How Memorial Hermann’s Lab Uses HIE to Connect with 20
Community Hospitals, Plus Other Innovations in Integrating
Lab Informatics
Robert Weeks, MHA
robert.weeks@memorialhermann.org
MHiE Powered in part by:
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
CHC 2011
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Memorial Hermann Healthcare System
CHC 2011
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Memorial Hermann “Big Dot” Strategies
Quality,
Patient Safety
& Infection
Control
• Clinical
Excellence
Patients
• Inpatient
Experience
(HCAHPS)
• Do No Harm
• Saving Lives
• Other
Patient
Experience
Physicians
People
Operational
Excellence
• Physician
Satisfaction
• Retention
Rate
• Operating
Cash Flow
• Clinical
Integration
• Operating
• MH
Margin
Employee
Satisfaction
• Advanced
Primary Care
Physicians
Growth
• Strategic
Patient
Growth
• Physician/
Hospital
Alignment
CHC 2011
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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
CHC 2011
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HIMSS Analytics EMR Adoption
MH
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Memorial Hermann IT - Current State 2011
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Our Strategic Evolution: Towards Accountability
Total Costs
Episodic Costs
Prospective
Payment
System (FFS)
Pay-for- Hospital-Physician Episodic
Performance
Bundling
Bundling
SharedSavings
Model/ACO
Capitation
Provider Cost Accountability
Source: Innovations Center interviews and analysis.
CHC 2011
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Framework of Accountability
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The Paradigm Shift…
DIGITAL HOSPITALS
MHiE Services
•Diagnostic Tests
•CCD Exchange
•Medical Images
•eCW - eHX
•eCW – P2P
CHC 2011
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What is an HIE?
Attributes of an HIE
HIE Definition
Goal
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.
The goal of HIE is to facilitate
access to and retrieval of
clinical data to provide safer,
more timely, efficient,
effective, equitable, patientcentered care. Data
exchange should support
high accountability and
enable smooth transitions of
care.
CHC 2011
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What is MHiE?
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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CHC 2011
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MHiE – “Connecting our Community”
PRIMARY CARE
PHYSICIANS
PATIENTS
eClinicalWorks, GE
AllScripts, etc.
“PHR” on WEB
LAB & RAD
PAYORS
Orders &
Results
“Payor
Portal”
PUBLIC
HEALTH
IMAGING CENTERS
Reportable
Labs
OPID
HOSPITALS
Memorial Hermann
& Community Partners
SPECIALTY
PRACTICES
Non MH-Hosted
EMR’s
SURGERY
CENTERS
& FQHC’s
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CHC 2011
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MHiE - Clinical Information Exchange (cHX)
Launching Houston’s First HIE - How We Did It
Powered by :
MHiE - Where do we start?!
CHC 2011
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MHiE - Implementation Methodology
Planning
Design
Build
Test &Train
Assess and Plan Make Decisions Set Up new system Prepare Staff
•Identify project
team members
•Establish
Interface Needs
•Install
Hardware
•Identify Project
Organizational
Structure
•Identify
Success
Indicators /
Baseline
Statistics
•Test Software
Configuration
•Define Project
Scope
•Vendor Selection
•Observe Current
Workflows
•Develop and
Approve Project
Plan
•Communicate
Implementation
Progress
•Order
Hardware
•Test Interfaces
•Identify and
Document
Future Workflow
& Practices
•Communicate
Decisions and
Timelines
•Develop
Interfaces
•Determine
Department
Training
Schedule
Implement
Go-Live
Maintain/Improve
•Obtain Acceptance
of Project
Deliverables
•Train Staff
•Implement PILOT
•Simulate
Future Workflow
Processes with
Case Studies
•Turnover Project to
Support Team
•Refine Future
Workflow
Processes
•Refine Set-up
•Capture
Baseline
Statistics
•Monitor Baseline
Statistics & Clinician
Satisfaction
•Deploy in Phases
•Continue to Improve
Workflow Processes
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CHC 2011
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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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CHC 2011
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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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CHC 2011
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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?
CHC 2011
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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?
