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Massachusetts: Transforming the Healthcare Economy John D. Halamka MD CIO, Harvard Medical School and Massachusetts: Transforming the Healthcare Economy John D. Halamka MD CIO, Harvard Medical School and Beth Israel Deaconess Medical Center

Massachusetts Healthcare IT Organizations • Massachusetts Health Data Consortium • Massachusetts e. Health Collaborative Massachusetts Healthcare IT Organizations • Massachusetts Health Data Consortium • Massachusetts e. Health Collaborative • New England Healthcare Exchange Network • Massachusetts Technology Collaborative

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The NEHEN Appliance Built on a common messaging gateway framework CDX • Publishing Service The NEHEN Appliance Built on a common messaging gateway framework CDX • Publishing Service • Record Index Management • Record Locator Service Placed on the network of each participating institution Rx Gateway • EHR Adaptors • XDS Repository Adaptor • Pharmacy Directory Core Gateway • Security • Trading Partner Registry • Logging • Validation • Translation • Routing • Guaranteed Delivery NEHEN • NEHEN Express • Direct Data Entry • Billing / PMS Adaptors • ADT Adaptors • Formulary Service • Drug Eligibility • Medication History • e. RX Adaptors • Prescription Routing

Architecture Overview Local Gateway Participant EMRs and Other Enterprise Systems Interface Engine or Portal Architecture Overview Local Gateway Participant EMRs and Other Enterprise Systems Interface Engine or Portal Local Gateway Participant Published Patient Data E-Mail Server Local Provider Directory HIE Application Server / Gateway Secondary Local System Local Provider Directory EMRs and Other Enterprise Systems HIE Application Server / Gateway Web Server CCD Standard Messages, e-mail or fax encapsulation Fax Server • Local gateway users control integration, etc. Summary / Results • Can leverage infrastructure for internal integration Viewer • Interfaces can be direct or use interface engine or similar tools Fax Server Internet / Network Subscriber Web Server Fax Web Server E-Mail Server Secondary Local System Summary / Results Viewer CCD Standard Messages, HTTP encapsulation E-mail, fax or HTTP encapsulation Summary / Results Viewer Interface Engine or Portal Hosted Portal E-Mail Server Printer • No infrastructure support requirement – just Internet connection, fax or email Published Patient Data External Networks Community Provider Directory HIE Application Server / Gateway • Hosted by service provider (MA-SHARE) • Provides document / data storage, HTTP viewing for subscribers, and common provider index for dissemination to local gateway participants

Visit/Discharge Summary Exchange Send / push / route hospital data to interested parties As Visit/Discharge Summary Exchange Send / push / route hospital data to interested parties As a result of a referral, admission, or emergency, patient registers in hospital Patient receives care and details are noted in hospital medical record HIE service checks provider directory for routing instructions Consents and provider routing preferences are sent to HIE service Patient visits PCP or specialist and establishes trusted relationship and consents for release of data Standard format discharge summary or ER report is transmitted to HIE network Patient is discharged from hospital HIE service routes discharge summary to PCP, specialist or other interested and trusted party (e. g. , health insurance case manager)

Referrals Send / push / route visit and other data in support of referral Referrals Send / push / route visit and other data in support of referral consultation Provider refers patient to a specialist, hospital or other provider for consultation or service HIE service checks provider authorization request to payer for approval and referral # directory for routing instructions and sends referral request with pertinent patient information / history, diagnosis and service requested to consulting provider; business rules can be stored in HIE service for elements of real-time decision support HIE service routes visit Standard format visit HIE service submits referral Patient visits PCP or specialist and establishes trusted relationship and consents for release of data; consents and provider routing preferences are sent to HIE service summary to PCP, specialist or other interested and trusted party (e. g. , health insurance case manager) summary with consultation notes transmitted to HIE network Patient visits consulting provider, receives services, and details are noted in patient chart , electronic medical record or other result is created (e. g. , at lab)

Admission Notification Send / push / route admission notification to payers and providers Consents, Admission Notification Send / push / route admission notification to payers and providers Consents, provider routing preferences, and admission notification notice are sent to HIE service checks provider directory for routing instructions and sends admission notification to patient’s preferred payer and provider Patient visits hospital or other provider and establishes trusted relationship and consents for release of admission notification data Authorized payers and providers are notified of patient hospital admission

Laboratory Results Consents, lab results, and provider routing preferences are sent to HIE service Laboratory Results Consents, lab results, and provider routing preferences are sent to HIE service checks provider directory for routing instructions and sends laboratory results to patient’s preferred provider Patient undergoes tests from his or her physician, establishes trusted relationship and consents for release of laboratory data Authorized providers can access patient’s laboratory results

Standardized Quality Data Send / push / route visit and other data for standardized Standardized Quality Data Send / push / route visit and other data for standardized quality reporting (and other reporting) Consents, provider routing preferences and applicable data are sent to HIE service Patient visits PCP, specialist, hospital or other provider and establishes trusted relationship and consents for release of data Standard format visit summary or batch with data for determining quality metrics is sent to payer, government agency or other quality metrics organization based on patient consent and business rules in HIE service

Community Provider Directory HIE service consolidates organizational provider information into a single community provider Community Provider Directory HIE service consolidates organizational provider information into a single community provider directory Provider organizations track and maintains internal provider directory Provider information from each provider organization is sent to HIE service Authorized HIE users can access community provider directory

Healthcare / EHR Delivery Challenges 7 Healthcare / EHR Delivery Challenges 7

EHR Systems Overview 26 EHR Systems Overview 26