An Example of Interfacing Centricity EMRwith a Health Information ExchangePresented by:Joe Mikulas, Lead Software EngineerMargery Beck, Lead Systems Analyst

MIMA: Independent 125-provider multi-specialtygroup practice in Melbourne, FL 132,000 active patients 840 employees 200 servers 1400 workstations 60 applications

This presentation will cover the implementation of anEMR CCD interface to connect with an HIE:Learn the key terms and acronymsassociated with an HIE implementationDiscuss the benefits of participating ina Health Information ExchangeExplain the details of theimplementationConclusions and future developmentplans

HIE – Health Information Exchange According to Wikipedia: Is the mobilization of healthcareinformation electronically acrossorganizations within a region,community or hospital system. In our case, sharing patient data with ourlocal hospital

HIE – Health Information Exchange (cont.) Why should you participate in an HIE? Improved patient care Patient data can be found when thepatient is in the hospital Easier for physicians to find patientinformation at the hospital

CCD – Continuity of Care Document Document containing problems,allergies, medications, andimmunizations for a specific patient MPI – Master Patient Index Database used to accurately link recordsof patients from multiple unique systems

HL7– Standard healthcare message format ADT – Admissions, Discharges, and Transfers HL7 message containing patientdemographics updates XML – Standard CCD message format XDR / XDS – Common format/protocol for HIECCD transmission SAML - Security Assertion Markup Language Used to pass authentication data betweenparties

Infrastructure Centricity EMR & DTS Centricity Group Management QVera Interface Engine with HIE Module dbMotion HIE Initiate MPI Sunrise Clinical Manager EHR

When to send the CCD’s? To avoid negatively impacting EMR performance, weset the export to begin after our last office closed However, after testing, we realized the performancehit was minimal, and we switched to real-timeHow do you handle patient opt-in / opt-out? CPM does not store that data. How can we add it tothe ADT feed? What should be the default value for existingpatients?

All demographics changes arepassed from CPM to QVera viathe DataConnect interface.QVera looks up the patient’sHIE Opt-In preference in EMR,then adds it to the messagebefore sending it to the MPI.Initiate matches the ADTmessage to an existing recordand updates their data, orinserts a new patient.

As charts are changed, the DTS scans forchanges. If a chart has been changed,then it sends a message to QVera.

For each message received, QVera pullsthe CCD information for that patient andgenerates an XML message in theXDR/XDS format.

QVera send the newly generated CCD todbMotion through a VPN. dbMotionthen updates it’s records with the newdata.

QVera send the newly generated CCD todbMotion through a VPN. dbMotionthen updates it’s records with the newdata.

Initiate receives the requestand looks up the patient in theMPI. If a match is found, andthe patient is opted-in, then A user requests CCDinformation from a chartin Sunrise Clinical. the CCD is returned to theworkstation where the usercan review it.

Link two EMR implementationstogether Including linking two chart rooms Integrate into EMR with a chart update

Add the CCD Reconcile Form to the Update

Allows the user to reconcile data including: Demographics

Shows the new, changed,EMR only, and identicaldata. The user can choosewhich data to reconcile.

The form highlights thedata that is different in theCCD and the EMR.

Receive CCD’s back from the HIE with the LocalHospital Consider other HIE options Other local hospitals State of FL

Joining an HIE is extremely beneficial to yourpatients. With all of the components involved, it can beoverwhelming. Planning is essential! Map out your data workflow to simplify the process Consider reconciling CCD’s back to your EMR forgreater benefit

community or hospital system. . Sunrise Clinical Manager EHR . HIE Opt-In preference in EMR, then adds it to the message before sending it to the MPI. Initiate matches the ADT message to an existing