Presenter: Ken Hoffman Vice President, Interface & Integration 978-805-4103 Kenh@iatric

1. Hot Integration Topics – 2006Purpose: Discuss Integration Experiences Discuss Integration Interface Components Discuss Integration Challenges Presenter: Ken Hoffman Vice President, Interface & Integration 978-805-4103 Kenh@iatric.com

2. Meditech Integration Topics: • Physician Practice EMR • PACS • Physician/Community Portal • Emergency Department Systems • Access Images through PCI/EMR • Critical Care Online Documentation • HIPAA Security Exception Reports • RHIO’s

3. Meditech HCIS Physician EMR Software Inbound Orders Inbound Registration Outbound LAB Results Outbound RAD Reports Outbound OE Dept Reports EMR Orders to HIS HIS Results to EMR Physician Practice EMR Integration

4. Physician Practice EMR Integration • Bi-directional Integrations Points: • EMR sends HL7 ORM Order to Meditech • EMR Order triggers a Meditech Registration, CLI or REF Short • EMR Vendor will send Meditech MR# so new MR# is not created. • If no MR# patient match is based on SSN, Last Name, First Name, Gender, DOB. If still no Match patient is placed in work queue to be manual matched or a new MR# will be created. • EMR Orders are placed in Meditech Order Entry and flow to LAB or RAD • Meditech Results are sent to EMR vendor • Meditech Results contain EMR Order Number • Meditech Orders status updates are sent to EMR

5. Physician Practice EMR Integration • Uni-directional Integrations Points: • Meditech Results are sent to EMR vendor • Meditech Results do not contain EMR Order Number • EMR vendor will match patient by SSN, Last Name, First Name, Gender, DOB. If patient can not be matched results are placed in work queue to be manually matched with EMR patient.Additional Integration Points: • Meditech and Physician Practice share real-time transactions via secure VPN or other encrypted transfer method • Most EMR vendors have HL7 capability. • Hospitals are leveraging this type of integration to win practice business and reference lab work.

6. Physician Practice EMR Integration • Additional Integration Points (Cont.): • Have a “Scope of Work” agreement between practice and hospital. Can provide sample document. • Hospital practice liaison to facilitate communication and cooperation. • Hospital technical staff to help physician practice with connectivity.

7. Physician Practice EMR Integration • Interface Components: • EMR HL7 ORM Orders to Meditech Order Entry OrdersNOTE: ORM must contain enough information to perform Meditech Registration • HL7 ORU LAB Results to EMR • HL7 ORU RAD Reports to EMR • HL7 ORU OE Departmental Reports to EMR • HL7 ORM OE Orders to EMR (Status Update)

8. Meditech HCIS Inbound RAD Order Status Update Outbound ADT Outbound RAD Orders Outbound RAD Reports Onetime Backload Orders/Reports PCI PACS Image Viewer PACS Vendor Or Broker PACS Orders to HIS HIS Results to PACS Vendor PACS Integration

9. PACS Integration • Bi-directional Integrations Points: • HL7 ADT is not always required, but does supply patient demographic updated information. • Voice recognition can be integrated to PACS Vendor system and can provide reports to PACS vendor. Still recommend RAD reports come from Meditech so no updates or Meditech originated reports are missed. • Inbound status updates are sent to Meditech to update the order to a taken status. • PACS image viewer can be launched from PCI/EMR via Web browser. • Not all PACS Vendors require a broker (data converter). • Need to consider back loading reports, orders, and images.

10. PACS Integration • Interface/Integration Components: • HL7 ADT to PACS Vendor or BrokerNOTE: Not all PACS system require ADT interface. • HL7 ORU RAD Report to PACS Vendor. • HL7 ORM RAD Orders to PACS Vendor. • PACS Vendor to Meditech RAD Orders Status Update. • PACS Images access via PCI/EMR

11. Meditech HCIS Application Specific Inbound Interfaces Query Interface or Application Specific Interfaces Portal Vendor Portal Vendor to Meditech Meditech to Portal Vendor Physician Portal/Web Enabled Systems

12. Physician Portal/Web Enabled Systems • Interface/Integration Points: • Common objective to web enable Meditech data display and data entry • Data retrieval/storage techniques used by portal vendors: 1) Staging Database – Portal vendor receives & stores x days worth of data 2) EMR – Portal vendor incorporates repository/EMR for long term storage 3) Query – Portal vendor queries Meditech as data is needed 4) Highbred – Cache & Query: combination of query & staging. • Replace PCI/EMR for Physicians view • Portal vendors can provide both desktop and mobile solutions • Community wide portals for employee, physicians, and patients

