Strategic Planning Session
Today’s Goals
 Get Educated
 Get Inspired
 Get Connected
 Get Involved
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-2-
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-3-
Introductions - NHHIO Board of Directors
Board Member
Representation
Board Member
Representation
Denise Purington
CIO Elliot Hospital
NHHIO Chair
Board Member at Large
Hospitals
David Briden
CIO Exeter Hospital
NH Hospital
Association
Large Hospitals
Mary Beth Eldredge
IT Director
Dartmouth Hitchcock
NHHIO Vice Chair
Board Member at Large
Hospitals
Patricia Witthaus
IT Director
Valley Regional Hospital
NH Hospital
Association
Critical Access
Hospitals
Kirsten Platte
CHAN
NHHIO Secretary
Bi-State Primary Care
Association
Dr. Richard Lafleur
Anthem BC/BS
Board Member at Large
Health Plans
Carol LaCross
CFO - Retired
NHHIO Treasurer
Board Member at Large
Michael Lehrman
Catholic Charities
Board Member at Large
NH Health Care Assoc.
Deb Mullen
Concord VNA
Home Care Association
Mark Guptill
Community Partners
NH Behavioral Health
Association
Dr. Daniel Waszkowski
Derry Medical Center
NH Medical Society
David Querusio
Harvard Pilgrim Healthcare
Board Member at Large
Health Plans
William Baggeroer
DHHS
Board Member at Large
DHHS
Dr. Christine Rosenwasser
Dartmouth Hitchcock Pediatrics
Board Member at Large
Physicians
Victor St. Pierre
Consumer Advocate
Board Member at Large
Consumers
Lorraine Nichols
IT Consultant
Board Member at Large
Vacant
Retail Pharmacy
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-4-
Introductions – NH Team
NHHIO Staff:
Jeff Loughlin – Executive Director
Jackie Baldaro – Project Manager
Micky Tripathi – Senior Advisor
NHHIO Partners:
Mark Belanger – Strategic Advisor
Nancy Fennell – Regional Extension Center (REC) Director
Jaime Dupuis – EHR/HIE Consultant
Len Levine – EHR/HIE Consultant
Gary Tomlinson – Hospital Consultant
Jennifer Monahan – Program Coordinator
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-5-
Introductions
Orion Health Partners:
Nick Yarker
Project Manager
Lisa Sherwin
Regional VP, Professional Services Group
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-6-
Introductions
 Large Hospitals and providers
 Critical Access Hospitals and providers
 Private practices
 Home health care, VNA, and hospice
 Long term care or rehabilitation facilities
 Behavioral Health
 NH State entities
 Surgical centers
 Legislators
 Professional Associations
 Members of the press
 Anyone I missed?
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-7-
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-8-
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
-9-
Health Information Exchange in New Hampshire
Where did we start from – How far have we come?
September 20, 2013
Massachusetts eHealth Collaborative
- 10 -
In 2010 we collectively established a high degree of
consensus around five strategies
1. Establish a sustainable organizational, governance, and technical
foundation for achievement of long term statewide health information
goals
2. Level-set individual providers’ abilities to meet Stage 1 Meaningful Use
criteria by facilitating e-Prescribing, lab results delivery, and patient care
summary exchange across the state
3. Catalyze the efforts of programs focused on HIT adoption
4. Expand availability of HIE services to providers that do not currently have
access to robust capabilities for health information exchange
5. Collaborate with Legislators to define the future policy governing HIE
purpose and participants
Massachusetts eHealth Collaborative
- 11 -
NH DHHS, NHHIO, the REC of NH, and many committed
volunteers have made steady progress ever since
Major accomplishments to date:
• The New Hampshire Health Information Organization (NHHIO) is now in place
• The NHHIO Board of Directors has been established, has set bylaws, has elected officers,
and has formed committees
• The Executive Director has been selected and NHHIO has been staffed for operations
• The Technical services provider, Orion Health, has been selected and is on board
• The contract with NH DHHS has been executed to transfer duties and funding to NHHIO
• The Participation Agreement, Policies & Procedures, and pricing has all been finalized and
is being used with new members
• Technical services have been configured and NHHIO has moved forward with 4 pilot sites
(Exeter, Seacoast Mental Health, Elliot, and DPH)
• The Legislature has passed legislation allowing public health to participate in NHHIO and
for PH reports to be sent via NHHIO – There is recent progress to align the HIE law with
HIPAA
• Alongside NHHIO and NH DHHS, the REC of NH has helped many of the state’s providers
and critical access hospitals implement and use EHRs.
• 26 organizations have kicked off with NHHIO and 10+ more are in the pipeline
Massachusetts eHealth Collaborative
- 12 -
Where do we stand?
eRx in NH - 2012
eRx in NH - 2012
% of pharmacies participating in eprescribing (Surescripts)
96%
% of physicians actively e-prescribing
via Surescripts network (SS)
83%
% of physicians actively using an
electronic health record to e-prescribe
via SS network (SS)
76%
% of new and renewal prescriptions eprescribed (SS)
0%
64%
20%
40%
Massachusetts eHealth Collaborative
60%
80%
100%
- 13 -
Where do we stand?
Lab order/result exchange in NH - 2012
Lab order/result exchange in NH - 2012
% of ambulatory providers able to view
lab results electronically (NAMCS)
77%
% of hospitals sharing laboratory results
electronically with ambulatory providers
outside their system (AHA)
73%
% of ambulatory providers able to send
lab orders electronically (NAMCS)
63%
% of labs electronically sending
structured lab results to providers
outside their organization (UNH)
45%
% of hospitals sharing laboratory results
electronically with hospitals outside their
system (AHA)
0%
28%
20%
40%
Massachusetts eHealth Collaborative
60%
80% 100%
- 14 -
Where do we stand?
Care summary exchange in NH - 2012
Care summary exchange in NH - 2012
% of hospitals sharing electronic care
summaries with ambulatory providers
outside their system (AHA)
% of ambulatory providers electronically
sharing care summaries with other
providers (NAMCS)
% of hospitals sharing electronic care
summaries with hospitals outside their
system (AHA)
0%
27%
22%
20%
20%
40%
Massachusetts eHealth Collaborative
60%
80% 100%
- 15 -
Where do we stand?
Care summary exchange with Patients in NH - 2012
Care summary exchange with Patients in NH - 2012
% of hospitals capable of providing
patients with an electronic copy of their
health information (AHA)
84%
% of ambulatory providers able to
provide patients with clinical summaries
for each visit (NAMCS)
0%
59%
20%
40%
Massachusetts eHealth Collaborative
60%
80% 100%
- 16 -
What other “pain points” should we keep an eye on?
1. Focus first on those gaps we identified originally such as facilitating
medication reconciliation and transfers of care
2. Need to stay aligned with and support Accountable Care and Stage 2
Meaningful Use
3. Admission/Discharge/Transfer (ADT) transport and support of real time
notifications and alerting.
4. Stay out front with privacy & security issues
5. Help providers avoid building infrastructure and/or interfaces twice
6. Interstate connectivity
7. Address the needs of provider types that were left out of Meaningful Use
8. Facilitate administrative transactions such as prior authorizations, claims
eligibility, and claims status
9. Provide translation services (e.g., RxNorm, LOINC mapping)
10.Stay cognizant of market consolidation and adjust accordingly
Massachusetts eHealth Collaborative
- 17 -
What organization types should be prioritized for connection?
Importance of exchanging data with stakeholder types (June 2013 survey results n=20)
Hospitals
5
Physician Practices
15
4
15
Public Health Agencies
12
Home Health
6
9
9
LTC/SNF
12
Quality Data Reporting
6
8
Case Managers
8
6
9
Veteran's Administration
12
Laboratories
7
Patients
7
Payers
3
8
7
5
medium priority
9
Pharmacies
10
Imaging Centers
9
Out of State Providers
5
5
0
2
high priority
4
4
4
6
8
10
Massachusetts eHealth Collaborative
12
14
16
18
20
- 18 -
What are the reasons to join NHHIO?
Reasons to Join NHHIO (June 2013 survey results n=17)
Satisfy meaningful use requirements
14
Improve care transitions through sending and receiving patient care
summaries with outside providers
14
Provide clinicians with a means to more easily access critical patient
information from providers outside my organization
14
Support Patient Centered Medical Home information sharing needs
12
Support Accountable Care Organization information sharing needs
11
Send required reports to the Department of Public Health
11
Reduce (consolidate) interfaces my organization has with other
organizations
10
Send lab orders to labs outside of my organization
10
Reduce staff time, effort, and cost spent on medical records
management
9
Send and receive event notifications
9
Receive lab results from labs outside of my organization
8
0
2
4
Massachusetts eHealth Collaborative
6
8
10
12
14
16
- 19 -
Thank you!
Mark Belanger
Director of Advisory Services
Massachusetts eHealth Collaborative
860 Winter Street, Waltham, MA 02451
mbelanger@maehc.org
Tel: 781.434.7889
Mobile: 339.223.2051
Massachusetts eHealth Collaborative
- 20 -
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 21 -
New Hampshire Health Information Organization
Legislative Updates
Denise Purington
Board Chair
CIO Elliot Hospital
Our Changing Environment
ARRA Signed
Feb 2009
2009
RSA 332:I
PHI Use
2009
ACA Signed
Mar 2010
ONC Approves
SOP
Sep 2010
2010
DHHS begins
HIE development
Nov 2009
HB489
Creates NHHIO
Jul 2011
SB288
DHHS Reporting
Jun 2012
2011
NH ACO
Pilots
Jun 2010
Stage 1
MU
2011
2012
Pioneer ACO
Dec 2011
New Hampshire Health Information Organization
Stage 2
MU
2013
2013+
PCMH, P4P, ACO
2012
© NHHIO. All rights reserved.
