How Memorial Hermann’s Lab Uses HIE to Connect with 20
Community Hospitals, Plus Other Innovations in Integrating
Lab Informatics
Robert Weeks, MHA
MHiE Powered in part by:
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Session Learning Objectives
Overview:
Memorial Hermann Healthcare System launched Houston’s first HIE to improve quality, safety, efficiency, transition and cost effectiveness of care.
Learning Objectives: Identify key benefits of HIT interoperability
Discuss medical-legal issues around patient consent
Discussion of Direct vs. Indirect Care lab service models
Understand the case for HIE and develop a value proposition for community-wide Health Information Exchange (HIE)
Recognize how HIE technology connecting community healthcare providers enhances quality of care, improves patient safety, decreases costs and forges stronger relationships with regional referral centers and physicians
Assess the key drivers and challenges of implementing HIE technology
Discuss various HIE services offered by MHiE in Houston
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Memorial Hermann Healthcare System
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Memorial Hermann “Big Dot” Strategies
Quality,
Patient Safety
& Infection
Control
Patients Physicians People Operational
Excellence Growth
• Clinical
Excellence
• Do No Harm
• Saving Lives
• Inpatient
Experience
(HCAHPS)
• Other
Patient
Experience
• Physician
Satisfaction
• Clinical
Integration
• Advanced
Primary Care
Physicians
• Retention
Rate
• MH
Employee
Satisfaction
• Operating
Cash Flow
• Operating
Margin
• Strategic
Patient
Growth
• Physician/
Hospital
Alignment
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Awards & Recognition
2005-2011
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Memorial Hermann IT Factoids
28,400 devices connected to the enterprise network from 80 different locations
2 data centers, 2 mainframes, 43 mid-range UNIX/VMS systems, 1100+ servers,
20,561 PCs, 4,781 printers, 746 scanners, 103 handheld devices, 340 closets
24,000 calls per month to the Support Center
350,000 sessions per month on memorialhermann.org
24,600+ Exchange Email user accounts
12 million spam emails & 600,000+ network attacks blocked each month
56 telephone systems – 28,000+ phones, 8,000+ pagers, 2,434 Spectralink
phones
8.26 million unique person records in CARE4 w/17,654 total users
9,289 unique physician users to CARE4 monthly
450+ applications supported by ISD
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HIMSS Analytics EMR Adoption
MH
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Memorial Hermann IT - Current State 2011
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Source: Innovations Center interviews and analysis.
Episodic Costs Total Costs
Shared-Savings
Model/ACO
Pay-for-Performance
Hospital-Physician Bundling
Episodic Bundling
Prospective Payment
System (FFS)
Provider Cost Accountability
Capitation
Our Strategic Evolution: Towards Accountability
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Framework of Accountability
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MHiE Services
•Diagnostic Tests
•CCD Exchange
•Medical Images
•eCW - eHX
•eCW – P2P
The Paradigm Shift…
DIGITAL HOSPITALS
What is an HIE?
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Attributes of an HIE
HIE Definition
HIE provides the capability to
electronically exchange
clinical information among
disparate HIT systems while
maintaining the meaning of
the information being
exchanged upon which
clinical decisions can be
based.
Goal
The goal of HIE is to facilitate
access to and retrieval of
clinical data to provide safer,
more timely, efficient,
effective, equitable, patient-
centered care. Data
exchange should support
high accountability and
enable smooth transitions of
care.
What is MHiE?
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A non-profit corporation within
Memorial Hermann Hospital
System designated to enable
community-wide interoperability.
