State HIE Lab Summit
and Pilot Program
May 30, 2012
Team Pilot Overviews
West Virginia
Key Partners
Scenario 2:
Grantee team: Phil
Weikle, Kathy Moore,
WVHIN
Lab representative: Nick
Jachelski , Grafton City
Hospital Lab
LIMS vendor(s) Mark
Jones, Ginger Wooster,
Orchard Software
Practice or hospital
representative: Ann
Rexroad, Grafton City
Hospital. Preston Taylor
Community Health
Center (not attending)
HISP vendor(s): Chris
Lewis, Thomson Reuters
Health Care.
REC: Dwayne Edwards
(not attending)
Key Milestones
• Orchard generates first
puff , creates a Direct
message, attaches results
and sends through
WVDirect to Preston
Taylor. 6/30/12.
• Preston Taylor receives
message through
WVDirect web portal and
manually re-enters
information in to EHR.
8/1/2012.
Key Resources
• Orchard technical
team, Grafton City
Hospital Lab, REC
technical support for
Preston Taylor
Community Health
Center, Preston Taylor
Operations Manager.
User Story
Scene 1: Patient visits
Preston Taylor & lab tests
are ordered from Grafton
City Hospital using paper
requisition form.
Scene 2: Grafton receives
paper order from the
presenting patient, enters
order into Orchard and
includes WVDirect
address as preferred
result delivery method.
Grafton completes tests
and results are
transmitted to Preston
Taylor using WVDirect.
Scene 3: Preston Taylor
receives the results via
WVDirect, manually
enters info into EMR
record and triggers a
notification to treating
physician.
Pilot Scenario Diagram – Partially Automated, Unstructured
Orchard
programmatically
generates pdf,
creates Direct
message,
attaches
message and
sends to
WVDirect..
Value Proposition
•Our goal is to support
unconnected rural
hospital labs to deliver
structured lab results to
ambulatory providers in
their community as part
of their clinical workflow.
If EMR vendor is not
available, value will still
be seen on the lab
delivery side.
Legal Agreements
•WVDirect Subscription
Agreement and BAA
between WVHIN and
Grafton City Hospital , and
WVHIN and Preston Taylor
Community Health Center.
Open Questions
•What will the CLIA
requirements be to
ensure Direct is
compliant?
•What agreements are
needed to ensure future
participation in State
HIE?
•What are the
incremental steps
needed to allow for
participation in the State
HIE. Participation in the
State HIE can facilitate
mandatory ELR
reporting as well as
providing a more
complete patient record
upon inquiry, thus
adding value to patients
care providers.
•How can EMR venders
be convinced to
participate?
Preston Taylor receives Direct message w/ attached
‘print image’ of results (e.g., PDF) in a webmail portal
and manually re-enters results into EHR.
Edge Protocol
SMTP w/ S/MIME
Grafton City Hospital Lab / Orchard
WVDirect hosted by TRH
3
Preston Taylor Community Health Center
North Carolina
Key Milestones
• Identify providers
and establish DIRECT
capability
• Create humanreadable lab results
document
• Create Rhapsody
route to send Direct
message
• Educate providers on
DIRECT use
Key Partners
•
•
•
•
NC HIE
Orion Health
Solstas Lab Partners
Providers to be
identified from
Solstas’ NC clients
Key Resources
• BG Jones, Orion Health
• John Lightfoot, Orion
Health
• Patrick Blaylock NC HIE
• Keith Scott, NC HIE
• Rob Lindsey, Solstas Lab
Partners
• Diane McAllister, Solstas
Lab Partners
• Providers
User Story
Scene 1: Provider orders
a lab from Solstas using
existing processes
Scene 2: Solstas receives
lab order, completes
testing, and generates
results. Results are
rendered in a humanreadable document. That
document is transmitted
to NC HIE using the
established connection.
Scene 3: NC HIE received
the results document and
forwards it to the Orion
Health HISP for DIRECT
delivery to the ordering
provider.
Scene 4: The ordering
provider receives the
DIRECT message and
examines the lab results.
The results can be added
to the patient’s paper file
or entered into a EMR.
Value Proposition
This pilot will give providers
an interim solution to
achieve a MU goal without
the expense of an EMR.
Open Questions
• Will NC HIE store
results document?
• What is the format of
the document?
Legal Agreements
• NC Direct Subscription
Users Agreement.
Pilot Scenario Diagram
4
Alaska
Key
Resources
State HIT Office
AeHN – State HIE
Orion Health –
HISP
Providence
• Providence
Hospital
• Epic
• LaTouche
Pediatrics
Allscripts
State
• State Lab
Chemware
• Anchorage
Neighborhood
Clinic
• Orchard LIMS
• Vitera Intergy
Key Milestones
User Story
Providence:
• Finalize user stories
• Determine which lab
results will be included
• Develop LIMS
functionality to send
results
• Develop EHR/LIMS
functionality to receive
results
• Send test results
• Validate receipt of test
results
• Send live results
• Validate against paper
results
• Capture lessons learned
State:
• Determine which lab
results will be included
• Develop LIMS
functionality to send
results
• Send test results
• Validate receipt of test
results
• Send live results
• Validated against paper
results
• Capture lessons learned
Providence:
LaTouche Pediatrics PCP orders a lab
test from the Providence lab using a
paper requisition form. LaTouche’s
EHR creates and prints the paper
order which is sent via fax or with
specimen. Providence lab receives
the paper order and enters the
order into the LIMS including Direct
as preferred result delivery method.