- 23 -
Healthcare Improvement Goals
Better Care
 Patient Safety
 Quality
 Patient Experience
Reduce Per Capita Cost
 Reduce unnecessary and unjustified medical cost
 Reduce administrative cost thru process simplification
Improve Population Health
 Decrease health disparities
 Improve chronic care management and outcome
 Improve community health status
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 24 -
Health Information Technology Drivers
Meaningful Use and CMS EHR Incentive Program
 Maximizes use of electronic data exchange for efficiency and
safety
 Requires care coordination and patient engagement
 Requires HIPAA compliant transactions
Patient Centered Medical Home
 Develops closed-loop electronic referral system
 Encourages patient engagement and participation
 Maximizes care coordination to eliminate redundancy and waste
Accountable Care Organizations
 Requires effective care coordination and care management
 Maximizes clinical efficiency and decreases costs
 Requires HIPAA compliant transactions
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 25 -
NHHIO Legislative Updates
Update Definitions to Fully Align with HIPAA
 Undefined terms leads to ambiguity and misinterpretation of meaning
 “Healthcare Services” is not defined in provider definition
 “Treatment” is not defined under use and disclosure
Update Use and Disclosure to Fully Align with HIPAA
 Variability of transmission methods drives inconsistency and increased
cost
 Allow all parties currently receiving and reviewing PHI to do so using
safe, secure and auditable methods
 Patient engagement increases self-management, self-regulation, and
informed decision making process for clinical and cost effectiveness
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 26 -
NH HIE Facts: (RSA 332-I:2)
 A health care provider or business associate may disclose an individual's PHI
and information about the location of an individual's medical records to a HIE –
allows for Electronic Master Person Index (EMPI) (Phase 2)
 Individual must be given an opportunity to opt out of sharing his/her name,
address, and PHI through a HIE – information not sent to HIE, does not prevent
public health reporting
 Only a health care provider, for purposes of treatment, may access PHI in a HIE
– does not include patients or payors
 A HIE must maintain an audit log of health care providers who access PHI –
central site will maintain transmission logs
 When federal certification standards are established, a HIE must be certified to
be in compliance with nationally accepted interoperability standards and
practices – NHHIO is using Direct standards for message transport
 SB288 – Authorized reporting to Department of Health and Human Services
(DHHS) – AHEDD, Cancer Registry, Immunization Registry
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 27 -
Legal Language Updates
II.
In this chapter:
(a) The following terms have the same meaning as given in the regulations under sections 160,
262 and 264 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA):
(1)
Business associate;
(2)
Use;
(3)
Disclosure; and
(4)
Protected health information; and
(5)
Health care provider
(b) "Health care provider'' means any person, corporation, facility, or institution either licensed
by this state or otherwise lawfully providing health care services, including, but not limited to, a
physician, hospital, office, clinic, health center or other health care facility, dentist, nurse,
optometrist, pharmacist, podiatrist, physical therapist, or mental health professional, and any
officer, employee, or agent of such provider acting in the course and scope of employment or
agency related to or supportive of health care services.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 28 -
Legal Language Updates
Comment:
The current law uses an undefined term of “health care services” in order to
define a health care provider. In order to alleviate any ambiguity, and to ensure
consistency of interstate communication capabilities with other organizations,
we suggest using the standard HIPAA definition of a Health care provider.
Section 160 of HIPAA contains the definition of Health care provider.
“Health care provider” has the meaning given such term in section 160.103 of title 45,
Code of Federal Regulations: Provider of services (as defined in section 1861(u) of the
[Social Security] Act, 42 U.S.C. 1395x(u)), a provider of medical or health services (as
defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s)), and any other person or
organization who furnishes, bills, or is paid for health care in the normal course of business.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 29 -
Legal Language Updates
332-I:3 Use and Disclosure of Protected Health Information; Health Information
Exchange. –
I.
Except as provided in paragraph VI, a health care provider, or a business
associate of a health care provider, or patient, may transmit an individual's protected health
information through the health information organization. Only a health care provider, for
purposes of treatment, may have access to Except as provided in section 332-I:4, protected
health information transmitted through the health information organization., may only be
used and disclosed in accordance with the Health Insurance Portability and Accountability
Act of 1996 (HIPAA).
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 30 -
Legal Language Updates
Comment:
1. The current language prevents the transmission to, or the receipt of
information from patients that may be required by a variety of clinical
improvement and home monitoring programs.
2. By limiting the transmission of data for treatment purposes only, which is
also an undefined term, providers will be required to build a variety of
alternative conduits for data transmission for care coordination and
accountable care reporting.
3. By allowing the data to be utilized in accordance with HIPAA, organizations
may utilize the data for care coordination purposes, or it may be de-identified
for use by NH Medicaid Manage care plans for population reporting and
management activities that are critical for cost saving programs.