MHiE Services:
• MHiE Community Health Exchange (cHX)
• MHiE Diagnostic Health Exchange (dHX) POWERED BY LIFEPOINT
• MHiE Image Gateway
• MHiE eClinicalWorks® Health Exchange (eHX)
• MHiE eClinicalWorks® Provider to Provider (eP2P)
• MHiE ScheduleNow
• MHiE Payor Portal POWERED BY LIFEPOINT
WWW.MEMORIALHERMANN.ORG/MHIE
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MHiE – “Connecting our Community”
15
LAB & RAD
Orders &
Results
PUBLIC
HEALTH
Reportable
Labs
SPECIALTY
PRACTICES
Non MH-Hosted
EMR’s
IMAGING CENTERS
OPID
PAYORS
“Payor
Portal”
PATIENTS
“PHR” on WEB
SURGERY
CENTERS
& FQHC’s
PRIMARY CARE
PHYSICIANS
eClinicalWorks, GE
AllScripts, etc.
HOSPITALS Memorial Hermann
& Community Partners
MHiE - Clinical Information Exchange (cHX)
Launching Houston’s First HIE - How We Did It
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MHiE - Where do we start?!
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•Obtain Acceptance of Project
Deliverables
•Implement PILOT
•Turnover Project to Support Team
•Monitor Baseline Statistics & Clinician
Satisfaction
•Deploy in Phases
•Continue to Improve Workflow Processes
Implement
Go-Live
Maintain/Improve •Determine Department
Training Schedule
•Train Staff
•Simulate Future Workflow Processes with Case Studies
•Refine Future Workflow Processes
•Refine Set-up
•Capture Baseline Statistics
Test &Train
Prepare Staff
•Install Hardware
•Test Software Configuration
•Test Interfaces
•Identify and Document
Future Workflow & Practices
•Communicate Decisions and
Timelines
•Develop Interfaces
Build
Set Up new system
•Establish Interface Needs
•Identify Success
Indicators / Baseline Statistics
•Communicate Implementation
Progress
•Order Hardware
Make Decisions
Design
•Identify project team members
•Identify Project Organizational
Structure
•Define Project Scope
•Vendor Selection
•Observe Current Workflows
•Develop and Approve Project
Plan
Planning
Assess and Plan
MHiE - Implementation Methodology
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MHiE Planning & Design Questions
Patient Consent
What Consent Model Do We Use?
Opt-in?
Opt-out?
Global vs. Federated?
Do we acknowledge “sensitive” data sets?
What Does Consent Mean?
View Data Only?
Submit Data Only?
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MHiE Planning & Design Questions
Exchange Member
What is an Exchange Member?
Physician?
Clinic?
Hospital?
How Do We Govern Exchange Members?
Exchange Member Agreement?
Terms & Conditions?
Auditing?
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MHiE Planning & Design Questions
Clinical Data
What Kind of Clinical Data Do We Want
to Exchange?
ADT’s?
HL7’s ?
CCD’s?
CCR’s?
What is a CCD?
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MHiE What’s in the CCD?
CCD = Continuity of Care Documents
A standard for CCD transactions has been published, each EMR/EHR vendor is developing capability to send and receive CCD data. Not all vendors can send/receive all CCD sections yet. CCD content includes:
Header/Purpose
Allergies
Problems
Medications
Immunizations
Procedures
Family History
Social History
Test Results
Advanced Directives
Alerts
Medical Equipment
Vital Signs
Functional Stats
Encounters
Plan of Care
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MHiE Planning & Design Questions
Sharing CCD’s
What Kind of Share Model Do We Use?
Push (Unsolicited Delivery)?
Pull (Query\Retrieve)?
How Do Exchange Members View CCD’s?
URL Query?
XDS Query?
Patient Search via Web Portal Login?
Aggregated vs. Itemized List?
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MHiE Planning & Design Questions
Our Design Answers:
Patient Consent Model: Opt-in; Federated
Exchange Member Policy: EMA (T&C)
Push vs. Pull Model: Pull (Query\Retrieve)
Document Type to Exchange: CCD & ADT
Aggregated vs. Itemized Views: Both
Viewing Options: IHE Integrated EMR’s, Patient
Search via Web Portal, Patient-context URL Query
(aka mPages in Cerner Millennium)
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MHiE Planning & Design Questions
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MHiE Defining Patient Consent Rules
Opt-In Model
Federated Consent: Exchange Members obtain
patient consent for all data sent into MHiE.
