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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. Presentation Overview. New Mexico Telehealth Alliance – Technology and Infrastructure

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identity architecture and management of health information exchange

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

presentation overview
Presentation Overview
  • New Mexico Telehealth Alliance – Technology and Infrastructure
  • New Mexico Health Information Cooperative – Technology and Infrastructure
  • Infrastructure Gaps
  • National Health Information Network
new mexico telehealth alliance
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
nmtha operational telehealth projects
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
nmtha current state
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
nmtha future state
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
nmhic overview
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.

nmhic services
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

nmhic current state services
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
nmhic future state
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

combining telehealth and hie
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
telehealth hie combination benefits
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
telehealth hie combination challenges
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
key integrative components
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
nhin issues
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
more nhin issues
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?)
for further information
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