4. These changes retain all the original limitations on use of the data for
marketing and fundraising activities.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 31 -
Questions and Comments
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 32 -
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 33 -
New Hampshire Health Information Organization
Jeff Loughlin
Executive Director
American Recovery and Reinvestment Act (ARRA)
Transforming Healthcare
HITECH: Catalyst for Transformation
Three-Part Aim:
Better Healthcare
Better Health
Paper Records
HITECH Act
Pre 2009
2009
EHR Incentive Program and 62
Regional Extension Centers
A system plagued
by inefficiencies
Reduced Costs
EHRs & HIE
2014
Widespread adoption &
meaningful use of EHRs
Health Information Technology for Economic and Clinical Health
(HITECH) - Framework
Regional Extension Centers
ADOPTION
Improved Individual &
Population Health
Outcomes
Workforce Training
Medicare and Medicaid
Incentives and Penalties
MEANINGFUL USE
Improved
Ability to Study &
Improve Care Delivery
State Grants for
Health Information Exchange
Standards & Certification Framework
Increased
Transparency &
Efficiency
EXCHANGE
Privacy & Security Framework
37
HITECH Framework in New Hampshire
ADOPTION
Improved Individual &
Population Health
Outcomes
MEANINGFUL USE
Increased
Transparency &
Efficiency
Improved
Ability to Study &
Improve Care Delivery
EXCHANGE
New Hampshire Health Information Exchange Plan
 June 2010 created multi-stakeholder groups
 The plan is the result of collaborative
planning among over 80 stakeholders
 380 stakeholder comments were addressed
in the current version
The plan continues to evolve as we refine the
strategy, obtain broader stakeholder input,
and incorporate updated use cases from the
field
Current strategic plan is posted at http://www.dhhs.nh.gov/hie/strategic.htm
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 39 -
Establishing Governance
 HB #489 (July 2011) created the New Hampshire Health Information Organization
(NHHIO)
 NHHIO Governed by a broad community based multi-stakeholder Board of Directors
 Seven (7) seats named by statute with 10 at-large members
 501(c)(3) Public Charity organization status received August 2012
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 40 -
NHHIO Board of Directors
Board Member
Representation
Board Member
Representation
Denise Purington
CIO Elliot Hospital
NHHIO Chair
Board Member at Large
Hospitals
David Briden
CIO Exeter Hospital
NH Hospital
Association
Large Hospitals
Mary Beth Eldredge
IT Director
Dartmouth Hitchcock
NHHIO Vice Chair
Board Member at Large
Hospitals
Patricia Witthaus
IT Director
Valley Regional Hospital
NH Hospital
Association
Critical Access
Hospitals
Kirsten Platte
CHAN
NHHIO Secretary
Bi-State Primary Care
Association
Dr. Richard Lafleur
Anthem BC/BS
Board Member at Large
Health Plans
Carol LaCross
CFO - Retired
NHHIO Treasurer
Board Member at Large
Michael Lehrman
Catholic Charities
Board Member at Large
NH Health Care Assoc.
Deb Mullen
Concord VNA
Home Care Association
Mark Guptill
Community Partners
NH Behavioral Health
Association
Dr. Daniel Waszkowski
Derry Medical Center
NH Medical Society
David Querusio
Harvard Pilgrim Healthcare
Board Member at Large
Health Plans
William Baggeroer
DHHS
Board Member at Large
DHHS
Dr. Christine Rosenwasser
Dartmouth Hitchcock Pediatrics
Board Member at Large
Physicians
Victor St. Pierre
Consumer Advocate
Board Member at Large
Consumers
Lorraine Nichols
IT Consultant
Board Member at Large
Vacant
Retail Pharmacy
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 41 -
NHHIO Architecture and Services
CHAN
Health
Centers
Public
Health
(DHHS)
VNA /
Homecare
Inter-state
communications
ASCC
NH Statewide Network – “Backbone”
Phase I:
Node
addressing
Security
Provider
addressing
Audit
• Direct Secure Messaging
Record Locator Service (EMPI)
• Inter-state gateway
Phase II:
Provider
Practices
NH
Hospital
Hospital
MD
MD
MD
MD
Behavioral
Health
Diagnostic
testing
Long-term
care
SNFs
• Relationship Listing
Service (RLS) Electronic Master Person
Index (EMPI)
MD
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 42 -
Electronic Health Record (EHR) Integration
User types
HIE Services
3 methods of accessing HIE
services
Physician practice
Provider directory
EHR connects directly
Hospital
Certificate repository
EHR connects through
LAND Appliance
Long-term care
Other providers
Public health
Health plans
DIRECT gateway
Browser access to webmail inbox
Web portal mailbox
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 43 -
Gateway to access HIEs Across New England
ME
VT
NH
NY
MA
CT
R
I
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 44 -
Participant Schedule
Participant
Implementation
Messages current/planned
Status
September 2013
October 2013
November 2013
2-Sep 9-Sep 16-Sep 23-Sep 30-Sep 7-Oct 14-Oct 21-Oct 28-Oct 4-Nov 11-Nov 18-Nov 25-Nov
Production
AHEDD, ELR data
Exeter Hospital
Testing
Hospital Discharge Summaries
Seacoast Mental Health Center
Testing
Medical Summary
State of New Hampshire Department Public Health
Production
Recieving AHEDD, ELR
Dartmouth Hitchcock Medical Center
On boarding
AHEDD, ELR data
State of New Hampshire Cancer Registry
On boarding
Receiving Cancer Registry data
Cheshire Medical Center
On boarding
AHEDD data
Valley Regional Hospital (CAH)
On boarding
AHEDD data
Pemi Baker
On boarding
Provider Orders, Medical
Summary
Androscoggin
On boarding
AHEDD data, Medical Summary
Cornerstone VNA
On boarding
Medical Summary
Central VNA & Hospice
On boarding
Medical Summary
COOS County
On boarding
Medical summary
Catholic Medical Center
On boarding
Medical Summary
Franklin VNA & Hospice
On boarding
Medical Summary
Midstate Health
On boarding
Medical Summary
Community Health Access Network (CHAN)
On boarding
Medical Summary
Frisbie Memorial
On boarding
Cottage Hospital
On boarding
Derry Medical
On boarding
Medical Summary
Speare Memorial
On boarding
AHEDD data, ELR data,
Discharge/Medical Summary
Home Health & Hospice
On boarding
Medical Summary
Monadnock Family Services
Scheduled
Medical Summary
Access Sports Medicine
Scheduled
Medical Summary
Weeks Medical Center
Scheduled
AHEDD data, Medical Summary
Huggins Hospital
Scheduled
AHEDD data, Medical Summary
Mental Health Center of Greater Nashua
Scheduled
Medical Summary
VNA & Hospice of Northern Carroll County
Scheduled
Medical Summary
Mental Health Center of Greater Manchester
Scheduled
Gastroenterology PA (GASPA)
Scheduled
AHEDD data, Discharge
Summary
AHEDD data, ELR data, Medical
Summary
Stage 2 Meaningful Use
Elliot Hospital
Medical Summary
New
Health Information Organization
MedicalHampshire
Summary
© NHHIO. All rights reserved.