13. Physician Portal/Web Enabled Systems • Interface/Integration Components: • INBOUND to MEDITECH • HL7 ORM OE Orders for LAB, PHA, RAD, etc…, New Order and Status Update • HL7 ADT Pre-registration via patient portal • HL7 ORU RAD/ITS/OE Department Reports and Esign • HL7 ORU NUR/PCS Assessments • HL7 DFT Billing, Payments to apply to patient account • HL7 User ID and Password authentication, password changes, expirations Portal access using Meditech User ID and Password

14. Physician Portal/Web Enabled Systems • Interface/Integration Components: • OUTBOUND from MEDITECH • HL7 Query Engine for ALL Meditech Data • HL7 ORM OE Orders for LAB, PHA, RAD, etc…, New Order and Status Update • HL7 ADT Patient Demographics/Visit Information • HL7 ORU RAD/ITS/OE Department Reports, Status Updates • HL7 ORU NUR/PCS Assessments • HL7 ORU LAB Results, Status Updates • HL7 RDE Pharmacy Orders, Status Updates • HL7 DFT Billing Information • HL7 Employee Record

15. Meditech HCIS Inbound ED Reg Inbound OE Orders Inbound OE Report Outbound ADT Outbound Meditech Orders Outbound Meditech Results ED Vendor to Meditech EDS Vendor Meditech to ED Vendor Emergency Department Software Integration

16. Emergency Department SoftwareIntegration • Bi-directional Integrations Points: • EDS vendor sends HL7 ORM Order to Meditech, LAB & RAD • EDS workflow typically gets registration from Meditech, but registration can be received from EDS • EDS Vendor will send Meditech MR# so new MR# is not created. • If no MR# patient is match based on SSN, Last Name, First Name, Gender, DOB. If still no Match patient is placed in work queue to be manual matched or a new MR# will be created. • EDS Orders are placed in Meditech Order Entry and flow to LAB or RAD • Meditech Results are sent to EDS vendor • Meditech Results contain EDS Order Number • Meditech Orders status updates are sent to EDS

17. Emergency Department SoftwareIntegration • Interface Components: • EDS HL7 ORM to Meditech Order Entry OrdersNOTE: ORM must contain enough information to perform Meditech Registration • EDS HL7 ORU Discharge Summary to Meditech OE Departmental • HL7 ORU LAB Results to EDS • HL7 ORU RAD Reports to EDS • HL7 ORM OE Orders to EDS (Status Update)

18. Clinical Images Via PCI/EMR Image Server Web Based Image Viewer

19. Clinical Images Via PCI/EMR • Interface/Integrations Points: • Image server to centralize most or all clinical images • PACS images seem to be excluded from an imaging server, but can be incorporated. • Image examples are EKG/ECG, fetal monitor strips, endoscopy, cardiology, etc… • View images via URL Web access using Web Browser. Passing User ID, Password, MR# • Image viewer routine can be attached to an Other Data Source routine in PCI. Meditech has yet to release an Other Data Source link in EMR.

20. Clinical Monitor Online Documentation Clinician Validation Routine Critical Care Monitor Meditech HIS Validated ResultsFiled in NUR or PCS Results Server

21. Clinical Monitor Online Documentation • Interface/Integrations Points: • Critical care fixed monitors can send several HL7 ORU results message per minute. • Results servers can house this large quantity of unvalidated, raw monitored results. • These results can be queried, validated by clinicians, and filed into Meditech NUR/PCS, making validated results available via PCI/EMR. • EKG Images can also be acquired from fixed monitors and made available via imaging server.

22. HIPAA PHI Access Security Violations • Interface/Integrations Points: • Sites are actively looking for Protected Healthcare Information (PHI) access violations. • Here are some exception report examples: • Patient and User Last Name Same • Address Street of User and Patient Match • Emulated User • Guarantor/Subscriber and User Name Match • List of Patient that are facility employees • Several More…..

23. Stakeholder Hospital Stakeholder Hospital RHIO Trustee Authentication Trust Stakeholder Hospital Non-Stakeholder Hospital Regional Health Information Organizations (RHIO) • Made up of Stakeholders and non-stakeholder • Goal to improve patient treatment, safety, quality • Level of trust must be established – Chain of Trust • Independent authentication authority • Level of information shared • Staged or queried information

24. Regional Health Information Organizations (RHIO) • Integration Points: • Staging database at each point of data source – Clinical Data Repository (CDR) • Query at each point of data source - Query originates with RHIO Trustee • Data exchanged on secure connection with Trustee holding the keys to all information authentication • Level of information shared agreed upon by stakeholders • Query is real-time • Clinical information • Many models are being presented • What is the right model for you?