messaging Allow clinical and administrative users of the system to coordinate Patient Solution Create a patient-centric tool, allowing disparate systems to be viewed as one Aggregate complete patient demographic, events, and clinical results into one PHR HIE Solution Allow for interoperability among legacy systems Deploy meaningful clinical value in less than a year Offer an affordable, cost-effective and highly-valued solution Comprehensively improve care and outcome throughout the enterprise The Challenge Establish an enterprise-wide technology Provide interoperability among community care givers Deliver a comprehensive patient record Create a flexible and scalable platform

18. Infrastructure Application Server Windows 2003 R2 Server / Linux WebSphere / Glassfish / JBoss IP Monitor Database Server Windows 2003 R2 Server / Linux MS SQL / ORACLE / My SQL Intel SOA Server Linux Enterprise Edition

19. Universal Transfer Form (Patient Transfer / Discharge)

20. Universal Transfer Form (UTF) NJ State Department of Health and Senior Services (DHSS) Regulation A state-wide, mandatory use “transfer form” Assumption that the Mandate will be in place in fall of 2009 Inpatient/resident transfers between all licensed health care facilities & programs. Emergency Dept.  Emergency Dept. Emergency Dept.  Return to LTC New Born, Others Selective exclusions: Transfer from Facility Transfer to Facility Hospital  Hospital Hospital  SNF, NF, ALF, Sub-acute Care, Home Care SNF, NF, ALF, Sub-acute Care, Home Care  SNF, NF, ALF, Sub-acute Care, Home Care

21. Mandate Task Force NJDHSS (Dept. of Health) Home Care Association NJ NJHA (Hospitals/LTCFs) Center for Lifelong Learning NJAHSA (Non-Profit LTCFs) NJ Hospice & Palliative Care Organization (NJHPCO) HCANJ / NJALC (LTCFs) AMDA – NJ Chapter HQSI (QIO of NJ) Various facility / provider ER / ED Nurses (NJ-ENA) Medical Society of NJ representatives NJ Association of DONA

22. Benefits of Universal Transfer Form Improves accuracy of information shared about the patient Increases efficiency in providing care (for the receiving facility) Promotes patient safety by minimizing opportunities for errors Enhances quality of care through improved accuracy and timeliness of information shared Enables staff productivity because of standardization of information Focuses attention on most important clinical areas In electronic form, could draw data from existing data sources and manage documents – minimizing opportunities for error even further Promotes greater patient, family and clinical staff satisfaction with the coordination of care Helps increase staff satisfaction and retention Improves rapport between providers serving the patient Makes better use of scarce clinical resources Helps decrease liability risk

23. Universal Transfer Form History Paper pilot occurred in 2008 with over 50 organizations participating from five regions of the state, each with a “hub” hospital system and several post-acute partners (LTC, home care, assisted living, etc.) IGI contacted by HCANJ and NJHA to develop an electronic version of the paper form Automated Pilot–Began March 4th, Meridian Health Establish clean workflow with a good sampling of cases Refine form data elements Manage attachments Expand pilot participation Record Results 1 st HL7 import/export (CCD, ADT) requested to start in 2 other regions, with 1 st most likely being Seashore Gardens

24. Automated User Base Riverview Medical Center Patient Jersey Shore University Medical Center Ocean Medical Center Meridian @ Home Meridian Sub-Acute Expanding to other interested facilities Aristacare Whiting – 1 st External facility Alert Ambulance