- 45 -
Participant Schedule
Participant
Implementation
Messages current/planned September 2013
Status
2-Sep 9-Sep 16-Sep 23-Sep 30-Sep
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Pending Schedule
Homemakers Health Services
Memorial Hospital
St. Josephs Hospital
Southern New Hampshire Medical Center
Southern New Hampshire Internal Medicine
Concord Hospital
Concord VNA
Franklin Regional Hospital
Littleton Regional
Northern Human Services
New London Hospital
Ammonoosuc Community Health Center
West Central Behavioral Health
Wentworth-Douglass
Legend:
Status:Implementing
Testing
New Hampshire Health Information Organization
Production
© NHHIO. All rights reserved.
- 46 -
Can I query the HIE for available records and request the information?
Currently, NHHIO does not provide a centralized data repository of patient records for
querying and retrieving functions, but is creating a platform for electronic directed
secure messaging (DSM). However, through the Relationship List Service (RLS) in phase II,
NHHIO providers will be able to see a list of organizations where the patients have some
type of record associated and the date of the last encounter. Providers may then reach
out to the organization through traditional methods associated with the encounter and
request the information to be sent to them. NHHIO will also provide a Healthcare
Provider Directory (HPD) of all participating providers and organizations.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 47 -
What is the Healthcare Provider Director (HPD) used for?
NHHIO is establishing a payload agnostic platform to allow organizations to transmit any
type of message, file or document that relates to patient treatment. The message is
encrypted and transmitted based on the HPD information available to the HIE. This “To”
and “From” addressing information can be manually embedded into the file name of the
message, ie. FromAddress..ToAddress[##UniqueIdentifier][#Filename], or as an example,
from@sendingOrganization.com..to@receivingOrganizations.com##20130212#JoeBloggs.pdf
Or, the “To” and “From” information may also be embedded into the C32 CCD , or CDA
document, HL7 or XML message depending on vendor capabilities. The ability to include
this information into a local provider directory in your EHR or other source system, or
not, will help determine our integration methods with each source system.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 48 -
LAND Appliance
Device
Next Unit of Computing Kit
Processor
Intel Celeron 847 (1.10 GHz)
RAM
8GB RAM (2ea 4GB DDR3 SDRAM)
Hard Drive
120 GB SSD (Intel SSD 525)
Dimensions
4.59”x4.41”x1.55”
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 49 -
LAND Appliance
NHHIO Participant
NHHIO Central Site
Orion Health
Direct Secure
Messaging
Deployment Facility
EMR/
Interface
Engine
Messaging
LAND
Appliance
HISP
Services
Administration
Orion Health
Monitoring
• HIE Gateway – message packaging, transmission, encryption
• LAND Appliance uses outbound communication only
• Centrally managed and remotely supported
• Communicates “up” status to central site
• Local “hot-swap” appliances available
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 50 -
How does the LAND appliance communicate?
The LAND appliance periodically pings the central site in order to determine if messages are
waiting for retrieval. Communications are outbound only directed to a single IP address
through a single Port on the local firewall. Once messages are identified, they are then
pulled into the LAND, unencrypted, then delivered to destination. Communication between
the participant and the LAND appliance is un-secure.
http://www.nhhio.org/sites/nhhio.org/files/media/NHHIO%20Solution%20Diagram.pdf
Where is the best placement of the LAND appliance: Local Network vs.
DMZ?
Since communication between the LAND appliance and your sources systems is not
encrypted, we recommend the appliance is placed on your network behind your Firewall
which provides continuous security of PHI. Messages are encrypted by the LAND appliance,
and remain encrypted until they are received on the Receiver’s appliance, at which point
they are safely decrypted.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 51 -
How is data in transit secured and encrypted?
Data is sent through Orion HISP, following Direct ( http://www.healthit.gov/policyresearchers-implementers/direct-project ) standards, using TLS version 1 transport protocols
with PKI certificates, encrypted using AES256 algorithm. Encryption/Decryption takes place
within the LAND appliance and messages are not opened or deposited at the central site.
Where is the Central Site?
System is securely hosted by LogicWorks in a hybrid cloud environment,
http://www.logicworks.net/, (SSAE16 certified) with separate database and server
instances for NHHIO protected by Cisco ASA5520 firewalls with redundant communication
ports and full anti-virus and intrusion detection software.
What type of network connectivity is required?
NHHIO relies upon participant’s commercial internet connectivity and does not utilize any
private networks or dedicated circuits.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 52 -
LAND Appliance Integration Methods
Description
Directory Interfaces
Simplified File Exchange
Sending Receiving
Drop a specially named file into a directory to send the file.
✔
✖
Simplified CDA Documents
Exchange
Drop a specially named CDA document into a directory to send the file.
Information is extracted from the CDA document and included as
metadata for the message.
✔
✖
Document Exchange using the
SendDocuments format
The sender creates a specially formatted XML document that contains
metadata information and either the file to send, or the name of the file
to send.
