Pilot Project Brief - MedAllies

PROJECT BRIEF: PROPOSED NHIN/DIRECT PILOT IMPLEMENTATION

Sponsor(s)/Contact(s): MedAllies, Inc., represented by LeRoy Jones - Acting CIO

NOTE: When filling out this template, be sure to address the considerations listed in the Implementation Operational Plan.

Objectives

• Provide advanced support to clinicians through enabling of proactive delivery of clinical information to other providers for patient care.
• To demonstrate NHIN/Direct User Stories (top three; not intended to be exhaustive):
  • Primary care provider refers patient to specialist including summary care record
  • Specialist sends summary care information back to referring provider
  • Hospital sends discharge information to referring provider

Description

• MedAllies will implement the full NHIN Direct infrastructure, including both the required SMTP backbone, and the XDR elective protocol. We have an HIE associated with a local RHIO and an IPA that help us to garner support from the physician community. The current thrust of the HIE is to enable point-to-point push of structured information, and the IHE stack has been used heretofore. Our integration efforts have been around the XDS.b and XDR integration profiles, and will migrate to the XDD profile being worked on by NHIN Direct & IHE. In the mean time, we are encouraging vendors to begin the integration process using the XDR profile, anticipating that this will be largely transferable to XDD.
• We are attempting to have wide coverage and conformance across the service area by connecting all of the participating vendors that we can. We are asking vendors with customer footprint in the area (Hudson Valley, NY) to join with us, identify their customers, and work with us to bring those provider entities into the fold.
• The result we anticipate is a free-flowing, comprehensive referral area that can move and respond to referrals with little encumbrance. We also envision broad incorporation of patient visit information in the inpatient settings to be incorporated into the electronic records of the relevant primary care physicians and specialists
• Pilot project - Integration capabilities

Clinical workflow capabilities -

• • The hospitals participating in the pilot project should be able to generate a (CDA based) discharge summary at the time of each patient discharge. The discharge summary at minimum should include medication list.
  • The ambulatory facilities participating in the pilot project should be able to send the (CDA based) patient summary to the physician through MedAllies HISP at the conclusion of each patient visit.
  • Care sites should be able to accept referrals from other practices.

Technical workflow capabilities -
MedAllies’ NHIN- Direct pilot implementation supports a set of transport requirements for participating hospitals and/or their vendors based on role they assume in the user story. Integrating vendors may implement some or all of the technical requirements based on the ease of integration for the pilot site and vendor's technical preferences provided there is no deviation from the NHIN Direct specifications. MedAllies is open for discussion to expand on HISP’s technical capabilities for the integrating vendors. Listed below are current set the transport capabilities for each actor in participating in the health message exchange in the proposed pilot implementation.

• • Recommended Capabilities of source
    • Create CDA based document as a payload.
    • Communicate to MA – HISP using XDR or S/MIME encrypted IHE-XDM package.
  • Capabilities of HISP
    • NHIN-Direct addressing specification support (Integrating vendors can obtain NHIN Direct Id from MedAllies HISP using PIX or PDQ (HL7 v3)).
    • Inter-conversion (Step-up/Step-down) between XDR message and XDM package for delivery based on destination capabilities.
  • Recommended Capabilities of destination
    • Receive health message using XDR or SMTP client (S/MIME Encrypted XDM package)
    • Ability to accept CDA based document as payload and incorporate in the clinical workflow.

Participants

• HISP(s): MedAllies is the HISP in this geography, and will serve as a national HISP as well.
• Various eClinicalWorks practices in the Hudson Valley representing hundreds of physician deployments;
• Several larger physician practices in the Hudson Valley utilizing NextGen (to be confirmed);
• Half a dozen hospitals in the Hudson Valley with disparate inpatient EHRs and hospital information systems;
• eClinicalWorks - integration partner
• Greenway Medical - integration partner
• Siemens - integration partner
• Allscripts - integration partner
• NextGen Healthcare - integration partner
• Kryptiq - Integration partner (as HISP)
• Microsoft HealthVault (Tentative)

Resources Anticipated Being Available for Pilot

• Channel to physicians
• Integration support
• HISP Services for XDR and SMTP connections

Success Metrics

• Measurable leverage of NHIN Direct exchanged data in community efforts, such as Patient Centered Medical Home, Meaningful Use achievement, etc.
• Comparable rates of electronically-sent hospital discharge summaries vs. out-of-band exchange
• Comparable rates of electronically-sent referrals and consult notes vs. out-of-band exchange
• Preservation of vendor choice among practices while preserving comprehensive electronic exchange capability
• Incorporation of patient participation in electronic exchange within provider network (being evaluated)

Other Notes

• last updated October 27, 2010