Patients must Opt In.
Transmission of data into MHiE by Exchange Member
EMR/EHR systems is triggered by patient consent
received.
Exchange Members all use a common consent
agreement.
Patient may opt out of any or all Exchange Member by
calling the MHiE Hotline at 713-456- MHiE.
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MHiE Operations & Support
Creating a business support model
Marketing Material •Patient Brochure
•Global Consent Form
•Marketing Packet
•Exchange Member Agreement
Hotline Support Number •713-456-MHiE
•Global Opt-out
•Patient & Physician Customer Support Line
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MHiE The Aggregated View
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MHiE Exchange Metrics
Pilot launched May 1, 2011
LIVE today at 15 MH hospitals, and 7 ambulatory
facilities
215,000+ consented patients
100,000+ CCDs submitted
900+ patients with aggregated data
Contributing EMRs include Cerner, GE, eCW, AllScripts,
others
MHiE currently connected to 1 other HIE (eClinical
Works eHX)
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MHiE What’s Next?
Additional CCD sections
Family and social histories, procedures, etc.
Additional Documents
Currently performing gap analysis on which note types would
best supplement CCD data, as there is significant overlap
ER Notes, Discharge Summary, Progress Notes, History &
Physical, Consult Notes
Radiology Images
Image-enable the HIE
Grow the Network
Rapidly expand to new members
Streamline the on boarding process
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MHiE “CCD” Exchange Performance Metrics
MHiE Diagnostic Health Exchange (dHX)
Orders and Results
POWERED BY LIFEPOINT INFORMATICS
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MHiE dHX Overview
MHiE Diagnostic Health Exchange functions as a router
between EMR systems and Memorial Hermann Outreach
Services, making Memorial Hermann diagnostic and
therapeutic test results immediately available to Exchange
Members. In the absence of an EMR, Exchange Members
can access an online web portal anytime, anywhere.
Enter the Direct vs. Indirect Care Dilemma…
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Current dHX capabilities include:
Enter laboratory test orders directly in EMR
Receive electronic laboratory test results from MHHS
Receive electronic radiology test results from MHHS
Access radiology image links (via secure portal)
View transcription documents (via secure portal)
Coming soon:
Enter radiology test orders directly in EMR (a.k.a. Radiology
Request to Schedule)
Receive electronic transcription documents from MHHS
Ability to access secure web portal via mobile device
MHiE dHX Key Capabilities
General Flow of
Information
Cerner Millennium
( CARE 4 )
LifePoint
HealthQuest
HL 7 Data CloverLeaf
L o
g i c
i a n
Allscripts
N o
n M
H H
S
D a
t a
Data
D a
t a
MedAvant
Printer
Fax
Machine
Network
Printer
Local
Printer
Fax Data
Fax Data
Data
Data via AutoPrint
Data
Data
( VSFTP )
MSO
ORG
LOC
FAVS
INSURANCE
PHYSICIAN
TRANSCRIPTION
( VMMGDTS )
ALLSCRIPTS / LOGICIAN A and
B / ECW Interface Files
Web Development
MSO ( PHYSICIAN )
ePostOffice ( FAVS )
Data Files
Data Files
ORG / LOC /
Transcription
Data Files
INS
SOVERA Data Files
Data
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MHiE dHX “Diagnostic Test Exchange”
Interfaced EMRs: MHMD eCW Lab orders, lab results, rad results
External eCW Lab results, rad results
Allscripts UT Lab orders, lab results
MHMG GE lab results
POSC GE Lab results
Supra Lab results, rad results
MHiE Image Gateway
Houston’s First Image Exchange
Powered by:
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What is the MHiE Image Gateway?