✔
✔
Web Service Interface
Simplified CDA Documents
Exchange
Uses a web service to send a CDA document. Information is extracted
from the CDA document and included as metadata for the message
✔
✖
Document Exchange using the
SendDocuments format
Use a web service and a specially formatted XML document with
embedded attachment(s) to send a message.
✔
✔
Uses an HTTP Post and a specially formatted XML document with
embedded attachment(s) to send a message.
✔
✔
Uses the IHE XDR web service to send messages. This interface is
appropriate for systems with full XDR implementations.
✔
✔
Use an external FTP server and a specially formatted XML document with
embedded attachment(s) to send/receive messages.
✔
✔
HTTP Interface
SendDocuments format
IHE XDR Interface
IHE XDR Interface
FTP Client Interface
Document Exchange using the
SendDocuments Format
How do I select an appropriate integration method?
With support and guidance from NHHIO and the Orion teams, each participant will need to
work with their EHR vendor(s) to determine the best integration method based on the
export functions of their system, the ability to include HPD information, and the trigger
events for the release of information such as:
• Medical Summary / Continuity of Care Document (CCD) / (CDA)
• Transfer of Care Summary (TOC)
• Progress / SOAP notes
• Referral requests / Referral letters
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 54 -
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 55 -
HIE Trends
September 20, 2013
Context
1997 – Healthbridge HIE
1999 – New England Health Exchange Network
2001 – Rhode Island Quality Institute
2003 – Indiana Health Information Exchange
2005 – Vermont Information Technology Leaders
2005 – YouTube
2006 – Maine HealthInfoNet
2006 – Facebook
2006 – Accountable care
2007 – Twitter
2007 – Mad Men
2008 – Breaking Bad
2008 – Android
2009 – Modern Family
2009 – HITECH (Meaningful Use)
2010 – Obamacare
2010 – iPad
2011 – NHHIO
HIE is maturing
HIE 1.0
hie 2.0
• Focused on “the noun”
• Focused on “the verb”
• Trying to solve “market failures”
• Demand-driven -- trying to meet
market needs
• Multi-entity governance, but often
driven by third-party entities
• Strived to solve wide variety of rich
use cases through comprehensive
interoperability
• Complex legal, business, and
technical requirements to support rich
array of use cases
• Tried to tackle policy issues to enable
business practices and technology
solutions
• More tactically focused to meet
immediate interoperability needs
• Led by any organization that has
business need and ability to marshal
financial, technical, and
organizational resources
• Designed to fit within existing legal,
business, and technical constraints –
technology out ahead of policy in
some areas
What is driving this transition?
Limited successes of the prior model
Bottom-up demand -- systems are not interoperable because not enough
customers asked for interoperability
•
Meaningful Use incentives
•
Value-based purchasing
•
Market expectations about standards of care
•
Younger provider expectations about use of technology
•
Consumer expectations about use of technology
Supply-side
•
EHR certification requirements – common denominator important in a
fragmented industry
•
Technology advancements in cloud services, mobile, broadband,
storage, patient-matching capability, etc
Industry changing rapidly
70%
60%
50%
EHR Adoption
National
40%
NH
Massachusetts
30%
Vermont
20%
Maine
10%
0%
2008
2009
2010
2011
2012
80%
70%
60%
eRX Use
ME
50%
MA
40%
National
30%
NH
20%
VT
10%
0%
2008
2009
2010
2011
2012
National-level HIOs are most comprehensive HIE
implementations, but still quite thin
•
Over 20 participants (4 federal) as of September 2011
•
Over 90,000 transactions conducted
•
HIE solution based on NHIN standards enabling send/receive and
query/retrieve
•
DURSA covering complete set of exchange patterns
•
Five provider organizations (Geisinger, Kaiser, Mayo, Intermountain,
Group Health)
•
Complete solution based on NHIN standards enabling send/receive
and query/retrieve
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
- 61 -
EHR vendors with high penetration generating large
amount of vendor-specific HIE traffic
• Large majority of customers
(200+) participating in
query-based exchanges
• 16,743 providers using
query-based exchange
• ~1.5 million query-based
exchanges per month
• Currently CCD/CDA querybased exchange is ~2.2
million records for ~385K
unique patients per month
• ~2.5 million new CCD
records made available on
query exchange hubs or
sent directly to referral
providers per month
• ~58.5 million directed
exchange transactions per
month (including HL7 lab
result delivery)
• Volume doubled over
previous year
• Processed over 75+ million
lab result records in 2012
• Does not include HL7
directed exchange
transactions
Source: January 2013 -- Epic, eClinicalWorks, Cerner
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
- 62 -
Some vendors teaming to
standardize cross-vendor HIE capabilities
• Nascent collaboration effort among some leading EHR vendors
• Creating common infrastructure for directed query capability
facilitated by:
• Record locator service
• EMPI
• Patient-controlled consent management
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
- 63 -
What will drive HIE in the future?
MU Stage 1 – get everyone electronic, push transactions that already work (labs,
eRX)
MU Stage 2 – establish new “push” transactions (provider-to-provider)
MU Stage 3 – establish new “query” transactions
MU Stage 4? 5? 6?
Accountable care?
Market forces?
