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Identity Architecture and Management of Health Information Exchange. Tracy W. Smith Lovelace Clinic Foundation [email protected] Stephen D. Burd New Mexico Telehealth Alliance [email protected] Presentation Overview. New Mexico Telehealth Alliance – Technology and Infrastructure

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Identity Architecture and Management of Health Information Exchange

Tracy W. Smith

Lovelace Clinic Foundation

[email protected]

Stephen D. Burd

New Mexico Telehealth Alliance

[email protected]

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Presentation Overview Exchange

  • New Mexico Telehealth Alliance – Technology and Infrastructure

  • New Mexico Health Information Cooperative – Technology and Infrastructure

  • Infrastructure Gaps

  • National Health Information Network

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New Mexico Telehealth Alliance Exchange

  • 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

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NMTHA Operational Telehealth Projects Exchange

  • 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

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NMTHA Current State Exchange

  • Current NMTHA-supported programs use, a state network connecting higher education institutions

  • Most locations connect to 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

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NMTHA Future State Exchange

  • 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

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NMHIC Overview Exchange

  • Community-wide effort

  • Health information exchange

  • Lead / grant administrated by Lovelace Clinic Foundation

    • $1.5 million AHRQ grant

    • $1.5 million in-kind


To provide a sustainable statewide health information exchange that transforms health care quality, safety, efficiency and outcomes.

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NMHIC Services Exchange

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

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NMHIC Current State - Services Exchange

  • 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

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NMHIC Future State Exchange

  • 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

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Combining Telehealth and HIE Exchange

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

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Telehealth/HIE Combination Benefits Exchange

  • 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

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Telehealth/HIE Combination Challenges Exchange

  • 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

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Key Integrative Components Exchange

  • 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

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NHIN Issues Exchange

  • 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

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More NHIN Issues Exchange

  • 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?)

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For further information Exchange

  • These slides:


  • RHIO- and telehealth-related NM organizations: