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From HELP2 to EDEN via HL7: EDRS interoperability in Utah. Jeffrey Duncan and Barry Nangle NAPHSIS Annual Meeting St. Louis, June 2010. Acronym Translator. EDEN = OVR’s EDRS HELP2 = IHC’s EMR HL7 =US standard for HIE. Presentation Outline. The problem: why EDRS are often not real time.

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from help2 to eden via hl7 edrs interoperability in utah

From HELP2 to EDEN via HL7: EDRS interoperability in Utah.

Jeffrey Duncan and Barry Nangle

NAPHSIS Annual Meeting

St. Louis, June 2010

acronym translator
Acronym Translator
  • EDEN = OVR’s EDRS
  • HELP2 = IHC’s EMR
  • HL7 =US standard for HIE
presentation outline
Presentation Outline
  • The problem: why EDRS are often not real time.
  • How Health Information Exchange could help.
  • Utah’s private/public approach
  • Interoperability project update
slide4

Current Death Registration Workflow

Is MD EDEN user?

FD initiates EDEN record (demographics)

MD certifies death certificate in EDEN

Yes

Death

FD = Funeral Director

MD = Physician

LHD = Local Health Department

No

FD prints paper death certificate

LHD registers death

Death is reported to NCHS

FD delivers to MD Office

MD signs Paper Certificate (cause of death)

FD delivers to LHD

LHD keys Paper certificate into EDEN

Drop-to-paper process

edrs participation in utah
EDRS Participation in Utah
  • Virtually 100 % Funeral Director participation
  • Only 545 of approximately 5,000 physicians participate.
  • Medical certification is all electronic in 60 % of cases, Feb. 2010.
reasons physicians do not participate
Reasons Physicians Do Not Participate
  • About 75 % of physicians that do certify do <1 death certificate per year.
  • They account for about 35 % of all DC’s
  • Difficult to maintain EDEN skills
  • Lack of incentive
interoperability with the ehr a market based approach
Interoperability with the EHR: a Market-based Approach
  • “Mandates” unwelcome in Utah healthcare
  • Legislation requiring physician EDR use rejected in Committee
  • Public Health does adopt standards for electronic health information exchange
partners in cdc funded demonstration of emr edr interoperability
Partners in CDC-funded Demonstration of EMR/EDR Interoperability
  • Office of Vital Records and Statistics
    • Modified EDEN to Accept HL7 message
  • Intermountain Healthcare
    • Cause-of-Death module in Help2 EMR
  • Utah State University
    • Developed matching algorithm
intermountain market share
Intermountain Market Share
  • Provides healthcare to approximately one-half the Utah population.
  • During 2007-2009, Intermountain physicians certified 39 % of Utah deaths.
  • 52 % of Electronic certifications (within EDEN) come from Intermountain physicians.
transmit cause of death certification from emr to eden
Transmit Cause of Death Certification From EMR to EDEN

Intermountain HL7 Message Server

Cause of Death Interface

Intermountain EMR

HL7 Over VPN Tunnel

UDOH HL7 Message Server (Rhapsody)

EDEN Master Database

EDEN Cause of Death Table

Matcher & Merger

new death certificate workflow with electronic interface to intermountain emr
New Death Certificate Workflow With Electronic Interface to Intermountain EMR

Death

New Intermountain process

FD notifies MD that cause of death data is needed

FD initiates EDEN record (fact-of-death)

MD enters cause of death data in EMR

Is MD an EDEN user?

No

Data transmitted electronically to state

Yes

OVRS matches MD-provided data against FD-provided data to complete record

MD certifies death certificate in EDEN

LHD registers death

FD = Funeral Director

MD = Physician

LHD = Local Health Department

Death reported to NCHS

eden matching flow chart
EDEN Matching Flow Chart

Front-end Matcher

Matching Request

Candidate-set Matching Rules

Candidate Set Builder

EDEN Master Database

Application Program Interface

Candidate Set

Classification Rules

Classifier

Result Set

workflow among matcher merger and deferred match resolver
Workflow Among Matcher, Merger, and Deferred Match Resolver

Cause of Death Table

Matcher

EDEN Master Database

Cause of Death

Data Loader

Merger

Deferred Match Table

Deferred Match Resolver

physician login to eden through uhinet web interface
Physician Login to EDEN Through UHINet Web Interface

UHINet Web Interface

https redirect to EDEN

https POST with physician identifying information, UHIN server login and password

EDEN User Table

EDEN Web Interface