HIE Functional Needs Vary With Business Goals
Enterprise
Integration &
Management
Population, Risk,
and Financial
Management
Population, Risk,
and Financial
Management
Measurement &
Reporting & CDS
Measurement &
Reporting & CDS
Case management
& patient access
Case management
& patient access
Case management
& patient access
Registries &
Repositories
Registries &
Repositories
Registries &
Repositories
Cross-system
query
Cross-system
query
Cross-system
query
Cross-system
query
Message &
document delivery
Message &
document delivery
Message &
document delivery
Message &
document delivery
EHR functions
EHR functions
EHR functions
EHR functions
IPA/PHO
Accountable
care entities
Independent
actors
IDN
• Business
integration
• Business alignment
• Team-based care
• Patient
engagement
• Performance mgmt
• Population mgmt
• Utilization mgmt
• Case facilitation
• Become electronic
• Fill in gaps in care
transitions
Massachusetts HIE Plan
Record Locator Service
Patient name
Local name
Institution
MRN
Last visit date
# visits
Jones, Jennifer L
Jones, Jennifer L
Jones, Jennifer
Jones, Jenny
Hospital A
PCP
1234
5678
Dec 3, 2012
Jul 8, 2010
3
12
4. View Patient Relationships (constrained
to patients with established relationships)
2. Send demographics to RLS
5. Request patient record
Specialist
N
PCP
Y
Hospital A
6. Send patient record
Y
Hospital B
Y
1. Consent to Publish Provider
Relationships
3. Consent to Search
or Retrieve
Jennifer L Jones
Jennifer L Jones
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
- 66 -
Massachusetts HIE Plan – Possible Patient Access
Options
Patient Directory
Patient name
Local name
Certificate
Institution
MRN
Direct address
Jones, Jennifer L
Jones, Jennifer
34X&)VX
Jones, Jenny
34X&)VX
Hospital A
1234
Jennifer.Jones@hv.masshighway.net
PCP
5678
Jennifer.Jones@hv.masshighway.net
Jones, Jennifer L
2. Lookup Patient Address
3c. Notification of RLS Change
3b. View RLS or RLS Audit Log
or Manage Consent?
Specialist
N
PCP
Y
Hospital A
3a. Send Record
Y
Jennifer L Jones
1. Consent
Jennifer L Jones
Massachusetts eHealth Collaborative
© MAeHC. All rights reserved.
- 67 -
Conclusions
HIE activity is starting to flourish….just not in the way we expected a few years ago
Heterogeneity will be the hallmark of HIE activity in the coming years
There will not be a “National HIE” – but there are already many of them…
Multi-layered HIE modes developing as business practices mature
•
“B2B”-style patterns to move documents around with light centralized coordination –
Direct and Directed Query
•
“Supply-chain” style patterns with deep integration among very closely aligned
entities seeking centralized orchestration for rich applications to support complex
uses
Most state-level HIEs will not survive, and the survivors will be the ones who:
•
Focus on customer needs
•
Tackle the problems that only they can solve
•
Remain flexible to market changes
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 69 -
New Hampshire Health Information Organization
HIE Use Cases
Mary Beth Eldredge
Board Vice Chair
DH Director of Regional IT Systems
New Care Team Model Extends the Reach and Need for Data
ACO
PCP
eRX
Home
Health /
LTC
Acute Care
Specialty
Care
PQRS
Patient &
Families
Diagnostic
Testing
eHealth
Portals
Mobile
Technology
MU & CQM
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 71 -
EP Meaningful Use – Stage 2
Core Objective: Summary of Care record sent with transitions of care and referrals
(CCD)
Measure:
1.
Sent for more than 50% of transitions of care and referrals
2.
10% sent electronically in Direct compliant format
a) Transmitted using CEHRT
- Or b) Transmitted via NwHIN participating exchange or ONC established
governance mechanism (NHHIO)
3.
Conduct exchange test
a) Different EHR
- Or a) CMS-designated test EHR
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 72 -
EP Meaningful Use – Stage 2 (cont)
Core Objective: Submit immunization data (Dependent on NHDPH)
Measure: Submit data
Other related Objectives:
1. Core: Secure messaging
2. Core: Patient ability to View, Download, Transmit health information
3. Core: Structured lab data >40%
4. Menu: Syndromic Surveillance data
5. Menu: Cancer and other registries
6. Menu: Imaging results
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 73 -
Value Propositions
 Increases care coordination efforts by transmitting structured data elements in
care summaries, discharge notes, lab results, history and physicals, etc.
 Replaces traditional point-to-point communications (unsecure fax, mail, etc.)
with electronic directed exchange streamlining workflow in the practice setting
 Provides consistent method for private, secure and auditable transmissions of
protected health information (PHI)
 Streamlines Public Health reporting to the State with connections for AHEDD,
electronic lab reporting, cancer care registry and immunization registry
 Uses national standards to allow providers and hospitals to comply with
multiple incentive and quality programs
 Eliminates the creation and management of multiple point-to-point connections
for results delivery and information sharing
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 74 -
Dartmouth Hitchcock Use Cases
Replacing Faxing between sites

DH to DH providers

DH to non-DH providers
Delivering Lab results to ordering providers
Referral Requests / Referral Information from referring providers
NCCC Outreach Clinics – dual documentation in local record and DH record

New London Hospital, Valley Regional Hospital, Catholic Medical Center,
Weeks Medical Center, Littleton Regional Hospital, Cottage Hospital, St.
Joseph Hospital
CHaD Outreach Clinics – dual documentation in local record and DH record

CHaD @Wentworth Douglass, Elliot Hospital
Discharges to Home Health agencies and SNF/LTC

40% of DHMC discharges go to post-acute care sites
Discharge summaries from local hospitals to DH Clinics

Manchester, Nashua, Concord
Interstate communication of all the above information

Vermont, Massachusetts, Maine
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 75 -
What are your use cases?
