Care Coordination and Interoperable Health IT Systems

1. Care Coordination and Interoperable Health IT Systems Unit 4: Principles and Technology of Interoperable Health IT Lecture c – Tools and Technologies for Interoperability Part 1 This material (Comp 22 Unit 4) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Principles and Technology of Interoperable Health ITLearning Objectives • Objective 1: Name and define types of interoperability (Lecture a) • Objective 2: Explain the complexities of semantic harmonization and the benefits of using standards (Lecture a) • Objective 3: Describe and contrast intra- and inter-organizational interoperability (Lecture b) • Objective 4: Identify and discuss common types of tools and technologies used to solve health interoperability problems (Lectures c and d)

3. Interoperability tools can help to simply implementation • Interface Engine Software • Enterprise Master Patient Index Software • Terminology Management Software • Health Information Exchange (HIE) Software • And other tools to help build, document, and validate standards implementations.

4. Interface engine • An interface engine is a term used to refer to a kind of middleware application that is used to transform, route, clone, and translate messages • Also known as “message broker” 4.10 (Lorenzi, V., 2016)

5. Interface engine capabilities • Often acts like a hub in the hub and spoke model or as a hybrid with multiple hubs • Provides a robust mechanism for interface analysts to build maps, filters, translations, and routing rules to connect systems together that are not fully “plug and play” • If a receiving system is not available, the interface engine queues the messages so that data is not lost • This is referred to as “Store and forward capability” • It keeps audit logs in case messages need to be replayed or in case production issues require further inquiry • It provides sophisticated monitoring capabilities allowing for 24/7 support of all the interfaces that flow through it • Several vendor offerings are available

6. The role of the interface engine • “In today’s connected healthcare environment, the role of an interface engine should be to enable faster deployment cycle times of high quality interfaces using people who have analyst-level, workflow-based skill sets. With healthcare data flowing through it, an interface engine should ease connections to remote care facilities (e.g., physician practices, labs, radiology centers, etc.) and leverage the data to improve operations and workflows.” • Corepoint, 2009

7. Patient identifiers in an organization • In most health care organizations, there is a single authority responsible for assigning a unique identifier to all patients in its domain • At a hospital, the “assigning authority” is usually called Health Information Management (HIM) or the Medical Records Department and the ID is called the Medical Record Number • Sometimes there are errors in ID assignment (e.g. duplicates, etc.) • Some organizations have multiple assigning authorities and IDs for patients – these organizations benefit from an Enterprise Master Patient Index (EMPI)

8. Enterprise master patient index • Definition • A system that owns and manage patient identification across an enterprise • Includes: • An Enterprise-wide patient identifier • A single source of truth on patient demographics for the enterprise. • An association between local identifiers for a patient across the enterprise and their mapping to the EMPI. • Ability to match IDs and map local IDs. • Tools to maintain index quality.

9. Use cases for an enterprise master patient index (EMPI) • Find patients and their information allowing for care coordination across the continuum of care • For example, HIE record lookup • Reduce double entry and provide a better experience for the patient • Wherever patient presents, he is recognized and his history is retrieved • Prevent misidentification for safety reasons • Share systems across domains • For example, a shared lab system across several hospitals

10. Models of EMPI • Active Model • Patient identity source systems allows the EMPI to manage identification • Used in some intra-organizational settings • Less duplicates / incorrect matches • Passive Model • Patient identity source system does not allow the EMPI to manage identification • Common in health information exchanges • Today’s EMPIs are a combination of both approaches • Numerous vendor solutions are available as well as an open source EMPI • www.OpenEMPI.org

11. Active EMPI model 4.11 (DaSilva, G., 2016)

12. Passive EMPI model 4.12 (DaSilva, G., 2016)

13. Patient matching across organizations • Patient matching is especially difficult between organizations • When a provider receives a summary of care from another provider, he/she must rely on demographics, and not IDs, to match the patient • Health information exchanges (HIEs) help by providing a community-level EMPI • IHE PIX/PDQ is often used by EMPIs to communicate about patient identification across enterprises

14. Integrating the Healthcare Enterprise (IHE) Patient Identifier Cross Referencing (PIX) 4.13 (IHE Wiki, 2011)

15. Enterprise identificationbeyond patients • Enterprise Master Patient Index (EMPI) is an important concept because it provides a way of matching and linking patients across disparate systems • This same need exists for other entities within the health care ecosystem • Examples include associated parties (insured, caregiver, next of kin), providers, and health care devices • Technology like EMPI can be used to provide similar matching and linking and index capabilities for these other entities

16. Unit 4: Principles and Technology of Interoperable Health IT, Summary – Lecture c, Tools and Technologies for InteroperabilityPart 1 • “Middleware” tools and technologies commonly used for healthcare interoperability include: • Interface Engine • Enterprise Master Patient Index • Terminology Management System • Health Information Exchange (HIE) Software • In this lecture, we covered two of these technologies: • Interface Engine • EMPI

17. Principles and Technology of Interoperable Health ITReferences – Lecture c References Corepoint. (2009). The role of an interface engine in modern healthcare. Available at: http://corepointhealth.com/sites/default/files/whitepapers/Role-of-an-Interface-Engine-in-Modern-Healthcare.pdf http://wiki.hl7.org/index.php?title=Interface_Engine http://wiki.ihe.net/index.php?title=Patient_Identifier_Cross-Referencing Charts, Tables, Figures 4.10 Figure: Lorenzi, V. (2016). Interface engine. Used with permission. 4.11 Figure: DaSilva, G. (2016). Active EMPI model. Used with permission. 4.12 Figure: DaSilva, G. (2016). Passive EMPI model. Used with permission. 4.13 Figure: Integrating Healthcare Enterprise. (2011). IHE PIX.

18. Unit 4: Principles and Technology of Interoperable Health IT, Lecture c – Tools and Technologies for Interoperability Part 1 This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004.