Lab completes test. Providence LIMS
transmits to LaTouche PCP using
Direct via AeHN HISP. LaTouche
receives results via Direct. LaTouche
staff attaches lab results to patient
record.
Key Resources
Providence:
• To be determined
State:
• Money
State:
Anchorage Neighborhood Health
Clinic (ANHC) PCP orders lab from
State lab using paper requisition
form. State lab receives the paper
order and enters the order into the
LIMS including Direct as preferred
result deliver method. Lab
completes test. State lab Chemware
LIMS transmits results to HIE via HL6
interface. HIE stores results and
transmits results to PCP using Direct
via AeHN HISP. ANHC staff attaches
lab results to patient record.
Value
Proposition
Since national
labs are offering
electronic
delivery to EHR’s,
Providence needs
to offer similar
service in order to
maintain market
share.
Additionally there
should be
improved patient
outcomes by
more timely
access to results.
.
Legal
Agreements
• Alaska
eHealth
Network Data
Use
Agreement
• MOU
between
ANHC and
State Lab
• Additional to
be defined
Open Questions
1.What validation requirements exist
for the lab?
2.Will HIE need to provide HL7
translation services?
3.Will HIE provide LOINC
standardization services?
4.Will HIE store lab results?
5.Do any of the participating LIMS or
EMRs have Direct messaging built in
or will we need a second HISP?
6.Should the lab generate a PDF or the
HIE?
7.What output format does Providence
and State LIMS support?
8.How will delivery and read notice be
accomplished?
9.Do participants need to have an
interface to the HIE in order to
participate?
10.What documentation is necessary
for HIPAA/CLIA to prove system is
compliant?
11.If lab results are to be stored in the
repository as well as sent to the
ordering provider how will the HISP
know which message to store or
which PCP should receive them via
Direct?
12.Can the human readable form be
included in the HL7 attachment?
13.How will destination of lab results
be identified in the message?
5
Alaska
Guam and Hawai’i Key Milestones
Key Partners
1.
2.
3.
4.
5.
Guam HIE
Hawaii HIE
Guam providers
Hawaii providers
Medicity (The Hawaii
HIE/HISP technical
vendor)
6. ApeniMED (The Guam
HIE/HISP technical
vendor)
xx/xx/2012 – Plan and
timeline finalized for HISP
to HISP connectivity.
xx/xx/2012 – Completion
of legal agreements.
xx/xx/2012 – Testing for
HISP to HISP connectivity.
xx/xx/2012 – HISP to
HISP connectivity go-live.
Key Resources
1. ApeniMED HISP
interface
2. Medicity HISP
interface
User Story
1. Guam PCP receives
lab reports as
attachments via the
Guam HIE Direct
Portal.
2. The lab reports
indicate a condition
that leads to a referral
to a Hawaii provider.
3. The referral and lab
reports are sent to
Hawaii using Direct
and the HISP to HISP
connection.
4. The Hawaii provider
treats the patient.
5. The patient discharge
report and related
documents are sent to
the Guam PCP Direct.
Open Questions
Value Proposition
1. HISP to HISP
connectivity facilitates
fast, secure
coordination of care
through transmission
of referrals, lab results
and related
documentation
throughout the
Pacific.
1. Provider discovery
2. EHR integration
Legal Agreements
1. Business Associate
Agreements
between providers
and their respective
HIEs
2. Data sharing
agreement between
the Guam and
Hawaii HIEs
Pilot Scenario Diagram
Lab results as
Direct Message
attachments
Local and
Regional Labs
Guam
Provider
Direct Messages
HISP to HISP connection
Guam HIE
/HISP
Guam PCP receives lab reports that lead
to a referral to a Hawaii provider. The
referral and lab reports are transmitted
to Hawaii using Direct messaging.
HISP to HISP connection facilitates
transmission of referrals and
relevant lab reports and related
documentation.
Hawaii HIE
/HISP
Hawaii
Provider
Hawaii Provider accepts the referral
using Direct Messaging. Later, she
returns discharge information to the
Guam PCP using Direct Messaging.