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 76 -
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 77 -
New Hampshire Health Information Organization
Getting Connected
Jackie Baldaro
Project Manager
NHHIO Resources
www.nhhio.org
On-Boarding Documentation
 NHHIO On-Boarding Document (~5 week on-boarding project plan)
 Appendix A – Readiness Questionnaire (updated to identify multiple systems)
 Appendix B - LAND Form (technical contacts and integration method(s))
 Appendix C – Provider Directory Upload File Format (.CSV file to be updated)
 Appendix D – LAND Appliance Documentation (specifications and integration)
 NHHIO Solution Diagram (description of technical infrastructure and
communications)
 Available at www.nhhio.org
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 80 -
HIE Technology Grant Program
Reduce barriers to implementation and adoption
 Financial support for hardware purchases
 Financial support for software upgrades
 Financial support for additional staffing needs
Award amount based on need justification in
application
Workflow assistance and guidance from the Regional
Extension Center of New Hampshire
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 81 -
In-Kind “Donation” Tracking
 NHHIO is responsible for a 25% match against all Federal dollars spent
 In order to keep participant fees low, NHHIO requests tracking of resources
spent by the participants:
 Internal staff time – meetings, staff training, education & outreach
 Hardware, software purchases
 External consulting/integration services
 Documentation in NHHIO tracking form
 Participant retains auditable receipts
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 82 -
On-Boarding Process (i) ~ 5 weeks
Week 3-4:
2-3:
1:
Participant
NHHIOAppliance
LAND
– completes
Orion –installation
Participant
documentation
and
Kick-off
HIE connection
Call
• Participant
Orion reviews
NHHIO
Participation
installs
systems
LAND
agreement
and
Appliance
architecture
andon
associated
LAN
for preliminary
addendums
guidance
••Technical
Orion completes
Configure
architecture
firewallLAND
withinformation
IPform
/ Port
with
information
Participation
– Integration for
Engine
NHHIO approval (PKI)
• Particpant/Orion
Orion configures/delivers
Identify
system connections
test connectivity
LAND Appliance
with central site
• LAND Form contact information
• HPD CSV file
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 83 -
LAND Appliance Integration Process
8) Participant Integration - EHR to LAND Appliance
Participant, with assistance and guidance from NHHIO, will need to
work with their EHR vendor(s) or internal IT team to develop a
process to transport, test and validate messages from EHR
system(s) to LAND Appliance. Depending upon the Participant’s
integration method, additional network directory set-up work may be
required to support file exchange.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 84 -
On-Boarding Process (ii) ~ 5 weeks
Week 3-4: LAND Appliance Integration
• Participant establishes system(s) to LAND Appliance integration method(s)
Week
4-5: System
testing
• Participant
establish
initial use case(s) for export
•• Participant
creates
test
messages
for
transmissionneeds
Integration
engine
/
EHR
system(s)
configuration
Week
5: Move
to production
•• NHHIO
will
facilitate
receiving
participant (directory method)
Network
security
/
file
share
configuration
•• Complete
acceptance
testing
validates
connectivity
•• Orion
EHR
vendor
or
other
IT
resources/programming
may be required
Review
support
/
help
desk
methods
•• Participant
validates
results
– acceptance
testing
NHHIO
/
RECNH
can
provide
integration
management
assistance
• NHHIO dues payment (quarterly)
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 85 -
Project Contact Information
Jeff Loughlin
Executive Director
c: (508) 326-3944
o: (781) 434-7751
jloughlin@maehc.org
Jackie Baldaro
Project Manager
c: (339) 223-0888
o: (781) 434-7553
jbaldaro@maehc.org
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 86 -
Agenda
 Welcome and Introductions – Denise Purington, Board Chair, NHHO - Jeff Loughlin,
NHHIO Executive Director
 The State Perspective – William Baggeroer, Chief Information Officer, NH DHHS
 Where did we start from – How far have we come? – Mark Belanger, Director of
Strategic Advisory Services, Massachusetts eHealth Collaborative
 Legislative Issues and Concerns – Denise Purington, Board Chair, NHHIO
 Current State of NHHIO – Jeff Loughlin, NHHIO Executive Director
 Future of Health Information Exchange – Micky Tripathi, President & CEO,
Massachusetts eHealth Collaborative
 HIE Adoption and Use Case Review – Mary Beth Eldredge, Board Vice Chair, NHHIO
 Participant Discussion
 Getting Involved, Getting Connected – Jackie Baldaro, Project Manager, NHHIO
 Q& A - Closing Remarks
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 87 -
Conclusion
Today’s Goals
 Get Educated
 Visit www.nhhio.org for updated information
 Email nh-hio@maehc.org to get on our distribution
 Get Inspired
 Contact us with use cases and leads
 Get Connected
 Download our agreements
 Contact Jackie to set up a kick-off meeting
 Get Involved
 Contact your legislators to support HIE expansion
 Check out our calendar for committee meetings
 Join us for webinar series and discussions
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 89 -
Thank You!
Thank you for partnering with the New Hampshire
Health Information Organization (NHHIO) as we take
this important next step in the evolution of health care
delivery in the Granite State.
New Hampshire Health Information Organization
© NHHIO. All rights reserved.
- 90 -