Identity Architecture and Management of Health Information Exchange

1. Identity Architecture and Management of Health Information Exchange Tracy W. Smith Lovelace Clinic Foundation tracy.smith@lcfresearch.org Stephen D. Burd New Mexico Telehealth Alliance burd@mgt.unm.edu

2. Presentation Overview • New Mexico Telehealth Alliance – Technology and Infrastructure • New Mexico Health Information Cooperative – Technology and Infrastructure • Infrastructure Gaps • National Health Information Network

3. New Mexico Telehealth Alliance • The New Mexico Telehealth Alliance (NMTHA): • is a non-profit 501c3 corporation • represents present and potential telehealth users and providers in New Mexico • has a partnership with New Mexico Technet to provide: • network planning and operation • equipment acquisition • telehealth program coordination and resource sharing

4. NMTHA Operational Telehealth Projects • Screening, Brief Intervention, Referral and Treatment (SBIRT) • Counseling and intervention for substance abuse • Connects patients in rural clinics and schools to service providers in Santa Fe. • Video conferencing to provide services and training • New Heart • Monitoring and consultation for cardiac rehabilitation • Connects patients at rural facilities to cardiac specialists in Albuquerque • Video-conferencing and remote exercise telemetry

5. NMTHA Current State • Current NMTHA-supported programs use Checs.net, a state network connecting higher education institutions • Most locations connect to Checs.net via leased T1 lines • Video conferencing bridges and management software are managed by NM Technet • End point hardware is owned by member programs and institutions and shared on a capacity-available basis

6. NMTHA Future State • Additional or alternative backbone network capacity will eventually be required as users and traffic increase • Centralized network and administrative services must be added to support: • Fault tolerance • End point scheduling • Authentication and authorization • Medical record access

7. NMHIC Overview • Community-wide effort • Health information exchange • Lead / grant administrated by Lovelace Clinic Foundation • $1.5 million AHRQ grant • $1.5 million in-kind Vision: To provide a sustainable statewide health information exchange that transforms health care quality, safety, efficiency and outcomes.

8. Architecture Overview

9. NMHIC Services Master Patient Index (MPI) is State resource Used within the main exchange system for Patient Referral system Patient records Some limited State reporting Can be used or integrated (with approvals) Other data sharing participants Practice management systems Clinical management systems Assist with linking specific business partners

10. NMHIC Current State - Services • Master Patient Index (MPI) is working well • Enables the sharing/exchange of patient information • Diagnosis • Procedures • Lab results • Encounter data • Disease specific guidelines • Diabetes and asthma • Patient referral system • Messaging for providers and their staff • Secured and encrypted platform • Role based security

11. NMHIC Future State • Discharge summaries delivery • Disease management • Start with diabetes and asthma • Enhance work flow • DOH Newborn Hearing Screening • Other data entry forms for reporting • Medication reconciliation • Scheduling, Calendaring, Reminders, and Alerts • Early warning and surveillance Not an exhaustive list

12. Combining Telehealth and HIE Why combine telehealth and HIE? • Support clinical medicine with shared health information: • Medical records • Clinical decision support • Interfaces to existing support services (e.g., Health X-Net) • Support health information applications with detailed clinical information • Public health • Legal and regulatory • Homeland security

13. Telehealth/HIE Combination Benefits • More effectively use scarce resources including: • Network capacity • Technical support staff • Funding • Avoid duplication due to similar needs and characteristics: • Users and sites • Security and confidentiality • Low-level (infrastructure) services

14. Telehealth/HIE Combination Challenges • Complexity • Separating the networks divides the “problem” into to smaller/simpler pieces • Combining the networks increases management and other challenges. • Different network traffic types • Telehealth traffic tends to be continuous, video-intensive, and real-time • HIE traffic tends to be more bursty and less time-sensitive • Policies and procedures are required to deal with contention • For example, which applications receive priority when network capacity is limited or overloaded? • Electronic health record (EHR) adoption levels are low • Data exchange and other needed standards are relatively new

15. Key Integrative Components • A backbone network with sufficient capacity and the ability to handle all traffic types • Low-level services including: • Master patient, provider, and user indexes • Security services (encryption, authentication, and authorization across organizations) • Messaging • Scheduling • A management structure to support/run the network and help connect data/service consumers and producers

16. NHIN Issues • Standards • Development is being driven at the national level • We’ll be followers/adopters – we can’t afford to be on the bleeding edge • Network models and prototypes – we need to adopt best technologies and practices from others, including: • Existing RHIOs • NHIN RHIO Prototypes • DOD and VA

17. More NHIN Issues • EHRs • High EHR adoption is a prerequisite to a successful statewide network • We must tap NHIN resources (certification, $, expertise, etc) to the maximal extent to fully deploy EHRs in NM • Access to service providers • NM has limited access to many services (e.g., speciality care) • As the NHIN develops, we must use it to expand access to service providers elsewhere in the country (and the world?)

18. For further information • These slides: • averia.mgt.unm.edu • RHIO- and telehealth-related NM organizations: • www.nmtelehealth.org/TelehealthInNm.htm • Please send additions to burd@mgt.unm.edu