Florida
Key Partners
Grantee team (Florida
Agency for Healthcare
Administration)
Florida HIE Harris Corporation
Quest Diagnostics Lab &
EMR
HMA State Lab
iOS Health Systems
Key Milestones
•Finalize lab summit preplan
with team by May 23, 2012
•Finalize post-summit plan
by June 13, 2012
•Quest HISP in Test by July 1,
2012
•IOS HISP in Test by August
1, 2012
•Production Implementation
by September 1, 2012
Key Resources
Florida HIE
- Direct Secure Messaging HISP
- Web Services to receive XD
message
- Integration Support staff
Quest Diagnostics Lab & EMR
- Quest Diagnostics HISP
- Automated lab feed for copy
of HL7 & pdf of lab report
- Automated interface between
Quest HISP & Care360 EMR
- Integration support staff
HMA State Lab
- LIS
- CONNECT GW provided by
Florida HIE
- Automated lab feed for copy
of HL7 & pdf of lab report
- XDR from CONNECT GW to
other HISPs
- Integration support staff
iOS Health Systems (EMR)
- iOS HISP
- Automated interface to EMR
- Integration support staff
User Story
Scene 1: HMA Labs receives a
paper order from Dr. A for a CBC
with request for copy to Dr. B and
Dr. C. All three physicians’ Direct
email addresses are in the order.
HMA labs logs onto DSM, creates
new email and attaches the
report and addresses it to the
three physicians.
Dr. A logs onto DSM and views the
new email directly.
Dr. B using Care 360 mailbox views
the result and saves in the patients
record.
Dr. C using iOS Inbox views the results
and saves to chart
Scene 2: Quest Diagnostics Labs
receives an order from Dr. A for a
CBC with request for copy to Dr.
B. The physicians’ delivery mode
was previously defined as Direct.
Both PDF &HL7 results created.
Quest Diagnostics labs
automatically sends the reports
via their HISP to the two
physicians.
Dr. A logs onto DSM and views the
new email directly.
Dr. B using iOS Inbox views the results
and saves to chart
Scene 3: Quest Diagnostics Labs
receives an order from Dr. A for a
CBC with request for copy to Dr.
B. The physicians’ delivery mode
was previously defined as Direct.
Both PDF &HL7 results created.
Quest Diagnostics labs
automatically sends the reports
via their HISP to the two
physicians.
Dr. A logs onto DSM and views the
new email directly.
Dr. B using iOS EHR views the results
that have already been saved to chart
Value Proposition
•Standard interface – labs and
EMRS can interface via Direct
and those providers on the
Florida HIE DSM Portal
•Enable exchange of
information between ancillary
service providers like labs,
EMRs and providers
•Automated feeds to remove
human in the loop
•Provide an audit trail for
both manual and automated
lab results & other messages
•Decrease costs and reduced
errors in providing copies of
lab results in either a
structured or unstructured
format
Legal Agreements
•Florida HIE DSM Direct
Reciprocal Support
Agreement (DRESA) for HISP
to HISP connections
•Florida HIE DSM Terms of
Use and Subscription
Agreement for DSM Users
•Quest Diagnostics Terms of
Use Agreements for Care360
Users
•IOS Health Systems Terms
of Use and Agreements for
IOS Users
•HMA State Labs Health
Systems Terms of Use
Agreements for HMA Users
Open Questions
•Exposing participating
HISP provider or
participant directories
for use by each
connected HISP
•Proposed read receipt
or other network to
network delivery
notifications meeting
legal and regulatory
requirements such as
CLIA?
•Implementation of XD*
within the proposed
timeline
•Alignment of marketing
and outreach
communications to drive
mutual adoption among
participating
organizations
•Impact of other
unknowns TBD
Florida Implementation Scenario Diagram: Manual to Manual
HMA labs logs
onto DSM,
creates new
email and
attaches the
report created
from their LIS
and addresses
it to the three
physicians.
Edge Protocols
Direct
Backbone
SMTP w/
S/MIME
Florida HIE DSM HISP
HMA Lab
Dr. A logs onto DSM and views the new email
directly.
Dr. B using Care 360 mailbox views the result
and saves in the patients record.
Dr. C using iOS Inbox views the results and saves
to chart
Edge Protocols
Quest Diagnostics HISP
IOS Health Systems HISP
Ambulatory Provider(s)
Florida Implementation Scenario Diagram: Automated to Manual
Quest Diagnostics
Labs receives an
order from Dr. A for
a CBC with request
for copy to Dr. B. The
physicians’ delivery
mode was previously
defined as Direct.
Both PDF &HL7
results created.
.
Edge Protocols
Quest Diagnostics
Lab
Direct
Backbone
SMTP w/
S/MIME
Dr. A logs onto DSM and views the new
email directly.
Dr. B using iOS Inbox views the results and
saves to chart
Edge Protocols
Florida HIE DSM HISP
Quest Diagnostics HISP IOS Health Systems HISP
Ambulatory Provider(s)
Florida Implementation Scenario Diagram: Automated to Automated/Manual
Quest Diagnostics
Labs receives an
order from Dr. A for
a CBC with request
for copy to Dr. B. The
physicians’ delivery
mode was previously
defined as Direct.
Both PDF &HL7
results created.
Edge Protocols
Direct
Backbone
SMTP w/
S/MIME
Dr. A logs onto DSM and views the new
email directly.
Dr. B using iOS EHR views the results that
have already been saved to chart
Edge Protocols
.
Quest Diagnostics
Lab
Florida HIE DSM HISP
Quest Diagnostics HISP IOS Health Systems HISP
Ambulatory Provider(s)