CHC 2011
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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
CHC 2011
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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.
CHC 2011
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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
CHC 2011
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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)
CHC 2011
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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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CHC 2011
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MHiE “CCD” Exchange
Performance Metrics
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MHiE Diagnostic Health Exchange (dHX)
Orders and Results
POWERED BY LIFEPOINT INFORMATICS
Powered by:
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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MHiE dHX Key Capabilities
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
CHC 2011
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Fax
Machine
MedAvant
Printer
Fax Data
Fax Data
Network
Printer
Data
Logician
Web Development
MSO (PHYSICIAN )
ePostOffice (FAVS)
General Flow of
Information
Local
Printer
Cerner Millennium
(CARE 4)
Data via AutoPrint
Data
Data
Data Files
ORG/LOC/
Transcription
Data
Data Files
HL7 Data
LifePoint
Data
(VSFTP)
MSO
ORG
LOC
FAVS
INSURANCE
PHYSICIAN
TRANSCRIPTION
(VMMGDTS)
ALLSCRIPTS/LOGICIAN A and
B/ECW Interface Files
Non MHHS
Data Files
HealthQuest
CloverLeaf
Data
Data Files
INS
SOVERA
Data
Allscripts
MHiE dHX “Diagnostic Test Exchange”
Interfaced EMRs: MHMD eCW
External eCW
Allscripts UT
MHMG GE
POSC GE
Supra
Lab orders, lab results, rad results
Lab results, rad results
Lab orders, lab results
lab results
Lab results
Lab results, rad results
CHC 2011
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MHiE Image Gateway
Houston’s First Image Exchange
Powered by:
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)
CHC 2011
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MHiE Image Gateway Network Design
MH Referring & PCP
Physicians
MH Imaging
Centers
(eCW, Logician,
AllScripts, etc.)
Memorial Hermann
SECURE INTERNET “CLOUD”
Level 1 Trauma
SAFE & SECURE IMAGE TRANSFER
BETWEEN EXCHANGE MEMBERS
MH Radiologists
&
ANYTIME ANYWHERE ACCESS
MH Retail OPID
Clients
Radiology
Groups
(Richmond Bone
& Joint, etc.)
Rural & Trauma
Referring Hospitals
Other Specialists and
Network Physicians
Other MH Friends &
Family MHiE
Members
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CHC 2011
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MHiE Image Gateway
Current Connections
Facility
Huntsville Memorial
Baptist Hospital of Southeast Texas, Beaumont
Richmond Bone and Joint Clinics
Baptist Hospital of Southeast Texas, Orange
Liberty Dayton Regional Medical Center
Physicians at Sugar Creek
Bayside Community Hospital - Anahuac
Sweeny Community Hospital
Memorial Health System of East Texas, Lufkin
Memorial Health System of East Texas, Livingston
Memorial Health System of East Texas, San Augustine
Bellville General Hospital
Angleton Danbury Medical Center
Tyler County Hospital
Columbus Community Hospital
EliteCare Emergency Center
Texas Emergency Care Center
Go Live Date
4/19/2011
4/19/2011
4/21/2011
5/12/2011
8/15/2011
8/22/2011
8/22/2011
9/9/2011
9/12/2011
9/12/2011
9/12/2011
9/13/2011
10/12/2011
11/29/2011
12/9/2011
12/12/2011
12/16/2011 CHC 2011
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MHiE “Image Gateway
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MHiE eClinicalWorks® Health Exchange (eHX)
HUB-to-HUB Interoperability
and
MHiE eClinicalWorks® (eP2P)
Provider-to-Provider Network
Powered by:
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MHiE Payor Portal
Secure Payor Access to Key Clinical Information
POWERED BY LIFEPOINT INFORMATICS
Powered by:
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
CHC 2011
phone calls
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MHiE Payor Portal
CHC 2011
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MHiE ScheduleNow®
Patient Self Scheduling
Provider Scheduling
Powered by:
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
CHC 2011
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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
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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
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QUESTIONS and CLOSE
Robert Weeks, MHA
robert.weeks@memorialhermann.org