The MHiE Image Gateway allows medical
images (i.e. Radiology Studies) to be
shared between Exchange Members.
Basic Use Cases Include: • Trauma Network Image Transfers
• Routine Transfers with Images
• Provider-to-Provider “P2P” sharing of Images
• PACS Back-up “Cloud-based” Storage for Medical Images (Business Continuity)
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MHiE Image Gateway Network Design
MH Referring & PCP
Physicians
(eCW, Logician,
AllScripts, etc.)
Other Specialists and
Network Physicians
MH Retail OPID
Clients
(Richmond Bone
& Joint, etc.)
Rural & Trauma
Referring Hospitals Other MH Friends &
Family MHiE
Members
MH Radiologists
&
Radiology
Groups
SECURE INTERNET “CLOUD”
SAFE & SECURE IMAGE TRANSFER
BETWEEN EXCHANGE MEMBERS
ANYTIME ANYWHERE ACCESS
MH Imaging
Centers
Memorial Hermann
Level 1 Trauma
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MHiE Image Gateway Current Connections
Facility Go Live Date
Huntsville Memorial 4/19/2011
Baptist Hospital of Southeast Texas, Beaumont 4/19/2011
Richmond Bone and Joint Clinics 4/21/2011
Baptist Hospital of Southeast Texas, Orange 5/12/2011
Liberty Dayton Regional Medical Center 8/15/2011
Physicians at Sugar Creek 8/22/2011
Bayside Community Hospital - Anahuac 8/22/2011
Sweeny Community Hospital 9/9/2011
Memorial Health System of East Texas, Lufkin 9/12/2011
Memorial Health System of East Texas, Livingston 9/12/2011
Memorial Health System of East Texas, San Augustine 9/12/2011
Bellville General Hospital 9/13/2011
Angleton Danbury Medical Center 10/12/2011
Tyler County Hospital 11/29/2011
Columbus Community Hospital 12/9/2011
EliteCare Emergency Center 12/12/2011
Texas Emergency Care Center 12/16/2011
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MHiE “Image Gateway
MHiE eClinicalWorks® Health Exchange (eHX)
HUB-to-HUB Interoperability
MHiE eClinicalWorks® (eP2P)
Provider-to-Provider Network
and
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MHiE Payor Portal
Secure Payor Access to Key Clinical Information
POWERED BY LIFEPOINT INFORMATICS
Powered by:
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MHiE Payor Portal
What is the MHiE Payor Portal?
A limited search capability for payors to have self-access to
their patients diagnostic testing results, radiology image
links and basic transcription documents.
Value Proposition:
Payors want access to real-time or retrospective lab/rad
test results and radiology images.
This access can prevent un-necessary duplication/costs
or confirm the best plan of care.
The access provides expedient access to information.
MH wants payors limited to only their patients.
Less time faxing information
Call center folks focus on D/C planning and follow-up
phone calls
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MHiE Payor Portal
MHiE ScheduleNow®
Patient Self Scheduling
Provider Scheduling
Powered by:
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Online Scheduling Trends
Online scheduling is becoming more popular
Well-established in travel industry (scheduling service)
Wall Street Journal Online, Harris Interactive Poll, September 2006
75% of patients want online appointment scheduling
Intuit Health Survey, 2011
81% of the survey’s respondents would schedule their own appointments
59% of generation Y respondents and 29% of Baby Boomers said they would switch providers for one with better online access
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Memorial Hermann Objectives
Develop capabilities that allow patients to schedule visits on-line which leads to increased utilization for MH MDs and services
Be the market leader in online scheduling capabilities
Increase ED, ambulatory and physician office business
Improve ability to manage referrals – Patient Access Center
Influence consumer preference for MH services
Reduce administrative cost in handling phone calls
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ScheduleNow
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ScheduleNow
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ScheduleNow
PHR – the Personal/Portable
Health Record
One way we engage patients in accountability for their health.
Powered by :
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Reporting Biometric Results
